Topic: Aging

Stroke Prevention

Friday, September 30th, 2011 by American Senior Fitness Association   View This Issue of Experience!

Here’s more important news on the subject of avoiding stroke: Researchers have discovered that aggressive medical therapy could help prevent stroke, perhaps even more effectively than surgery involving balloon angioplasty and stent insertion. For details, see the following news release from the University of Florida Health Science Center in Gainesville.

To prevent a common type of stroke, intensive medical therapy could be better by itself than in combination with surgery that props open affected arteries. But it remains to be seen whether the apparent advantage will prove true over the long term.

The findings, from a national clinical trial conducted by University of Florida researchers and colleagues, were published online in The New England Journal of Medicine on Wednesday, Sept. 7.

Against expectations, the short-term risk of stroke and related death was twice as high in some cases for patients whose diseased arteries were widened via balloon angioplasty and stent insertion, compared with patients who received medical therapy alone. Although the 30-day risk of stroke for the stenting patients is concerning, long-term results could be more favorable, the researchers said.

“Five years from now, who will be doing better — the patients who are being medically managed, or those who received a stent?” said study co-author Michael F. Waters, M.D., Ph.D., director of the Shands at UF Stroke Program, who along with Brian L. Hoh, M.D., the William Merz associate professor of neurological surgery in the College of Medicine, led the UF portion of the trial.

The study will have a substantial impact on clinical practice and research, the researchers said, because it is the first randomized stroke trial to pit stenting against nonsurgical treatment for symptomatic intracranial atherosclerosis, a type of stroke caused by artery blockage in the brain. Early results clearly show that intensive medical management is key to improving health, the researchers said.

“This study provides an answer to a longstanding question by physicians — what to do to prevent a devastating second stroke in a high-risk population. Although technological advances have brought intracranial stenting into practice, we have now learned that when tested in a large group this particular device did not lead to a better health outcome,” said Walter Koroshetz, M.D., deputy director of the NIH National Institute of Neurological Disorders and Stroke, which funded the clinical trial.
Every 40 seconds, someone in the U.S. has a stroke. Stroke is the fourth leading cause of death and a leading cause of disability in the U.S. Almost 800,000 people a year have a new or recurring stroke, according to the American Heart Association. With higher than average rates of stroke and related deaths, parts of the southeastern U.S. are together termed the “Stroke Belt.”

Patients with the type of stroke known as symptomatic intracranial atherosclerosis do not respond well to existing treatments. One-quarter of those patients have another stroke within 12 months, and the risk of additional strokes continues in subsequent years. Doctors are unsure what the best course of treatment is.
To find out, the UF researchers and colleagues launched a clinical trial, nicknamed SAMMPRIS, at 50 sites around the country, including at the Medical University of South Carolina, the lead site. The study recruited 451 participants age 30 to 80 who had at least 70 percent narrowing in the arteries in the brain, and had experienced symptoms within the previous 30 days. UF recruited the second-highest number of patients among all sites, through its stroke program, which has been designated a Comprehensive Stroke Center by the Agency for Health Care Administration.

Patients in one group were randomly assigned to receive intensive management involving smoking cessation and medications for blood pressure, cholesterol, diabetes and blood-clot prevention. A second group of patients had that same medical treatment but also had balloon angioplasty and stent implantation into the affected brain artery to improve blood flow.

Almost 15 percent of patients who received stents had a stroke or died within 30 days of enrolling in the study, compared with just under 6 percent of patients in the medical therapy group. The stark difference between the groups persisted almost a year, by which time about 21 percent of patients who had received stents had had negative effects, compared with 12 percent in the medical group.

The researchers initially thought that patients who received stents would have fared better, given the successful use of similar procedures in clinical practice at the Shands at UF Stroke Program and other medical centers.

But the striking difference between the two patient groups prompted the study’s independent safety monitoring body to call off new recruitment. The researchers will, however, continue to monitor previously enrolled patients for the next two years.

It’s not unusual for surgical patients to have more complications at first, the researchers said. That’s because the invasiveness of surgery poses an inherent risk regardless of the illness being treated.

“The real question is, is there a benefit to patients over the long term,” said study co-author and co-principal investigator Hoh, who is an associate professor of radiology and neuroscience in the UF College of Medicine. “If you think about it, when people are concerned about stroke, it’s not just their first month that matters, so we’re waiting to see what the longer-term results will be.”

Over time, improvement of stent design and honing of surgical techniques could help improve outcomes for patients.
“This is certainly not the final say on managing this disease,” Waters said. “This is another piece of the puzzle that helps to guide our hand.”

The University of Florida Health Science Center – the most comprehensive academic health center in the Southeast – is dedicated to high-quality programs of education, research, patient care and public service. The Health Science Center encompasses the colleges of Dentistry, Public Health and Health Professions, Medicine, Nursing, Pharmacy and Veterinary Medicine, as well as the Veterinary Hospitals and an academic campus in Jacksonville offering graduate education programs in dentistry, medicine, nursing and pharmacy. Patient care activities, under the banner UF&Shands, are provided through teaching hospitals and a network of clinics in Gainesville and Jacksonville. The Health Science Center also has a statewide presence through satellite medical, dental and nursing clinics staffed by UF health professionals; and affiliations with community-based health-care facilities stretching from Hialeah and Miami to the Florida Panhandle.

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Stick With It

Monday, May 23rd, 2011 by American Senior Fitness Association   View This Issue of Experience!

The passage of time can be a good thing under the right circumstances. That’s the take-away from recent research conducted by cardiologist Paul Bhella of the JPS Health Network. He found that a lifelong (or long-term) devotion to physical activity can preserve the heart tissue of senior citizens – to a degree, in fact, that is comparable or superior to that of younger, healthy persons who don’t work out, according to a report by Alex Branch of the McClatchy-Tribune.

By now most people know that physical exercise is heart-healthy. But some may fear that they started their fitness programs too late in life to do them any good. Over time, the human heart loses mass and elasticity, which increases the risk of heart failure. But here at SFA, we emphasize that it is never too late to get going and reap worthwhile physiological and psychosocial benefits.

At the annual meeting of the
American College of Cardiology in April, 2011, Dr. Bhella discussed his research team’s findings. They compared the hearts of subjects over age 65 who had exercised different amounts (if at all) during their lives with the hearts of subjects under 35 who, while healthy, were physically inactive. MRI results showed that youthful heart mass was maintained in the older adults who had habitually exercised four or five times per week. Better still, exercising six or seven times per week not only preserved mass, but also promoted new mass – exceeding that of youngsters (ages 25 to 34) who didn’t exercise. Similar outcomes were observed regarding heart elasticity.

For the study’s purposes, “exercise” was defined as aerobic activity, such as walking or cycling, generally performed for more than 20 minutes per session. Importantly, a “lifelong” commitment to exercise did not necessarily mean uninterrupted physical activity since childhood – or even since high school. Most of the senior citizens with notably desirable heart mass and elasticity levels had been physically active for about 20 to 25 years. That suggests that middle-aged and older persons can gain greatly by embarking on a regular program of physical exercise.

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Walk — Don’t Shuffle

Monday, May 23rd, 2011 by American Senior Fitness Association   View This Issue of Experience!

SFA author Jim Evans is a 44-year veteran of the health and fitness industry and an internationally recognized fitness consultant. Today he offers helpful advice to a lady concerned by her recent history of falling. In addition to participating in balance training programs, there are also practical everyday measures that people can take to reduce their risk of falling. Jim explains below.

DEAR JIM: I’ve been falling frequently during the past several months, and I’m afraid I’m really going to hurt myself one of these days. Most of the time I just trip on the carpet and manage to catch myself, but yesterday I fell as I was getting out of the shower and struck my head on the toilet. Fortunately, I escaped with only a nasty bruise on my forehead, but it could have been much worse. I try to stay physically active by walking around the block several times a week, but sometimes I even trip outside on the sidewalk. What can I do to prevent losing my balance so often? I’m only 72, and I’d like to make it to my next birthday in one piece. TRIPPING IN TEMECULA

DEAR TRIPPING: Watch where you are going and pick up your feet, my dear. I assume that you have checked with your doctor to rule out any medical issues. Otherwise, you should do so right away.

It is not unusual for older adults to start dragging their feet as they grow older — shuffling, if you will. It’s a cautionary behavior intended to prevent exactly what you don’t want to happen — fall — but in fact it can often cause you to, well, fall. Shuffling involves shorter steps so your feet are closer together which gives you a shorter stability base, making you more prone to falling.

Sometimes your shoes contribute to the problem, too. Many people wear comfortable rubber-soled walking shoes or sneakers nowadays, so when you shuffle your feet, the rubber soles drag or catch on whatever surface you are walking on. The shoes are doing exactly what they are supposed to do — give you more traction — but that extra "grip" can also cause you to trip or stumble more easily when you don’t lift your feet.

Even your vision can be a factor in tripping. Many older folks look down at the ground when they walk instead of looking forward in anticipation of the next step. The rationale for looking down is, of course, so that you don’t trip over anything, but exactly the opposite happens because your vertical vision does not allow you to see what is coming in front of you. Consequently, when an obstacle of any kind suddenly appears under your feet, you cannot act quickly enough to react to it, and down you go!

According to the Centers for Disease Control  (www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html), one out of three adults age 65 and older falls each year. Among those age 65 and older, falls are the leading cause of injury death. Worse, the chances of falling and of being seriously injured in a fall increase with age because we don’t bounce back like we used to — in fact, we may not bounce at all.

So, start developing different walking habits when you take your walks:

  • Look ahead in the direction you are walking.
  • Focus on lifting your feet a little higher off the ground and placing them in front of you.
  • Step forward with a normal stride.

After you have developed these new walking habits, they will become routine and you won’t have to think about them so much. Of course, be careful about walking on uneven terrain, and watch out for the usual wet spots, bumps in the road and banana peels. Also, be careful about changing directions in a hurry because sometimes your feet might not move as quickly as your brain (or the other way around) and — oops — down you go again!

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Thanks, Jack!

Friday, April 15th, 2011 by American Senior Fitness Association   View This Issue of Experience!

Quoted by Jim Evans in a 1996 SFA article, Jack LaLanne encouraged seniors this way: “Challenge yourself. Swim against the clock and swim vigorously.” He added, “Exercise should be a daily habit. Just get up and do it!” In today’s issue of Experience! Jim Evans provides further insight into the man he knew. Also included are several photographs that Jack gave to Jim over the years.

DEAR JIM: I was saddened to learn about the passing of Jack LaLanne, but, frankly, I wasn’t surprised. I thought he should have died years ago performing some of those crazy stunts of his. I used to exercise to his TV show in the fifties — I’m 75 now — but I quit working out years ago because I thought he took exercise too seriously. After all, doesn’t it just prove that no matter what we do to take care of ourselves, we will all die eventually anyway? DOUBTING THOMAS

DOUBTING THOMAS: Wow! You certainly missed Jack’s message by a mile!

Jack had no illusions about living forever, even though he joked that “dying would ruin his image.” And he often said – very honestly – that he didn’t work out because he “liked it” but, rather, because it enhanced his quality of life as he grew older and allowed him to continue to do things that people half his age had long since give up because they were simply “too old.”

“People don’t die of old age,” he said. “They die of inactivity.”

I first met Jack LaLanne (www.jacklalanne.com/) on his birthday – September 26 – in 1968 at the grand opening of the European Health Spa in Dublin, Ohio. Of course, I had grown up with Jack, watching him on TV with my mother in the fifties, but it is something else when you get to meet a legend in person.

Several hundred people had gathered to see the new club but, more important, they wanted to meet the guest of honor – the “godfather of fitness.” Small in stature – he was only about 5’6” – Jack was “big” in personality with a terrific sense of humor. As he was about to speak to the crowd, a very large woman elbowed her way rudely to the front of the room to see the fitness icon in person. The crowd grumbled audibly but parted so that she could get by, curious about her purpose. Finally, face to face with Jack, she looked him up and down and appeared noticeably crestfallen.

“Why,” she said with disappointment, “you’re not any bigger than my husband.”

“That’s right,” replied Jack with a big grin. “The difference with me is that everything still works.”

The crowd erupted in laughter as he gave her a big hug.

I ran into Jack many times during my 44 years in the fitness industry, and he was always the same outgoing, friendly, fun-loving guy with a positive attitude about life. While many so-called fitness experts have had more academic credentials or titles than Jack, no one could sell the concept of physical fitness with more natural enthusiasm – more passion – than Jack. He made exercise fun.

“Better to wear out than rust out,” he said. He was right, you know. Why don’t you put away your cynicism and start doing something physical? I know Jack would approve.

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Life’s Journey

Friday, November 19th, 2010 by American Senior Fitness Association   View This Issue of Experience!

In this special issue of Experience! two outstanding authors address sensitive matters that can be expected to confront us along the intricate pathway of life. Included are thoughtful treatments regarding end-of-life considerations and the awareness of human mortality.

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Dare to Understand and Ask for Palliative Care

Friday, November 19th, 2010 by American Senior Fitness Association   View This Issue of Experience!

Today we are pleased to present the following article by Terry F. Katz, MD. Dr. Katz is medical director of The Center for Healthy Living in Teaneck, New Jersey. An internist specializing in the care of the elderly, Dr. Katz is associated with PMR, the Physical Medicine and Rehabilitation Center, PA, of Englewood, New Jersey. PMR is devoted to the diagnosis and treatment of medical problems related to pain and disability, and its multidisciplinary treatment teams provide comprehensive care for sports, spine, orthopedic, and neuromuscular conditions. For more information, click on www.Rehabmed.net.

The primary purpose of palliative care is to alleviate suffering and enhance the quality of life. The concept of medical palliation in its inception conjured up images of dying patients with a similar set of physical symptoms that required relief. As older people began living longer with incurable chronic disease, the concept of palliative care took on a broader meaning. Palliative care now includes providing care that addresses the physical, emotional, cultural, and spiritual issues that affect a patient and their family during the final phase of life. This stage may last days to weeks when associated with an acute event, or may last months to years as in chronic illness with progressive debility.

Providing quality palliative care requires a multifaceted approach that achieves best results when a team of nurses, social workers, physical therapists, religious counselors, and other therapists supply care under the supervision of a physician team leader. The expertise and involvement by all these individuals is important to identify and address the "whole person." Members of the palliative care team conduct their own evaluations over a period of time talking to the patient, family, and care providers to obtain the complete picture. The evaluation will elucidate team members as to social needs such as financial concerns, need for closeness, care-giving needs, and access to care; spiritual needs such as the degree of distress, role of spirituality, and the extent to which one has settled relationships; medical needs such as the role of further diagnostic evaluation and treatment of physical and mental symptoms; and finally therapeutic issues that illuminate the goals of care.

The evaluation is a constant process. Goals of care and treatment priorities shift with increasing disease burden, but treating physical symptoms is always paramount. Symptom management includes nondrug interventions such as physical therapy modalities and acupuncture, and pharmacological management with both traditional and alternative choices. Typically treatment is a combination that minimizes potential adverse reactions. After therapy is initiated, regular patient follow-up is important to assess relief of symptoms, effect of treatment on abilities to maintain usual activities, and measure whether the identified goals are being met.

The concept of a "good death" is central to the modern palliative care movement, but watching the diminishing physical capabilities and the death of someone close is never easy. The truth is: no one can escape the experience. We all feel the fragility of life and worry about our own future end-of-life experience. Embracing palliative care allows better management of symptoms and prevents unnecessary suffering for the patient, bolsters the family and care-givers with skills to adapt to the transitions and face the losses, and, in creating a more positive outlook on end-of-life care, can help so many groups of people.

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Facing Mortality Without Fear

Friday, November 19th, 2010 by American Senior Fitness Association   View This Issue of Experience!

SFA author Jim Evans is a 42-year veteran of the health and fitness industry and an internationally recognized senior fitness consultant. Today he discusses natural concerns that may arise with advancing age.

DEAR JIM: I have managed to outlive most of my friends and three wives to make it to age 92, and I feel pretty good for my age. I don’t drink or smoke, and I try to stay physically active. Still, I can’t help thinking about dying. I have seen so many of my friends expire after lingering for months with cancer, heart problems, Alzheimer’s disease, and other conditions, and I have to admit that it scares me to think that it could happen to me too — and the likelihood becomes greater with every passing year. Am I just being paranoid?

SCARED IN SCARSDALE

DEAR SCARED: No, you’re not being paranoid. The thought of dying becomes more commonplace as we get older and have a greater sense of our own mortality. And, as many of our friends and loved ones pass on, we think about it more often. However, you seem to be living a healthy lifestyle which has probably contributed to your longevity and could sustain you for years to come.

To put your mind more at ease, you might be surprised to know that most people in their eighties, nineties, and above are often healthier than those 20 years younger. Many medical afflictions usually happen to people in their sixties and seventies. Those who have reached their eighties and nineties — like you — are "survivors" who often carry on for years in comparative health.

With all of the current concern about Medicare, most people are not aware that the average Medicare bill for someone who dies by age 70 is three times greater than for someone who lives to be 90. In fact, the medical cost during the last two years of life — which are usually the most expensive — is typically just $8,300 for someone who dies at age 90 compared to $22,600 at age 70. It won’t be the centenarians who stretch the limits of Medicare but, rather, it will be the baby boomers turning 65!

It is not easy to put the thought of death on the back burner when so many of your peers are already deceased, but dwelling on it will not add years to your life either. You have been given a great gift to live so long, so continue to take good care of yourself and enjoy each and every day. Your healthy lifestyle has seen you through the years and should continue to serve you in good stead. Remember, it is not how long you live that counts but the quality of those years. With more and more people living longer, you are in good company.

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As Autumn Gives Way to Winter

Friday, November 19th, 2010 by American Senior Fitness Association   View This Issue of Experience!

The English poet and philosopher Samuel Taylor Coleridge(1772-1834), along with his close friend William Wordsworth, was a founder of the English Romantic Movement. Well known for his poem The Rime of the Ancient Mariner, Coleridge also shared his thoughts on the changing seasons of life:

"The one red leaf, the last of its clan,

That dances as often as dance it can,

Hanging so light, and hanging so high,

On the topmost twig that looks up at the sky."

– Samuel Taylor Coleridge

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Many Chronically Ill Elderly Live Alone

Tuesday, October 5th, 2010 by American Senior Fitness Association   View This Issue of Experience!

Family and friends outside of the household are an important resource for older adults with chronic health problems, according to University of Michigan (U-M) research. Below is a report on the subject from the University of Michigan Health System:

Almost 40 percent of chronically ill older adults in the U.S. live alone, and a majority of those who are married have spouses with at least one chronic illness than can affect their ability to provide support, according to a U-M study published in the journal Chronic Illness.

The results underscore the importance of health care professionals directly addressing the roles that family members play in the care of their aging parents or other relatives.

"Family members have the potential to significantly help many patients with chronic illness manage their health conditions," says co-author Ann-Marie Rosland, MD, clinical lecturer in the Department of Internal Medicine at the University of Michigan Medical School and research investigator for the Center for Clinical Management Research in the VA Ann Arbor Healthcare System.

"However those family members need more than just information to be successful. We need to teach family members communication skills and provide the tools that they can use to encourage patients to stick to their health regimen."

The study’s authors looked at U.S. residents who were age 51 or older with chronic health problems who participated in the 2006 Health and Retirement Study, a national longitudinal study conducted at the University of Michigan’s Institute for Social Research and funded by the National Institute on Aging.

Researchers found that 93 percent of the chronically ill older adults had adult children, but for half of them, the children lived more than 10 miles away. Roughly 19 million older chronically ill Americans have adult children living at a distance.

"Even when a spouse is available, the vast majority struggle with their own
chronic medical needs and functional limitations," says John D. Piette, PhD, professor of internal medicine and a senior career scientist with the VA Ann Arbor Healthcare System.

"Fortunately, most of these people had adult children who could be another source of support for their chronic illness care," he says. "But these
relationships are increasingly strained as adult children move farther away from their parents to seek employment or find a more affordable living situation. Distances pose a barrier to the monitoring and frequent support for behavior change that many chronically ill patients need."

Piette and his colleagues at U-M are working to develop telephone monitoring systems that involve family members in a relative’s care through email alerts or automated phone calls. The "CarePartners" program has been developed for
patients with heart failure, diabetes, depression, and cancer chemotherapy. The program is being studied as part of randomized trials and community demonstration programs.

"We know that people with family support follow their self-care regimen more regularly and this is vital to maintaining their health," says Maria Silveira, MD, MPH, physician scientist at the VA Ann Arbor Healthcare System and assistant professor of internal medicine at the U-M Medical School.

"The challenges facing chronically ill patients, their families and their clinical teams are enormous," Piette says. "We need a recognition that for many patients ‘self’ management is a misnomer, since their disease care is actually shared by their family and broader social network."

Informal caregivers play essential roles in filling the gaps in services found in most formal health care systems, such as providing assistance with transportation, medication refilling, emotional support, activities of daily living and a host of other vital tasks.

"Indeed, for many chronically ill patients, sharing their burden with intimate others makes living with their disease not only possible physically, but also worthwhile emotionally and spiritually," says Piette.

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Happiness Is Growing Old at Home

Friday, September 17th, 2010 by American Senior Fitness Association   View This Issue of Experience!

American Senior Fitness Association (SFA) member Maria Tadd has penned a practical and timely book addressing an important, contemporary issue. Published by the Terrapin Press of Chapel Hill, North Carolina, it is titled Happiness Is Growing Old at Home and subtitled Discover New Ways to Help Your Aging Parent Remain Independent.

The publisher’s description, reprinted below, provides a good overview of the 269-page book’s contents:

  • Innovative options provide quality and compassionate care, many at reduced costs.
  • New, easy-to-use, high-tech devices facilitate independent living.
  • Living a healthy lifestyle will help your parents age in place.
  • Detailed questionnaires will assist you in evaluating health care agencies and rehab facilities before you sign on the dotted line.
  • Sample flowcharts, schedules and logs will help keep you and your parent organized and will make sure that all caregivers are on the same page.
  • An extensive, annotated list of websites provides volumes of information.
  • Maria Tadd, a freelance medical writer, is a graduate of the New England School of Acupuncture and a life-long student of holistic health, meditation and nutrition. For more information about Happiness Is Growing Old at Home, click on www.agingathome.info.

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