Yearly Archives: 2020

Does Having Alzheimer’s Disease and Dementia Affect Severity of Delirium?

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Journal of the American Geriatrics Society Research Summary

Forms of dementia, including Alzheimer’s disease, gradually affect your cognitive function by harming your memory and your ability to think and make decisions. By 2050, experts project that 13.8 million older adults in the United States will develop Alzheimer’s disease and related Dementias (ADRD). Although Alzheimer’s disease is the most common form of dementia, other forms include Lewy Body dementia, frontotemporal dementia, and vascular dementia—all of which have upsetting consequences for people with dementia and their families.

Since no cure or treatment yet exists for ADRD, healthcare providers currently focus on preventing the treatable risk factors that can lead to dementia. This strategy could potentially slow the onset and progression of ADRD.

Hospitalization poses risks to people with ADRD and can have life-threatening consequences, including predisposing us to delirium (the medical term for a rapid change in mental state, often marked by confusion), a decline in mental or physical function, being admitted to long-term care facilities, and even death.

In particular, delirium can worsen the course of an illness, quicken physical and mental decline, lengthen hospital stays, and cause higher rates of hospital re-admission and death. One in 8 hospitalized people with ADRD who develops delirium will have at least one serious problem, including cognitive decline, possibly leading to admission to long-term care or death.

Here’s the good news: Experts say 30 to 40 percent of delirium cases are preventable. But until now, we have not studied how delirium and its severity affect hospitalized older adults with and without ADRD. Continue reading →

When You’re 84…What Should Life Look Like as We Age?

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Journal of the American Geriatrics Society Research Summary

Have you thought about what you’d like your life to look like when you’re 84?

 When a leading health system leader put that question to Lewis A. Lipsitz, MD, Director, Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and Professor of Medicine at Harvard Medical School, Dr. Lipsitz published an essay in the Journal of the American Geriatrics Society that outlined his thoughts. What follows is a summary of his essay, titled “When I’m 84: What Should Life Look Like in Old Age.” 

Knowing that I am a geriatrician, an esteemed health system leader once asked me: “What would you like your life to look like in old age?” I immediately listed the top contributors to a healthy longevity: Regular exercise, a well-balanced diet, a sense of purpose, social and family connections, intellectual stimulation and preventive health care.

However, many of us have trouble meeting these goals for various reasons. While we all hope to live long, productive lives, the field of geriatrics is more focused on achieving a long “health span,” in which we’re free of disease and disability, cognitively intact, and socially engaged. Since social factors account for most poor health outcomes, we need to help older adults address healthy longevity in our environment, our homes, communities, and lifestyles.

Here’s what I envision: Continue reading →

Don’t Let Social Isolation Keep You from Being Active

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Journal of the American Geriatrics Society Research Summary

By now, we’re all aware that COVID-19 is especially dangerous for older adults—the older you are, the higher your risk for serious illness and even death if you contract the virus. Because there is no treatment or a vaccine yet, it’s vitally important that we practice social distancing and wear masks to protect ourselves from disease.

But as we work to keep ourselves safe, we also need to be sure we’re not falling into physical inactivity. When we cut ourselves off from shopping, walking in malls, and going to the gym and other places where we can exercise, we can become sedentary. Older adults who don’t get regular exercise may become prone to chronic diseases, weakened muscles, and frailty.

Researchers from the University of Sao Paulo in Brazil recently reported on the dangers of physical inactivity for older adults during COVID-19. Their paper was published in the Journal of the American Geriatrics Society. Continue reading →

Staying Safe as Your City Reopens: Friends and Neighbors May be Resuming Their Regular Activities—Should You?

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Cities and counties across the country are beginning to ease or even end the regulations that closed stores, restaurants, businesses, services, and schools back in March 2020. But adults 65 years and older and those with chronic health conditions are still at high risk for contracting COVID-19 and facing its most serious complications, including death.

If you have underlying medical conditions, particularly if they are not well controlled, the CDC suggests that it’s wise to continue to maintain the highest level of vigilance about going out and resuming your regular activities. Some of the specific underlying health conditions noted by the CDC include:

  • Chronic lung disease
  • Moderate to severe asthma
  • Serious heart conditions
  • Being “immunocompromised”
    • People who are immunocompromised have a reduced ability to fight infections and other diseases.  Many things can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.
  • Severe obesity (body mass index [BMI] of 40 or higher)
  • Diabetes
  • Chronic kidney disease and undergoing dialysis
  • Liver disease

You can’t reduce your chances of contracting COVID-19 to zero. But if you understand the risks and use proven prevention measures, you may be able to help reduce the spread of the virus.

KEEP IN MIND: If you have COVID-19, have COVID-19 symptoms, or have been in close contact with someone who has COVID-19, you must stay home and away from other people. Talk to your healthcare provider about your specific precautions. When you can leave home and see others depends on different factors for different situations. Follow the CDC’s recommendations for your circumstances.

Here is the CDC’s science-based guidance for the best way to protect yourself as you begin to resume daily activities:

Continue reading →

Should Nursing Home Residents Nearing the End of Life Continue Taking Statins?

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Journal of the American Geriatrics Society Research Summary

Cardiovascular disease (also called heart disease) is one of the most common medical conditions older adults face. In nursing homes, almost half of all older adult residents have been diagnosed with problems affecting the heart and/or blood vessels.

In spite of this, we know very little about how effective a class of popular heart disease medications may be for those 75 and older. Known as statins, these medications are prescribed to reduce the amount of cholesterol in your blood. High blood levels of cholesterol can damage your heart’s blood vessels and lead to the formation of blood clots, which can cause stroke and heart attacks.

The reason we have a knowledge gap as to how well statins work in older adults is because early medical studies that examined statin therapy for heart disease prevention included few adults age 75 and older. More recent trials that did include older adults often found that statin therapy did not help prevent these individuals from developing heart disease.

Why? It’s possible that, as we age, our sensitivity to medications may change. For instance, myopathy (muscle pain and weakness) is a commonly reported side effect of statins. This side effect may have a heightened effect on older adults who are already frail, which could speed up physical decline.

A team of researchers conducted a study to learn more about statin use among older adults, especially those nearing the end of their lives. Their study stemmed from concern about unclear statin prescribing guidelines for people over age 75, and a lack of information on the medications’ uses in nursing homes. The study, published in the Journal of the American Geriatrics Society, evaluated statin use by people with life-limiting conditions across nearly all U.S. nursing homes. The researchers hoped to identify statin use among nursing home residents who were unlikely to benefit from treatment. Continue reading →