Everybody knows that if you want to have strong muscles and a healthy heart, regular exercise is the way to get there, but did you know that it can also be one of the ways to get to better bone health? When we move weight with our muscles, our bodies are triggered to increase or maintain the mass of those muscles, causing them remain strong or grow stronger. A similar system works with our bones. When there is a weight load being applied to our bones, the body responds by increasing or maintaining bone mass, which makes our bones strong and less prone to breakage. Because it is weight being applied to our bones that causes them to stay strong, it tells us that the kind of exercise we need to be doing is weight -bearing exercise. Weight-bearing exercises are ones that cause there to be pressure applied to the bones. The best example of this is walking or jogging. Every time you take a step, force is applied to every bone connected from your toes up to your neck, stimulating those bones to stay strong.

While walking or jogging is the most effective way to exercise the bones, it is not for everyone. Those with arthritis or more advanced osteoporosis should not be doing any kind of high impact exercise due to the risk of doing more damage to the joints or bones. These individuals should do lower impact exercises like using an elliptical, lifting weights, or using resistance bands. This will still stimulate bone growth without causing more damage. In individuals with impaired balance, standing exercises should be done under supervision in order to prevent falls.

In addition to strengthening our bones, exercises will also help strengthen muscles, leading to better balance and a decreased risk of falls. Not falling means a greatly reduced risk of fractures, which is the goal of osteoporosis treatment.

Copyright: Niels Kold, 2004

Ideally we should try and exercise for at least thirty minutes per day most days of the week, but any amount you can do is beneficial. There are many other benefits to exercise other than good bone and muscle health, including joint, heart, and cognitive health. With this information in mind, I would encourage everyone to make exercise a part of their regimen for better bone health.

Proper Foot Attire

• Start with your feet.  Our feet are where the rubber meets the road, and can be a cause of falls if we are not careful. Try and always wear good-fitting shoes, and fasten them properly. House slippers and sandals are nice and comfy, but they fit loosely and are flimsy and can trip us if we are not careful.

Adequate Lighting

• Make sure you can see where you are going. When you are up and moving around, make sure your house is well lit so you can see where you are placing your feet and identify obstacles. Use nightlights in your bedroom, halls and bathroom so if you need to get up at night it won’t be too dark to find a light switch.

Clear Walkways

• Clear the path. Keep things picked up and out of walkways. Don’t forget things like power cords and rugs; they can catch your feet if you are not paying attention. Also be very careful with stairways and steps if you have them in your house. Try and grab on to something when going up and down. That brings up my next tip:

Maintain Your Balance

• Make sure you have something to hang on to. If you have stairs or steps in your home, make sure to grab a handrail to stabilize yourself. Even if you go up and down a dozen times a day, sometimes we get weak or dizzy without realizing it and steps can catch us off guard. Also consider having handrails installed in places where there is nothing to hang on to like in hallways or in the bathroom.

Slowl To Rise

• Don’t shoot up out of bed. Even if you wake up feeling like a million bucks, take your time rising out of bed. It is not uncommon to get dizzy or black out if we rise too quickly. Sit up, swing your feet around, and sit for a second before standing. This gives your heart a second to catch up with the drop in blood pressure in the upper part of your body. This same advice goes for getting up out of a chair or getting out of a car.

Bathroom Safety

• Beware of the bathroom. Tubs, tile, and vinyl floor can become very slick, especially when wet. Keep floors as dry as possible,
  

  www.SeniorSafetyOK.com

  and get handrails install to hang on to if need be. If you have shower mats, make sure they are securely fastened to the floor. You can also check out specialty tubs and showers that have a door on them so you do not have to step up and over the edge of the tub with getting in or out.

Good Ears, Good Eyes

• Make sure you can see and hear what you are doing. Our sense of sight and hearing are very  important in staying upright. You must be able to see to make sure where you are placing you feet and to avoid obstacles. Your sense of hearing can help you avoid things like pets and children that may be moving about your house. Your ears also host an organ called the vestibular apparatus, which is what our body uses to sense balance. It is recommended to get your eyes checked annually and your hearing  checked every other year.

Ask For Help

• Last, get help when help is needed. I know that having a sense of independence is important to us all, but not doing too much is vital in preventing falls. If you need help getting up and down when someone else is around, ask them for help. If you have a lot of work to do around the house, don’t work yourself to the point of exhaustion. Get someone to help you or spread the work out. If you need something from a high place you cannot reach, get help and let the young people climb up and get it. Step stools and ladders do not mix well with older adults.

If we all take the time to fall proof our lives, we can do a lot to help prevent putting ourselves at risk of breaking bones, being placed in a nursing home, or even dying before our time.

With that being said, the other half of preventing fractures besides strengthening our bones is to prevent events that would cause the fractures to begin with. The biggest bone-breaking event we want to prevent is FALLS.

Did you know that falls will happen in one of every three adults over 65 years old? Of these adults, two of three will have a second fall within a year of the first one! For each fall that occurs, 10-15% will result in a broken bone or serious injury. Some of the most detrimental injuries that can be sustained are hip fractures. 20% of seniors will die within one year of a hip fracture! Another 20% will have to go on to live in a nursing home.

So what contributes to falls?

Unfortunately, as we age our muscle mass declines and this in turn reduces our stability, making us more likely to fall. We also have slower reaction times making it hard to catch ourselves when we do lose balance. We can also have changes in body shape due to osteoporosis, which can shift our center of gravity making us less balanced. 

Another contributor to falls in the elderly is that elderly individuals tend to be more sensitive to the effects of some medications.

I am going to go through some classes of drugs that can increase the risk of falls in elderly patients, and some recommendations that can help prevent them from causing falls. In part two of this blog, I will go over some things we can do to our homes to help make them more fall-proof.

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  (C) 2007 Hervé de Brabandère

  The first group of drugs to be aware of are the sedative-hypnotics. These include the benzodiazepines like alprazolam (Xanax®), diazepam (Valium®), and temazepam (Restoril®), and the non-benzodiazepine hypnotics like zolpidem (Ambien®), zalpelon (Sonata®), and eszopiclone (Lunesta®). The benzodiazepines are often prescribed for conditions such as insomnia, anxiety, and muscle spasms, while the non-benzodiazipine hypnotics are prescribed for insomnia only.Since these drugs depress brain activity, they can cause confusion, sedation, dizziness, weakness, and fatigue, all of which can place us at a higher risk of falling. Ideally we would like to try non-medicinal options for sleep (i.e.: chamomile tea) or alternative medicines for elderly patients due to this fall risk.

• The second group of drugs are the anti-depressants. Drugs in this class include the selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa®) and sertraline (Zoloft®), and the tricyclic antidepressants (TCAs) like amitriptyline (Elavil®).These drugs can cause confusion, sedation, dizziness, weakness, and fatigue as well. The TCAs are older and tend to have even more sedative effects than other classes of anti-depressants. If an elderly patient is taking a TCA, an attempt should be made to find an alternative medication.

• Third are the anti-psychotics like risperidone (Risperdal®) and aripiprazole (Abilify®). They can have the same side effects as the other classes above, and even have a black box warning about their use in older patients with dementia.These medications should be avoided in the elderly with dementia unless absolutely necessary.

• The fourth class on my list is the anticonvulsant drugs. For the most part all of these drugs depress nerve activity to prevent seizures and to treat nerve pain, and therefore increase fall risk. On the other hand, having a seizure makes you pretty likely to fall as well.These drugs should only be discontinued if you have been seizure free for a long time, meet certain other criteria, and only as instructed by your physician.

• The fifth class I want to talk about are the anti-hypertensives.Most drugs that lower blood pressure can cause you to be dizzy, especially if you stand up too quickly.  If it is severe enough you can even black out. This is caused by the blood pressure drop in our head when you raise it too quickly. The two things you can do to minimize this is to get your blood pressure checked regularly to make sure it is not too low, and to rise slowly from a seated or lying position.

• The last class of drugs I would like to cover are the first generation anti-histamines. There are several in this class, but the big one is diphenhydramine (Benadryl®).It is in several different over the counter preparations, but the most problematic one is when it is taken regularly for sleep in products like Tylenol PM. It can cause the same effects as other hypnotics listed above, and can stay in the system long enough to cause problems the morning after it is taken. Try and avoid self treating insomnia with this product.  If you are having trouble sleeping, refer to “Didn’t anyone ever teach you how to sleep?“, a previous post of mine, on the Medication Advisors’ website about sleep hygiene for some tips on getting better rest.

Now that we have some medication problems cleared up, check out part two about fall proofing your life.

(C) 2007 Hervé de Brabandère

Obviously no one literally needs to be taught how to sleep, but many folks could use a word of advice or two on how to sleep better.

In the medical world, the behavioral and environmental factors that precede sleep, and may interfere with sleep, are called “sleep hygiene”.

Practicing good sleep hygiene means doing things before you go to bed that can assist in improving the quality and quantity of sleep you receive.

Have a regular sleep cycle

The first aspect of sleep hygiene involves regulating your sleep cycle. Avoid taking daytime naps as they can reduce your ability to sleep at night.You should also set regular sleep and wake times, trying to keep them somewhat consistent throughout the week and even on weekends.

Also, avoid working in a dark room during the daytime hours. Exposure to bright lights during the day can help regulate your sleep cycle and lets your body know that light means wake time and darkness means sleep time.

Be tired when you go to bed

The second part of good sleep hygiene is making sure you are tired when you go to bed. No, this does not mean saying up until you feel sleepy. This means changing what you do during the day to help you feel tired when you’re supposed to at night.

One way to do this is to get regular exercise in the morning or daytime hours. Try not to exercise too close to bed time as this will actually activate chemicals in your body that trigger you to be more alert, and therefore make it very difficult to sleep.

Try and avoid any excitement from TV or books as well as bright lights for about an hour before bed. This gives you some wind-down time before you go to sleep.

Also, try to avoid stimulants such as caffeine or nicotine after noon. These drugs can stay in your system for a while and keep you awake at night. Caffeine is also a diuretic and may make you have to wake up in the middle of the night to go to the bathroom.

Make yourself comfortable

Thirdly, you need to make yourself comfortable. Try and make your bedroom quiet, dark, and a comfortably cool temperature.

Also, only use the bed for sleep and intimacy, as doing things like watching TV or paying bills in bed can train your subconscious that the bed is not the place for sleep. Make sure your mattress and pillows are comfortable, and have enough pillows to put between your knees or beneath your waist for comfort if needed.

Although most of these recommendations seem like common sense, really trying to implement them can do wonders to help you sleep at night and stay awake and alert during the day.

OSA is defined as a partial or complete closure of the upper airway that occurs during sleep and causes you to stop breathing. In other words, when you fall asleep your throat is literally closing down on itself, and the loud snoring noise is you unconsciously forcing air through your blocked airway.

Who tends to be at risk?

Although OSA can occur in anyone, being male and obese tends to be the two biggest risk factors.

Other risk factors include having a family history of OSA, having a short neck, a short jaw, sleeping pills and alcohol use and, for  women, being post menopausal.

What are the consequences?

When left untreated, OSA can have several negative benefits to your health.

The first and most obvious one is the noise level. If OSA is treated, it can reduce the amount of snoring, and in turn, decrease the disruption of sleep for other members of the household.

Second, untreated OSA can impact the quality of sleep of the person with the condition. Since the affected person actually quits breathing for short periods during the night, they have lower oxygen levels available which results in a less restful sleep and feeling tired during the day. This can put the individual at risk for having poor job performance or a higher likelihood of being involved in an automobile accident, all because of daytime drowsiness.

Third, the chronic lack of rest and good oxygenation can lead to worsening of conditions such as high blood pressure and heart failure.

What can be done?

The good news is that OSA is very treatable.

Before any medical interventions are done, the individual can try techniques like sleeping in a recliner instead of lying down, or lying on his or her side instead of on their back. This slight change of posture alters the direction that gravity is working on his or her throat which helps to keep it open.

Other things that can help include losing weight, quitting smoking, and reducing alcohol intake.

There are also devices your physician can order as well. One of these devices is a brace the goes in the mouth while sleeping to help hold the throat open. The next step up the treatment ladder is the continuous positive airway pressure machine, or CPAP. This involves wearing a mask that actually increases the air pressure inside the persons mouth, throat, and lungs, which helps hold the throat open.

Lastly, for severe cases, there are surgical interventions available that can help make sure the airway stays open during sleep.

Overall there are many treatments available for individuals with obstructive sleep apnea. These treatments can quickly and significantly improve a person’s quality of life.

If your family notices you snoring loudly or making chocking or gasping noises during the night, and you constantly feel like you need to get more sleep, it may be worth your while to talk to your physician about setting up a sleep study to see if OSA is what’s causing the problem.

According to the study by Johnston and colleagues (1) one cause of low influenza vaccine rates for long-term care (LTC) facilities is high turnover rates.

(C) 2008 – Brian Hoskins

It has been reported that turnover rates for nursing aides is as high as 70% nationally.

The current study demonstrated a model for influenza vaccinations delivered by LTC pharmacists which increased the vaccination rate from 58% to 76% during the study period.

The model used pharmacists within LTC pharmacies to administer the vaccines. They chose this method of delivery because LTC pharmacies have multiple facilities that they service and therefore have access to a greater number of health care workers.

If you would like this service provided for your Senior Care Community, contact us through our contact page or call us at 1-888-407-8643.

1. Impact of the Raising Immunizations Safely and Effectively (RISE) Program on Healthcare Worker Influenza Immunization Rates in Long-Term Care Settings. Johnston BC , Ma SS , et al. Nace DA, Handler SM, et al. J Am Med Dir Assoc. 2012;13 (November): 806-810.

The human spirit is stronger than anything that can happen to it.

- C. C. Scott

With February being National Cancer Prevention Month, I thought it would be the perfect time to review the recommended cancer screening guidelines put forth by the American Cancer Society.

In this blog I cover Breast Cancer, Colorectal Cancer, Cervical & Uterine Cancer and Prostate Cancer.

Breast Cancer

Breast cancer is the second most common cause of cancer in women.

The most common signs are a new lump, general swelling of the breast, skin dimpling, pain or deformities of the nipple, scaliness of the nipple, or spontaneous nipple discharge (not including breast milk).

If found early, almost all breast cancers can be treated successfully.

• For women 40 years of age and older, it is recommended to have both a yearly clinical breast exam (palpation) and a yearly mammogram.  A very small percentage of women (<2%) may also require an MRI.   Your physician will make this determination.

Colorectal Cancer

Colorectal cancer is the third most common cancer in both men and women.

In the early stages of colorectal cancer, no signs are generally present so it can go unnoticed.  In the later stages of the disease, signs such as rectal bleeding, blood in the stools, or lower abdominal cramping may be present.

Colorectal cancer is usually treated with a surgical procedure and if needed chemotherapy alone or in combination with radiation.  Typically polyps (a small growth arising out of the colon or rectum wall) are the first stages of colorectal cancer.

• For men and women aged 50 years and older, it is recommended to have one of the following screenings conducted:
  • Flexible sigmoidoscopy every 5 years, or
  • Colonoscopy every 10 years, or
  • Double-contrast barium enema every 5 years, or
  • CT colonography (virtual colonoscopy) every 5 years, or
  • Fecal occult blood test (multiple sample method) yearly, or
  • Fecal immunochemical test (multiple sample method) yearly

 Cervical Cancer

Cervical cancer begins with pre-cancerous cells that can develop, over time, into cervical cancer.

Both pre-cancerous cervical cells and early cervical cancer typically have no signs or symptoms.  However, cervical cancers sometimes present with vaginal spotting or discharge, or pain or bleeding during sexual intercourse.  Because no signs are typically present and the earlier detected the better, the following screening guidelines should be employed.

• Women ages 21 through 29 should have a Pap Smear every 3 years
• Women ages 30 through 65 should have either:
  • A Pap Smear every 3 years, or
  • A Pap Smear plus  an HPV (Human Papilloma Virus) test every 5 years
• Women over 65, if up until this time they have had regular cervical cancer screenings that have been normal, no longer need a Pap Smear.
• Women who have received a complete or total hysterectomy, as long as there is no history of cervical cancer (or serious pre-cancer), no longer need a Pap Smear.

Uterine Cancer

Uterine cancer is also known as endometrial cancer.

Symptoms may include abnormal vaginal bleeding or other discharge, pelvic pain, or unexpected weight loss.  Greater than 50% of all uterine cancers are found in women between the age of 50 and 69 years old.

Unfortunately, there are no screening tools available that can reliably detect this type cancer in women without symptoms.  Women with symptoms should see their physician for an endometrial biopsy.

Prostate Cancer

Prostate cancer is the second most common cause of cancer in men.

Although not always present, some early signs of prostate cancer are frequent urination, blood in urine, weak or painful urination, or difficulty beginning urination.

Prostate cancer is a very slow growing cancer, but when it spreads outside of the prostate, it usually does so quickly.  Because the cancer is very slow growing and no definitive benefit has been realized to date from routine screening, the American Cancer Society recommends the following:

• At the age of 50, all men that are not at high risk for prostate cancer (not African American or have a first-degree relative diagnosed before age 65) should have a discussion with their physician about the risks and benefits of screening, which may include a PSA (prostate-specific antigen) test with or without a digital rectal exam.
• At the age of 45, men at high risk should have this same discussion with their physician, and
• At the age of 40, men with multiple close relatives diagnosed before age 65 should have this discussion with their physician

For more information on these type of cancers and others, please visit www.cancer.org.

Exactly WHY Medication Advisors is needed!

A study by Ziaeian and colleagues(¹⁾ focused on patients over the age of 65 with health conditions such as acute coronary syndrome, heart failure and pneumonia, and were admitted to the hospital.

The study looked at the frequency of medication errors and patient misunderstanding upon discharge from the hospital.  Of the 377 patients that were contacted, about 70% of patients had an admission medication (the medication they were on when they came into the hospital) re-dosed or stopped, and 85% of patients got at least one new medication added to their regimen during their hospital stay.

Geriatric Patients Experience Prescribing Errors and Poor Understanding of Medication

The results showed that 27% of patients experienced at least one provider error in their modified medications.  Regarding patient understanding of their new medication regimen,  only 1 of 6 patients expressed clear understanding of their re-dosed or stopped medications, and greater than 80% of patients  had no knowledge at all that their medication had been discontinued.  The overall conclusion of this study is that  in older hospitalized patients, it is very common to experience a prescribing error and poor patient understanding of their medication.

Errors Common During Transitions in Care

Transition in care (moving from one type of care to a different type – example from a hospital to a nursing home) has been demonstrated to be a harbor for medication errors, both from actual mis-prescribing errors to comprehensive and understanding issues with the patient.

How can Facilities Help Avoid these Errors and Miscommunications?

By getting a pharmacist involved.

The pharmacist is a key player in this process of transitional care.  In fact, this is the stimulus for Medication Advisors involvement in Independent Living Facilities and with private clients.  The entire premise is to review a patient’s medications, from top to bottom,  start to finish, pre-hospital to post-hospital, looking to make sure that errors have not occurred and if so, addressed immediately.

We are also there, just as importantly, to ensure that the patient has a complete understanding of their new or altered drug regimen.

In summary, when medication errors and misunderstandings are not corrected right away, significant negative outcomes can occur very quickly – hospital readmissions, empty apartments at Independent Living Facilities, and decreased quality of life for the patient themselves.

Sure isn’t how I want to picture my mother’s Golden years.

1.  Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge. Ziaeian B, Araujo KLKLB, et al. J Gen Intern Med. 2012;27 (November): 1513-1520.

Tommy’s Bio:

Hello, my name is Tommy Shehan and I am a fourth year pharmacy student at Southwestern Oklahoma State University. I am very excited to be joining Medication Advisors for the month of February as part of my final year of education. The last four years have been such an exciting time for me as I have worked my way through pharmacy school with the loving support of my wonderful wife Janna. I consider myself so blessed to have such a great wife, to have high prospects for the future, and to be part of a great profession where I can use my knowledge for the betterment of others.

I am a Tulsa area native so it is nice to be able to work back home for a while. I look forward to being able to apply what I learn about good pharmaceutical care here at Medication Advisors to my future practice.

What Happens when I stop smoking now…

1. 20 minutes after quitting: your heart rate and blood pressure decrease
2. 12 hours after quitting: the carbon monoxide level in your blood returns to normal levels
3. 2 weeks – 3 months after quitting: improved circulation and lung function
4. 1-9 months after quitting: decreased coughing and shortness of breath
5. 1 year after quitting: The risk of heart disease is half that of a continuing smoker
6. 2-5 years after quitting: Stroke risk falls to that of a non-smoker
7. 5 years after quitting: The risk is decreased by 50% for cancer of the mouth, throat, esophagus, and bladder, and cervical cancer risk falls to non-smoker status.
8. 10 years after quitting:  Risk of dying from lung cancer is half of a person who is still smoking
9. 15 years after quitting: The risk of heart disease has returned to that of a non-smoker.

So, is there even hope if you have smoked for years, that stopping smoking with improve your health?

The answer is clear – Now’s the time to QUIT.

http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-benefits