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Study: For Sleep Problems In Older Age, Try Mindful Meditation

(Fairy Heart/flickr)

(Fairy Heart/flickr)

Insomnia is insidious, infuriating and often debilitating.

For anyone who has suffered with eyes-wide-open at 4 a.m. it’s not terribly surprising that more and more Americans (particularly older people and women) are being prescribed serious drugs to help them sleep.

But these medications, known as benzodiazepines, have been linked to numerous health problems, ranging from an increased risk of dementia, to car crashes and falls. And once you’re on them, it’s hard to stop, as I can attest from personal experience. While debate continues over the safety and effectiveness of these medications, a small study suggests that an alternative approach may offer some relief.

Research published online by JAMA Internal Medicine found that a practice of mindful meditation — basically just focusing on breathing and remaining in the present moment while observing your thoughts easily drift by — may help certain people with sleep problems. “Mindfulness meditation practices resulted in improved sleep quality for older adults with moderate sleep disturbance…” the report concludes.

The study, by researchers at the University of Southern California in Los Angeles, reflects a growing body of evidence showing that the practice of “mindful meditation” can be used as a low-cost, non-drug intervention that can, in certain cases, reduce stress and help with other physical and mental health woes.

Here’s more from the JAMA release:

Sleep disturbances are a medical and public health concern for our nation’s aging population. An estimated 50 percent of individuals 55 years and older have some sort of sleep problem. Moderate sleep disturbances in older adults are associated with higher levels of fatigue, disturbed mood, such as depressive symptoms, and a reduced quality of life… Continue reading

Delirious: Study Finds Simple, Humane Fixes For Aged, Disoriented Patients

(Xavi Talleda/Flickr)

(Xavi Talleda/Flickr)

By Alison Bruzek
Guest Contributor

The patient was an older man, living at a nursing facility. He’d originally been admitted to the hospital for surgery to treat a urinary tract infection. But now, lying in his bed at the hospital after the operation, he was convinced that two people were standing outside his room and planning to blow it up.

“We could tell this person was delirious,” says Dr. Eyal Kimchi, a neurologist at Massachusetts General Hospital

Delirium is a complicated syndrome, most common among the hospitalized elderly where it’s estimated 29 to 64 percent of patients have it. However, it’s underreported and researchers estimate as many as two-thirds of cases go undiagnosed.

While usually temporary, it leaves people feeling severely confused. Their brains switch rapidly between mental states, increasing their risk of falling and later brain problems like dementia.

Though the patient’s mind was muddled, the idea of an explosion hadn’t appeared to him out of the blue — he was at the hospital around the time of the Boston Marathon bombing. What had likely happened, says Kimchi, is the patient had begun misattributing the news reports he saw playing on the television to actual life.

And even though that patient fully recovered, some of those delirious thoughts remained. “Ultimately this person said, ‘I know I’m better, I know I was confused, but I also know they were trying to blow up the place,’ ” says Kimchi.

People with delirium can often run the gamut of states, from hyperactive and aggressive to withdrawn and nearly comatose. The causes are not well understood but it’s a combination of a person’s predisposition to delirium as well as an event that sets it off, says Kimchi. These could be “surgery, infections, other sorts of brain injuries like trauma,” he says. “It’s still very hard to predict on an individual basis.”

While there’s not a lot of research on the predictors of delirium, there are ways to prevent it, according to a study released this week in the Journal of the American Medical Association Internal Medicine.

Prevention may be as simple as reminders and attentive care, says, Dr. Tammy Hshieh, a researcher of aging and geriatrics at Brigham and Women’s Hospital and author of the JAMA study. She suggests preventative measures like reorienting patients to where they are, keeping them hydrated and healthy, and ensuring they have hearing aids or glasses or other physical assistance is an effective method to stop delirium. Continue reading

Out, Proud And Old: LGBT Seniors More Likely To Age Alone

(W.E. Jackson/Compfight)

(W.E. Jackson/Compfight)

By Jessica Alpert

Margueritte Wilkins was, as she likes to say, “born, bred, and buttered” in Manhattan’s Sugar Hill neigborhood, a northern section of Harlem.  Wilkins remembers that she came out to her family when she was in kindergarten: “My brother called me an early bloomer.”

Her family didn’t really know how to respond to her homosexuality and so they just “played it by ear.”  As she found support in friendships throughout middle and high school, her relationship with family deteriorated. Now, at age 66, Wilkins has no contact with her family.  “They think something is wrong with me,” she sighs.

Recent analyses suggest that there are at least 1.5 million lesbian, gay, bisexual, and transgender (LGBT) Americans over the age of 60.  These numbers are based on an estimate from UCLA’s Williams Institute on Sexual Orientation and the Law which has calculated that approximately 3.8 percent of Americans identify as LGBT.

LGBT elders deal with significant economic and health disparities as compared with heterosexual seniors. According to a 2011 national health study co-authored by the Center for American Progress and Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders (SAGE), more than half of LGBT respondents have been told by a doctor that they have depression; 39 percent have seriously contemplated suicide; and 53 percent feel isolated from others. Social isolation remains a major issue as LGBT seniors are 3-4 times less likely to have children, twice as likely to live alone, and twice as likely to be single.

According to a 2010 MetLife Study  of Boomers from the MetLife Mature Market Institute, about 42% of the LGBT population identified their relationship status as single, far higher than the 27% of the general population. Like Margueritte Wilkins, many LGBT seniors may also be estranged from their biological families.

“This generation came of age when homosexuality was considered criminal, a form of mental illness, or a security risk,” says Brian De Vries, a professor of gerontology at San Francisco State University. “They don’t have the safety net available to them that heterosexuals have.”

Continue reading

Elderly Man (Me) Found In Snow With Punctured Lung But Still, At 79, I Ski

Author Ralph Gilbert, who suffered a punctured lung in a ski accident, and his son, Keith, his rescuer (Courtesy)

Author Ralph Gilbert, who suffered a punctured lung in a ski accident, and his son, Keith, his rescuer (Courtesy)

By Ralph M. Gilbert
Guest Contributor

Traumatic pneumothorax: the presence of air or gas in the pleural cavity, which impairs ventilation and oxygenation, caused by a severe trauma to the chest or lung wall. Symptoms are often severe, and can contribute to fatal complications such as cardiac arrest, respiratory failure, and shock.

Every time I tried to lift my head the sky began to spin. Then I felt the nausea. I knew that I had to get up out of the snow but after a few attempts, I just lay back, exhausted. Suddenly, a spray of powder was kicked onto my face as a young ski patrolwoman executed a hurried skid stop. She bent down and put her cold face next to mine:

“Sir,” she said looking into my unfocused eyes. “Are you all right? Do you know where you are, sir? Where are you, sir?”

“Huh?”

I realized that she wasn’t asking a particularly hard question, but I just couldn’t come up with an answer.

“I don’t know,” I replied.

She helped me to my feet.I looked around and saw the other skiers.

“I’m skiing…right?”

She radioed for help. The next thing I knew, I was being leaned back into a toboggan. Fighting the nausea and afraid that I would have to throw up, I asked to be tipped over momentarily before they restrained me to the sled for my ride down.

I regained consciousness in a strange hospital ER.

A young woman was standing over me. She asked: “Do you really think, sir, that a man of your age should be skiing alone in the glades?”

I hated that question. I found it particularly humiliating. As an intrepid, former U.S. Army trooper, I didn’t want to be talked to that way, especially by a woman who asked me the same questions my wife often asked.

Tests indicated a concussion. Upon release, I was told to buy a new helmet (each helmet can absorb only one crash), and not to ski for a week. I took only one day off, which I thought was plenty. I then purchased a new helmet and two days later I was back up on my skis again.

My next accident a few years later was to be worse, much worse.

Age denial? Not So Much

Before I tell you that story, I’d like to note that I’m not in total age denial. Now 79, I spend less and less of my après-ski time trading embellished ski stories with my buddies in smoky bars. These days, when we go on our annual ski trip, I can be found at night alone in my little room, carefully applying ice packs and winding compression bandages around my ill-treated joints.

I reject the idea, however, that I am suffering from any age-related diminution of muscle tone, balance or endurance. My ski dreams are still intact even if my body is not. I do realize that I should avoid the super steep double black diamond trails that I once traversed. But I just can’t resist.

Why? By story’s end, I’ll try to explain.

Male Bonding

Each year, twelve of us, former army buddies at Fort Bliss, Texas go on a ski trip together. We had trained as Nike Missile crewmen back in 1958 during the Cold War. Our job was to join with others to protect the City of New York.Stationed in a darkened radar van, we were to monitor our radar screens for Russian bombers. Our Nike Missiles were buried in concrete shafts near us. Our vantage point was Spring Valley, New York, which otherwise is known for kosher chickens and Hassids. If we saw any Russians in the air we were to electronically challenge them, then shoot them down. Continue reading

Why To Exercise (Outdoors) Today: Tranquility For Aging Ladies

(frodrig/Flickr)

(frodrig/Flickr)

It’s cold, it’s dark, it’s uninviting out there. So, all the more reason to drag yourself outside and do something.

In yet another study on how exercise can combat the bad physical and mental effects of aging, new research suggests that women who can get out the door, fight the elements and exercise might find some nifty benefits. Those benefits include alleviating depression and increasing adherence to an exercise program.

The small study, published in the journal Menopause, asserts it’s the outside air that really helps (as opposed to the stuffy gym or the treadmill in your basement, though I’ve found that when you’re desperate, those work too):

“Between baseline and week 12, depression symptoms decreased and physical activity level increased only for the outdoor group…” write the authors, led by Isabelle Dionne of the University Institute of Geriatrics of Sherbrooke in Quebec.

From the Reuters report:

Outdoor workouts left women in a better mood and kept them exercising longer than counterparts who exercised indoors, according to a small study from Canada.

Results of the three-month trial involving women in their 50s and 60s suggest that outdoor exercise programs should be promoted to help older women keep active, the researchers conclude…Only about 13 percent of Canadian women older than 59 years and less than 9 percent of older American adults get at least 150 minutes of physical activity each week… Continue reading

Foggy Days, Sleepless Nights: When Alzheimer’s Care Goes Nocturnal

(Ronel Reyes/Flickr via Compfight)

(Ronel Reyes/Flickr via Compfight)

By Jessica Alpert

Marion Tripp was what you might call a quintessential “Yankee.” From impeccable pie crusts to crackshot deer hunting, she regularly impressed people with her wide range of skills. When her daughter and son-in-law started an organic farm in rural Maine, she’d bundle up in a snowmobile suit and sell their rutabagas at the local farmer’s market. I never knew Marion but her grandson — my husband — loves to remember her this way.

Not the way she was at the end.

Alzheimer’s ravaged Marion’s brain and left her confused, “mean,” paranoid, and violent. The last three years of her life, she had round-the-clock care since she rarely slept more than a few hours at a time. Her nocturnal habits were not unique. Indeed, in the world of Alzheimer’s, this tendency toward nighttime wakefulness is known as “sundowning.”

“Several things go awry with Alzheimer’s that affect the person’s brain chemistry and changes their circadian rhythm,” says Dr. Paul Raia, vice president of clinical services for the Massachusetts/New Hampshire chapter of the Alzheimer’s Association. He says there are various reasons for this nocturnal shift including lack of melatonin, diminished access to natural light and less rapid eye movement or REM sleep.

But it’s not just about being unable to sleep for long stretches of time. Like Marion Tripp, many Alzheimer’s patients are often agitated, angry, even violent. “During that period [of REM sleep], you are ridding the toxins from your brain and you’re stabilizing memory and you’re dreaming and essentially you are paralyzed with your body in a relaxing mode,” says Raia. “[The patients] may take a series of small naps throughout the day and when they wake up, they may not be fully awake. They can’t navigate well or negotiate well in their environment.” Continue reading

Bullying Is Ageless: Conflict And Violence Widespread In Nursing Homes, Study Finds

Ulrich Joho/flickr

Ulrich Joho/flickr

By Nell Lake
Guest Contributor

For Eileen, who is disabled and reliant on a wheelchair to get around, life in a nursing home isn’t easy. Particularly when it comes to the other residents: “There’s this guy,” she says. “He made advances to me all the time. I did not want his advances. Many times I had to take my grabber and actually strike him to get him to leave me alone.” Another resident, Eileen says, is a “real bully. She has terrorized quite a few people. She tries to boss people around. She says harassing things.”

In coping with this type of hostile behavior, Eileen (who asked not to be identified) has plenty of company. New research released last week shows that aggression among residents in nursing homes is widespread and “extremely high rates of conflict and violence” are common, according to study author Karl Pillemer, professor of gerontology in medicine at Weill Cornell College of Medicine in New York. His stark findings, presented at the annual meeting of the Gerontological Society of America: One in five people living in the nursing facilities studied was involved in at least one “negative and aggressive encounter” with another resident during a four-week period.

“In most environments — say my work environment at a university — someone yelling at me angrily is so unusual that it would keep me up all night worrying about it,” Pillemer says. Yet such conflict in nursing homes appears to be routine.

Abuse and Mistreatment

As part of the study, researchers examined patient records at ten nursing homes in New York state, interviewed staff and residents, and recorded incidents through direct observation. In a sample of more than 2,000 residents, 16 percent were involved in incidents of cursing, screaming, or yelling; about 6 percent in physical violence such as hitting, kicking, or biting; one percent in “sexual incidents, such as exposing one’s genitals, touching other residents, or attempting to gain sexual favors”; and 10.5 percent in events researchers labeled “other” — residents entering rooms uninvited, for example, or rummaging through others’ belongings. Continue reading

Facing The Inevitable: From Lost Keys To Dementia

I recently turned 50 and, on cue, my AARP card came in the mail and my doctor told me to schedule my first colonoscopy.

Also on cue, I’ve noticed what seems to be my own increased mental scattered-ness — misplaced keys, sluggish name recall. As a catastrophizer, I immediately link this apparent (but my doctor assures me normal) ever-so-slight decrease in cognitive sharpness to full blown Alzheimer’s and the start of a bleak, diminished future.

I am slightly comforted by two factors. First, I’m hardly alone. As Michael Kinsley eloquently reports in his recent New Yorker piece, “Have You Lost Your Mind?” we baby boomers are the first generation to have witnessed our parents cognitive decline and know in terrifying detail what’s in store for us; but at least we’re all on this sinking ship together. Second, there’s a lot of genetics behind Alzheimer’s and cognitive decline, and in that department, I’m not in bad shape. My parents kvetch, but they’re both nearly 80 and my mother, in particular, lives an incredibly active life on her own in Brooklyn: she recently learned chess, ushers off-Broadway with friends most weekends and walks and does yoga everyday.

joeduty/flickr

joeduty/flickr

Also, researchers are busily trying to tackle this problem on numerous fronts. On Sunday, for example, Harvard scientists reported what felt like a breakthrough: a new protein that in mice seems to have a rejuvenating effect on brains and muscles.

And a fairly technical study just out in Biological Psychiatry also hints at the possibility of future fixes: using something called “imaging genetics” researchers at the Lieber Institute for Brain Development and the National Institute of Mental Health are trying to identify “key molecular switches that control age-related memory impairment” and are specifically looking at a protein known to play a role in human memory, called “KIBRA and the gene responsible for its production.” Continue reading

Younger Muscles And Minds: Protein Turns Clock Back In Mice

Nonagenarian Olga Kotelko, left, on her way to victory in her age group in the 100-meter dash at Sacramento State in July 2011. Pat Peterson, right, won a younger age group. (Ken Stone/masterstrack.com, with permission)

Nonagenarian Olga Kotelko, left, on her way to victory in her age group in the 100-meter dash at Sacramento State in July 2011. Pat Peterson, right, won a younger age group. (Ken Stone/masterstrack.com, with permission)

Just about a year ago, Harvard stem cell scientists reported promising news for elderly heart failure patients: In mice, they found, a protein called Growth Differentiation Factor 11 could undo heart damage wrought by aging.

But was it just a heart thing? Or might GDF11 apply more broadly to other ways that we get older but not better?

New research finds that the protein has similarly rejuvenating effects on brains and muscles — though again, only in mice, so it will be years before we’ll know whether humans might see similar benefits. But GDF11 does circulate in the human bloodstream as it does in the mouse, so it’s not totally outlandish to imagine that we might someday pop pills to increase our circulating GDF11 to stay stronger, smarter and generally healthier as we age. And already, researchers are discussing the need to seek potential benefits for patients with Alzheimer’s and other degenerative diseases.

Upcoming papers in the journal Science found that when given GDF11, some older mice — the equivalent of roughly 70-year-old humans — became able to run as long and smell as well as young mice.

The Harvard press release quotes Doug Melton, chair of the university’s Department of Stem Cell and Regenerative Biology, as saying he couldn’t “recall a more exciting finding to come from stem cell science and clever experiments. This should give us all hope for a healthier future. We all wonder why we were stronger and mentally more agile when young, and these two unusually exciting papers actually point to a possible answer:  the higher levels of the protein GDF11 we have when young. There seems to be little question that, at least in animals, GDF11 has an amazing capacity to restore aging muscle and brain function.”

I spoke with Harvard stem cell biologist Amy Wagers, a leader in the GDF11 research, about what it means. Our conversation, edited:

I imagine our headline shouldn’t say ‘Fountain of Youth discovered.’ How do you prefer the effects of GDF11 to be described?

I like ‘healthy aging.’ It’s really important to say that we don’t have any idea whether GDF11 might affect lifespan at all, but it does seem to improve or enhance healthy function in multiple different tissues.

What’s our best understanding at this point of what GDF11 does biologically?

I would say our understanding is still in its infancy. What we know is that GDF11 is a protein that is produced and present in the bloodstream at high levels when you’re young and it goes away as you get older. When you add it back to older animals, there are beneficial effects on a number of different tissues.

At the organismal level, we know that it enhanced muscle repair capacity and skeletal muscle structure so that physical function is improved. We know that in the brain it increases the production of neural stem cells and functioning of the olfactory system. And we know in the heart it reverses cardiac hypertrophy. Continue reading

Aid-In-Dying Loophole: Advocates Want You To Know You Can Stop Eating And Drinking

Lee J. Haywood/flickr

Lee J. Haywood/flickr

By Nell Lake
Guest contributor

One sunny day in the spring of 2012, Kathleen Klein sat in a car by the California coastline with her 84-year-old mother, Jackie Wilton. The two women had been quietly gazing at the view, watching seagulls along the shore. “I’m ready to go,” Klein recalls her mother saying. “Not go home…Go.”

Klein didn’t need the clarification. Her mother had been speaking of wanting to die for years, ever since Wilton was diagnosed with an unspecified dementia a few years before. Wilton’s memory had become significantly impaired. But even before her diagnosis, Wilton was clear: She wanted to die before she became severely incapacitated.

Not long after the conversation by the water, Wilton asked Klein explicitly for help in ending her life. In interviews and a recent blog post, Klein remembers wanting to help her mother, but of being unwilling act illegally.

Even if Wilton had lived in one of the five states with an aid-in-dying law, she would not have qualified for such aid from a physician. That would have required a doctor’s determining that she would likely die within six months. Given the usual course of chronic, progressive dementia, Wilton would likely have lived much longer.

So Wilton needed another option for ending her life. Soon Klein heard a radio interview about “the possibility of helping someone die by letting them stop eating and drinking,” she wrote. “The way I understood it, it was the only legal form of assisted suicide.”

Klein mentioned the scenario to her mother. Wilton said she would think about it. A few days later, Wilton again mentioned wanting to die. “I asked her if she remembered the idea I had run by her. She didn’t, so I told her again. I suggested we give it a try (a ‘dry run,’ we called it) for a day and see if she wanted to continue.”

Wilton began the “dry run” on April 28, 2012.

No Food, No Drink

Most often referred to as VSED — voluntary stopping of eating and drinking — the practice of giving up food and drink in order to hasten one’s death is being increasingly publicized by aid-in-dying advocates as a legal alternative to physician-assisted suicide.

VSED is legal everywhere, even in states without aid-in-dying laws, and in cases in which a person, like Wilton, would not qualify for assistance with dying even in those states.  Compassion and Choices, a leading “death with dignity” organization, is beginning to more actively promote VSED as an option because “it’s something that patients can openly pursue, in open dialogue with their physicians, with the support of hospice,” says Barbara Coombs Lee, the group’s director. “We do want to make it more public. We want to make it more visible because it upholds the truth that ultimately patients should be and are in charge. That’s kind of a consciousness-raising task. Continue reading