Medication Adherence: A Letter to Patients

It is a sad commentary on our current cultural worldview that sunlight is widely perceived to be harmful, a cancer-causing threat. But what does the research actually say? And does this research affect older adults differently than other people?Spectrum: For starters, we should understand that sunlight is a complex combination of photons, with different wavelengths and properties. The sun is the original full-spectrum illumination, while both incandescent and LED lights emit, as one might expect, mostly visible-spectrum light.Intensity: The other important variable is the intensity of light, measured in LUX units (a foot away from one candle): direct sun comes in at 100,000; a cloudy day at 1,000; a kitchen or office measures 500; and a living room only 50. Thats why you need to get outside.UV: At one extreme is ultraviolet light (UV), whose wavelength is slightly shorter than visible violet. With regard to our health, UV is a mixed bag.It does cause sunburns, damages DNA, and triggers the aging of skin. It is also statistically associated with malignant melanoma, although, curiously, not with increased deaths from melanoma (because these cancers are mostly treatable).On the other hand, there are numerous health benefits: UV lowers the risk of hypertension, diabetes, atherosclerosis (hardening of the arteries), blood inflammation, and COVID infections. UV also stimulates Vitamin D synthesis in the skin. A large-scale study of 500,000 Brits, with a 12-year follow-up, found that frequent UV exposure lowered all-cause mortality by 14%, with cardiovascular deaths down 21% and total cancer mortality decreased by 13%. It gives one pause to reconsider the vast sums spent on sunscreen lotions. Just wearing light summer clothing blocks 80% of UV.IR: UV radiation represents only about 3% of the sunlight that strikes the surface of the earth, while about 50% is infrared (IR), whose lightwaves are just beyond (longer) than visible reds. IR radiation is more predominant at the beginning and end of days, while UV is strongest when the sun is overhead. A thick cloud cover reduces IR significantly more than UV. In a recent superb Huberman Lab podcast, Dr. Roger Seheult touted the many benefits of IR radiation. Most severe and chronic diseases also involve mitochondrial dysfunction (mitochondria are the small organelles within a cell that produce the energy-generating chemical ATP). One aspect of aging is that we lose 70% of our mitochondrial functioning after age 40. Unlike UV, IR radiation passes through light clothing and the surface of the skin to penetrate deep into body tissues, where it significantly stimulates mitochondrial ATP synthesis.Effects: The effects of improved mitochondrial functioning are pervasive, correlated empirically with sun exposure. Dr. Seheult cited statistics demonstrating that the greatest number of all-cause mortality comes soon after the shortest day of the year, and the lowest number of deaths occurs close to the longest days.People who live far north or south of the equator where days are particularly short in winter have higher overall mortality rates, particularly in mid-winter. In a study of almost 30,000 Swedish women, avoidance of sun exposure carried the same risk of premature death, as did smoking.There is well-replicated rigorous research that moderate IR exposure lowers the risk of cancer, heart disease, diabetes, hypertension, and it reduces blood lipids and chronic inflammation. IR increases immune system response to infections, such as influenza, COVID and pre-cancerous cells.On a sunny day, just 15 minutes outside can make a big difference. If youre in a green space with lots of grasses, leaves, bushes, and trees, you can receive two to three times the IR dose because plants reflect much of the IR that strikes them (notice that most leaves dont get hot in the sun because of these reflective properties).Red Light Therapy: There are many red-light therapy devices now available if you are considering them, be sure to carefully research IR wavelengths, dosage, safety, and therapeutic benefit. One study, utilizing an IR desk unit shining only on face, neck, and hands, proved to be quite therapeutic.Forest Bathing? Dr. Seheult delighted in reminding us of the wisdom of the ancient beliefs that sunlight and fresh air promote convalescence. Forest bathing has become a thing the air around trees is infused with phytoncides that defend plants from bacteria, fungi, and insects. When inhaled by humans, they up- regulate immune functioning and lower stress levels, and reduce stress hormones. The beauty and serenity of such an environment further enhances these benefits, some of which are detectable by lab tests a month later. Furthermore, getting up with the sun (and out from behind the filtering effects of plate glass windows) helps to set your circadian rhythm, which can improve sleep patterns. Take home message: forests, parks and even golf courses soothe the soul, and the body. And early morning and late afternoon may be particularly beneficial.Sweat Benefits: Dr. Seheult is a pulmonologist who treats many respiratory infections he also reminded us about how previous generations treated patients with hot baths and hot packs, as if to sweat out infections. Its been recently discovered that body temperatures a little over 100 degrees Fahrenheit actually accelerate the production of interferon, a powerful anti-viral protein. Maybe weve been a little too quick to reduce our fevers with aspirin, Tylenol, and Advil. And maybe the saunas so favored by Scandinavians and Russians are more therapeutic than weve realized.Conclusion: As spring has sprung, we encourage everyone to get away from your screens, go outside and enjoy the benefits of the sunshine that so amply surrounds us. Residents at Kavod Senior Life have a myriad of ways to get outside, whether it be on the sunlit patio areas, in the resident gardens, on the nearby walking paths in Cherry Creek or on the many benches and sitting areas surrounding the campus. Come for a visit and see for yourself!Ben and Scott  https://theagingwiselyproject.com/

By Faith Protsman, MD, Regional Medical Director, VITAS HealthcareVietnam War veterans face unique obstacles throughout the twilight of advanced illness. For hospice care providers to tailor care to meet the needs of veterans who have served in this theater of war, they must consider the tribulations these patients face as they reach the end of their lives.The Vietnam War era was a very tumultuous time to be a soldier. The United States' prolonged involvement in a war of questionable motivation left society with disdain toward the government and its institutions, especially the military.Coupled with horrific images shown on television, constant controversy was a new reality and negative public opinion formed around this conflict, of which those serving the nation were not spared.Careful consideration is necessary when treating patients facing these traumas.Tours of duty proved to be traumatizing in many ways. Young soldiers, some having just turned 18, were drafted into a war that many of them did not believe in. They were not fighting for love of country and God; rather, they were fighting for survival and out of fear for their lives.Intimate battles in the dense jungle led many to be subjected to the horrors that come with fighting in a foreign land that was only familiar to the elusive guerilla enemy soldiers.Servicemembers did not receive a warm welcome when returning home from Vietnam, often being judged and labeled as cruel and even inhumane.Moral Injury Can Impair Mental HealthThis perfect storm of trauma led to lasting moral injury that plagues many veterans for their entire lives. Veterans returning from the war were marginalized and pushed into isolation, often turning to alcohol and substance abuse, which worsened their anxiety and exacerbated their strife.Questions like Ive never spoken about the war, can I now? Was the war moral or immoral? and Was I a good soldier? come bubbling to the surface later in life as their illnesses intensify and their defenses weaken.Careful consideration is necessary when treating patients facing these traumas.The restlessness that can result from post-traumatic stress disorder (PTSD) is often treated with benzodiazepines. In most cases, these medications can bring relief through calming the patient.Yet, there is a common trend amongst veterans who cope with trauma that results in the opposite effect.Benzodiazepines can lower the walls that Vietnam veterans have built up throughout a lifetime of suppressing trauma and negative memories. This class of medications can exacerbate the symptoms of PTSD as traumatic experiences and feelings of regret resurface. Benzodiazepine-induced inhibition of neurotransmission can even lead to agitated toxic psychosis, increased anxiety, hostility, and rage.1The Value of Compassion Along with Clinical CareRemaining considerate does not end with simply staying mindful during the planning of clinical solutions. Providing care for Vietnam veterans requires a high level of empathy.A key to an empathetic approach is taking the time to listen nonjudgmentally. Though seemingly simple, practicing nonjudgmental, open communication with patients facing trauma from war can help avoid the all-too typical responses of Its okay and You did what you had to do.These patients do not need sympathy, because they have been judged enough throughout their lives. When care teams approach them without judgment, they honor the sacrifices these heroes have made.VITAS hospice care provides compassionate care approaches that are tailored to meet the distinctive needs of Vietnam veterans. With the Veterans Administration (VA) offering hospice care as part of its medical package, VITAS team members can provide empathetic psychosocial support, while utilizing clinical solutions that help manage symptoms.The qualifications for veterans to receive hospice benefits include: A life-limiting illness Treatment goals that focus on comfort, rather than curative treatments A life expectancy of 6 months or less, if their illness runs its normal course Veterans also benefit from the option to receive concurrent care through the VA. The VA can provide curative treatments as the patient simultaneously receives symptom-managing comfort care administered by the hospice care provider of their choosing.Offering solace, while remaining compassionate when patients need it most, is too often overlooked in the busy practice of healthcare. Acknowledging the adversity that Vietnam War veterans have had to face throughout their lifetimes and adapting care approaches to meet their needs is the best way for healthcare providers to give back to those who have sacrificed so much for the preservation of freedom.1Paton, C. (2018, January 2). Benzodiazepines and disinhibition: A review: Psychiatric bulletin. Cambridge Core. Retrieved November 2, 2022, from https://www.cambridge.org/core/journals/psychiatric-bulletin/article/benzodiazepines-and-disinhibition-a-review/421AF197362B55EDF004700452BF3BC6

Maintaining proper nutrition is a crucial aspect of healthy aging, especially for seniors who wish to continue living independently and enjoying their golden years. By stocking your pantry with the right combination of nutrient-dense foods, you can empower yourself to prepare wholesome, energizing meals that support your overall well-being. In this article, well explore the top pantry essentials that should be on every seniors radar.The Importance of a Well-Stocked PantryA thoughtfully curated pantry is the backbone of a balanced diet. When you have a variety of healthy ingredients on hand, it becomes significantly easier to whip up nutritious meals on the fly, without the need for multiple trips to the grocery store. This not only saves you time and money but also helps you avoid the temptation of less-than-ideal food choices that can compromise your health.Pantry Essentials for SeniorsNow, lets delve into the specific pantry items that should be on every seniors radar. These versatile and nutrient-dense foods will serve as the foundation for countless delicious and nourishing meals.Whole GrainsWhole grains, such as brown rice, quinoa, and whole-wheat pasta, are powerhouses of fiber, vitamins, and minerals. These complex carbohydrates provide sustained energy and can help regulate cholesterol levels and blood pressure, reducing the risk of chronic conditions. Oatmeal, a classic breakfast staple, is another excellent whole-grain option that can be easily customized with fresh fruit, nuts, and a touch of honey.Beans and LegumesBeans and legumes are true nutritional superstars, offering a potent combination of protein, fiber, and antioxidants. From kidney and black beans to chickpeas and lentils, these versatile ingredients can be incorporated into soups, stews, and even meatless chili, providing a satisfying and filling base for your meals.Nuts and SeedsNuts and seeds are nutrient-dense snacks that can also be used to enhance the flavor and texture of various dishes. Almonds, pistachios, walnuts, and pumpkin seeds are all excellent sources of healthy fats, protein, and essential minerals. Keep a variety of these on hand for quick and nourishing between-meal bites or to sprinkle on top of salads, oatmeal, and yogurt.Canned GoodsCanned goods, such as tuna, salmon, and a variety of fruits and vegetables, are convenient and cost-effective pantry staples. These items often have a long shelf life, making them ideal for seniors who may not have the time or energy to frequent the grocery store regularly. When selecting canned goods, opt for low-sodium or no-added-salt options to keep your sodium intake in check.Spices and HerbsElevating the flavor of your meals is not only enjoyable but can also encourage healthier eating habits. Spices and herbs, such as garlic, ginger, turmeric, and basil, are not only packed with antioxidants but can also help reduce the need for salt, sugar, and unhealthy fats in your cooking. Experiment with different flavor combinations to keep your taste buds engaged and your meals exciting.Healthy Fats and OilsIncorporating healthy fats into your diet is crucial for maintaining overall health. Olive oil, avocado oil, and coconut oil are excellent choices for cooking, dressings, and marinades. Additionally, consider keeping a bottle of apple cider vinegar on hand, as it can be used to add a tangy twist to a variety of dishes, from salads to stir-fries.Dried Fruits and NutsFor a quick and satisfying snack, keep a selection of dried fruits and nuts in your pantry. Raisins, apricots, and cranberries provide a natural sweetness, while nuts like almonds, walnuts, and cashews offer a crunchy texture and a boost of healthy fats and protein. These shelf-stable items can also be used to add texture and flavor to baked goods, oatmeal, and trail mixes.Honey and Maple SyrupWhen it comes to satisfying your sweet tooth, opt for natural sweeteners like honey and maple syrup. These alternatives to refined sugar can be used in baking, drizzled over yogurt or oatmeal, or even incorporated into marinades and dressings. Not only do they provide a touch of sweetness, but they also offer additional health benefits, such as antioxidants and anti-inflammatory properties.Whole-Wheat Flour and Baking EssentialsFor any of your baking needs, keep a supply of whole-wheat flour, baking soda, baking powder, and spices like cinnamon and nutmeg. These ingredients can be used to create healthier versions of your favorite baked goods, from muffins and breads to cookies and scones. Experiment with natural sweeteners like honey or maple syrup to reduce your intake of refined sugars.Putting It All TogetherBuilding a well-stocked pantry takes time and effort, but the benefits are well worth it. Start by gradually incorporating these essential items into your shopping routine, and dont be afraid to try new recipes and flavor combinations. Remember, healthy eating is a journey, and by embracing these nutrient-dense pantry staples, youre taking a significant step towards nourishing your body and supporting your overall well-being in the golden years!