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Elderly And Drugged: Far More Psych Meds Prescribed To Old Than Young

Evidence suggests that anti-anxiety medications like Xanax increase the risk of falls in older adults, which can cause a cascade of problems. (johnofhammond/Flickr, with edits by WBUR)

Evidence suggests that anti-anxiety medications like Xanax increase the risk of falls in older adults, which can cause a cascade of problems. (johnofhammond/Flickr, with edits by WBUR)

By Nell Lake
Guest Contributor

Are we over-treating the elderly with psychiatric drugs?

That’s the natural question arising from a recent report that found adults over 65 are receiving psychotropic medications at twice the rate of younger adults. The study, published in this month’s Journal of the American Geriatrics Society, also found that elders are much less likely to get their mental health care from psychiatrists or to receive psychotherapy.

What’s the problem? First, psychotropic drugs generally pose greater risks to the elderly than they do to younger patients, and non-drug approaches, from therapy to meditation, may be as effective as psychotropic medications for some seniors’ mental disorders, without the risks.

The findings suggest that physicians and insurers should reassess psychotropic drug use among the elderly, says lead author Donovan Maust, a geriatric psychiatrist and assistant professor of psychiatry at the University of Michigan.

Maust’s team used 2007-2010 data from the CDC’s National Ambulatory Medical Care Survey and from the U.S. Census to compare the rates at which older and younger adults — those 65 and older, and those 18-64 — get prescribed psychotropic medications during outpatient doctors’ visits. After analyzing more than 100,000 of these doctor visits, and taking into account the fact that the younger population is much larger than the older one, the researchers found that older adults were much more likely to be prescribed psychiatric drugs for anxiety, depression and other mental health conditions. Researchers also found that these seniors were less likely to receive other types of non-drug treatment for their mental distress.

The importance of all this is fairly clear: The elderly population is booming, and seniors use the health care system more than any other demographic. So, finding safe, effective and appropriate treatments for their mental health problems is critical — for the well-being of a large swath of people, and as a policy matter.

Too Many Meds, And The Wrong Kind?

Psychotropic drugs pose both direct and indirect risks to the elderly: First, the drugs themselves can be dangerous. The American Geriatrics Society lists many psychotropic medications as potentially inappropriate for elderly patients. Continue reading

Happy 100 To You, And You — Centenarians Multiply, At Forefront Of Age Wave

Ethel Weiss, 100, dances with her daughter Anita Jamieson at the “Party Of The Century” at the Brookline Senior Center on Wednesday. (Jesse Costa/WBUR)

Ethel Weiss, 100, dances with her daughter Anita Jamieson at the “Party Of The Century” at the Brookline Senior Center on Wednesday. (Jesse Costa/WBUR)

It’s a rare milestone, to turn 100 — but not nearly as rare as it used to be.

This week in the town of Brookline, Massachusetts, the senior center hosted more than a dozen local centenarians for a “Party of the Century.” In the not-so-distant past — centenarian parties in 2002 and 2007 — party organizers had to reach out to centenarians from all of Greater Boston to gather a critical mass for a fete.

But now, the 99-and-over set has so grown that the party had to limit itself to just Brookline, says Ruthann Dobek, director of the Brookline Council on Aging. And if the numbers keep growing, she told the crowd, “we’re going to have to start it at 105 or 110 to be eligible.”

The centenarians are the leading edge of the fastest-growing sector of the population: people over 60. In this state, the population over 60 has grown 17 percent over just the last five years, and the over-60 cohort will soon outnumber people under 20 for the first time in history, says David Stevens, the executive director of the Massachusetts Association of Councils on Aging. Continue reading

Why To Exercise Today: To Promote Cognitive Health (It’s Official)

(Diabetes Care/Flickr)

(Diabetes Care/Flickr)

The venerable Institute of Medicine came out with a report this week on cognitive aging (yes, that means you…) and a few things that can help avert the inevitable. The panel’s No. 1 recommendation? “Be physically active.” Enough said.

To be clear, “cognitive aging is not a disease,” the report notes. “Instead, it is a process that occurs in every individual, beginning at birth and continuing throughout the life span.”

That process impacts the brain like no other body part, the authors say. And while the extent and quality of cognitive aging (read: decline) varies greatly, many older men and women will experience problems related to the speed at which they process information, the ability to problem-solve and make decisions and, of course, memory. (Lost keys, anyone?)

Putting a little silver lining on things, the IOM news release quotes the chairman of the committee, Dan G. Blazer, the J.P. Gibbons Professor of Psychiatry Emeritus at Duke University Medical Center, saying that “…wisdom and knowledge can increase with age, while memory and attention can decline.”

So what should we do about our aging brains? The report is clear:

· Be physically active.

· Reduce and manage cardiovascular disease risk factors, including high blood pressure, diabetes, and smoking.

· Regularly discuss and review health conditions and medications that might influence cognitive health with a health care professional. A number of medications can have a negative effect — temporary or long term –on cognitive function when used alone or in combination with other medication.

The committee also identifies additional actions for which there is some scientific evidence to suggest positive effects on cognitive health:

· Be socially and intellectually active, and continually seek opportunities to learn.

· Get adequate sleep and seek professional treatment for sleep disorders, if needed.

· Take steps to avoid a sudden acute decline in cognitive function, known as delirium, associated with medications or hospitalizations.

· Carefully evaluate products advertised to consumers to improve cognitive health, such as medications, nutritional supplements, and cognitive training.

Continue reading

Sexual Reality: The Checkup Podcast Debunks A Few Myths (Like Size And Age Matter…)

Possibly our juiciest segment yet, the latest installment of The Checkup podcast, our joint venture with Slate, takes on some sexual myths and offers a bit of reality.

We bring you surprises about penis size, stories of great sex over 70 and new insights on how both men and women are lied to about their sexuality. As we have in past segments, Carey and I offer our fresh take on research-based news that could brighten up your life below the waist. Check it out here:

And in case you missed our last episode, “Grossology” (including a look at the first stool bank in the nation and research on the benefits of “bacterial schmears” from a mother’s birth canal) — you can listen now.

And if you want to hear earlier episodes: “Scary Food Stories” includes the tale of a recovering sugar addict and offers sobering news to kale devotees. And “On The Brain” includes fascinating research on dyslexia, depression and how playing music may affect our minds.

Make sure to tune in next time, when we present: “High Anxiety,” an episode on the (arguably) most prevalent of mental health disorders.

Each week, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues. If you listen and like it, won’t you please let our podcasting partner, Slate, know? You can email them at podcasts@slate.com.

Why To Exercise Today: For Long-Term Weight, It May Matter More Than Diet

feetonscale

The usual wisdom goes: You really need to be active for your health, but you can’t count on exercise as a weight-loss method. Some people even gain weight when they ramp up exercise — and not just muscle mass.

But if you look at the big picture and the long haul, people who succeed at long-term weight loss tend to have high levels of physical activity. Now a new study of more than 5,000 Americans in the journal Medicine & Science in Sports & Exercise finds a strikingly strong link between exercise and weight — arguably stronger than the link to diet.

The American College of Sports Medicine offers this summary:

The study found that moderate-to-vigorous physical activity was significantly associated with two measures of weight status – body mass index and waist circumference.
For both men and women and in all age groups, higher levels of moderate-to-vigorous physical activity were associated with lower BMI and smaller waist circumference.
The associations of diet quality with weight status were much less consistent; higher diet quality was associated with lower weight variables in only a few gender and age groups.

Which groups? From the paper’s abstract: “Diet quality was inversely associated with the weight status variables only in men age 30–39, 40–49 (BMI only), and 50–59 and women age 50–59.”

And of course, if you’re in one of those cohorts now, you won’t be forever. More from the summary:

“The study also found that, as age increased, physical activity declined, diet improved, and BMI and waist circumference increased.”

In other words, even as we get more virtuous in our diets, we tend to exercise less and gain weight. Continue reading

Why To Exercise Today: Avoid Brain Shrinkage As You Age

MilitaryHealth/flickr

MilitaryHealth/flickr

Middle-age adults take note: the exercise you shirk today may lead to shrunken brain tissue in a couple of decades.

This, according to research presented at the American Heart Association Epidemiology/Lifestyle meeting in Baltimore this week.

After reviewing exercise data taken from more than 1,200 adults who were around 40 years old — a subset of the Framingham Heart Study — researchers found that twenty years later when these same individuals underwent MRI scans, those with “lower fitness levels in midlife also had lower brain tissue levels in later life,” said Nicole L. Spartano, Ph.D., lead author and a postdoctoral fellow at the Boston University School of Medicine.

Though the findings are preliminary, Spartano says it looks like there’s a link between lower fitness levels and faster brain aging. Since the MRI’s in this study were done on people about 58 years old, the researchers didn’t expect to see high rates of dementia, but they did detect “the beginning of shrinkage,” Spartano said. “We look at the brain MRI as an early warning sign for deterioration. This may give us some idea of decreased cognition a decade or so later.”

Specifically, the researchers evaluated fitness based on how the heart changes in the early stages of exercise. Continue reading

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