Senior Living Is the Greatest Gift of Independence

By the time you read this, the reported deaths from COVID-19 and its variants in the U.S. will be close to 900,000. As staggering as that statistic is, its 400,000 short of the number of Americans killed by Heart Disease in the same time period. Heart disease is the leading cause of death for men and women of most racial and ethnic groups.Lets not allow the topic to overwhelm the fact theres a miracle inside your chest. Weighing about as much as a grapefruit, the heart is a powerful pump that drives five to six quarts of blood to every microscopic part of your body every second. And if it fails for even a second, the body is very unforgiving. Even though its the one piece of machinery driven by the brain, we tend to treat the heart like a kitchen appliance that we take for granted. Rarely serviced, rarely cleaned, and overworked until it burns out. Although heart bypass and transplant have become routine since the pioneering operations in the 1960s, its not like replacing the coffee maker you neglected too long. One Thing at a TimeThe better way to treat your heart with the respect it deserves is to start with changing just small habits. That way, youll avoid the relapse from trying to change everything at once and falling back to unhealthy heart habits inside of a month. The most obvious: if youre a smoker or heavy drinker, work on that first. Imagine a small team of remodelers arriving at your heart to do a makeover. The first thing theyre going to say is, Well, we cant do anything with the plumbing until we clear the smoke. Look for Help During Heart MonthQuitting smoking and reducing alcohol is never easy, but this is probably as good a time as any during the year to start a cessation program with help. February is American Heart Month, so youre likely to be reminded frequently of heart health and offered tips on modifying your routine to help your heart and prolong a happy life. If you only look to one place, trust the American Heart Association  www.heart.org. Prediabetes and Heart DiseaseWhats your blood sugar level? If you dont know, you should find out from your doctor if youre not already monitoring it yourself. You could be pre-diabetic without knowing it or showing any symptoms. Theres a good chance you could avoid becoming diabetic and reverse your pre-diabetic blood sugar to normal with relatively little change to your diet and a slight increase inyour activity. Diabetes has long been linked to heart disease, but recent studies suggest that reversing prediabetes is also linked to fewer heart attacks and strokes. [Reversing Prediabetes linked to fewer heart attacks, strokes, heart.org, Jan. 26, 2021.]While youre at it, get your cholesterol tested and routinely monitor your blood pressure.If youre worried you might be at risk for heart disease, ask your doctor to perform a simple cholesterol test to let you know if youre at risk and should adjust your diet. Home blood pressure monitors are not expensive, theyre digital, and theyre easy to use. Blood pressure stations are common in supermarkets now, and you can also check your weight and pulse. Womens Heart HealthWhy the emphasis on womens heart health? The American Heart Association tells us that cardiovascular disease is the No. 1 killer of women, causing 1 in 3 deaths each year about one woman every minute. They devote an entire website to womens heart health: Go Red for Women (www.goredforwomen.org). Here are just a few of the common misconceptions about womens heart health:Myth: Heart disease is for men, and cancer is the real threat for womenFact: Heart disease is a killer that strikes more women than men and is more deadly than all cancer forms combined. While one in 31 American women dies from breast cancer each year, heart disease is the cause of one out of every three deaths.Myth: Heart disease is for old peopleFact: Heart disease affects women of all ages. For younger women, the combination of birth control pills and smoking boosts heart disease risks by 20 percent. Heart defects are more common than you might think: 1.3 million Americans alive today have some form of congenital heart defect and at least nine of every 1,000 infants born each year have a heart defect. Even if you live a completely healthy lifestyle, being born with an underlying heart condition can be a risk factor.Myth: I run marathons no way I could be at risk.Fact: Factors like cholesterol, eating habits, and smoking can counterbalance your other healthy habits. You can be thin and have high cholesterol. The American Heart Association says to start getting your cholesterol checked at age 20. Earlier, if your family has a history of heart disease. Age and Heart HealthMany things, like wine and most people, grow better with age. The heart, however, takes more tending than a glass of fine wine. Avoid things that weaken your heart beyond the normal aging process. These are the usual suspects: smoking and tobacco use, lack of exercise, diet, alcohol, overeating, and stress. Some preexisting conditions you cant control: irregular heartbeat, congenital (inherited) heart defects, sleep apnea (although this may be a product of obesity or alcohol consumption).Viruses and MyocarditisMyocarditis is an inflammation of the heart muscle mostly caused by a virus, including COVID-19, and can lead to left-sided heart failure. The left ventricle of the heart is the part that pumps oxygen-rich blood back to the body. This valve tends to stiffen with age. Thats one of the many reasons why age combined with a preexisting condition puts you at greater risk of death from COVID-19. Even survivors of the novel coronavirus infection can sustain permanent heart damage. All people must protect themselves and others from COVID-19 by observing precautions, not just because of its immediate lethality but also because of its impact on the heart, known and unknown. How to Start with Your HeartThe factors involved in heart health and the onset of heart disease are many, varied, and complicated. But the common preventions (listed here, from the Mayo Clinic) are simple. You probably already know them by heart, so to speak:Not smokingControlling certain conditions, such as high blood pressure and diabetesStaying physically activeEating healthy foodsMaintaining a healthy weightReducing and managing stress Those may seem like six significant challenges, especially if you take on all six. But you should notice something else about them. Almost every one of them can affect the other five. So, if you pick one, youll find it easier to take on the next one. People who quit smoking usually discover that they have more energy within the first week, and exercise becomes easier. A little exercise and switching out one unhealthy food will help with weight, stress, blood pressure, and diabetes. Easy does it, especially if youre 65 and older. Youve spent a whole life learning one way. You can take your time. Learn to enjoy your healthier heart. But start today.First, Get a Checkup!Most of the questions this article has raised in your mind (Whats my blood sugar level? Whats my blood pressure? I used to smoke am I at risk?) can all be answered in a single doctors visit with simple lab work done a few days before. Schedule it now, before you start a program of exercise and diet. And schedule a regular exam per your doctors recommendation. Relieving the stress of not knowing will be a good start on your way to a healthier heart.

Lets start with what most of us know about Parkinsons disease (PD). Comparatively common in older adults, its a neurological disorder estimated to affect nearly 2% of those over age 65, estimated by the National Parkinsons Foundation to be one million Americans in 2020. Public figures, such as the popular actor Michael J. Fox, who has PD, have increased the publics awareness and understanding of the disease. Now lets consider the side of PD less talked about: Parkinsons Disease Dementia (PDD). Usually, the condition is depicted as auditory and visual hallucinations of imagined occurrences, delusion, and paranoia that follow the more visible motor dysfunction typical of Parkinson's. In fact, the dementia component of PD usually does not appear earlier than a year or more after the diagnosis. The average time from onset of Parkinsons to signs of dementia may be around ten years if certain studies are correct. The phenomenon may also be more common than most people think. Thats why, to recognize April as Parkinsons Awareness Month, were focusing on the dementia phase of the disease.Recognizing PDDThe University of California, San Francisco, Weill Institute for Neurosciences Memory and Aging Center outlines the symptoms of PDD: 1Trouble focusing, remembering things or making sound judgementsMay develop depression, anxiety or irritabilityMay hallucinate and see people, objects or animalsSleep disturbancesThe Alzheimers Organization states that an estimated 50 to 80 percent of those with Parkinsons eventually experience dementia as their disease progresses. There's no single test or combination of tests that can give a conclusive diagnosis of PDD, which may partly account for the wide range in the statistics. An original diagnosis of Parkinsons will be based on movement irregularity, with PDD symptoms at least a year off. This puts greater importance on working closely with a physician for an early diagnosis. Sadly, the deterioration of brain cells by PDD can't be stopped or slowed. Drug therapy can alleviate some of the symptoms.The Difference Between Parkinsons Dementia and OthersThe difference among various dementias can be confusing, and dementia should never be self-diagnosed instead of consulting with a neurology specialist. First, consult your primary physician. The International Parkinson and Movement Disorder Society provides a directory of movement disorders specialists to search for a specialist in your area.Dementia with Lewy bodies (DLB) is a spectrum of dementia-related to Parkinson's, which is also characterized by the formation of Lewy bodies, clumps of protein that form in the brain. PDD symptoms resemble DLB, which also causes changes in thinking, behavior, and movement. The difference between PDD and DLB is that with DLB behavior and cognition impairment symptoms occur first, whereas Parkinsons will present as movement impairment with dementia appearing later.2 While the cause of PDD is unknown, scientists think the progression of Lewy body protein build-up first affects motor control, and eventually, enough nerve cells die that the first signs of dementia appear.Different clumps of protein form in a brain affected by Alzheimer's Disease (AD). Another difference between Alzheimers and similar dementia is that Parkinsons tends to affect attention and executive function more than memory. An essential and hopeful distinction: although the symptoms are similar, people with PDD are not at risk of developing Alzheimers Disease, according to the Pacific Brain Health Center. Nor is long-term memory likely to be as affected. The characteristic loss of recognition of loved ones and a general awareness that affects Alzheimers patients is not typical of PDD.3Aging and ParkinsonsJohns Hopkins Medicine states: The older you are, the greater your risk of developing Parkinson disease.4 The Michael J. Fox Foundation, in its downloadable brochure Navigating Cognitive Changes in Parkinsons, also notes "Cognitive changes from Parkinson's often are different or more than you'd expect with age." The example they offer is a helpful illustration of the difference between ordinary changes in memory function due to age and those caused by Parkinson's. Ordinarily, you'll forget where you left your keys, and this may become more common as you age. By contrast, forgetting what your keys are used for or how to use them signifies a more severe dysfunction related to dementia.Caregiving at HomePeople with PD may get along well with home caregiving with the help of a spouse for years. The onset of PDD can change this significantly, primarily in disrupting the ability to communicate. Be prepared that the disorientation will change a persons behavior. They may not be able to be left alone and may become moody, impulsive, and annoyed. A few simple communication techniques are recommended for the caregiver:Establish a daily routine. Having meals, exercise, and activities at roughly the same time every day avoids annoyance and anxiety in your loved one.Simplify living areas. Reduce distraction and shadows.Keep the home brightly lit.Remain calm and empathetic. Remember, it's the disease and not a conscious decision that creates erratic behavior.When evaluating the move to an Assisted Living or Memory Care community, consider that all the above features are incorporated into a well-designed, quality care residence.Try to establish a gentle regimen for your loved one with PDD. It will be difficult to change old habits, and those that are not harmful might be comforting. But some boundaries may need to be set to add years of a higher quality of life. These are things to encourage the person with PDD to do: Be socially active Engaging with friends exercises your cognitive skills, remembering names, etc.Get involved in the residence Maintain a sense of self-worth.Exercise regularly Exercise also releases natural brain chemicals that can improve emotional well-being.Eat a healthy, balanced diet High protein meals can benefit your brain chemistry.Train your brain Play brain games online puzzles are great or playing cards with your caregiver.Reduce stressSleep wellTake care of medical conditions Diabetes, high blood pressure, and high cholesterolcan damage your brains blood vessels and lead tothinking and memory problems.Check on mood and motivation.Review your medications Certain prescription and over-the-counter medications can confuse some people. Consult your physician.Drink in moderationDon't smoke Smoking is related to Alzheimers and other cognitive disorders.Caregiver stress shows up on your face and in your manner in subtle ways that nonetheless are easily picked up by your loved one. Give yourself a break. Dementia will place demands on your relationship, and this is natural. You should get enough sleep and regular nutrition. Seek counseling from your specialist to help you stay on even keel. Assisted Living, Memory Care and Nursing HomesThere are no long-term care residences exclusively for people with Parkinson's. Assisted Living and Memory Care residences are typically equipped for their particular needs because of the prevalence of the disease. There will very likely become a point where loved ones will not care for themselves in significant ways, such as getting dressed and preparing food. Dementia, of course, will further inhibit their abilities. Assisted Living is a good option for earlier PD stages. Still, the onset of dementia, which can take years, will require Memory Care for optimum therapy and assistance with daily living. It is worth considering whether an inevitable move from Assisted Living to Memory Care is desirable or if Memory Care is the best initial choice. Memory Care residences should include specific physical design to aid dementia patients in navigating to and from and within their rooms or apartments. Staff should be highly trained and compassionate. Programming should rely on the best medical practice and cognitive science. Either Assisted Living or Memory Care, or a nursing home, will provide meals, assistance with daily living routines, and emergency care. The costs and level of care among the three vary widely. Interview the residence director and health care director to assess the level and quality of care the residence can provide. For More Information About Parkinson's:If you or your family has questions about Parkinsons disease and Parkinsons Disease Dementia, want information about treatment, or need to find support, consult your primary care physician and contact any of the following organizations:The American Parkinson Disease Association.800-223-2732apdaparkinson.orgNational Institute of Neurological Disorders and Stroke800-352-9424braininfo@ninds.nih.govwww.ninds.nih.govMichael J. Fox Foundation for Parkinson's Research800-708-7644www.michaeljfox.orgParkinson's Foundation800-473-4636helpline@parkinson.orgwww.parkinson.org

The typical person in their later sixties and older takes several medications for chronic conditions. These may be drugs to regulate blood sugar, thyroid, blood pressure, cholesterol, allergies, mood, or any of hundreds of other mild-to-serious conditions. Your comprehensive blood panel is your and your doctor's way of monitoring the effect of the drugs prescribed, as well as whether they're working or not or if they may be interacting with one another. And, besides, you're changing. How do we know you're changing? You're aging. Your liver and kidneys break down and eliminate drugs from your body, and your liver and kidneys are aging. You may lose muscle and gain fat, affecting how drugs work. All of this can complicate the effectiveness of meds and, especially important, create harmful side effects. So, consider these medication tips  after you see your doctor. 1. Take Medicine as Prescribed with Regular Discussions with Your Health Care Provider On that all-important visit with your doctor, be involved. The doctor or nurse should ask you if your meds have changed or if you've stopped or started either prescribed medicine or over-the-counter drugs or supplements. They all count! If you're taking something prescribed by another doctor that's not on your primary's list speak up. Take only prescription meds your health care provider has prescribed. None of this, "Here, try one of mine" from your golf partner. Taking someone else's medicine can be very dangerous. This is particularly true of pain medication, which could worsen your condition or cause addiction. You probably know opioids are highly addictive but are not the only ones. The interaction of drugs is unpredictable. Your doctor has the proper outlook on your entire series of medications. Please don't stop taking or skip prescribed medications because you think you don't need them anymore, feel they've stopped working, or think they're causing a side effect. Consult your doctor about any side effects. Take side effects seriously. In the United States, 125,000 people die annually from incorrectly taking their medications! Talk to your pharmacist or health care provider about ways to help you take the proper dosage on time every time. It's typical to forget to take your meds. But it's not okay. Many antibiotics must be taken after the infection stops or after you stop feeling the symptom. Hence the instructions to take every dose until they're gone. If you're a family member or caregiver reading this, please provide the person under your care with prefilled pillboxes and automated reminders attached to pill bottles, or subscribe to a pill packaging service that sorts, packages, and delivers by individual dose. 2. Store Your Meds Safely and Keep Current Keep all medicine up and away from children, wherever you store them. Around 10,000 children are accidentally poisoned by prescription meds every year, and a child dies every 12 days from such poisoning. If you have questions about safely storing your medicines, contact your pharmacist or health care provider.Store meds in a safe, cool, dry place. A high drawer reserved for medications in a dresser or cabinet is good. Be careful that meds that need to be cooled are stored in the fridge, but give them a shelf where children can't reach them. There will be storage instructions on the bottle. Due to fluctuating heat and humidity, a bathroom medicine cabinet may be the worst place. Even if meds are not expired, improper storage can render them ineffective or unsafe.Remember we talked about how you're changing as you age? So is your medication. If you have an old bottle of aspirin that's been haunting the top shelf of a kitchen cabinet for a couple of decades, don't use it. Some meds lose their effectiveness, but others can degrade into toxicity. Check the expiration dates. There are proper ways to dispose of unused medications. Throwing them in the trash is not one of them. Discarded drugs can end up in the water supply and may be eaten by wildlife or pets. See any disposal instructions that may be on the side of the bottle. Many pharmacies have disposal sites where you can drop the old drugs. You can search for "medication disposal sites" or see the FDA's webpage that instructs you on the options of disposing of meds.3. Be Aware of Potential Medication Interactions and Side Effects, Even Unexpected InteractionsGrapefruit juice is always good for you. Here's something you may need to learn about grapefruit juice. The grapefruit has these beneficial enzymes that naturally protect it from the effects of insects and other harmful stressors. Unfortunately, these same enzymes inhibit the breakdown of certain medications in the human stomach, making some drugs ineffective or even toxic. So, what's good for the grapefruit is only sometimes suitable for the patient. Don't let this stop you from enjoying your morning grapefruit. Ask your doctor because this has been studied, and there's a list of drugs more likely to interact. And we only bring this up to illustrate how seemingly harmless or good-for-you foods and supplements can seriously interact with your medication. Ask your doctor about any potential adverse interactions.Prescription drugs can affect each other dramatically. For example, nitroglycerin, which treats angina, should not be taken with many erectile dysfunction medications, including Viagra and Cialis, because serious interactions can occur. Your pharmacist can also advise you about potential medication interactions and side effects.You may also have a medical condition that makes a particular medication risky. Again, your healthcare provider armed with your health record, a physical exam, and blood work is the best call here. Even herbal supplements you get off the shelf at the grocery store, though you're free to take them without a prescription, can interact. It may surprise you, but 40 percent of the drugs behind the pharmacist's counter are derived from plants used as natural remedies since ancient times. Grapefruit juice is used to prevent gout attacks, for example. Go figure. So, supplements are drugs, too, and they deserve the same caution as prescription meds when mixed with others.Not surprisingly, alcohol is a common offender. The NIH warns that "mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing." In other words, alcohol, whether it has sedative or stimulant effects on any person, should be considered a drug when taking other medication. If you're experiencing something you suspect is a medical condition, such as memory loss or difficulty, dizziness, or sleepiness, particularly for seniors, the medication may mimic the symptoms. Before you skip or stop taking the meds, consult your doctor. Ask your healthcare provider if any new health problems you are experiencing could be due to your medications at your regular physical. 4. Keep a Medication List There are many good reasons to keep a list of your current medications besides remembering which ones you're taking. Making a list is an excellent excuse to go through your cabinet or drawer and collect all your medicines. You can check duplicates and expired prescriptions (Don't mix expired medications with new ones!), find out if you need to take one you've forgotten about, and add any non-prescription medicine or supplements (including vitamins) you need to update your doctor on.Keep the list with you. And keep it current. Give a copy to a friend or relative for sure your emergency medical contact person in case of emergency and when you're traveling. Note any medicines you're allergic to or have had bad reactions to. Wear a medical alert bracelet for severe medicine needs (like insulin) or allergies. Store your medication list on your cell phone in a notepad app. If you're fortunate enough to have a healthcare provider who has your prescription record online, this can save you a lot of headaches when filling out medical forms even at the dentist. These forms almost always ask for the dosage, too, so those should be included. A medication list should include the following:Your prescription medicine's brand name or generic name.Over-the-counter medication, herbal preparations, and supplements that you take regularly or on occasion.Condition you're treating with the medication.The dosage (for instance, 300 mg).How often do you take it?Anything you're allergic or reactive to.The phone number of your pharmacy.Most people see more than one provider. Even if they don't ask, share your list with each provider and ensure it's updated at each visit. It's okay to suggest it to your provider, and it's essential, and it would be worth scheduling an annual review of medications with your primary care physician.Some meds are expensive, and sometimes there are generic alternatives. It also matters which insurance you use and where the pharmacy might get the medicine. These days, a good pharmacy can check the price of drugs from one provider or another. Using prescription discount cards (they're free) also can get you a surprising discount sometimes. Ask your healthcare provider if there is a less expensive, effective alternative.Also, tell your doctor if the medication doesn't work. If you're taking pain medication, it should lessen the pain. It could be a simple fix. New drugs are being developed all the time. Your primary physician is the one to ask. They may say it's safe to try it. Before you try a new brand-name pharmaceutical, you know the price. A drug that costs two dollars in its generic form may be $600 in its brand version.