Low Blood Pressure in Elderly People: The Vital Facts You Should Know

Most people are aware that high blood pressure in seniors can lead to serious medical issues, but low blood pressure in elderly individuals gets far less attention. However, blood pressure that drops too low can have equally serious effects on your health. It's important to know the facts so that you can take proper care of yourself. 

A low blood pressure reading is not necessarily cause for panic. While high blood pressure is harmful even if you don't know you have it, low blood pressure is generally not a problem unless you start experiencing symptoms like dizziness or blurred vision. If that happens, you need to take action. Symptomatic low blood pressure in the elderly can be very dangerous because it raises the risk of a fall. At its most extreme, it can lead to shock and even death. 

This article explains the basic facts about blood pressure, including how it's measured and what the measurements mean. It also describes common symptoms of low blood pressure and outlines a variety of factors that can cause such a condition. And it provides information about different ways that low blood pressure in older adults can be treated or managed.

Blood Pressure Basics 

Blood pressure (BP) is a measurement of the amount of force being used to keep blood circulating throughout your body. This pressure is essential to ensuring that your organs and tissues get the oxygen and nutrients they need. 

Blood pressure commonly rises as we age due to stiffening of the arteries. High blood pressure can be a serious health risk. In fact, in 2017, the American Heart Association and the American College of Cardiology redefined high blood pressure and how it should be managed in older adults. 

The new blood pressure guidelines for seniors are aimed at encouraging more aggressive treatment at an earlier stage in order to keep blood pressure levels from getting too high. 

But sometimes BP levels are actually lower than they should be. Low blood pressure means that the force moving blood around the body is lower than expected. So, what happens when your blood pressure is low? In some cases, nothing. You may feel fine and require no treatment. But if it gets too low, you might experience low blood pressure symptoms such as feeling lightheaded or dizzy. If your BP drops dangerously low, key organs (like your brain) may not receive enough blood and oxygen to function properly. 

In extreme cases, you may go into shock and require emergency medical attention. Severe, prolonged low blood pressure can be fatal if it results in bodily organs being starved of essential nutrients.

How blood pressure is measured and what the readings mean 

An older man in a white button-up shirt wearing a blood pressure cuff while an unseen person holds a stethoscope to his arm Blood pressure is expressed as two numbers, with one "over" the other. The first, or top, number is the systolic blood pressure. This indicates the amount of pressure your blood exerts against the walls of your arteries when your heart contracts. The second, or bottom, number is the diastolic pressure, which refers to the amount of pressure in your arteries when your heart refills between beats. 

Your healthcare provider typically measures your blood pressure using a stethoscope and an inflatable cuff that wraps around your upper arm. The cuff is inflated until it is tight enough to stop the blood from flowing, then it is slowly deflated. Through the stethoscope, your doctor or nurse will hear the whooshing sound of the blood returning; this is the systolic pressure. The moment the whooshing sound disappears marks the diastolic pressure. 

The commonly accepted ideal blood pressure for adults is 120/80 mm Hg or lower. (The "mm Hg" represents millimeters of mercury, which refers to the gauges used to measure pressure.) But since blood pressure naturally rises with age, your BP might be higher than that without any cause for concern. For instance, according to a chart from Disabled World, a normal blood pressure reading for an 80-year-old woman could be 134/84 mm Hg. 

So, what is considered low blood pressure in elderly people? Typically, the low blood pressure range is anything below 90/60 mm Hg. This is called hypotension. The Disabled World chart shows that a dangerous blood pressure level is 50/33 mm Hg. Keep in mind that only one of the numbers has to be below the healthy range in order to qualify as low blood pressure. So, for instance, if your top number (the systolic pressure) is 90 or less, you may have low blood pressure, no matter what your bottom number is. 

Many medical experts believe that the most important number in blood pressure is the top one (i.e., the systolic pressure). That's because research has shown that your risk of heart disease and stroke is greater when you have elevated systolic pressure. However, a study in the New England Journal of Medicine found that both types of elevated pressure influence your risk of having a stroke or heart attack. 

A low systolic number means that your organs and tissues may not be getting enough blood and oxygen, but a low diastolic number indicates that there may not be enough pressure in your coronary arteries to adequately nourish your heart. It's important to understand that your readings can vary depending on factors like your stress level, body position, physical condition, medications, and diet. In fact, your levels can fluctuate as much as 30 or 40 mm Hg over the course of the day. They will be lowest when you rest and higher when you exercise or experience stress. 

That's why, in order to accurately compare readings, it's essential to measure your blood pressure in similar circumstances every time. Blood pressure is also very individualized. A level that is too low for someone else might be typical (and healthy) for you. However, you should worry about low blood pressure when you experience related symptoms.

Blood pressure vs. heart rate 

Blood pressure and heart rate are both important indications of how well your heart is working, but they measure different things. As noted above, blood pressure is the force of your blood flowing through your arteries. By contrast, heart rate (or pulse) is the number of times your heart beats each minute. In adults, the heart typically beats 60 to 100 times per minute while at rest. But as with blood pressure, a healthy heart rate will differ between individuals. 

For instance, a pulse below 60 beats per minute is slower than normal, but it might not cause any issues for you. (It might even be a sign that you are in really good physical shape.) However, in some situations, a low pulse means that the heart is not circulating enough blood to satisfy the body's needs. That can cause you to feel dizzy and weak. A pulse in the 30s is a dangerously low heart rate and should be investigated. The relationship between blood pressure and heart rate is complex. If you're concerned about your numbers, see your doctor.

Symptoms of Low Blood Pressure in Elderly Individuals 

As long as you feel OK, a low blood pressure reading is generally nothing to worry about. Doctors are not usually concerned about a low BP in otherwise healthy individuals. So, when is blood pressure too low? You should see your healthcare provider if you experience hypotension symptoms such as: 

• Dizziness 

• Blurry vision 

• Fatigue Fainting (known as syncope) 

• Confusion or inability to concentrate 

• Nausea 

• An irregular or rapid heartbeat 

• Weakness Pale, cold, clammy skin 

• Shallow breathing 

A condition called orthostatic or postural hypotension is common among seniors. It's when a temporary, sudden drop in blood pressure happens after a rapid change of position, such as when you go from lying down or sitting to standing. 

Under normal circumstances, some blood pools in your legs when you stand up, but your body compensates by telling your heart to beat faster. If such compensations are delayed or do not take place at all, your blood pressure can drop rapidly. That can cause you to become dizzy. Some estimates suggest that up to 50 percent of elderly adults experience orthostatic hypotension. 

You may also become dizzy due to a sudden drop in blood pressure after eating, especially if you've had a large meal involving lots of carbohydrates. This is called postprandial hypotension. It, too, commonly affects older adults. It's particularly prevalent among seniors who have disorders that affect the autonomic nervous system, such as diabetes and Parkinson's disease.

Causes of Low Blood Pressure 

A variety of factors can explain low blood pressure readings. For instance, dehydration can cause low blood pressure because it reduces blood volume. Diabetes can cause low diastolic pressure but high systolic pressure. And conditions like bradycardia (a very low heart rate) can keep the heart from pumping enough blood to maintain adequate pressure. 

Medications are also a common cause of low blood pressure in elderly folks. Drugs that are used to treat high blood pressure, including diuretics, calcium channel blockers, alpha blockers, and beta blockers, can go too far and cause hypotension instead. In addition, some prescription medicines for depression (such as imipramine and doxepin), erectile dysfunction (such as tadalafil and sildenafil), and Parkinson's disease (such as levodopa and dopamine agonists) can trigger low blood pressure.

Other low blood pressure causes can include: 

• Hypoglycemia (low blood sugar) 

• An underactive thyroid

•  Addison's disease (a disorder of the adrenal glands) 

• Excessive heat 

• Extended bed rest 

• Anemia due to lack of vitamin B-12 and folate 

• Major blood loss 

A sudden drop in blood pressure can be caused by severe infections, anaphylactic reactions, uncontrolled bleeding, or extreme dehydration due to fever, diarrhea, or vomiting. The plunge in blood pressure caused by such factors can be dangerous and even life-threatening. 

To identify the cause of your low BP, your doctor may conduct: 

• A blood test to check for anemia or issues with your blood sugar levels.
  

• An echocardiogram to obtain images of the shape and size of your heart and see how well it is functioning.
  

• An electrocardiogram (ECG) to look for abnormalities in your heart's rhythm and pulse rate.
  

• An exercise stress test to assess your heart's performance during periods of physical activity.
  

• The Valsalva maneuver, which involves monitoring your blood pressure while you take a deep breath and attempt to blow out against your closed mouth. This allows your healthcare provider to check for issues with your autonomic nervous system.
  

• A tilt table test, in which you are hooked up to blood pressure monitors and an ECG machine, then secured to a table that can rapidly switch you from a horizontal to an upright position. This enables your doctor to see how your blood pressure responds to the changes in your body position.

Treatment for Low Blood Pressure in Elderly People 

If you aren't bothered by symptoms of low blood pressure, treatment is likely unnecessary. After all, a low BP on its own is not usually a problem. In fact, it's often taken as a sign of good health. But if it's affecting your well-being, you need to take steps to address it. Low blood pressure is treated in the elderly by first determining the underlying cause. 

If your low BP is a result of your medication regimen, your doctor may be able to adjust your dosages or change your meds. (If you find it difficult to keep your meds organized, a pill dispenser for seniors could help.) If dehydration is the culprit, fluid replacement may solve the problem. In some cases, you may require medication specifically for your low BP. 

Two of the most commonly prescribed medicines are fludrocortisone and midodrine. Fludrocortisone is a steroid that causes the body to retain sodium and fluid, thus increasing blood volume and raising blood pressure. Midodrine causes your blood vessels to resist expanding, thereby boosting blood pressure. 

However, many people are able to manage their hypotension through diet and lifestyle changes rather than medical interventions. Here are some tips on how you can fix low blood pressure: 

• Drink more water. Consuming additional fluids can boost blood volume and prevent dehydration. Having a glass of water before you stand up or at the end of a meal can sometimes help avoid sudden drops in blood pressure. Sport drinks containing electrolytes can also help, but try to avoid ones with high amounts of sugar.
  

• Limit the booze. Alcohol is dehydrating and can drive your blood pressure even lower.
  

• Eat smaller meals more frequently. Going too long between meals can wreak havoc on your blood sugar levels. And indulging in heavy meals can cause a sudden drop in blood pressure as the blood moves from your brain to your intestines to help you digest your food. As a general guideline, it's a good idea to eat small amounts five or six times a day.
  

• Choose your diet carefully. Cutting back on carbs (especially refined carbs such as white bread and pasta) may help keep you from feeling dizzy after you eat. Plus, foods that are high in folate and vitamin B-12 can help alleviate low blood pressure that is caused by anemia. Asparagus, legumes, leafy greens, eggs, and fortified cereals are good choices.
  

• Increase your salt intake. Salt causes your body to retain fluid, which raises your blood pressure. Your doctor may recommend taking salt tablets or adding a bit of salt to your meals. Carrots, beets, and olives are a few examples of foods that have naturally higher levels of sodium. But be aware that potassium-rich foods like apricots and bananas lower blood pressure by causing you to lose sodium through your urine.
  

• Make slower transitions. Change positions slowly and gradually. If you're lying down, sit up and dangle your feet or march your feet gently for a couple minutes before you try to stand. Once you're on your feet, stay still for a bit until you feel steady enough to walk.
  

• Wear compression stockings. They promote better circulation by compressing the leg veins. This keeps blood from pooling in your lower legs and shifts it toward other areas of the body. Styles for both men and women are available.
  

• Don't overheat. High temperatures cause blood vessels to dilate, which lowers blood pressure. Plus, sweating out fluids can cause reduced blood volume and dehydration. So be careful to stay out of the sun and don't do anything too strenuous when it's really warm. Avoid spending long periods of time in hot tubs or saunas. You might also want to keep a nonslip chair in the shower in case you feel dizzy. 

Get a Handle on Your Health 

Low blood pressure in elderly people has a wide variety of causes and effects. The information above can help you understand the danger signs and take appropriate steps to safeguard your well-being.

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Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Great Senior Living

Stigma About Cognitive Decline and Dementia Is Widespread Among Adults Ages 40 and Older

Misperceptions and stigma impact individuals and healthcare providers when adopting brain-healthy behaviors and addressing dementia. Fear of cognitive decline hinders open conversations and prevents people from accessing the care and services that could help them through earlier diagnosis and interventions. A successful strategy to enhance brain health should combat the stigma of dementia and drive systemic changes that make it easier for individuals adopt and sustain lifestyles and behaviors that support their brain health, reducing risks for cognitive decline and improving quality of life for people living with dementia.

Findings from a survey of more than 3,000 adults ages 40 and older revealed widespread misunderstandings about brain health and a lack of awareness about the practical steps people can take to support better cognition (Mehegan & Rainville, 2021a). The survey showed us that the opinions we heard from individual advocates were indictive of how many more people felt about cognitive decline and dementia. The survey demonstrated that stigma surrounding dementia is extremely widespread.

Six in 10 of those surveyed (62%) agreed that society has a negative judgment of people with cognitive impairment. Only three conditions rated a higher level of stigma than dementia in the survey: addiction (87%), obesity (85%), and mental illness (78%). Majorities of adults in the United States believe that society negatively judges those who have cognitive impairment (62%) and those who have dementia (56%), making declines in brain health significantly more stigmatized than other common diseases associated with aging such as diabetes, heart disease, and cancer.

People Are Too Pessimistic About Their Future Brain Health

The idea of dementia sparks deep fear in most adults, yet worries of cognitive decline greatly exceed the risks actually faced, according to the research by AARP (Mehegan & Rainville, 2021b). Six in 10 adults believe cognitive decline is inevitable and a normal part of aging, and close to half of adults (48%) believe it is likely that they will get dementia as they age. These perceptions exacerbate the fear of aging and perpetuate negative stereotypes of people living with dementia. While close to half of adults believe they are likely to develop dementia, the reality is far fewer will. Most older adults will not experience significant declines in their cognitive skills serious enough to impact their daily functions.

According to the Alzheimer’s Association, the overall prevalence of Alzheimer’s disease is 11% among adults ages 65 and older, rising to 33.2% for those ages 85 and older (Alzheimer’s Association, 2022). According to a 2007 NIA-funded epidemiological estimate, the prevalence of dementia among individuals ages 71 and older was 13.9% (Plassman et al., 2007). People should understand that age-related changes in the brain, which can be disconcerting as we notice them, usually are not serious enough to cause real concerns, and as the Global Council on Brain Health (2022) has laid out, there are many lifestyle choices we can make to help reduce those risks. But our surveys showed us that we are swimming against the tide of current attitudes.

Healthcare Providers Stigmatize Dementia More Than the General Public

We also conducted parallel research among healthcare providers who regularly see older adults and diagnose dementia to determine if stigma might be affecting the care provided older adults (Mehegan & Rainville, 2021c). Interviews were among physicians, nurse practitioners, physician assistants, and psychiatrists/psychologists who evaluate people for the presence of cognitive impairment, wherein approximately 25% or more of their patients were ages 50 and older. The research represented a mix of specialties including: Family medicine/Internal medicine (n=296) Geriatrics (n=48) Neurology (n=84) Psychiatry/Psychology (n=115). Together these surveys revealed that fear, confusion, and false information are clouding the truth about dementia for the general public and healthcare providers. But most surprising were the significant disconnects between consumers’ and healthcare providers’ attitudes when it came to dementia stigma.

Healthcare providers often underestimate their patients’ desire to be informed of a dementia diagnosis, while overestimating the shame patients feel upon receiving such news, resulting in some providers not telling patients the truth about their diagnosis. An overwhelming majority of adults (91%) said they would want to be informed of a dementia diagnosis, but a smaller percentage of health professionals (78%) said they always reveal the truth to their patients. Healthcare providers substantially overestimated the worry that adults ages 40 and older would feel if they had dementia. While one in five adults (19%) said they would feel ashamed or embarrassed if they had dementia, a staggering seven in 10 providers (69%) said their patients would feel ashamed or embarrassed.

Swap the Paralysis That Comes From Stigma for Action That Empowers Better Brain Health

Contrary to these gloomy attitudes about the inevitably of cognitive decline and likelihood of having shame or embarrassment caused by dementia, adults can proactively engage in healthy lifestyle activities that have been demonstrated to reduce their risks. Healthcare providers can help people diagnosed with mild cognitive impairment maximize their abilities, shorten their period of disability and help patients improve their quality of life if they should develop dementia. Here are the ways that adults can counteract those feelings of vulnerability and foster a sense of empowerment by modifying their lifestyles to:

• Engage in the recommended amount of physical activity per week (Global Council on Brain Health, 2016)

• Get proper nutrition (Global Council on Brain Health, 2018a).

• Cultivate mental well-being, including managing stress effectively, strengthening one’s purpose in life, and accentuating the positive (Global Council on Brain Health, 2018b).

• Participate in socially engaging activities (Global Council on Brain Health, 2017a).

• Get enough quality sleep (Global Council on Brain Health, 2017b).

• Engage in cognitively stimulating activities (Global Council on Brain Health, 2017c)

• Maintain their heart health (making sure blood pressure, cholesterol, and weight are within normal limits) (Global Council on Brain health, 2020a).

• When faced with elective surgery, prehab (if possible) to minimize the chances of developing delirium while hospitalized (Global Council on Brain Health, 2020b).

Call to Action for Providers and the Public: Stop Stigma From Stymieing Solutions

There is a clear opportunity to inform providers and the public about the real concerns surrounding dementia and the known lifestyle habits that can help maintain brain function as people age. People are willing to take actions to sustain good brain health. Rather than thinking of dementia as something to be ashamed of and embarrassed about, let’s empower people by encouraging them to reduce their risks or slow the development of the diseases that cause dementia. Most adults surveyed said they exercise only occasionally or not at all. Yet of this group, more than four in 10 (44%) said they would exercise more often if they knew it would help them stay sharp. Better still, 85% of those who exercise frequently said they would work out even more often if they were aware of the benefits to brain health.

The stigma associated with a diagnosis of dementia or Alzheimer’s disease often leads to a delay in diagnosis and a lack of discussion about brain health with healthcare providers. Survey respondents agreed that early diagnosis would give them more time to plan for healthcare (86%), prepare advance directives or living wills (85%), and plan their finances (83%).

Reassuring healthcare providers that patients do not hold as negative a view of dementia as they do may help remove barriers to sharing clear and direct information and relieve some of the anxiety or reluctance some healthcare providers have in delivering a diagnosis of dementia. The surveys show that most people want to know the truth and to plan accordingly. Better communication between patients and healthcare providers can pay off in early diagnoses that enable people to plan, modify risky behaviors, and get the most effective treatments.

A large majority of healthcare providers knew that healthy lifestyle modifications such regular exercise, cognitively stimulating activities, and socializing with others helps with dementia symptoms (Mehegan & Rainville, 2021c). Even with a diagnosis of dementia, people can live meaningful lives for years to come. By approaching dementia more as a chronic disease that can be better managed through healthy lifestyle interventions, rather than continuing to stigmatize the condition as a hopeless diagnosis, we begin to empower the person to be an active participant in their future.

Let’s eliminate the cloud of misunderstandings and reluctance to openly discuss cognitive issues that stoke the stigma the public and healthcare providers associate with dementia. Once we do, we can move from fear and avoidance toward supporting adults’ ability to take the actions that can reduce their risks and that can make a difference in their quality of life if they or their loved one should experience dementia.

Consider The Top-Rated Home Care Agency in North Carolina

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: American Society of Aging

Creating a Safety Net: Advanced Planning for a Secure Retirement

In a landscape where reliance on governmental support like Social Security and Medicare is uncertain, establishing a robust safety net for retirement and healthcare is more crucial than ever. This comprehensive guide will explore diverse strategies to secure your financial and health-related future independently.

Securing Future Healthcare Needs

One of the initial steps in crafting a reliable retirement plan is to ensure coverage for potential healthcare needs. Investing in disability and long-term care insurance can provide crucial financial support if you face unexpected health challenges. These types of insurance not only offer peace of mind but also safeguard your savings by covering costs that regular health insurance may not, such as extended nursing care or rehabilitation services.

Investing in Education to Elevate Earnings

Increasing your educational qualifications can significantly boost both your earnings and your understanding, especially in sectors such as healthcare. By pursuing a master's in health administration, you deepen your knowledge of the healthcare industry and gain essential leadership skills needed for upper management roles. The availability of online programs makes it possible to advance your education while maintaining your current career, fostering both personal and professional development simultaneously.

Opening a Health Savings Account

Opening a health savings account (HSA) is an excellent strategy to manage healthcare expenses efficiently. Contributions to an HSA are tax-deductible, the funds grow tax-free, and withdrawals for qualified medical expenses are untaxed. This triad of tax benefits makes HSAs a potent tool in your retirement planning arsenal, providing a fund that supports health costs while also serving as a financial buffer.

Digitizing Your Important Documents

In the digital age, securing and organizing your essential documents through digitization is a wise step. Scanning important paperwork—such as insurance policies, wills, and medical records—ensures you have secure, quick access to them when needed. Here’s an option to transform these scanned documents into editable and shareable files, simplifying any updates or changes you might need to make. This approach not only streamlines document management but also enhances overall efficiency and security.

Collaborating with a Financial Advisor

Navigating the complexities of retirement planning can be daunting. Working with a financial advisor brings clarity to this process, helping you tailor a personal strategy that fits your financial goals and risk tolerance. A skilled advisor can guide you in choosing the right investments, managing assets, and planning for future expenditures, ensuring a stable
financial future.

Establishing an Emergency Fund

An emergency fund is an essential element of any financial safety net. This reserve should cover at least six months of living expenses, providing a buffer that can help you avoid debt during unexpected financial or medical crises. Regular contributions to this fund can ensure that you are prepared for any unforeseen events without jeopardizing your retirement savings.

Optimizing Social Security Benefits

While the goal is to build a retirement plan that doesn't solely rely on Social Security, it’s wise to optimize this benefit if available. Delaying Social Security claims can significantly increase your monthly benefits. Waiting until you are 70, if possible, allows you to maximize the payout, which can be a crucial supplement to your other retirement income sources.

Everyday Savings Strategies

Lastly, cultivating daily saving habits can lead to substantial financial growth over time. Simple actions like reducing recurring expenses, using energy-efficient appliances, and cutting down on dining out can accumulate into significant savings. These funds can then be redirected toward your retirement savings.

Building a comprehensive retirement and healthcare safety net requires a multifaceted approach. By integrating insurance protections, educational advancements, strategic financial planning, and everyday savings, you can secure a future that is not solely dependent on government programs. Taking proactive steps today ensures that you are prepared for what the future holds, maintaining your quality of life and independence in your later years.

Enhance your loved one's quality of life with exceptional, personalized services from Aroga Home Care Services—contact us today to find the perfect care solution!

Consider The Top-Rated Home Care Agency in North Carolina

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Jennifer Scott

Your Brain at 40, 50, 60, and Beyond: What to Expect as You Age

Key Takeaways

• Our brains start to shrink as early as our thirties and forties.

• In middle age, we start having trouble with tasks requiring quick thinking or handling multiple pieces of information at the same time.

• Some cognitive skills improve with age, including accessing long-term memory and vocabulary building.

Most of us don’t expect to have the same wrinkle-free skin we had in our twenties or be able to run a mile at our high school pace, but we often expect our memory and other thinking skills to stay the same — or close to it — as we approach midlife and beyond. 

But our brains are organs, and just as with other organs in the body such as the heart, lungs, and skin, growing older means age-related changes are a fact of life. 

However, although declines in memory and cognitive processing speed can be a normal part of brain aging, they can also be signs of dementia or Alzheimer’s disease. Telling the difference can be challenging, even for doctors, especially when the changes can be gradual and subtle. 

To put it another way, the line between “normal” forgetting, and “cause-for-concern” forgetting can be hard to define.

But knowing how your brain normally changes throughout your lifespan can help to make it clearer what changes in brain functioning may be important to discuss with your doctor or neurologist. 

How Your Brain Changes Beginning in Your Thirties

In the early years of life, the brain grows at a super-fast rate — about 1 percent per day for the first three months of life. At one year, a baby’s brain is 64 percent larger than it was at birth, and at age 5, the brain has reached about 90 percent of its adult size.[1]

In our thirties and forties, the brain starts to shrink, with the “shrinkage rate” increasing by age 60 and beyond. Areas like the frontal lobe and hippocampus, which are responsible for cognitive functions, shrink more than other areas.[2]

Other changes include less effective communication between neurons, a decrease in blood flow, and an increase in inflammation. 

“These types of changes can be linked to physical or health changes that can happen with aging, including conditions such as heart disease and diabetes,” says Molly Mather, PhD, assistant professor of psychiatry and behavioral sciences and a researcher in brain aging at the Northwestern Medicine Feinberg School of Medicine in Chicago.

These changes in the brain can affect mental function, even in healthy older people without any type of impairment or dementia, says Dr. Mather. But there’s also evidence that the brain keeps the ability to change and adapt as we age and even improve in a few key areas, she adds. 

The Brain Becomes Less Efficient as We Age

The types of changes that are pretty typical with aging can be described as a reduction in efficiencies, says Mather. 

“This would include the types of thinking that requires fast processing, juggling multiple pieces of information at the same time, and remembering new information that doesn’t have any sort of inherent structure or meaning. Those are all tasks that are actually pretty complex and require a lot of coordination between different parts of your brain and different networks,” she says.

There’s evidence that very gradual declines in these areas can start in a person’s thirties, though you may not notice them for a few more decades, says Mather. 

At that point, “maybe you don't feel quite as sharp, or things that used to feel easy or routine become a bit more challenging,” she says. 

The ‘Middle-Aged Movie Review’ and Other Normal Brain Changes

The ability to master new technology is also a typical complaint, says Joel Kramer, PsyD, professor of neuropsychology and director of the Memory and Aging Center Neuropsychology program at USCF Weill Institute for Neurosciences in San Francisco. “Patients will tell me, ‘Ugh, I just got a new phone, and I have no idea how to work it,’” he says.

Another common struggle is “mental math,” says Dr. Kramer. “Estimating how much the groceries in your basket will cost or calculating a tip may take a little longer,” he says. 

There's also something that Kramer calls “middle-aged movie review.” 

“That’s where people say, ‘Oh, we liked that movie we saw last week — you know, the one that stars what’s-her-name and that other guy from that show we used to watch?’ That’s pretty common, and some of that is word-finding and some of it is really just memory,” he says.

Mather calls that a “tip of the tongue experience.” 

“It’s not coming to your mind right now, but it might pop into your head 20 minutes later, or three days later. That’s a failure of word retrieval more than anything else; it’s not that the information isn’t stored in your brain, but it was hard for you to efficiently pick out that one piece of information,” she says. 

Why Did I Just Walk in Here? 

Walking into a room and forgetting why you went in there is a classic example of a normal sign of brain aging, says Mather. “Certainly, that happens to me relatively regularly, and I think a lot of people can relate to it,” she says.

As with the other changes mentioned, this may be annoying, but it’s probably a normal sign of aging and not cognitive problems, says Mather. “However, if those things start becoming very frequent or interfering with your ability to carry out daily activities, that's when we start to get concerned,” she says.

That distinction can be tricky, because what’s normal for one person might be a sign of cognitive issues in another person. If you (or your partner or loved one) grow concerned, it’s a good idea to talk to
your provider. 

Some Language Skills Can Stay Sharp or Even Improve

Your ability to access information that's been stored in your brain for even a very long time may actually improve, says Mather. 

“Trivia is one example. I’ve played Trivial Pursuit games where my older family members remembered answers to things from 40 years ago that they had no idea they still knew. That’s where you’re relying on this long-term storage of knowledge,” she says. 

Your ability to do word games and crossword puzzles might stay the same or improve as well,
Mather adds.

Although the ability to find the right word immediately might go down, vocabulary tends to continue to increase over time, says Kramer. “In fact, some people think that even as we get into our eighties, our vocabulary can continue to increase,” he says. 

Emotional Well-Being Can Get Better With Age

There’s evidence to suggest that older adults (aged 60 and older) report better emotional well-being — for the most part — than midlife or even younger adults, says Mather. Emotional well-being is a state of good mental health and the ability to remain stable even in the face of challenging situations. 

“In some older people, their perspective shifts more towards prioritizing what's important to them. There is often improved emotional functioning, and I think that comes from increased life experience and wisdom to figure out how to cope with different things that come up,” she says. 

‘Superagers’ Have the Memory Abilities of Someone Much Younger

Mather is part of a group of researchers at Northwestern Medicine studying “superagers,” defined as adults over age 80 who have the memory abilities at the level of people at least 20 to 30 years younger. The main goal of the research is to find factors that could help others maximize their health span and, someday, even potentially avoid Alzheimer’s disease.

Part of that research involves people donating their brains to research after they die.

“When we examine the brains of superagers under a microscope, we’ve found certain parts of the brain that are larger and have maintained their thickness, and the health of their neurons is better than what you would expect at the age of their death,” says Mather.

Mather is often asked what a person can do to be a superager.

“Although it’s certainly a goal, at this point we haven’t identified clear modifiable factors to have this type of memory ability,” she says. There is one thing that seems to stick out — anecdotally at this point — which is that many superagers have active social connections, says Mather.

“They are usually engaged and involved in different types of activities or social get-togethers that bring them enjoyment, social engagement, and intellectual stimulation,” she says.

What’s Good for the Body Is Good for the Brain

“A lot of the recommendations that we give to improve brain health are essentially the same things that are true for overall body and heart health,” says Mather. 

That includes trying to move your body more and sit less, eat a nutrient-dense diet, and avoid heavy alcohol use or other substances, she says. 

“Beyond that, staying engaged, learning new things, and finding ways to challenge yourself are all good practices for brain health,” says Mather. 

Consider The Top-Rated Home Care Agency in North Carolina

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Content Credits: Everyday Health

Cognitive Screening: When Should You Get It? What Can It Show?

Ideally, cognitive screening should take place before you notice changes in your thinking
and memory.

​​Even if you’ve made peace with growing older, the outward signs of aging — graying hair, spotty skin, achy joints — are unavoidable. Likewise, for the changes in the parts of the body you don’t see, including the brain.

As early as your thirties and forties, the brain starts to shrink, including the part called the hippocampus, which is important for learning and memory. Aging also causes communication between neurons (nerve cells) to be less effective, blood flow in the brain to decrease, and inflammation to increase.

With these changes, older adults might experience challenges in their thinking like difficulty recalling names or words, or decreased attention; both could just be signs of normal aging.

However, in some people, neurodegenerative changes take place in the brain that are not normal aging, even though they are more likely to occur at an older age. Certain processes in the brain cause the collection of toxic clumps of proteins called amyloid. Amyloid permits another toxic protein called tau to injure and kill neurons and cause true memory loss, including being unable to recall recent details, events, or conversations. This type of memory loss can be an early sign of mild cognitive impairment (MCI), dementia, or Alzheimer’s disease.

Why Get a Cognitive Screening?

There are many good reasons to get screened for cognitive impairment. For starters, it can pick up changes in your memory or thinking functions before you start to have significant difficulties. In many cases, the changes could be due to an underlying (and fixable) cause, such as a side effect of certain medications or nutritional deficiencies.

For people with the early stages of dementia, new drugs have been shown to slow down progression of the disease, and lifestyle changes may do the same, says Maryjo Cleveland, MD, a gerontologist who specializes in Alzheimer’s disease and dementia at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina.

But when is a good time to get screened for cognitive decline, and what do you do with the information once you have it? Here’s what you need to know about when to get screened for cognitive changes, where to get screened, and what to do with the results.

What Is Cognitive Screening?

A cognitive assessment tests various aspects of a person’s cognitive functioning, with the goal of detecting any early signs of memory loss or difficulty with thinking, problem-solving, language, or other cognitive functions.

People with early cognitive changes often either aren’t aware of them or may deny what
they’re experiencing.

The screening is typically a questionnaire or brief assessment, says Dr. Cleveland. “A screening is not used to make a diagnosis, but rather a preliminary step to identify individuals who may need further evaluation by healthcare professionals,” she says.

Cleveland compares it to other types of health screenings you may get during a yearly wellness check: “A cognitive screening is used to check to see if you might be at risk for dementia, just as you would get your cholesterol level checked to find out if you’re at risk for
cardiovascular disease.”

Should I Wait Until Changes in My Memory or Thinking Are Noticeable to Get Screened?

No, says Cleveland. “If someone comes in and says, 'I'm having terrible memory problems or I keep forgetting to take my medicines,' we’re going to do a diagnostic evaluation at that point,” she says.

With a screening, you’re looking for something that’s not clinically apparent — you don’t need to have noticeable declines in memory or cognition to get one, she says.

Is There a Recommended Time to First Get a Cognitive Screening?

Once you enroll in Medicare, usually at age 65, a basic cognitive screening test is supposed to be included in the annual wellness visit to see if you have any cognitive impairments,
says Cleveland.

“For people who haven’t had any symptoms, I think 65 years old is a reasonable age to begin getting screened,” she says.

Some research shows, however, that not all Medicare beneficiaries take advantage of the annual wellness visit and, of those who do, not all report having a cognitive assessment at that visit.

Can My Primary Care Doctor Perform a Cognitive Screening?

Yes. Cleveland recommends getting screened for cognitive changes in your primary care doctor's office. “There are not enough specialists on the planet — geriatricians or neurologists — to screen everyone in a timely manner,” she says.

Your primary care doctor is also the logical choice because a patient's history and physical exam should be part of a cognitive assessment, according to StatPearls.

Is There More Than One Screening for Dementia? Does It Matter Which One I Take?

There's not an official statement or agreement among experts about which screening is the best; the most important thing is to get screened, says Cleveland. “And that can be once you turn 65 or maybe earlier if you have a family history of dementia or Alzheimer’s disease,” she says.

The more widely used screening tools typically take 10 minutes or less and include the Mini-Mental State Exam, Montreal Cognitive Assessment, Mini-Cog, and Saint Louis University Mental State Exam.

What’s Involved in a Cognitive Screening?

The screening will be given by a healthcare provider — usually a doctor or a nurse — and there’s nothing you need to do to prepare for the screening.

The Mini-Cog is basically two parts: Your provider will give you three words and ask you to repeat them back a few minutes later. Then they will have you draw a circular clock with the hands pointed to a
specific time.

Cognitive screening tests check different areas of brain function, including orientation (date, where you are, your name), attention and short-term learning, short- and long-term memory, concentration, and the ability to use and understand language, according to the Cleveland Clinic.

Are There Online Screenings That Can Be Performed at Home?

The Self-Administered Gerocognitive Exam (SAGE) is a brief written screening tool designed to detect early signs of cognitive, memory, or thinking impairments, and it can be taken at home. Unlike other assessments, it doesn’t require an experienced or trained professional; you just need to be able to print out the test.

“People can take this test if they or a loved one notices that they are a little more forgetful than they used to be. It’s a helpful tool to assess if further evaluation is necessary,” says SAGE creator Douglas Scharre, MD, the director of the division of cognitive neurology at The Ohio State University Wexner Medical Center
in Columbus.

The test takes about 10 to 15 minutes, and it measures a wide range of cognitive domains, such as orientation, language, reasoning, and memory. There is no answer key or scoring provided. After completing the test, you need to take it to your primary care doctor, who can score the test, interpret the results, and decide if you need further evaluation.

RELATED: All About the SAGE Test for Alzheimer’s and Dementia Detection

What Are the Next Steps After Cognitive Testing?

If your results indicate some level of cognitive impairment, more testing will be necessary to learn more about what’s causing it, says Cleveland. “Those will likely be performed by your primary care doctor,”
she says.

Mild cognitive impairment doesn't always mean that you're going to get dementia. About half of people who have mild cognitive impairment have it for some other reason than the foreshadowing of dementia, says Cleveland.

One of the first steps to determining a cause is ususally looking at all the medications that a person is taking. “Sometimes it’s a medication that’s causing the cognitive issue. A common example is the antihistamine drug meclizine; it seems to affect memory in some people,” she says.

Thyroid issues, sleep issues, and vitamin deficiencies — especially vitamin B12 deficiency — can also cause cognitive problems, says Dr. Scharre. “If an underlying cause is identified and treated, the impairment will likely improve,” he says.

In some cases, a brain scan might be performed. “We’re looking for any evidence of small strokes, inflammation, tumors, infections, structural issues — any of these could be causing a person to not be thinking as well,” says Scharre.

What if I’m Diagnosed With MCI?

In some people, further testing will lead to a diagnosis of MCI. This is the space between expected cognitive decline that comes with aging and the more serious decline of dementia, says Cleveland.

Common signs of MCI include losing things more often than normal, forgetting appointments, or having trouble finding the right words. It can be easy to miss or to mistake for normal signs of aging, even by doctors. One study that examined Medicare data found that only about 8 percent of the 8 million people with MCI the researchers expected to find in these health records were actually there — meaning that more than 9 in 10 people with MCI may not realize they have it.

Although having MCI increases your risk for eventually developing dementia or Alzheimer’s disease, the symptoms of MCI can stay the same or even improve, according to the National Institute on Aging.

Your doctor can recommend lifestyle measures that may help slow any further cognitive decline.

Expert Lifestyle Recommendations for Brain Health

Scharre recommends good sleep, socialization, physical exercise, and good nutrition for brain health. “Sleep is very important. It seems to be a time where we remove toxins from our brains,” he says.

For the social piece, this can include chatting with people, interpreting information, and discussing issues, he says. “Your brain is like your muscles: Use it or lose it,” says Scharre.

"The best brain-healthy diet seems to be a Mediterranean-type diet — less red meat, more fruits and vegetables,” says Cleveland.

Both the MIND (Mediterranean-DASH Intervention for Neurogenerative Delay) and Mediterranean diets are associated with fewer signs of Alzheimer’s disease in the brains of older adults, according to a study funded by the National Institute on Aging.

Of all the lifestyle modifications, exercise has the strongest evidence. A review of 65 studies found that exercise was the most promising lifestyle intervention — meaning it improved various cognitive functions — for both MCI and dementia, and was most effective in MCI.

Talk With Your Doctor About Medications for Cognitive Impairment

Medications may help with MCI and early Alzheimer’s disease, says Cleveland. “These may help a certain segment of the population. This is a decision that can be made in partnership with your doctor,” she says.

Options include aducanumab (Aduhelm), lecanemab (Leqembi), and donanemab, which is expected to be approved in the near future.

Consider The Top-Rated Home Care Agency in North Carolina

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Content Credits: Everyday Health

Regular Brisk Walks and Other Exercise Can Help Prevent Falls in Older Women

Older women who exercised the equivalent of 30 minutes a day, five times a week were up to one-third less likely to hurt themselves in a fall, according to an Australian study published today in JAMA Network Open.

Brisk walking and moderate or moderate-to-vigorous activity were also all associated with lower risk, the authors wrote.

The findings are encouraging, though not necessarily surprising, says Deborah Kado, MD, a geriatrician at Stanford Health and co-director of the Stanford Longevity Center, both in
Palo Alto, California.

“It’s good to see data that suggests that getting more physical activity is associated with a lower risk of falling. Although we often take mobility — the ability to move safely from one place to another — for granted, when you lose it, you really lose your ability to be independent,” says Dr. Kado, who was not involved in the research.

3 Million Older Adults Go to the ER Each Year Because of a Fall

The Centers for Disease Control and Prevention estimates that about 1 out of 4 older U.S. adults fall each year, and about three million are treated in the ER, making it a major
health concern.

Falls resulting in hip fracture are especially concerning — one meta-analysis suggests that about 3 in 10 older adults who break their hip die within the next year.

More Than 1 in 4 Participants Reported Falling Within the Past Year

The evidence on whether physical activity reduces fall risk has been inconsistent, and it’s also not clear how much exercise is required, according to the authors. To find out more about how physical activity impacted both injurious and non-injurious falls, researchers recruited over 10,000 women between the ages of 45 and 50 years old back in 1996. Over 7,000 participants, with an average age of 67 years old, completed follow up questionnaires between 2016 and 2019.

Participants self-reported their weekly amount of three types of physical activity:

• Walking briskly, for recreation or exercise or to get from place to place

• Moderate activity, such as social tennis, moderate intensity exercise classes, and recreational swimming

• Vigorous exercise that made them breathe harder or puff and pant, like aerobics, vigorous cycling, running, and swimming

The subjects were then placed into groups according to the number of minutes they logged: none, less than 150 minutes, 150 to 299 minutes, and 300 minutes or more.

Those amounts were chosen to align with the World Health Organization (WHO) guidelines on physical activity. “Any amount of physical activity is better than none, and more is better,” advises WHO. The organization recommends at least 150 to 300 minutes of moderate or vigorous aerobic activity per week.

Participants in the 2019 survey answered three questions about falls in the
past year:

• Did they have a fall to the ground?

• Were they injured because of a fall?

• Did they seek medical attention for a fall-related injury?

About 2,000 women reported falling in the last 12 months, with about half leading to injury and half not.

Being Active for 2.5 Hours a Week Cut Fall Risk

After adjusting for factors that could influence risk, researchers found that doing 150 to 300 minutes of exercise per week reduced fall risk that didn’t cause injury by 26 percent and injurious falls by 30 percent. Exercising for more than 300 minutes — five hours — cut the risk by 34 percent for injury-free falls and 23 percent for falls that caused injury.

These findings support multiple exercise trials that show a link between physical activity and reduced fall risk, says Kado. “For example, tai chi has been shown to help older adults reduce their risk of falling,” she says.

Tai chi originated as an ancient martial arts practice in China, and the modern practice incorporates slow movements and physical poses with controlled breathing. A meta-analysis of 24 randomized controlled trials published in September 2023 found that tai chi “can effectively reduce the risk of falls in older adults” and improve balance and walking speed.

Walking Reduced Fall Risk by 17 Percent

Brisk walking lowered the risk by 17 percent compared with no exercise at all, according to
the authors.

This supports earlier research that shows that walking can help prevent falls. A Japanese study of 90 older adults found that a walking intervention reduced the risk of falls more effectively than balance training.

The Good News: You Don’t Have to Exercise 3 Hours a Week to Get Health Benefits

Although the study didn’t find any reductions in fall risk in the group with less than 150 minutes a week of activity, that doesn’t mean that there’s no benefits to small chunks of movement, says Kado.

“The WHO guidelines are terrific, but to tell people they need to get 150 minutes of physical activity a week — I think that can be a deterrent for some people,” she says. In the real world, most people aren’t getting between 2.5 and 5 hours of exercise a week, says Kado.

But you don’t have to meet that threshold to make meaningful improvements in your health, she says. “The truth of the matter is, if you look at data, even the smallest amount of activity has benefits. And the biggest bang for the buck is at the early part of the curve. So basically, if you're a couch potato and don’t do any physical activity, if you just increase a little bit, like get up and down and walk around the house every 15 minutes, that will decrease your risk of dying early,” says Kado.

Consider The Top-Rated Home Care Agency in North Carolina

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Understanding the Basics: What is Domiciliary Care?

What is Domiciliary Care?

We also call domiciliary care as home care or home-based care. Domiciliary care is a kind of health service. It’s for people who wish to live in their own homes, but need help. This assistance can be for daily tasks or medical needs.

It especially benefits seniors, disabled individuals, and those recovering from injuries
or illnesses.

Domiciliary care is when professionals like caregivers, nurses, or therapists come to your home. They give you personal care and help you stay independent. This way, you can stay in a familiar setting – your
own home.

The Importance of Domiciliary Care

Domiciliary care is very important. It helps people who have trouble moving around or need regular medical check-ups. We aim these types of care at promoting their well-being.

Getting care at home can help individuals feel more comfortable. It also lets them stay in a familiar space for their emotional and mental well-being.

Domiciliary care helps people keep their social ties. It keeps them involved in their local community. This can help cut back on feelings of being alone or isolated.

The Impact on Quality of Life

The quality of life of individuals receiving domiciliary care significantly improves due to the personalized nature of the services provided. Caregivers work closely with clients to understand their unique needs and preferences, tailoring care plans accordingly.

This way of doing things ensures people can still do what they love. They can keep up with their hobbies and interests. This gives them a reason to enjoy each day.

Domiciliary care can lead to cost savings compared to nursing home care. According to AARP, 90% of seniors prefer to age in their homes rather than move to institutional care facilities.

Benefits for Family Members

Domiciliary home care benefits the individuals receiving care and offers significant advantages to their family members. Family members often feel at ease when they can care for their loved ones at home. It’s comforting to know they’re in a familiar place.

These services can make things simpler for family caregivers. It helps them manage their tasks better and avoid getting too stressed or tired.

How Domiciliary Care Programs Work

Domiciliary care programs typically start with assessing the individual’s needs and preferences. We then create a care plan. This plan lists the required services. These might include help with bathing, grooming, managing medicines, preparing food and keeping the house clean.

The number of caretaker visits can change based on the client’s needs. It can be a few hours each week or even round-the-clock support, 24/7.

The Role of Caregivers

Caregivers play a crucial role in home-based care, also known as domiciliary care. They’re the main person who connects with and helps the one getting the care. They get to know their clients well and offer more than just caregiving tasks. They also give emotional help, making sure their clients feel good while doing their jobs.

Caregivers make sure to talk often with the family. They keep them up-to-date on how their loved one is doing. They also tell the family about any changes in their care plan.

Nursing and Medical Services

In addition to non-medical care, domiciliary care includes nursing and medical services. Qualified nurses visit clients at home to administer medications, dress wounds, monitor vital signs, and provide specialized medical care as needed. This integrated approach ensures that individuals with complex medical conditions can receive comprehensive care without leaving their homes.

The Impact on Healthcare Facilities

Domiciliary care positively impacts healthcare facilities by reducing the strain on hospitals and nursing homes. By providing care at home, domiciliary care helps prevent unnecessary hospital readmissions and frees up hospital beds for more critical cases. This, in turn, leads to cost savings for both healthcare facilities and patients.

Enhancing Independence and Autonomy

One of the key objectives of domiciliary care is to support individuals in maintaining their independence and autonomy. Caregivers motivate clients to join in with daily tasks. They also help them make decisions as much as they can. This gives the patients a feeling of control
and respect.

Personalized Care and Flexibility

Domiciliary care offers a level of personalization and flexibility that is often not possible in institutional care settings. If a person’s needs change, the care plans can also change. Caregivers can switch up their methods to fit each person’s likes and daily routines.

Quality Assurance in Domiciliary Care

To ensure the highest level of care, domiciliary care providers often have quality assurance programs in place.

These programs might have several parts. One part could be regular check-ups of the caregivers. Another part could involve getting opinions from clients and their families. Lastly, they need to stick to accepted rules and good methods.

The Future of Domiciliary Care

The future of domiciliary care looks promising, with an increasing focus on technological advancements to enhance care delivery. Technology will have a crucial role in bettering the care experience. This is beneficial for clients and caregivers alike. It can be through things like remote monitoring devices or telehealth meetings.

Conclusion

To sum up, domiciliary care is really important in healthcare. It lets people get custom help and medical care at home.

Domiciliary home care greatly improves life quality for people who need these services. It’s also really beneficial for their families. That’s what makes it a key part of today’s healthcare.

FAQs

What is the difference between domiciliary care and residential care? 

Domiciliary care is when you get care at your home. On the other hand, residential care means living in a place that cares for you, like a nursing home. Domiciliary care lets people stay in their own comfortable space. On the other hand, residential care gives 24-hour help in a community setting.

Does insurance cover domiciliary care? 

Certain insurance plans, including long-term care insurance or specific government-funded programs like Medicaid may cover domiciliary care. It is essential to check with your insurance provider to understand the coverage options available.

Can domiciliary care be provided for temporary situations, such as post-surgery recovery? 

Yes, you can set up domiciliary care for short times. This can happen after surgery or during sickness. We can personalize care plans. They can help people briefly until they can take care of themselves again.

How do I find a reputable domiciliary care provider? 

To find a reputable domiciliary care provider, consider seeking recommendations from healthcare professionals, friends, or family members. Additionally, research online reviews and testimonials to gauge the experiences of other clients.

Can I choose my caregiver in a domiciliary care program? 

In many cases, domiciliary care providers offer the option to choose a preferred caregiver based on compatibility and experience. Open communication with the provider can help ensure a suitable match for the client’s needs.

Remember, domiciliary care is an invaluable service that empowers individuals to age or recover gracefully while preserving their dignity and independence. Are you or a loved one thinking about domiciliary care? If so, it’s important to look at all your choices. Then, choose the one that best suits your needs and likes.

Consider The Top-Rated Home Care Agency in North Carolina

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Help & Comfort

Does Your Loved One Need Help at Home?

Aroga Home Care Services was founded on the principle of delivering caregiver consistency and the idea that this consistency results in better outcomes. We understand that staying at home is important and having many different people come in your home can be uncomfortable and often time confusing for our seniors. We take time to sit down with each client and their family to understand their unique care needs and preferences. Taking this valuable time allows us to get to know our clients and include them in the process of choosing a caregiver that is the most qualified and best “fit.” Having consistency with a caregiver is not only more pleasant, it helps foster relationship growth and bonding between the caregiver, client and family.

Is your family or a loved one battling any or all of these questions below?

• Are they unable to track conversation?

• Do they repeat themselves?

• Have they had recent falls?

• Are they missing medications?

• Do they need assistance maintaining

• their appearance?

Aroga Senior Care Services

• Post-Surgery or Hospitalization Care

• Alzheimer’s and Dementia Care

• Bathing, Personal Hygiene and Dressing

• Medication Management and

• Diabetes Care

• Mobility Assistance, Fall Prevention and Much More

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Holidays and Aging Parents: 5 Red Flags to Look For

Visits with your aging parents often are a wake-up call this time of year. Perhaps you haven’t seen your loved one for some time and when you do, it’s startling. Aging can be a gradual process for some, but for others the changes accelerate so fast it shocks those who haven’t seen them in a while. Don’t wait for your loved one to bring up a need for help. Too often, they can’t face it and are in denial. Those living alone are especially vulnerable as day-to-day, no one is watching. The following are 5 signs to look for during the holidays that indicate it’s time to step in.

1. Unusually unkempt appearance.

A change in personal appearance should not be dismissed as unimportant. Dirty clothing, lack of basic hygiene, failure to notice grooming and personal appearance signal something has changed, and they need help.

2. Inability to track the conversation.

An aging parent who, in the past, could participate in a discussion and now can’t keep up or follow what is being said is showing signs of cognitive decline. It is not “just getting old,” as normal aging does not cause us to lose intelligence.

3. Repeating one’s self.

Older people start to lose short-term memory when dementia is developing, and short-term memory loss is a classic sign of cognitive impairment. If your loved one keeps asking the same question you just answered or tells the same stories over again, you have a warning that dementia could be in process.

4. Unsteady or recent falls.

If your loved one seems wobbly on their feet or has had a fall, you are seeing a big red flag. Falls are unfortunately common among elders and are often the trigger that leads to injury, hospitalization and loss of Independence.

5. Unattended paperwork around the house.

Unpaid bills, collection notices and requests for renewal or information that has been ignored is a sign your parent is struggling to keep track of important paperwork and there is a need for an adult child to step in.

Many older people are terrified at the thought of being “put in a home” which they see as a form of imprisonment and loss of control. There are other options such as home care, which can be good choice, as it offers support without the need for them to move.

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

What Types of Care and Services Are Provided by Home Health Agencies?

Home healthcare, or skilled care you receive at home, is a continuation of care your loved one might have received or needed in an inpatient care placement. This kind of care may be called senior home healthcare or elderly home healthcare.

These services may be part of a doctor’s treatment plan for your loved one, so they can be at home and still receive rehabilitation, recovery or other clinical healthcare. The doctor may recommend occupational or physical therapy, speech therapy, wound care, staff to provide medications or injections, and staff to monitor recovery while remaining at home.

This arrangement, as ordered by a doctor, is likely temporary as the patient may resume normal function and can handle household duties and functions after recovery. In some instances, caregivers decide to continue the skilled home healthcare after the physician’s order has ended, with the understanding that coverage for that benefit may change at that point.

You will have some ability to negotiate when care providers come to your home, depending on what kind of care the doctor has recommended. For example, a doctor may recommend that a physical therapist come to your home three times a week to work with your loved one. Your family will be able to work with the provider to find the times of day that work best for everyone. Since these services are part of a treatment plan, Medicare or insurance often covers the cost of home health care.

Senior home healthcare can benefit family caregivers, too. Having skilled healthcare personnel monitoring and helping care for your loved one can reduce your worry, and also relieve you of some caregiving activities you may be unable to provide. In some cases, you may find senior home healthcare services that offer additional staff who can also provide you with respite so you can care for yourself or take care of chores needed to keep your household running.

What Types of Care and Services Are Provided by Home Health Agencies?

Home health agencies have to be certified or licensed in compliance with state and local standards. In order to receive Medicaid or Medicare, they also have to meet certain standards set out by the Centers for Medicare & Medicaid Services (CMS). That means that the skilled nursing and other healthcare services your agency provides must be overseen by a team that includes a physician and appropriately qualified nurses, even though your family might not work directly with those medical administrators. They make sure that the home healthcare agency or group can provide a range of services, listed below.

How Do You Create a Home Healthcare Plan?

Home healthcare agencies will assess your loved one’s specific healthcare needs and propose a healthcare plan, sometimes called a plan of care. Your loved one’s doctor will then review the healthcare plan and sign it to show approval. The healthcare plan details what type of medical care your loved one will receive, what types of workers will provide the care, how frequently they will come to your loved one’s home, and how long the care is expected to last. You should receive a written copy of the plan of care.

Depending on how the patient’s needs progress, the home care agency may request an extension of services. They’ll send additional paperwork to the doctor for approval. And you’ll want to be sure to confirm that your loved one’s insurance will cover extended services.

How Much Does Home Healthcare Cost and What Are the Payment Options?

In most cases, home health care agencies are not set up to provide fee-for-service; they offer services that are reimbursed by Medicare or other insurance. If they do charge fee-for-service, Home healthcare costs range from $15 to $75 per hour, depending on the training and expertise of the specific healthcare worker who comes to your home. Nurses and physical therapists are more expensive; home health aides
charge less.

When your loved one is recovering from surgery, accident, or illness and home healthcare is prescribed by a doctor, it’s generally covered by Medicare. Here’s the tricky part: Medicare provides coverage for a specific ailment. Once recovery from that ailment is complete, Medicare coverage ends. And Medicare coverage also ends if your loved one ceases to make progress in recovery efforts.

When home healthcare is not covered by Medicare, you can explore additional options, such as veterans benefits, Medigap, Medicaid, long-term care insurance, or private pay.

Short-term home healthcare visits by a nurse, therapist, or certified home health aide — which typically follow a hospitalization, injury, or severe illness and are intended to help someone return to a stable condition — are usually covered by Medicare, Medicaid, the VA, and private health insurance. For home healthcare that’s not covered by any program or insurance, provided through a licensed home healthcare agency, expect the cost to run from $20 to more than $100 per hour, depending on location and the level of training of the care provider (nurse, physical therapist, or home health aide).

Note that home healthcare is different from long-term in-home care assistance that doesn’t involve medical care. In-home nonmedical care — to help someone with things like bathing, toileting, and other activities of daily living; or for companionship, security, or household tasks — involves different costs and coverage possibilities.

There are many options to pay for your loved one’s home healthcare. What follows are some of the most common payment options.

Public Benefits for Home Healthcare

If your loved one is enrolled in Medicare (including a Medicare Advantage Plan or Medicaid, or in the VA healthcare system, one or all of them will pay the full cost — meaning there are no co-payments — of home healthcare as long as certain conditions are met.

Medicare

Medicare pays the full cost of covered home healthcare provided by a Medicare-certified agency if prescribed by a treating physician. A different part of Medicare might cover home healthcare in different circumstances, and depending on which part(s) your loved one is enrolled in:

• Medicare Part A covers the care if, within the previous 30 days, your loved one has been a hospital inpatient for at least three days.

• Medicare Part B covers the care if there’s no prior three-day hospital stay.

• If your loved one is enrolled in a Medicare Part C Medicare Advantage plan, instead of traditional Medicare Part A and Part B, the plan will cover home healthcare regardless of a hospital stay but may require that it be provided by a provider/agency that’s a part of the plan’s network.

Medicare coverage for home healthcare lasts only as long as the physician and home healthcare agency certify that the patient needs regular at-home medical care in order to recover from an injury, surgery, or other acute condition.

Tip: For help with any Medicare question regarding home healthcare coverage, you and your loved one can get free, expert counseling at a local office of the State Health Insurance Assistance Program (SHIP) or Health Insurance Counseling and Advocacy Program (HICAP).

Medicaid

If your loved one is enrolled in Medicaid (for people with very low income and few assets other than their home and car), it can cover the full cost of care from a Medicaid-participating home healthcare agency. For people who have both Medicare and Medicaid, the Medicaid program might cover some home healthcare after Medicare coverage stops.

To find out about Medicaid home healthcare coverage, contact the Medicaid agency in your state by going to the online link to state Medicaid agencies. Or contact the Area Agency on Aging for the region where your loved one lives.

Veterans’ Benefits

If your loved one is a veteran, he or she might be enrolled in or eligible for Department of Veterans Affairs (VA) medical care, which includes home healthcare. To find out about enrolling for VA medical benefits, and how to receive home healthcare, call the VA at (877) 222-8387 or visit the healthcare pages on the VA website.

Private Insurance Options

Private health insurance usually provides good coverage for short-term in home nursing care, though, your loved one may have to pay a patient co-payment. This coverage includes health insurance based on current employment (the patient’s or spouse’s) or retiree health insurance. Learn more about using private insurance to help pay for home healthcare.

Other Payment Options

It may happen that your loved one would like to continue home healthcare after public or private insurance will no longer cover it. If so, you may have to pay out of pocket. But there may also be care options other than agency-provided home healthcare for which your loved one is covered or that are less expensive for you to pay out of pocket. Talk to your local Agency on Aging representative to find out what kinds of low-cost or volunteer-based services exist in your community.

Consider The Top-Rated Home Care Agency in North Carolina

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Care.com

A Senior Caregiver's Guide to Balancing Your Work and Your Personal Life

Working as a senior caregiver can be a very fulfilling job. You get to help senior individuals enjoy their golden years while earning a living. That said, caregiving can also be stressful. According to the Cleveland Clinic, caregiver burnout is a real issue, and you may be at risk if you don't take care of yourself. 

Below, Aroga Home Care Services shares some helpful tips to balance your work and personal life, so you can stay healthy.

Consider your big-picture goals

Just because you enjoy caregiving doesn't mean you don't have other dreams. Don't put your goals on hold. For example, if you really love technology and computers, you may want to take your career to the next level by becoming an IT professional. You can complete online coursework as you find that compTIA stackable certifications can further your career, whether that be in security analysis, networking, or cloud administration. Certifications earned online offer flexibility, so you can work and study simultaneously.

Make self-care a priority

Self-care isn't just some fancy buzzword. It's simply about making time to take care of yourself every day. Make sure you're eating healthy, doing some exercise, and getting enough sleep. Here are some additional self-care ideas, from taking a bath to reading a book or listening to music. The point is to do something that's purely for yourself and just for fun, without any bigger goal. You don't have to spend more than 15 minutes of your day doing a self-care activity to reap the rewards.

Try meditation to bust stress

Caregiving is rewarding but it's also stressful at times. Make sure you have coping mechanisms. If you don't address stress now, issues can arise later. For example, stress is shown to contribute to health problems like depression and anxiety. One way you can tackle stress is through meditation. Mayo Clinic notes that meditation can help combat stress through repetitive mantras and deep breathing techniques. Use an app like Headspace to get into meditation if you've never done it.

Hire help for household tasks

When you're trying to do your caregiving job while also pursuing your personal goals, finding time to take care of yourself can be tough. Get more hours in the day by seeking support for everyday household tasks. For example, you can hire people to help with home repairs and maintenance via Thumbtack. You can also save time on cleaning by enlisting the services of a cleaning service or save time in the kitchen by getting ready-made meals delivered.

Build up your support network

Being a caregiver isn't always easy. It's good to talk to your family and friends when you're feeling overwhelmed. There are also professional support groups for caregivers that you can try. It can be helpful to talk to people who understand the profession and know what you're going through when you face challenges. If you can't find a group in your area, try joining an online forum. Here are some resources to get you started.

Seek professional help if you're overwhelmed

Sometimes, a support group alone isn't enough. If you feel like your caregiving role is starting to take a toll on your mental health, talk to a professional. Signs that you could use help include not being able to sleep, having trouble focusing, and feeling irritable or anxious. Another option is to seek online counseling. There are many online platforms where you can talk to licensed therapists.

Caregiving can be a rewarding way to make a living. However, it's a demanding job and can be stressful. Make sure you're taking care of yourself by following the tips above. This can help you avoid burnout.

Aroga Home Care Services focuses on caregiver experience and keeping the caregivers we match with clients consistent and as few as possible. Reach out today to learn more at
(704) 319-5500.

Content Credits: Jennifer Scott | Spirit Finder

Caring From a Distance: Supporting Seniors Without Nearby Relatives

Sometimes, we want to lend a helping hand but don’t know where to start – especially when it comes to our seniors. Luckily, if you want to do your part to help the senior community, there are more options available today than ever before. Whether you’re ordering groceries, calling in via Zoom, or helping them to research housing, Aroga Home Care Services has some advice and resources that are sure to help.

Chores and Organization

Daily tasks can become a pain as we grow older. Often, you can assist with these using apps or internet services.

• Many lawn mowing and garden maintenance services are listed online via directories.
  

• You can use apps or shopping sites to organize food deliveries on behalf of seniors.
  

• Home repairs become increasingly important during the winter months and it can be necessary to carry out work to keep out draughts.
  

• You can help seniors digitize their documents so that it’s easier to stay organized; go here to access a free tool that can make things easier.

Social Life

For many seniors, socializing becomes increasingly difficult with age. Fortunately, the internet can open up all kinds of new options.

• If they aren’t already, you can encourage seniors to engage with others via social media. This is a great way to meet like-minded people.
  

• Many local clubs and societies are looking for new members, you can use search engines to help a senior locate these.
  

• You can connect with seniors over Zoom or other video conferencing apps and provide a calming influence to help alleviate their stress.
  

• Speaking of stress, make sure you’re remembering to take a breath, as well!

Housing

As we get older, sometimes we need to change our living situation. Many seniors would appreciate the help navigating their options.

• If a senior needs to seek alternative living arrangements, they may need to sell their house. You can help them to calculate the proceeds they’ll make from this.
  

• However, it’s not always necessary to sell the property as care can be provided in-house.
  

• This may also be the right time to wind up or sell any businesses they own.
  

• If they need medical assistance, they may have to move out. You can help them to find the best arrangement for their comfort and wellbeing.
  

• Aging is a natural part of life, but it can be intimidating and physically challenging for a lot
  of us.

That’s why assistance from kind-hearted people goes such a long way! Don’t be afraid to reach out. Your efforts and compassion mean more than you know.

If you’re looking for a boutique home care agency with experience and compassion, look no further than Aroga Home Care Services. Contact us today and request a professional home care adviser consultation at www.ArogaHomeCare.com or call 704-319-5500.

Content Credits: Jennifer Scott | Spirit Finder

Elderly Falls: How to Reduce the Risk and Choose an Alert System

Elderly falls impact the physical and psychological health of millions of older adults. According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury to people over 65. We can't know for certain how many seniors fall each year (since they don't always tell other people about their accidents). However, the CDC estimates the number to be about 30 million.

But many falls are preventable. With a few simple steps, you can reduce your odds of falling. In this article, you'll learn why seniors are at high risk for falls. You'll also discover tips for preventing falls and learn the steps to take if you do slip or tumble. As well, you'll learn about medical alert systems that help seniors get assistance in emergency situations.

• Falls in the elderly: Statistics you should know

• Why seniors fall

• Preventing falls

• Medical alert systems: Why they can help and how to choose one

• Recovering from elderly falls: What to do to stay healthy

Falls in the Elderly: Statistics You Should Know

Everyone falls sometimes. But falling can have dire consequences for the elderly. Fall statistics show the seriousness of the problem. According to the CDC:

• About three million seniors are treated for injuries from falls each year.

• Roughly 20 percent of falls cause head injuries, broken bones, or other serious damage.

• The vast majority of hip fractures are caused by accidental tumbling.

But when it comes to measuring the aftereffects of a senior citizen fall, statistics don't always tell the whole story. One reason is that many seniors don't tell anyone when they fall. (They don't want to appear "old.") And the numbers don't always account for the long-term effects of a nonfatal fall, particularly on a senior's sense of pride and independence.

A fall can be a minor incident, especially for young people. But many falls are dangerous for elderly people because seniors often have existing health issues, such as osteoporosis (which makes them more vulnerable to bone fractures) or heart problems (which can make recovering from an injury more difficult, especially if surgery is required).

Of course, the most serious consequence of a fall is death. According to the CDC, about 30,000 seniors die each year from injuries caused by falling. That makes fatal falls the leading cause of accidental death for seniors. (The overall leading cause of death for seniors is heart disease.)

The consequences of falls for the elderly often go beyond short-term injuries. Even seniors who don't have injurious falls can experience declines in their quality of life after falling. Fear is part of the reason why.

According to an article in the International Journal of General Medicine, up to 70 percent of seniors who have experienced a fall are worried about it happening again. And half of those seniors reduce their activity in response to their fears, which can lead to other physical and emotional health problems.

For example, after a hip fracture, 20 to 30 percent of seniors die within 12 months—not directly from the hip injury, but often from the negative effects of the resulting inactivity.

If you're worried about elderly falls, statistics like these may seem daunting. But you can take action to avoid future falls. Prevention can easily fit into your plans for positive aging and a healthy lifestyle.

Why Seniors Fall

Many falls are "multifactorial." That means a combination of factors causes elderly people to fall.

For example, consider an older woman who fell while going to the bathroom at night. All of these factors could be responsible:

• Physical: She felt dizzy when she stood up because of her blood pressure medication.

• Environmental: Her bedroom floor was cluttered because she can no longer bend over to pick things up.

• Situational: Her room was very dark, and there wasn't a light in the bathroom, so she couldn't see the things on the floor.

• Cognitive: She felt confused when she woke up because her husband is in the hospital and she's not used to sleeping alone.

In other words, if her adult children wonder why their elderly mother keeps falling, they might not find one simple explanation. Fortunately, however, some of those causes can be avoided in the future.

Preventing Falls

Many falls can be prevented. And the steps for reducing a senior's risk of falling are often quite simple. Plus, some fall precautions for elderly people can actually increase their quality of life in other ways.

Seniors can prevent falls by examining three areas in their lives:

• Overall health

• Physical activity and daily habits

• Environment

Overall health
The first step in proactive elderly fall prevention is talking to a doctor.
Because more and more older Americans are falling, new research in geriatrics focuses on ways to prevent slips and tumbles. For example, one risk improvement initiative used by doctors is STEADI (Stopping Elderly Accidents,

Deaths & Injuries) from the Centers for Disease Control and Prevention (CDC). The publicly available materials include resources such as a fall-prevention handout for physicians to pass on to patients and tips for evaluating elderly patients' fall risk.

Your doctor can perform a geriatric fall risk assessment and make recommendations to protect you. So tell your doctor if you would like this done. (Many doctors don't conduct fall risk assessments unless their patients specifically request them.)

As part of a risk assessment, your doctor may monitor the following health issues:

• Diabetes: Seniors with diabetes, especially those using insulin, have a higher risk of falling. That's partly because nerve damage in feet (caused by the disease) can lead to balance and gait problems. In addition, hypoglycemia (i.e., low blood sugar) caused by diabetes treatment can lead to vision problems and confusion.

• Blood pressure: Low blood pressure in elderly people can cause dizziness and lightheadedness, which in turn can lead to falls. Orthostatic hypotension is a sudden drop in blood pressure that can happen when a person stands up or changes position suddenly. About 20 percent of people over 65 are prone to this condition. In addition, many blood pressure medications can lead to dizziness.

• Medication: Drug side effects are one of the most common causes of frequent falls in elderly people. In short, your risk of falling increases as you take more medications. (If you have a complicated drug regimen, a pill dispenser for seniors might be helpful.) Drugs that are used to treat the following health issues have been linked to falls:

• Insomnia

• Diabetes

• Anxiety

• Depression

• Allergies

• Bladder problems

• Chronic pain

• Hypertension

• Cognitive issues, including Alzheimer's disease
  

• Ask your physician for information about specific medications. Taking a prescription drug is, of course, often very necessary. But doing an annual medication review with your doctor can help you determine whether a certain medication is worth the risk. A safer drug may be available, or you may be able to make lifestyle changes that eliminate the need for medication.
  

• Also, let your doctor know if you are taking any herbal remedies or undergoing any alternative medical treatments. These can also affect your balance, blood pressure, and other factors that contribute to falls.

• In addition to talking to your physician, visit the eye doctor. If you have a prescription for glasses or contact lenses, wear them at all times. And keep your glasses clean. Blurry vision is another one of the most common causes of falls in the elderly, and the solution can be as simple as wiping your lenses on a regular basis.
  

  Physical activity and daily habits
  

• Effective fall prevention doesn't mean limiting activities. It's actually better to be more active.

• As we grow older, we lose up to 30 percent of our muscle strength each decade unless we actively work to maintain it. Our flexibility also decreases. Having good strength, balance, and flexibility can mean the difference between recovering from a misstep and experiencing a major fall.

• In fact, one study found that doing exercise involving balance for more than three hours a week led to a 39-percent decrease in falls for older people. Exercise can also reduce the need for prescription medications that contribute to falls.
  

• Many effective fall-prevention exercise programs are available. In addition, the following activities have positive effects on strength and balance. They're also fun!
  

• Swimming: This may seem counterintuitive. (After all, you can't fall when you're in the water.) But according to a study in the American Journal of Epidemiology, swimming is one of the best exercises for improving balance.

• Yoga: This activity improves balance and proprioception (i.e., your awareness of where your body is in space), both of which can lower your risk of falling.

• Tai chi: Practicing this Chinese system of calisthenics can reduce elderly persons' risk of falls by up to 45 percent. The deliberate movements of tai chi exercises help with balance, proprioception, and mindfulness.

• Strength training: Improving muscle power and endurance through strength training helps with balance as well as the ability to stand up and sit down smoothly.
  

• Simple behavioral changes in your daily habits can also help you move through the world with more confidence. For example:
  

• Wear nonslip shoes (even inside): You may have been taught that wearing shoes inside is bad manners, but studies confirm that shoes are safer for seniors than bare feet, socks, or slippers. And if wearing shoes inside still isn't for you, nonslip socks are a good alternative that allow you to feel cozy and improve your safety at home.

• Take it slow in wet or icy conditions: Short steps reduce the odds of slipping. Wear solid boots or shoes, and make sure your hat or scarf doesn't interfere with your vision or hearing. If your footwear doesn't feel grippy enough in slippery conditions, you can also get some slip-on traction cleats for your shoes.

• Get up slowly: If you have to get out of bed at night, first move to a seated position and place both feet on the floor with your hands at the edge of the bed. Then, sit for a minute or two before you push yourself up from the bed to walk.

• Stay hydrated: Dehydration in elderly people can be a risk factor for falls, in part because it can lead to confusion and disorientation. If you're not sure how much water you should be drinking in a day, talk to your doctor.

• Avoid carrying too much: If you have to carry something heavy, keep it in front of you, at the center of your body. Try not to carry heavy objects up and down stairs.

• Don't rush around: For example, if the phone rings and you're worried you might not answer it in time, let your answering machine or voice mail service pick it up. And consider programming the machine or service to allow extra rings before the message plays in order to give yourself a bit more time.

• Shower safely: Try to have one body part touching a shower wall at all times. This helps with your body awareness. A nonslip shower mat is also a good tool for preventing falls, especially when getting in and out of the tub.

• Try a cane: If you don't already use one, a cane can help you get around without taking up the space of a walker or scooter. You can choose from a traditional cane with a single prong, or one with four prongs for extra stability. Additionally, there is a good variety of materials, colors, patterns, foldability, handle types, and more.

• Think about getting a walker or rollator: While many people don't feel ready to give up the independence of walking without assistance, it's important to take proper care to not fall if you want to stay on your feet longer-term. Walkers and rollators provide a good way to stay mobile and are available in a variety of price points and styles so you can find the right one for you.

• Consider a mobility scooter: You may not be ready to commit to one full-time, but medical and mobility scooters can be helpful for specific situations where you may feel more vulnerable on foot.

• Watch your alcohol intake: Drinking alcohol can significantly weaken your stability, not to mention your judgment.

• Check in with a physical therapist: A physical therapist (or physiotherapist, depending on where you live) can assess you for risk factors and help you work on exercises that help manage those risk factors and prevent falls.
  

• Environment
  Sometimes, older adults are reluctant to fall-proof their homes because they think that doing so makes them look helpless. But most falls among the elderly occur in the home. Making some small changes to your home environment can significantly reduce your fall risk. For example:

• Declutter: Remove anything you can trip over from the floors and stairs. Make decluttering a habit.

• Rearrange your furniture: Create clear paths through each room. Consider getting rid of unnecessary furniture, especially if it's not very stable—for example, decorative end tables. Pushing chairs and couches against a wall makes them more stable. And check the corners of all pieces of furniture to make sure they're not too sharp. Buy corner guards if they are.

• Make everything easy to reach: Ensure that the objects you frequently reach for in your cupboards can be accessed without a ladder or stool.

• Place a light source near your bed: Many falls happen when seniors get up at night. A nightlight in the bathroom is also a good idea.

• Evaluate your rugs: Get rid of small throw rugs or replace them with slip-proof rugs.

• Clean up all spills right away: Even a small spill on the floor can pose a hazard if you've forgotten about it.

• Use slip-proof mats in all showers and tubs: Falling in the bathroom is a common cause of injury, regardless of age.

• Fall-proof your bed: You can stop falling out of bed by installing bed rails. But keep in mind that there are two main reasons for seniors falling out of bed: (1) They roll out while they're asleep, or (2) they fall while they're trying to get up out of bed. A bed railing system can make it harder to get out of bed. That's why some seniors who find rails too confining attach pool noodles to the tops of their mattresses on each side. It's a low-cost and less claustrophobic alternative to rails. This creates enough of a "lip" in a bed to help prevent falls.

• Install other assistive devices: Many products are designed to help the elderly. Fall-prevention devices include things like:

• Grab bars beside tubs, showers, and toilets.

• Handrails for all stairs.

• Toilet seat risers (which are more discreet than you might think).

• Door handles that open easily so that you don't lose your balance.

• Non-skid strips for stairs.

• Contrasting tape to make stairs and door jams more visible.

• Shower chairs.
  

• Do you live in a nursing home, or are you concerned about someone who does? Talk to the managers of the home about their fall-prevention program. Good communication with staff is key to fall prevention for the elderly in nursing homes. Ask if they perform regular fall assessments on residents and find out if they have a plan for what to do when elderly residents keep falling while in their care. If you are worried about someone in a nursing home, tell the staff you want to be informed whenever he or she falls.
  
  If the fall risks become too much to manage, it may also be worth looking into assisted living for a more structured, safe environment. Living alone can be especially risky when it comes to falls, and it's important to know that if an accident were to happen, you or your loved one would be able to access help as soon as possible.

Medical Alert Systems: Why They Can Help and How to Choose One

Medical alert systems ensure that you get the help you need after a fall or other medical emergency. A medical alert system can also give you a greater sense of independence (by easing any worries about being alone and unable to help yourself).

Medical alert systems have advantages over other ways of getting help for seniors. The most obvious benefit is that these systems cost less than hiring in-home companions. As well, unlike a cellphone, you wear a medical alert device, so it can be with you everywhere (even in the shower if it's waterproof). Such devices are also easier to use than most cellphones. Typically, you just have to press a button in order to send out an alert.

You can read many medical alert systems reviews online to get a sense of what's offered by different companies. In addition, most companies have comprehensive websites through which you can order everything you need. Most sites also have a way for you to ask questions. (Just be aware that some companies have been accused of using aggressive sales tactics.)

You can also purchase the necessary equipment at stores like Costco, Walmart or online at Amazon. Medical alert systems deliver a wide range of services, with a lot of variation in price and technical capability. So, before you invest in one for yourself (or for a friend or relative), spend a little time researching the options.

The best medical alert system is one that matches your lifestyle, safety needs, and budget. Other things to consider before you commit to a system include:

• Can you test it out? Many companies offer a free trial period that you should take advantage of. After all, you want to make sure the system works for you.

• Is the system waterproof? Remember that a high percentage of falls happen in the bathroom.

• Do you have to sign a contract? Many companies permit month-to-month payments instead of binding contracts. Avoid contracts that require long time commitments if you can.

• Will you actually wear the device? Some seniors don't wear alert pendants or bracelets because they find them embarrassing or uncomfortable. But many companies are now making more stylish and discreet devices.

• How is the battery life? You don't want to be in a bad situation and discover that the batteries are dead.

• Does the range extend far enough? Consider your daily activities. For example, will you be covered if you are in your garden if that's your favorite hobby?

Usually, you don't need a landline for medical alert systems. Many now work through cellular networks. In addition, medical alert systems with GPS technology are a great option if you're an active older person. These systems can locate you if you have a fall while you're away from home.

Medical alert systems are divided into two basic categories: those that offer 24/7 monitoring and those that do not.

With a monitored system, activating an alert connects you to a call center that is staffed by people who can reach out to one of your contacts or call 911 if you need immediate help. The personnel at these centers are trained to communicate with seniors in many situations. Some services also offer help in multiple languages. For example, Philips Lifeline medical alert devices can connect users to support in over 140 languages.

Monitored systems typically require a monthly fee and can be more expensive than unmonitored systems. So if you'd prefer something like an emergency call button for seniors with no monthly fee, systems such as the LogicMark Freedom Alert Emergency System can connect you to preprogrammed contacts after you press a button on a wearable pendant. The system can be programmed to call 911 if none of your contacts are available. It can also be programmed to call 911, by default, immediately after you press the button.

Fall detection is also an option with many alert systems, both monitored and unmonitored. Systems with fall detection sense when a person wearing a fall-alert bracelet or pendant has fallen, then they activate a preprogrammed alert.

With a combination of features, a medical alert system can help seniors like you feel safe and independent. For example, products such as many ADT medical alert systems offer both fall detection and GPS capabilities, so a senior can quickly get help if he or she falls while outside the home.

Plus, some popular smart watches now offer features that can act as fall alarms for elderly people. For example, an Apple Watch Series 4 or later automatically enables fall-detection capabilities for users who have entered their age as over 55 in the user profile. (This feature can easily be manually enabled if you're under 55.) If the watch senses that you are not moving after a fall, it asks if you're OK. If you don't answer, the watch calls emergency services (i.e., 911), then it lets your emergency contacts know what's happening.

Other alert systems can track movement, send out an alert if an elderly person leaves the house, and monitor smoke and carbon monoxide levels in a home. You can even find systems that remind seniors to take their medication.

By now, you might be wondering how much a medical alert system is going to cost. Different price ranges reflect different levels of service. In general, monitored medical alert systems are $20 to $65 per month or more, depending on the features you choose. Some companies also charge set-up fees. As an example, the monthly charge for Life Alert is about $50 a month for a basic monitored system, in addition to a set-up fee ranging from $95 to $198.

You may qualify for assistance in covering the costs. Some companies offer discounts for veterans or members of organizations such as AARP. Medical alert systems are also often tax-deductible, so check with your accountant for more information.

In many states, Medicaid also covers medical alert systems through special programs. For instance, Medicaid's Home and Community Based Services (HCBS) waivers can help cover the cost of emergency assistance devices.

Generally, medical alert systems aren't covered by Medicare, although some Medicare Advantage programs might pay for part of the cost. Review your private insurance policy to see if this is an option for you.

The Importance of a Cell Phone

Cell phones for seniors are also worth exploring as an alternative or addition to a medical alert system. A phone that the senior in your life can easily carry and operate could be a lifeline if a fall occurs and help is urgently needed. Many are small enough to be easily carried in a pocket around the home or kept close enough to reach or summon using voice assistance. Apple iPhones, for instance, offer many features for safety, including voice assistant technology that responds appropriately to the phone owner saying, "Hey Siri, call 9-1-1."

Android phones also have safety features like an "emergency SOS" that sounds a loud alarm and calls for help, among other actions. Most phones will also have optional location sharing so authorized contacts can view the location of the cell phone. There are also phones designed specifically for seniors with dementia and cognitive impairments, like the RAZ Memory Cell Phone, which is made to ensure simplicity of use and reliability.

Technology has come a long way, but that doesn't mean it is always complicated to use. Cell phones of all brands and types offer a range of safety features that could be useful in an emergency. Look at our Best Cell Phone for Seniors article for a much more detailed list of what different phones offer and which may be the right choice for you or your loved one.

Recovering From Elderly Falls: What to Do to Stay Healthy

Even with careful fall and injury prevention, it's possible that you'll experience an accident at some point. Here are some steps to help you stay safe:

1. Remain calm. Don't panic. You'll be OK.

2. Take a quick inventory. Before you start to move, assess your situation. Can you feel any pain? Are you dizzy at all? Are you near any kind of help? Err on the side of caution if you're not sure whether or not you're injured.
   

If you aren't injured and feel as if you can get up:

1. Look for the nearest secure object or piece of furniture that you can use to pull yourself up.

2. Roll onto one side. Bend your top leg and push yourself to a crawling position.

3. Crawl carefully over to the furniture or object.

4. Put your strongest leg in front, then place your hands on the furniture and pull yourself up.

5. Carefully turn around so that you can sit down.

If you think you might be injured, or if you feel dizzy:

1. Activate your elderly-fall-alert device or other medical monitoring system if you have one. Don't worry about bothering anyone. Now is the time to use it!

2. Try to slide yourself toward the best place to be heard if you don't have a medical alert system. If a phone is in the room, try to move toward it.

3. Make noise if a phone isn't nearby. Tap the floor or cry out.

Even if you feel fine immediately after a fall, symptoms can appear afterward. Tell someone right away that you've fallen. And watch for symptoms such as:

• Unusual sleepiness

• An increase in headaches

• Dizziness

• Pain in any part of your body

• Feelings of nausea

• Vision problems

Also, be sure to tell your doctor that you had a fall. Don't be embarrassed: Everyone falls at some point. Your doctor can help you make a plan for avoiding future falls. He or she may also want to order some blood tests and review your medications.

Having a fall can be an upsetting experience. Many seniors feel helpless and discouraged. But a fall can also be a reminder to stay on top of any health concerns, and it can act as a prompt for making positive changes.

Once you have recovered from a fall, continue with your activities as much as you can (incorporating any new fall-prevention techniques, of course).

Remember that staying active can ultimately reduce your risk of falling. Many seniors reduce their activity after a fall because they are afraid it will happen again. But fear of falls, in older adults especially, can actually increase the risk. The result can be a vicious cycle. So if fear of falling is holding you back from any activities, talk to your doctor or mental health professional.

Elderly falls are not inevitable as we age. With a fall-prevention plan, you can protect yourself from the short- and long-term effects of falling. Talk to your doctor about ways to stay safe. And if you think a personal safety alert system is a good fit for you, research some options. Investing a little time right now in fall-proofing your life will benefit you significantly in the long run.

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Great Senior Living

Starting a Business for Senior Caregivers and How to Make It Work

We all love our seniors, and there are many great men and women who work as caregivers to ensure that our loved ones get the support that they need. However, sometimes, those caregivers also need help, so consider starting a business that supplies the tools that they need to succeed. Today, Aroga Home Care Services shares some tips and resources to help you get started with your new business.

Potential Services You Can Provide to Caregivers

If you really want to help the caregiver community, then there are many different business ideas that you might try depending on your skill set. You could start a website that provides educational tools for caregivers for specific diseases. Another idea is to create products, like calendars and medical equipment, that help caregivers to do their jobs. 

You could also work as a caregiver consultant that provides guidance when they have questions, like how to care for a senior with a particular condition. The point is that there are many different ways that we can help our caregivers thrive so that they can better the lives of our beloved senior citizens.

Consider Starting Your Company as an LLC

Once you have your business idea set in stone, you can start to get it off of the ground, and the first step is to form your company. There are many options when it comes to formation, depending on the type of services you plan to perform. However, many entrepreneurs go with a limited liability corporation. An LLC is a great choice for beginners because it offers a lot more flexibility and less paperwork than other options, and there are incredible tax benefits. 

The only issue is that the rules for starting an LLC differ by state, so you will need to tread carefully to ensure that you stay compliant. So, if you are wondering how to get an LLC, then the best idea is to hire a formation service. The experts will help you to form your company while ensuring that you are following the rules of your state. Plus, you could save some money in the process.

How to Get New Clients

With your company now working on all cylinders, it is time to start bringing in caregiver clients. There are many tactics you can try at first. One idea is to take out ads on social media sites like Facebook where you describe your business and invite potential clients to check out your website. 

Once you start finding clients and they are satisfied with your services, then ask them to rate your services and write reviews. Then, Smash Balloon explains that you can dedicate a page on your website to reviews so potential clients can see that you are worth the chance. You may also be able to find career fairs where potential caregivers may be present and advertise
your services.

Another great way to help spread the word is with the help of an infographic maker that combines eye-catching graphics with short lists of information about your services. You can easily design your own infographics, then share them via social media platforms like Instagram, Twitter, and Facebook to help build your customer base. And best of all, it’s free!

Ensure Client Satisfaction

When you secure a client base, you will want to make sure that you can retain their services. One way you can do so is to reach out to them periodically and have them fill out surveys to describe what they like and what they need. Then, find a way to meet their needs. 

You should also always be looking for ways to improve your services so that your clients are excited to continue doing business with you year after year. If you depend on customers to pay for your services, then consider offering promotions and coupons from time to time to incentivize people to continue working with your organization.

Create a Document Organization System

No matter what kind of business you start, you will need to stay organized. A paper filing system is generally functional, but going digital can have some big advantages. For one, you can save everything to the cloud with encryption to ensure client safety while also making sure you can access any information needed from anywhere. 

You can also collaborate with your team members using a free online PDF editor. In order to use a PDF file editor, simply upload the file and use the embedded tools (like highlighters, text tools, pens, and sticky notes) to give feedback. Send the completed file back to the sender and they will have a digital record of all comments for their reference. 

Carefully Consider Your Business Idea

In the end, starting a company to support the many great caregivers in your community is a very noble and thoughtful idea. Think of a good product, carefully consider your business structure, take steps to ensure client satisfaction, and your company can last for years
to come! 

The healthcare professionals at Aroga Home Care Services understand the importance of small, personalized care. If you are looking to join a team or have a loved one who is in need of in-home care, visit us online to learn more about our services. 

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Jennifer Scott | Spirit Finder

Leg Swelling in Aging: What to Know & What to Do

Swelling in the lower legs – known as “lower extremity edema” in medical terms – is a problem that often affects older adults.

The good news is that most of the time, it’s annoying, but not terribly dangerous. However, in other cases, swelling in the feet, ankles, or lower legs can be the sign of a new health problem, or a worsening
chronic condition.

And, even if it’s “benign” and not related to a dangerous health condition, edema can be a major risk factor for skin breakdown and reduced mobility in aging adults.

Since leg swelling becomes so common as people get older, in this article we’ll demystify leg edema and cover the most important things that older adults and families should know about this condition. In particular, we’ll  cover:

• How does edema happen?

• Common causes of swollen ankles or legs in aging adults

• Medications that can cause leg swelling as a side-effect

• How leg swelling should be medically evaluated

• How to prevent and treat leg swelling

• What to know BEFORE going on a “water pill”

How does edema happen?

We notice edema when our shoes are too tight, or we get marks on our ankles from our socks.  But what’s really going on inside the body?

Edema happens when fluid moves outside of blood vessels and into what’s called the interstitial spaces of the body. These spaces are  also sometimes called the extra-vascular space (which literally just means “outside of blood vessels”), and is basically the moist space between cells, organs, and body parts.

Although you make think of blood vessels as being “waterproof”, physically they are more like a semi-permeable membrane, made of blood vessel cells that usually stay close together, and it’s normal for small quantities of fluid to pass back and forth.

If more fluid than usual passes out of the blood vessels, and this happens in the legs or near the surface of the body, it looks like a swollen or puffy area under the skin.

Fluid can move into the interstitial spaces and cause edema for a few different reasons. The most common causes are

1. “Leaky” blood vessels: Sometimes the blood vessel cells don’t stick together as tightly as they should. This can allow fluid molecules to slip through the connections between the blood vessel cells (like gaps between the bricks in a wall).

   1. This can happen due to severe infection or inflammation, among other things.

2. Low levels of protein in the blood: Proteins, such as albumin, help keep fluid inside blood vessels. This is because protein molecules in the blood exert an “osmotic” pressure (also called “oncotic pressure”) that helps retain fluid inside a blood vessel. If protein levels fall in the blood vessel, even if the membrane of the blood vessel is intact, fluid moves outside of the vein or artery to equalize the osmotic pressure across the membrane, and this
   creates edema.

1. Some causes of low albumin levels in the blood include certain types of kidney disease, liver disease, and malnutrition.

3. Fluid overload: If there’s more fluid than usual in the blood vessel, it becomes “overloaded.” The extra fluid will be then end up pushed across the blood vessel wall because of high hydrostatic pressures.

Normally, our kidneys regulate body fluid levels by adjusting the amount of water and salt that is excreted or retained. But if those mechanisms fail or are overwhelmed, edema is often the result.

When we look at common causes of edema, keep these different mechanisms in mind.  The cause of the edema will play a major role in deciding on the best course of treatment.

What are the most common causes of leg edema

By far, the most common cause of leg edema is chronic venous insufficiency, but there are some other causes that are critical to rule out.

Chronic venous insufficiency

This is the cause in about 70% of older adults with leg edema.  To understand chronic venous insufficiency (CVI), we first need to cover how veins work.

Veins are the blood vessels that return blood to the heart so that it can be pumped to the lungs and get oxygenated. Veins don’t have muscles in their linings like arteries do; instead, they rely on a system of valves to keep blood from flowing backwards. Over time, these valves become less effective, and blood can hang around in the veins longer than it needs to – a phenomenon called venous insufficiency.

When venous insufficiency becomes chronic, this can cause varicose veins and/or edema, due to there being extra fluid in the veins. Venous insufficiency can also end up causing phlebitis (inflammation of the veins), ulceration of the skin (sores and wounds) and even sometimes cellulitis (skin infections).

CVI is common, affecting an estimated 7 million people worldwide and causing 3 million to develop venous ulcers, the most common type of leg ulcers. The cost of venous ulcers  to the  US healthcare system is estimated at  2 to 3 billion dollars a year.

Risk factors for CVI include:

• Advancing age

• Family history

• Prolonged standing

• Obesity

• Smoking

• Sedentary lifestyle

• Lower extremity trauma

• Prior venous thrombosis (blood clots in the veins)

In the section on treatment, I’ll explain how to manage edema due to CVI and share tips on reducing the risk of complications. Keep in mind that leg swelling is something that people live with on a chronic basis and is rarely completely cured.  The goals of a treatment plan are to reduce the edema, prevent the discoloration and thinning of the skin, and prevent or heal
skin sores.

Congestive Heart Failure (CHF)

Congestive heart failure (CHF) is the most common cause of generalized edema (affecting the legs, abdomen, and sometimes the lower back and even higher on the body), and a major cause of edema of the legs.

Heart failure is a term that we use when the heart muscle is weakened and not pumping blood as effectively as it should.  Heart failure is often described as being “right-sided” or “left-sided” depending on which chamber of the heart is most affected.  The “congestive” part refers to the backflow of blood into the veins in the lungs (if it’s “left-sided”) or the legs or lower part of the body (if right-sided”). Some people have right-and left-sided heart failure.

In CHF, there’s fluid congestion in the veins, but that’s not the whole story.  When CHF is chronic, lasting more than a few weeks, it reduces blood flow to the kidneys, and they respond by causing the retention of salt and fluid in the body. This is an especially important factor when treating the edema associated
with CHF.

In CHF, the edema in the lungs, or pulmonary edema, can be much more difficult to live with; it usually causes shortness of breath, coughing, and breathlessness when lying flat to sleep.

CHF treatment frequently involves diuretic medications (also known as “water pills” to relieve symptoms. Some commonly used diuretics used for CHF include furosemide, spironolactone and metalazone. The dosing of diuretics often must be managed  carefully to minimize the potential side effects of low blood pressure, potassium depletion, dehydration, and kidney injury.

People living with CHF are usually advised to restrict their daily fluid and salt intake, weigh themselves frequently, and adjust the daily water pill dose depending on their weight, along with regular bloodwork.

In this article, we won’t go into more detail about CHF, as it’s a complicated topic of its own. The main thing you should know is that if you’ve been concerned about leg swelling in an older person, it’s important to find out if they have a history of heart failure or heart problems, especially if they are also reporting symptoms of shortness of breath.

Medication-related leg edema

Some medications can cause or worsen swollen legs.  or make them worse.  In most cases, the drugs increase fluid and salt retention, causing edema, but for some drugs, such as dihydropyridine calcium channel blockers (like amlodipine) the capillaries become leakier, and in other cases, the exact mechanism for edema isn’t known.  Below is a list of medications that may cause edema.

• Antihypertensive drugs

• Calcium channel blockers

• Beta blockers

• Clonidine

• Hydralazine

• Minoxidil

• Methyldopa

• Hormones

• Corticosteroids

• Estrogen

• Progesterone

• Testosterone

• Other

• Nonsteroidal anti-inflammatory drugs (including over-the-counter painkillers)

• Pioglitazone

• Rosiglitazone

• Monoamine oxidase inhibitors

New or worsened leg swelling should always prompt a medical evaluation, to make sure the swelling isn’t due to a medication side-effect. (To learn more about medications to avoid in aging adults, read this article: Medications Older Adults Should Avoid or Use with Caution).

Liver disease

In cirrhosis of the liver, edema may occur in the lower limbs or, more commonly,  localized to the belly (called ascites).  The liver is where the body makes albumin, a major component of protein in the blood, but in cirrhosis, the damaged liver can no longer maintain adequate production of albumin and other key proteins.  The resulting lower blood protein levels mean that fluid will leak out into the interstitial spaces, which can cause edema and also noticeable swelling of the belly.

Diuretics can be used to help people with cirrhosis, and sometimes drainage of the abdominal ascites is performed, with careful management of blood pressure and electrolyte balance.

Kidney disease

A kidney condition called nephrotic syndrome is associated with protein leaking out into the urine.  This can cause edema in the legs and elsewhere in the body.

A urine dipstick normally checks for protein in the urine, and a more precise check can be done through
a urinalysis.

Lymphedema

Although most fluid in the body moves through blood vessels, the body also has a network of lymphatic vessels, which connect to lymph nodes and move fluid and immune system cells through the body.

Lymphedema means edema caused by fluid overload in the lymphatic vessels, not the veins. When there’s too much fluid for the lymph system to drain, or not enough capacity in the lymphatic channels, swelling is the result.

Lymphedema is most often associated with a history of cancer and/or lymph node surgery, and usually affects one limb, rather than both.  Seventy percent of prostate and breast cancer survivors experience lymphedema as do 80% of those with severe obesity.

This type of edema is treated by elevating the limb as much as possible, the use of compression garments, a special kind of decongestive massage, or microsurgery to enhance the lymphatic system. Of note,  treatment with diuretics (“water pills”) is not usually effective.

How Leg Swelling is Medically Evaluated

What to Tell Your Doctor About Leg Swelling

If you’ve noticed new or worsening leg swelling, it’s important to let your health provider know, so that you can be evaluated.

The doctor should check to make sure that you aren’t suffering from a potentially serious problem (such as one involving the heart, kidney, or liver), and will generally try to determine what is causing the leg swelling.

Questions the doctor will probably ask include:

• How long has the edema been there?

• Is it affecting both legs equally, or one more than the other?

• Is it painful? (Venous edema can cause aches, lymphedema is painless)

• What medications are being taken? Any recent changes?

• Does it get better overnight? Or with elevation of the legs?

• Any shortness of breath? Any difficulty lying flat?

Of course, they will also want to take a complete health history, to know whether you’ve ever had cancer, radiation or surgery to your pelvis or legs, and any known heart, liver or kidney problems.

Signs that more urgent evaluation of leg swelling may be needed

Certain signs and symptoms should prompt a more urgent evaluation. They include:

1. Breathing symptoms: Shortness of breath, cough, and trouble breathing when lying flat might be indicators of pulmonary edema, from CHF or another cause. If a person has these symptoms along with leg swelling, they should seek medical attention right away.

2. Swelling on one side only: Most of the causes of swelling described above will cause both legs to be affected, so if only one leg is swollen, it might be caused by:

• A blood clot, which usually does limited harm in the leg but could break off and travel to the lung causing severe illness or even death,

• Infection

• Blockage related to a tumor

(Of course, if a person has previously had a blood clot or injury to one leg, it may appear quite different from the other leg and the swelling might be chronically asymmetric, so that needs to be considered
as well.)

1. Pain: Most of the time, edema due to CVI is painless, although some people experience discomfort similar to an achy tiredness.  Severe or significant pain should not be ignored. In particular, a sudden severe pain in the legs or the chest is a reason to seek help
   without hesitation.

What Your Doctor Will Do

Your doctor will check for “pitting,” by gently pressing on the swollen area. Pitting occurs when pressure to the swollen area leaves a little depression behind for a few seconds to minutes.  Most causes of edema are pitting, but if there’s no pitting we would think about lymphedema or a fat deposit (lipedema).

A close examination of the legs is vital, to check for any varicose veins, discoloration of the skin, ulcers or breaks in the skin, and skin dryness.  If the legs seem to be different from each other in size, your doctor might measure both limbs to see if there’s true asymmetry.

It’s also important to do an examination of the heart and lungs. Expect your doctor to listen to the breath sounds and heart sounds, and to check your pulse and blood pressure. Doctors will also often examine the belly, to feel the liver and also make sure they don’t see signs of edema outside the legs.

Potential Tests and Additional Evaluation

Based on what you tell the doctor, your past medical history, and what the doctor observes through the physical examination, the doctor will then determine whether additional testing is needed.

Tests that may be ordered include urinalysis (to look for protein in the urine), creatinine (a test of kidney function), TSH (some thyroid conditions lead to edema), glucose,  albumin (a major protein found in the blood) and liver function tests may be ordered. (For more on blood tests, see Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.)

Tests of cardiac function may be a part of the work-up as well, such as a chest x-ray to look for an enlarged heart or fluid in the lungs, or an echocardiogram, which is an ultrasound study to look at the heart chambers and muscle contractility.

D-dimer is a blood test that can help detect a blood clot, and a doppler ultrasound of the leg can usually find a deep vein thrombosis – a common cause of swelling in one leg only.

If your doctor is looking for deeper causes to explain leg swelling, they may refer you for a sleep study.  Sleep apnea, if left untreated, can lead to the right-sided heart failure that we mentioned earlier.

It’s also possible that your doctor might not feel the need to order additional testing. Especially if bloodwork has been done in the past few months and if the symptoms and examination fit with chronic venous insufficiency, it can be reasonable for the doctor to proceed with treatment for this condition.

How Leg Swelling is Treated

As I noted above: most of the time, leg swelling in an older adult is caused by chronic venous insufficiency (CVI), an issue with the leg veins not doing an adequate job to return blood to the heart.

What to know BEFORE starting a “water pill” for leg or ankle swelling

You might think that a diuretic (a “water pill”) will help, and they certainly are often prescribed for this purpose. However, research has shown that they often don’t help much, probably because they don’t really address the underlying issue, which is weak valves in the veins and local fluid overload.

Furthermore, diuretics in older adults can easily cause side effects like dehydration low blood pressure, low potassium levels, and constipation.  They also increase urination, which can cause or worsen urinary continence issues. (For more on these issues, see How to Prevent and Treat Dehydration in Aging Adults and Urinary Incontinence in Aging.)

How to treat chronic venous insufficiency in aging adults

So before starting a water pill, be sure to ask your doctor about the cause of your leg swelling and consider trying these strategies first:

• Elevate the legs: raise your legs to at least the level of your heart for 30 minutes 3 or four times a day – this habit uses gravity to help the veins drain the blood from the lower limbs to return to the heart for circulation.

• Wear stockings: compression stockings with a low pressure (15-20 mmHg of pressure) are readily available at many drug stores and are not too difficult to put on and wear.  The stockings have higher pressure at the ankle which gradually reduces the higher up the leg it goes. Those with more moderate to severe edema may need to be specially measured and fitted for compression socks, which may require a prescription.

• Reduce salt intake: salt (aka sodium) can worsen edema by promoting fluid retention. Lowering salt intake can also reduce the risk of high blood pressure.  Hide the saltshaker and avoid processed food and takeout.

• Exercise the calf muscles: walking and pumping your calves is recommended to reduce the symptoms of CVI and speed the healing of ulcers if present.

Other treatment options for chronic venous insufficiency

• Venoactive agents: these are compounds that act in a variety of ways to relieve CVI symptoms. They improve venous tone, improve lymphatic drainage, fight inflammation, and increase blood viscosity. Examples are horse chestnut seed extract, micronized purified flavonoid fraction (MPFF)and pycnogenol.  A large review of scientific studies of venoactive agents showed that they can reduce swelling.

• Skin care: This may not help with edema but is a critical step to prevent ulcers (skin sores), which can occur as a complication of CVI.

• Ulcer care: ulcers on the legs and feet from CVI can be chronic and hard to treat. A specialized wound care team is often consulted to advise about any topical treatments or surgical procedures that can help with healing.  All of the measures to reduce edema described above will help with ulcer prevention and healing.

Again, the goal of treatment is to manage symptoms and prevent other problems, like ulcers and discomfort.  Most older adults can treat their leg swelling with some of the strategies described above and maintain their usual activities and quality of life.

Treatment of Leg Edema from Other Causes

If edema is not due to CVI, the treatment plan will target the underlying problem, whether it’s heart failure, a medication side effect, a kidney issue, or liver disease.

The Take-Home Messages about Leg Swelling:

Edema (or swelling) of the lower limbs is common in older adults.  The most common cause (about 70%) of leg edema is due to Chronic Venous Insufficiency (CVI).

Other serious causes of edema include congestive heart failure, kidney disease, and liver disease. Always be sure to get evaluated for new or worsened leg swelling, to make sure one of these more serious medical problems isn’t at hand.

If the leg swelling is present in one leg only, or if there’s a lot of pain, or if you notice other serious symptoms along with the leg swelling (shortness of breath, chest pain, cough or trouble breathing when lying flat), this could be a sign of an urgent problem which needs medical attention right away.

But again, most leg swelling in aging adults is chronic venous insufficiency. The ideal management of this chronic condition includes “lifestyle” measures such as elevating the legs regularly, using compression stockings, reducing salt intake,  and doing exercises which improve fluid movement in the legs.

It’s important to get help from your health providers to manage CVI, because without treatment, it can cause complications such as ulcers (skin sores), infections, and reductions in quality of life.

Diuretic medications (“water pills”) can sometimes help  to reduce edema from CVI, but the side effects can be serious: dehydration, potassium depletion, urinary incontinence and low blood pressure. So geriatricians recommend using these medications with caution in older adults. They are also not a substitute for the lifestyle measures listed above.

To learn more about edema, here are some useful links:

• VIDEO: What Causes Swollen Legs with Dr. Didyk

• Treatment of edema (American Family Physician Review)

• Patient education: Low-sodium diet (Beyond the Basics)

• Patient education: Edema (swelling) (Beyond the Basics)

• Phlebotonics for venous insufficiency – Martinez-Zapata, MJ – 2020 | Cochrane Library

• Chronic Venous Insufficiency | Circulation (ahajournals.org)

If you have swollen legs, you’re not alone and there are strategies you can use, without medications, to reduce the symptoms of edema.  Like everything, being consistent is key.

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500
Content Credits: Nicole Didyk | Better Health While Aging

10 Tricks for Getting Enough Fruits and Veggies

Fruits and vegetables are particularly important for older adults, but incorporating them into your diet can be difficult.

You know fruits and veggies are good for you, and yet filling your plate with produce is easier said than done. Fret not: If you consistently fall short of this goal, you’re not alone.

Despite the familiar refrain of nutrition experts (eat more fruits and vegetables), produce consumption has fallen over the past six years, according to the Produce for Better Health Foundation's 2020 State of the Plate report. Adults ages 50 and older, who typically eat the most fruits and vegetables, have shown the most significant declines.

Eating plenty of fruits and vegetables is important at any age, because produce is a top source of fiber and other nutrients that are necessary for good health. Many of those nutrients have been shown to help prevent or lower the risk of the illnesses that occur as we advance
in years.

“As we age, our bodies become more susceptible to chronic diseases, such as heart conditions, gastrointestinal disorders, obesity, and a weakened immune system,” says the New York City–based dietitian Aderet Dana Hoch, RD, who runs the blog Dining With Nature. A diet with plenty of fruits and vegetables can help reduce high blood pressure, lower your risk of heart disease, stroke, and certain cancers, stave off digestive problems, and help you maintain a healthy body weight.

That’s not all. The ascorbic acid in many fruits can help with iron absorption, which is a common problem for many older adults, according to Harvard Health. There has even been research linking increased intake of fruits and vegetables with lower incidence of dementia and cognitive decline. A study published in 2017 in Frontiers in Aging Neuroscience looked at nine studies and found a significant association between eating fruit and vegetables regularly and maintaining better cognitive function after age 65.

How Big Is 1 Serving of Fruit or Vegetables?

The four and a half servings of fruits and vegetables per day recommended by the most recent U.S. Dietary Guidelines may sound like a lot, but it’s probably not as much as you think. Hoch says that a good guideline is to think about the amount of produce you can hold in one cupped hand — that’s about a half cup, or one serving.

Hoch says that the best nutritional strategy is to aim for variety. Eating as many different types of fruits and vegetables as you can will help ensure that you get the variety of nutrients your body needs for healthy aging.

Why You May Be Struggling to Eat Enough Produce

Even though we know how essential fruits and vegetables are, the majority of American adults still struggle to get their fill. And certain factors can make it more challenging for older adults. Here are some of the reasons.

Cost Being on a limited budget may be a concern. If that’s the case, you may want to try adding more frozen or canned options, since they might be more affordable. They have similar nutrition to fresh produce, says Shena Jaramillo, RD, who is based in Ellensburg, Washington, and runs the blog Peace and Nutrition. Just check labels and avoid products with excess sodium or added sugar.

Access Food deserts, where grocery stores don’t exist, or food swamps, where there's mainly fast food, can make access to healthy produce challenging. Because of that, Jaramillo suggests finding a way to stock up every so often, such as doing a carpool shopping trip with friends to a large grocer that’s outside your immediate neighborhood.

Mobility problems For older people who are no longer able to drive, it may be difficult to get out and shop for fresh produce, says Jaramillo. That’s true for anyone with mobility issues, but there are some ways to overcome those challenges, such as using a grocery delivery service. Most major retailers offer such services, including Amazon Fresh, Instacart, Walmart, and many others.

Age-related health changes As you get older, you may find that your sense of taste isn’t as keen, you don’t tolerate certain foods as well, or that your appetite overall has diminished, says Jaramillo. Some people have dental problems that make it harder to chew certain foods. While these are all things that happen naturally as we age, they can make it difficult to get all the foods and nutrients we need. That’s why it’s important to make every bite count.

Meeting Your Healthy Eating Goal for Fruits and Vegetables

Follow these simple tips from Hoch to increase the amount of fruits and vegetables you eat each day.

Add fruits and vegetables to your favorite dishes. Find ways to incorporate fruits and vegetables into foods you already eat, Hoch suggests. For example, stir fruit into your cereal or yogurt, add strawberries or blueberries to your pancakes, pack your sandwich with extra veggies, add vegetable toppings to your pizza, stir greens into your favorite casserole or pasta dish, or stuff your omelet with extra vegetables. There are plenty of cookbooks to get you started, such as The Complete Plant-Based Cookbook for Beginners by Jordan Worthen, or How to Cook Everything Vegetarian by Mark Bittman.

Clean out your junk food cabinet. Researchers compared the food choices people made when given three options: an equal number of healthy and unhealthy foods, more healthy foods, or more unhealthy foods. The results, which were published in BMC Public Health in November 2018, indicated that eliminating the less-healthy options was more likely to result in healthy choices than any other scenario. So stocking plenty of produce is good, but eliminating junk food alternatives will seal the deal.

Make a list of your favorite vegetable-rich recipes. Keep a collection of recipes handy to serve as a resource when you make your shopping list, Hoch suggests. Pick out three or four to buy for in a week. Apps like BigOven or Paprika can help you find, save, and organize recipes and develop shopping lists.

Try new things. Next time you go to the grocery store, pick out a new fruit or vegetable to try. Better yet, sign up for regular produce deliveries from your local CSA. Community supported agriculture supports local farmers and gives you a surprise assortment of whatever’s growing. Check out FairShare to find one near you.

Cook vegetarian. At least once every week, skip the meat (you could join in on Meatless Monday) and try a new vegetarian recipe for dinner.

According to a study published in the Journal of the American Heart Association in August 2019, plant-based diets were associated with lower risks of cardiovascular disease as well as lower mortality from all causes. You can find recipes at The Post Punk Kitchen or It Doesn’t Taste Like Chicken.

Snack away. Try snacking on fresh or dried fruit. Hoch says to check labels to make sure there’s no sugar added. Try carrot and bell pepper strips with a low-fat dip, or baked chips with fresh salsa.

Have canned and frozen options on hand. These are just as nutrient dense as fresh, says Jaramillo, and they are often more cost-efficient as well. Just be sure to read labels — sometimes canned options can have lots of added sodium or sugar.

Consider a fruit smoothie in the morning. You can easily pile fruits and veggies into a healthy smoothie, says Jaramillo, and even “hide” the tastes you may not love, like spinach or kale.

Think seasonally. Take advantage of fruits and vegetables in season when you can, Hoch suggests, and that might mean visiting a farmers market and becoming aware of what’s available when.

Do more meal prep. Chopping up a few vegetables in advance and storing them in your fridge can make you more likely to reach for them when throwing together meals, says Hoch.

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Krisha McCoy and Elizabeth Millard | Everyday Health

How to Move Forward After Being Diagnosed With an Incurable Disease

Learning that you have an incurable disease is bound to be quite a shock. Give yourself some time to process the news and come to terms with your diagnosis. Once you feel ready, face your conduction head-on with a plan to move forward. Charting a course of action can help you cope with your condition and find ways to live with the accompanying symptoms. Below, we share some of the next steps you should take after receiving your diagnosis.

Aroga Home Care Services can give your senior loved one high-quality care and attention. Contact us to find out how we can help. 

Organize Your Medical Files

Keeping your medical files organized will help you advocate for yourself as you navigate the healthcare system. GoodRx Health explains that organizing your own medical records will help you better understand your health needs and access important information on demand. This will also make it easier to move between doctors and specialists while maintaining consistency in your care.

PDFs are the preferred file format for storing and sharing medical information. If your medical documents exist in other file formats, such as Microsoft Word or Excel, use a PDF converter. The PDF converter lets you drag and drop your files into the converter and download your new PDFs to your device.

Review Your Health Insurance Policy

Try to review your health insurance policy as soon as possible after receiving your diagnosis. You may need to make changes to your coverage, especially if you require expensive medications, tests, or treatments. If you work as a freelancer and don’t have medical coverage, start researching your insurance options. Ideally, you would be able to join your partner’s employment health insurance plan. Otherwise, look for health plans through the marketplace or the Freelancer’s Union.

Move into an Accessible Home

Certain incurable illnesses can make day-to-day life more challenging. Living in an accessible home is a great way to overcome these challenges and maintain your independence. Consider selling your home and moving into a new place that better accommodates your needs. For example, a single-story home with an open floor plan might be easier to navigate if you require a walker or wheelchair. 

Research your local real estate market to learn about local home prices in your area. This will also help you determine whether or not now is a good time to sell. If you’d prefer to rent, there are over 600 homes for rent in the Charlotte area at a variety of price points.

Improve Your Sleep Quality

Incurable illnesses that cause pain can wreak havoc on your sleep quality. Medications that are prescribed for pain and other conditions can further interfere with sleep patterns. But getting enough high-quality sleep every night is essential to your mental and physical well-being. According to Swedish.org, research shows that more hours of sleep correlate with lower levels of pain. Creating a cool, dark, and comfortable bedroom environment is one of the first things you should do to improve your sleep quality.

Create a Stress Coping Plan

Living with an incurable illness is undeniably stressful. Come up with a plan to cope with stress so you can focus on living your life. Take everything one day at a time, breaking up your treatment into steps. Schedule activities into your calendar that don’t revolve around your condition—things you really want to do and look forward to. Don’t hesitate to lean on friends and family when you need help and support. Finally, remember to practice self-compassion. Try developing a gratitude practice and seeking resources on mindfulness and acceptance. 

No one is ever ready to receive a diagnosis of a chronic illness. Once you’ve come to terms with your diagnosis, make a plan to face your illness moving forward. Organize your medical documents into PDF files, review your health insurance policy, consider moving into an accessible home, and take steps to improve your sleep quality. 

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Jennifer Scott | SpiritFinder.org

Home Care Versus Assisted Living - Breaking Down a Critical Decision

If you or a loved one are facing this decision, it can be overwhelming and emotional.  Can you or your loved receive proper care at home, or would it be best to move into an assisted
living facility.

What Are Assisted Living Homes?

Assisted living homes are best for individuals who require very little senior care daily. This means that most assisted living homes provide residents with some help accomplishing various tasks such as organizing medications, but they don’t offer full-time long-term care. These are not nursing facilities you may have seen in the news during the COVID-19 crisis.

There are almost 30,000 assisted living homes in the United States. These facilities currently house approximately 1.2 million residents. Most of these residents are mobile individuals over the age of 65 living full lives with just a little help with day-to-day chores.

Those who need a wheelchair to move around or suffer from behavioral or cognitive impairments are typically discouraged from moving to an assisted living facility since they require more specialized care. 

Maintaining Independence

Assisted living homes allow residents to maintain their independence as long as possible without compromising their safety. They support residents’ privacy, autonomy and dignity while focusing on community and family involvement.

Most assisted living homes also promote a resident’s right to interact and socialize with people both in and out of the facilities, to participate in residential councils, to continue using personal possessions and to manage their own finances.

Visitors can typically come to an assisted living facility at any time of the day and even stay overnight. Pets are also allowed in many assisted living homes.

Residence and Services

People living in an assisted living home typically live in their own private or semi-private apartments. These residences usually include a bedroom, bathroom and kitchen area. Residents get daily assistance with normal tasks such as eating, dressing and bathing. Dining programs offer meals three times daily, and activities for exercise and education are common.

Other assisted living services may include housekeeping, health services, recreational activities, laundry services, social and religious activities, transportation services, third-party nursing care through a home health agency, 24-hour security and wellness programs.

What Is In-Home Care?

The in-home caregiver is one of the fastest growing and most requested services in the United States today. Agencies providing in-home care offer a range of different services from simple companionship to supervision and personal care. In-home caregivers are appropriate for individuals who want to stay at home, but also need ongoing care that family members and friends cannot provide. This care can be augmented with a Medical Alert System.

It allows seniors to age in the comfort of their own home. Most in-home care plans include a combination of assisted living, or non-medical, services and skilled health care services. In the past, there was no significant difference between “home health care” and “in-home care”; however, many people now refer to home health care when skilled nursing care is involved and in-home care when only non-medical care is required.

While those differences may seem insignificant, they are important, as they help people understand the level of care being offered.

Non-Medical Care Services Typically Include:

• Personal care

• Companionship

• Supervision

• Laundry

• Light housekeeping

• Meal preparation

• Medication reminders

• Shopping

• Errands

• Transportation

Tips to Help You Choose

Even if you thoroughly understand the details of how assisted living homes and in-home care work, that does not mean this is an easy decision. This is an important step in your life or the life of your loved one, and you want to make sure you make the right choice logically, not emotionally.  To do this:

• Determine how much help you (or your loved one) needs Make a list of everything your loved one needs assistance with on a monthly, weekly and daily basis. This will give you a clear picture of the right level of care required.

• Compare those needs to the help that is already available. Then you need to realistically assess how much family and friends can help. It is essential that you look at this based on the long-term.

After critically comparing lists, you will have a better idea of how much additional help will be required. This may make your decision on in-home care or assisted living immediately clear, and it may not. Either way, it will be a very helpful tool as you continue.

Evaluate the Pros and Cons

Obviously, both assisted living homes and in-home care services offer some great benefits, but both also have disadvantages based on your specific situation. As with any comparison, a simple pro and con analysis can be valuable.

In-Home Care Pros

• One-on-one care tailored to meet unique preferences and needs.

• Remaining in the comfort of home and familiar community.

• The ability to choose the person who will be providing care.

• One consistent caregiver rather than several.

• May be more affordable.

• Different types of care can be combined to lower overall costs.

In-Home Care Cons

• If 24/7 care is required, it can be very costly.

• Managing caregivers and backup care planning requires family involvement.

• While living in the home has its benefits, it can also lead to social isolation.

• The home may need to be modified for wheelchair accessibility and safety.

Assisted Living Pros

• Assisted living homes are more affordable when 24/7 care is required.

• Residents have ample opportunities to socialize with others.

• The family will not have to manage, schedule or hire caregivers.

• The level of care can easily be increased as necessary.

Assisted Living Cons

• Due to frequent staff turnover, one-on-care won’t be as consistent.

• The quality of care can differ depending on the specific staff members.

• Residents may be asked to leave for a long list of reasons with little to no
  advanced notice.

• Your loved one may simply not enjoy living in a group environment.

Although deciding between assisted living homes and home care can be stressful, if you look at it critically and on paper, you and your loved ones may be able to embrace whatever decision you make more readily. If you determine an assisted living environment is best, do your research, there is a vast difference in quality, services and pricing.  

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Today’s Caregiver

8 Tips to Keep Your Brain Sharp and Healthy as You Age

So you’ve noticed some changes in your thinking. Perhaps you often misplace your keys or have trouble coming up with the right word in conversations. 

Before you assume you’re developing a serious health problem, such as dementia, be aware that your brain changes with age, both in terms of its size and structure, and these differences can, and usually do, impact how well it works over time.

However, there are steps you can take to help preserve functions such as memory, even as your brain shrinks in volume and its nerve cells decline in size and ability to communicate with one another.

Based on currently available research, these eight tips can help you remain mentally sharp
as you get older:

1. Control Your Cholesterol and Blood Pressure Levels

High cholesterol and high blood pressure increase your risk of heart disease and stroke, which are thought to contribute to the development of certain types of dementia, or severe
memory loss.

Good cardiovascular health — which means having healthy blood sugar, cholesterol, and blood pressure levels, along with maintaining a healthy weight — is associated with better cognitive function, according to a study published in 2021 in the Journal of Alzheimer’s Disease.

Your doctor can let you know whether your levels are in a healthy range, as well as what steps you can take to improve or maintain your cardiovascular health. 

2. Don’t Smoke or Drink Excessive Amounts of Alcohol

Because smoking and drinking too much both put you at an increased risk of dementia, according to the Alzheimer’s Association, if you smoke, it’s best to quit, and if you drink, to do so only in moderation.

The Dietary Guidelines for Americans defines moderate drinking as less than two drinks per day for men and less than one per day for women, on days when alcohol is consumed. A “drink” equals 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of distilled spirits or liquor.

Underscoring the importance of limiting your alcohol intake, a study published in July 2022 found that alcohol consumption above seven units per week is associated with higher brain iron, which in turn is associated with worse cognitive function. Seven units of alcohol is about the amount in four bottles of beer or three standard glasses of wine.

3. Exercise Regularly

Regular physical activity is thought to help maintain blood flow to the brain and reduce your risk of conditions such as high blood pressure that are associated with
developing dementia. 

A study published in 2020 found additional positive effects of exercise on the brain and concluded that promoting a physically active lifestyle in older adults could potentially delay about one-third of dementia
cases worldwide. 

At any age, it’s important to choose activities you feel comfortable doing, and to build up the time and intensity of your workouts gradually.

4. Maintain a Healthy Diet

What you eat can make a big difference in how well you think and remember things.

Foods containing nutrients such as vitamin E, B vitamins, and omega-3 fatty acids have been linked with improved cognitive function, a review of previously published studies found. Conversely, consuming foods that are high in saturated fats can negatively impact memory and other brain functions, according to a review published in May 2022. 

Based on these findings, it’s best if your diet emphasizes foods such as green leafy vegetables, other vegetables, berries, and seafood. Eating plans like the Mediterranean diet, which features vegetables, healthy fats like olive oil, and omega-3 fatty acids from fish, or the DASH (Dietary Approaches to Stop Hypertension) diet, which focuses on fruits and veggies, fat-free or low-fat dairy, whole grains, and lean meats, are good choices for overall good health. 

A newer diet called MIND (Mediterranean–DASH Intervention for Neurodegenerative Delay) incorporates many elements of the Mediterranean and DASH diets but with modifications to maximize the positive effects on brain function, says Rush University Medical Center
in Chicago. 

The MIND diet includes 10 brain-healthy food groups: green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine. And it limits five unhealthy groups: red meats, butter and stick margarine, cheese, pastries and sweets, and fried food and fast food.

5. Stimulate Your Brain

Having a mentally stimulating job and doing other activities that engage your brain may help build cognitive reserve — or the ability to function well in spite of brain diseases or other challenges — according to the Alzheimer’s Association. 

You can also keep your mind active by learning new skills. Acquiring skills in later life, including those related to adopting new technologies, may have the potential to reduce or delay cognitive changes associated with aging, a review of earlier studies published in 2021 found.

6. Socialize More

Making new friends or spending time with the ones you have might be good for your brain. A study published in 2021 that looked at older adults in Japan found that participants with consistently high or increased social engagement had a lower risk of dementia than those with consistently low social engagement.

7. Stay Sexually Active

Sexual intimacy — however you define it — can be pleasurable at any age, and a study published in 2017 actually linked weekly sexual activity with improved cognitive function in adults ages 50 to 83. Sex may increase the release of certain brain chemicals that boost cognitive function, the authors suggest. Consistent sexual activity may also be indicative of someone who is physically, mentally, and socially engaged, they say.

8. Play Brain Games

Playing brain or memory games — and even playing games in general — can help keep the brain healthy. Although these games won’t offset the brain changes that come with aging, they may help test and train your memory, experts say. In addition, playing games with friends and family can also be part of an active social life, which has its own brain benefits. 

“Brain training games” — or computerized cognitive training games designed specifically to exercise memory, attention, speed, flexibility, and problem-solving — can be fun, and may also help, but studies on their role in reducing dementia risk have yielded mixed results.

When to Seek Help for Fuzzy Thinking or Forgetfulness

Although these steps can help keep your brain healthy, they won’t reverse the effects of dementia. If you or a loved one is experiencing memory loss or other cognitive symptoms that interfere with normal activities and relationships, talk to your doctor.

Some signs you may be experiencing memory loss that’s beyond what’s normally seen with aging include:

• Asking questions repeatedly 

• Forgetting or mixing up common words when speaking

• Taking longer to complete normal daily tasks, such as following a recipe or
  assembly instructions

• Misplacing items in inappropriate places, such as putting keys in the medicine cabinet 

• Becoming lost while walking or driving in an area that’s familiar to you 

• Unexplained mood and behavior changes

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Everyday Health

What’s A Tremor

Tremor is an involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body. It is a common movement disorder that most often affects the hands but can also occur in the arms, head, vocal cords, torso, and legs. Tremor may be intermittent (occurring at separate times, with breaks) or constant. It can occur sporadically (on its own) or happen as a result of another disorder.

Tremor is most common among middle-aged and older adults, although it can occur at any age. The disorder generally affects men and women equally.

Tremor is not life threatening. However, it can be embarrassing and even disabling, making it difficult or even impossible to perform work and daily life tasks.

WHAT CAUSES TREMOR?

Generally, tremor is caused by a problem in the deep parts of the brain that control movements. Most types of tremor have no known cause, although there are some forms that appear to be inherited and run in families.

Tremor can occur on its own or be a symptom associated with a number of neurological disorders, including:

• multiple sclerosis

• stroke

• traumatic brain injury

• neurodegenerative diseases that affect parts of the brain (e.g., Parkinson's disease).

Some other known causes can include:

• the use of certain medicines (particular asthma medication, amphetamines, caffeine, corticosteroids, and drugs used for certain psychiatric and neurological disorders)

• alcohol abuse or withdrawal

• mercury poisoning

• overactive thyroid

• liver or kidney failure

• anxiety or panic.

HOW IS TREMOR CLASSIFIED

Tremor can be classified into two main categories:

Resting tremor occurs when the muscle is relaxed, such as when the hands are resting on the lap. With this disorder, a person’s hands, arms, or legs may shake even when they are at rest. Often, the tremor only affects the hand or fingers. This type of tremor is often seen in people with Parkinson’s disease and is called a “pillrolling” tremor because the circular finger and hand movements resemble rolling of small objects or pills in the hand.

Action tremor occurs with the voluntary movement of a muscle. Most types of tremor are considered action tremor. There are several sub-classifications of action tremor, many of which overlap.

• Postural tremor occurs when a person maintains a position against gravity, such as holding the arms outstretched.

• Kinetic tremor is associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.

• Intention tremor is produced with purposeful movement toward a target, such as lifting a finger to touch the nose. Typically the tremor will become worse as an individual gets closer to their target.

• Task-specific tremor only appears when performing highly-skilled, goal-oriented tasks such as handwriting or speaking.

• Isometric tremor occurs during a voluntary muscle contraction that is not accompanied by any movement such as holding a heavy book or a dumbbell in the same position.

WHAT ARE THE DIFFERENT CATEGORIES OF TREMOR?

Tremor is most commonly classified by its appearance and cause or origin. There are more than 20 types of tremor. Some of the most common forms of tremor include:

Essential tremor

Essential tremor (previously also called benign essential tremor or familial tremor) is one of the most common movement disorders. The exact cause of essential tremor is unknown. For some people this tremor is mild and remains stable for many years. The tremor usually appears on both sides of the body, but is often noticed more in the dominant hand because it is an action tremor.

The key feature of essential tremor is a tremor in both hands and arms, which is present during action and when standing still. Additional symptoms may include head tremor (e.g., a “yes” or “no” motion) without abnormal posturing of the head and a shaking or quivering sound to the voice if the tremor affects the voice box. The action tremor in both hands in essential tremor can lead to problems with writing, drawing, drinking from a cup, or using tools or a computer.

Tremor frequency (how “fast” the tremor shakes) may decrease as the person ages, but the severity may increase, affecting the person’s ability to perform certain tasks or activities of daily living. Heightened emotion, stress, fever, physical exhaustion, or low blood sugar may trigger tremor and/or increase its severity. Though the tremor can start at any age, it most often appears for the first time during adolescence or in middle age (between ages 40 and 50). Small amounts of alcohol may help decrease essential tremor, but the mechanism behind this is unknown.

About 50 percent of the cases of essential tremor are thought to be caused by a genetic risk factor (referred to as familial tremor). Children of a parent who has familial tremor have greater risk of inheriting the condition. Familial forms of essential tremor often appear early in life.

For many years essential tremor was not associated with any known disease. However, some scientists think essential tremor is accompanied by a mild degeneration of certain areas of the brain that control movement. This is an ongoing debate in the research field.

Dystonic tremor

Dystonic tremor occurs in people who are affected by dystonia—a movement disorder where incorrect messages from the brain cause muscles to be overactive, resulting in abnormal postures or sustained, unwanted movements. Dystonic tremor usually appears in young or middle-aged adults and can affect any muscle in the body. Symptoms may sometimes be relieved by complete relaxation.

Although some of the symptoms are similar, dystonic tremor differs from essential tremor in some ways. The dystonic tremor:

• is associated with abnormal body postures due to forceful muscle spasms or cramps

• can affect the same parts of the body as essential tremor, but also—and more often than essential tremor—the head, without any other movement in the hands or arms

• can also mimic resting tremor, such as the one seen in Parkinson’s disease.

• Also, the severity of dystonic tremor may be reduced by touching the affected body part or muscle, and tremor movements are “jerky” or irregular instead of rhythmic.

Cerebellar tremor

Cerebellar tremor is typically a slow, high-amplitude (easily visible) tremor of the extremities (e.g., arm, leg) that occurs at the end of a purposeful movement such as trying to press a button. It is caused by damage to the cerebellum and its pathways to other brain regions resulting from a stroke or tumor. Damage also may be caused by disease such as multiple sclerosis or an inherited degenerative disorder such as ataxia (in which people lose muscle control in the arms and legs) and Fragile X syndrome (a disorder marked by a range of intellectual and developmental problems). It can also result from chronic damage to the cerebellum due to alcoholism.

Psychogenic tremor

Psychogenic tremor (also called functional tremor) can appear as any form of tremor. It symptoms may vary but often start abruptly and may affect all body parts. The tremor increases in times of stress and decreases or disappears when distracted. Many individuals with psychogenic tremor have an underlying psychiatric disorder such as depression or post-traumatic stress disorder (PTSD).

Physiologic tremor

Physiologic tremor occurs in all healthy individuals. It is rarely visible to the eye and typically involves a fine shaking of both of the hands and also the fingers. It is not considered a disease but is a normal human phenomenon that is the result of physical properties in the body (for example, rhythmical activities such as heart beat and muscle activation).

Enhanced physiologic tremor

Enhanced physiological tremor is a more noticeable case of physiologic tremor that can be easily seen. It is generally not caused by a neurological disease but by reaction to certain drugs, alcohol withdrawal, or medical conditions including an overactive thyroid and hypoglycemia. It is usually reversible once the cause is corrected.

Parkinsonian tremor

Parkinsonian tremor is a common symptom of Parkinson’s disease, although not all people with Parkinson’s disease have tremor. Generally, symptoms include shaking in one or both hands at rest. It may also affect the chin, lips, face, and legs. The tremor may initially appear in only one limb or on just one side of the body. As the disease progresses, it may spread to both sides of the body. The tremor is often made worse by stress or strong emotions. More than 25 percent of people with Parkinson’s disease also have an associated action tremor.

Orthostatic tremor

Orthostatic tremor is a rare disorder characterized by rapid muscle contractions in the legs that occur when standing. People typically experience feelings of unsteadiness or imbalance, causing them to immediately attempt to sit or walk. Because the tremor has such a high frequency (very fast shaking) it may not visible to the naked eye but can be felt by touching the thighs or calves or can be detected by a doctor examining the muscles with a stethoscope. In some cases the tremor can become more severe over time. The cause of orthostatic tremor is unknown.

HOW IS TREMOR DIAGNOSED

Tremor is diagnosed based on a physical and neurological examination and an individual’s medical history. During the physical evaluation, a doctor will assess the tremor based on:

• whether the tremor occurs when the muscles are at rest or in action

• the location of the tremor on the body (and if it occurs on one or both sides of
  the body)

• the appearance of the tremor (tremor frequency and amplitude).

The doctor will also check other neurological findings such as impaired balance, speech abnormalities, or increased muscle stiffness. Blood or urine tests can rule out metabolic causes such as thyroid malfunction and certain medications that can cause tremor. These tests may also help to identify contributing causes such as drug interactions, chronic alcoholism, or other conditions or diseases. Diagnostic imaging may help determine if the tremor is the result of damage in the brain.

Additional tests may be administered to determine functional limitations such as difficulty with handwriting or the ability to hold a fork or cup. Individuals may be asked to perform a series of tasks or exercises such as placing a finger on the tip of their nose or drawing a spiral.

The doctor may order an electromyogram to diagnose muscle or nerve problems. This test measures involuntary muscle activity and muscle response to nerve stimulation.

HOW IS TREMOR TREATED?

Although there is no cure for most forms of tremor, treatment options are available to help manage symptoms. In some cases, a person’s symptoms may be mild enough that they do not require treatment.

Finding an appropriate treatment depends on an accurate diagnosis of the cause. Tremor caused by underlying health problems can sometimes be improved or eliminated entirely with treatment. For example, tremor due to thyroid hyperactivity will improve or even resolve (return to the normal state) with treatment of thyroid malfunction. Also, if tremor is caused by medication, discontinuing the tremor-causing drug may reduce or eliminate this tremor.

If there is no underlying cause for tremor that can be modified, available treatment options include:

MEDICATION

Beta-blocking drugs such as propranolol are normally used to treat high blood pressure but they also help treat essential tremor. Propranolol can also be used in some people with other types of action tremor. Other beta-blockers that may be used include atenolol, metoprolol, nadolol, and sotalol.

Anti-seizure medications such as primidone can be effective in people with essential tremor who do not respond to beta-blockers. Other medications that may be prescribed include gabapentin and topiramate. However, it is important to note that some anti-seizure medications can cause tremor.

Tranquilizers (also known as benzodiazepines) such as alprazolam and clonazepam may temporarily help some people with tremor. However, their use is limited due to unwanted side effects that include sleepiness, poor concentration, and poor coordination. This can affect the ability of people to perform daily activities such as driving, school, and work. Also, when taken regularly, tranquilizers can cause physical dependence and when stopped abruptly can cause several withdrawal symptoms.

Parkinson’s disease medications (levodopa, carbidopa) are used to treat tremor associated with Parkinson's disease.

Botulinum toxin injections can treat almost all types of tremor. It is especially useful for head tremor, which generally does not respond to medications. Botulinum toxin is widely used to control dystonic tremor. Although botulinum toxin injections can improve tremor for roughly three months at a time, they can also cause muscle weakness. While this treatment is effective and usually well tolerated for head tremor, botulinum toxin treatment in the hands can cause weakness in the fingers. It can cause a hoarse voice and difficulty swallowing when used to treat voice tremor.

FOCUSED ULTRASOUND

A new treatment for essential tremor uses magnetic resonance images to deliver focused ultrasound to create a lesion in tiny areas of the brain’s thalamus thought to be responsible for causing the tremors. The treatment is approved only for those individuals with essential tremor who do not respond well to anticonvulsant or beta-blocking drugs.

Surgery

When people do not respond to drug therapies or have a severe tremor that significantly impacts their daily life, a doctor may recommend surgical interventions such as deep brain stimulation (DBS) or very rarely, thalamotomy. While DBS is usually well tolerated, the most common side effects of tremor surgery include dysarthria (trouble speaking) and
balance problems.

Deep brain stimulation (DBS) is the most common form of surgical treatment of tremor. This method is preferred because it is effective, has low risk, and treats a broader range of symptoms than thalamotomy. The treatment uses surgically implanted electrodes to send high-frequency electrical signals to the thalamus, the deep structure of the brain that coordinates and controls some involuntary movements. A small pulse generating device placed under the skin in the upper chest (similar to a pacemaker) sends electrical stimuli to the brain and temporarily disables the tremor. DBS is currently used to treat parkinsonian tremor, essential tremor, and dystonia.

Thalamotomy is a surgical procedure that involves the precise, permanent destruction of a tiny area in the thalamus. Currently, surgery is replaced by radiofrequency ablation to treat severe tremor when deep brain surgery is contraindicated—meaning it is unwise as a treatment option or has undesirable side effects. Radiofrequency ablation uses a radio wave to generate an electric current that heats up a nerve and disrupts its signaling ability for typically six or more months. It is usually performed on only one side of the brain to improve tremor on the opposite side of the body. Surgery on both sides is not recommended as it can cause problems with speech.

LIFESTYLE CHANGES

Physical therapy may help to control tremor. A physical therapist can help people improve their muscle control, functioning, and strength through coordination, balancing, and other exercises. Some therapists recommend the use of weights, splints, other adaptive equipment, and special plates and utensils for eating.

Eliminating or reducing tremor-inducing substances such as caffeine and other medication (such as stimulants) can help improve tremor. Though small amounts of alcohol can improve tremor for some people, tremor can become worse once the effects of the alcohol wear off.

What is the prognosis?

Tremor is not considered a life-threating condition. Although many cases of tremor are mild, tremor can be very disabling for other people. It can be difficult for individuals with tremor to perform normal daily activities such as working, bathing, dressing, and eating. Tremor can also cause “social disability.” People may limit their physical activity, travel, and social engagements to avoid embarrassment or other consequences.

The symptoms of essential tremor usually worsen with age. Additionally, there is some evidence that people with essential tremor are more likely than average to develop other neurodegenerative conditions such as Parkinson’s disease or Alzheimer’s disease, especially in individuals whose tremor first appears after age 65.

Unlike essential tremor, the symptoms of physiologic and drug-induced tremor do not generally worsen over time and can often be improved or eliminated once the underlying causes are treated.

WHAT RESEARCH IS BEING DONE?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

Researchers are working to better understand the underlying brain functions that cause tremor, identify the genetic factors that make individuals more susceptible to the disorder, and develop new and better treatment options.

Brain Functioning

It can be difficult to distinguish between movement disorders such as Parkinson's disease and essential tremor. These debilitating movement disorders have different prognoses and can respond very differently to available therapies. NINDS researchers are working to identify structural and functional changes in the brain using non-invasive neuroimaging techniques to develop sensitive and specific markers for each of these diseases and then track how they change as each disease progresses.

Other researchers are using functional magnetic resonance imaging technology to better understand normal and diseased brain circuit functions and associated motor behaviors. Scientists hope to design therapies that can restore normal brain circuit function in diseases such as Parkinson's disease and tremor.

Genetics

Research has shown that essential tremor may have a strong genetic component affecting multiple generations of families. NINDS researchers are building on previous genetics work to identify susceptibility genes for familial early-onset (before age 40) essential tremor. Researchers are focusing on multigenerational, early onset families to better detect linkages.

Additionally, NINDS scientists are researching the impact of genetic abnormalities on the development of essential tremor. Previous research that has shown a link between essential tremor and possible genetic variants on chromosome 6 and 11; ongoing research is targeting the impact of other genetic variations in families.

Medications and other treatment methods

While drugs can be effective for some people, approximately 50 percent of individuals do not respond to medication. In order to develop assistive and rehabilitative tremor-suppressing devices for people with essential tremor, researchers are exploring where and how to minimize or suppress tremor while still allowing for voluntary movements.

Many people with essential tremor respond to ethanol (alcohol); however, it is not clear why or how. NINDS researchers are studying the impact of ethanol on tremor to determine the correct dosage amount and its physiological impact on the brain and whether other medications without the side effects of ethanol can be effective.

Other NIH researchers hope to identify the source of essential tremor, study the effects of currently available tremor-suppressant drugs on the brain, and develop more targeted and effective therapies.

Aroga Home Care Services is your go to 5-star rated private duty skilled caregiver agency in the greater Charlotte area. Contact us today and request a professional home care adviser consultation.  www.ArogaHomeCare.com or call 704-319-5500

Content Credits: Today’s Caregiver