Relevance to Centers for Independent Living (CILs)
As a person ages, they may develop multiple chronic conditions. An older adult's functional status may be affected by a combination of multiple conditions treated by multiple medications. This section covers the common chronic conditions that may affect older adults' (age 60+) functional independence.
Chronic conditions and age-related changes may contribute to declining function and loss of independence. They affect everyday activities such as activities of daily living (ADLs), driving, and employment. CILs that understand the affects of these conditions will be able to provide information and training about assistive technology, self-advocacy, hiring a personal assistant, home modification and transportation to consumers, caregivers, and family members.
Due to the number of chronic conditions and age-related changes that an older consumer may experience, they may also be consuming large quantities (as many as 8 or more) of medications. The older adult who consumes large numbers of medications may have difficulty remembering to take their medications at the designated time, may overdose due to forgetfulness or the large number of medications prescribed, or may forget to take them at all. The effects of medications can have a profound impact on performance. A consumer may appear confused, disoriented or intoxicated because of over-medication, absence of medication or medication reaction.
A list of medications used for treating common chronic conditions and age-related changes is provided with the medications' uses, potential side effects and potential interactions. This information will enable CILs to tell whether the individual is unable to perform daily activities because of decline in physical or cognitive function or because of improper medication administration.
Chronic Conditions | Heart Disease and Stroke | Cancer | Chronic Obstructive Pulmonary Disease (COPD) | Falls and Accidents | Diabetes | Pneumonia/Flu | Alzheimer's Disease and Dementia | Kidney Disease | Arthritis
This section provides CIL personnel with information about the most common chronic conditions that affect the functional status of older adults. Generally, older adults are faced with age-related physical changes and at least one chronic condition. Arthritis is the leading cause of disability in America with heart disease and stroke as the leading causes of death. It is important to understand that these and other chronic conditions have a great impact on independence, safety and quality of life for older adults. These conditions may cause the individual to seek help for assistance in their activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Since 2000, it is known that two out of five people over the age of 70 need help with one or more daily activities. Many older adults rely heavily on family and friends for assistance, while others do not receive the care they need. By 2030, it is estimated that 21 million elderly people may need help with their activities due to functional limitations.
Learning about the impact of the chronic conditions on functional status (causes, symptoms, suggested treatments and medications) will help the older adult understand their disabilities. CILs are suited to assist these elders and their informal caregivers by providing training in assistive technology use, self-advocacy, hiring personal assistance, home modifications, and transportation. Support groups with other older adults may help lessen the fear and stress brought on by the decline of functional status.
What is a chronic condition? A chronic condition is one that is persistent or continuous over an extended period. They can be non-life threatening, such as allergies, or life threatening, such as high blood pressure.1 Currently, there are 125 million people who suffer from chronic conditions. By 2030, it is expected that this number will rise to 171 million. Seventy-seven percent of Medicaid spending is for those community-based persons living with chronic conditions.2
In 2002, the Center for Disease Control (CDC) reported that chronic conditions, which included heart disease, stroke, diabetes, and cancer, were among the most common, costly, and preventable of all health problems. Chronic conditions are the leading causes of disability among adults and cause considerable pain, suffering and poor quality of life for millions of Americans. Medical care costs for people with chronic diseases account for more than 70% of the nation's $1 trillion spent on health care each year.3 The Center for Disease Control reports that two out of seven Americans die of a chronic disease.4
Due to advances in medicine and technologies, people are living longer and having more productive lives. Older people have a much greater risk of suffering from chronic illnesses than younger people. Researchers have reported that life expectancy for women is higher than that for men. Because of this, women age 70+ are more likely to live alone and be disabled for longer periods of time.
The CDC reported that activity limitations are common among elders who have arthritis and other musculoskeletal conditions, heart and other circulatory problems, vision and hearing difficulties, diabetes and respiratory problems. Activity limitations were found to involve managing personal care needs, activities of daily living (i.e. bathing, dressing), and instrumental activities of daily living (i.e. shopping, housekeeping, managing money). Also, the CDC found that these limitations were much more common among the elderly than those in the working-age group (ages 18-44).5 "The prevalence of multiple chronic conditions increases with age. A study by Reed and colleagues found that 37% of working-age Americans had at least one chronic health condition. 7 By age 65 and older, 62% have two or more chronic conditions and by age 80 and older, 70% have five or more chronic conditions.6
On average, those with five or more chronic conditions fill about 50 prescriptions and visit their physicians 15 times per year. Twenty percent of Medicare recipients have five or more chronic conditions.8 According to a research study conducted by Johns Hopkins Bloomberg School of Public Health in November 2002, Medicare recipients age 65 and over with four or more chronic conditions were 99 times more likely to experience one or more hospitalizations that could have been prevented.9
"As people age and experience either age-related changes or functional limitations from chronic health conditions they must learn new ways of interacting within their physical environments to successfully carry out daily life activities."10 The National Academy on an Aging Society reported, "on the whole, the conditions that are most common among older age groups require more care, are more disabling, and are more difficult and costly to treat than the conditions that are more common for younger age groups. For the future, it will be important to find ways to help this growing, aging population live more active and productive lives. It will be equally important to recognize that different groups of chronically ill people will have different needs."11
The U.S. does not have an effective system to care for chronic conditions. The available system of care is fragmented, inappropriate and difficult to obtain.12 One out of three people with chronic conditions do not understand the eligibility requirements for services, how to access the services, or who provides the services.13 Many services essential to caring for the chronically ill and disabled -including supportive care, rehabilitation and prevention of secondary conditions such as bedsores and depression-may be non-medical in nature, provided at home, and require healthcare workers other than physicians and little or low technology.14
15
Engaging in an active lifestyle with good nutrition and exercise can help prevent
the onset of these chronic conditions. According to the World Health Organization
(WHO), "sedentary lifestyles increase all causes of mortality, double the risk
of cardiovascular diseases, diabetes, obesity, and increase the risks of colon
cancer, high blood pressure, osteoporosis, lipid disorders, depression and anxiety."15
WHO states physical inactivity can have serious implications for people's health.
Approximately two million deaths per year are attributed to physical inactivity,
prompting WHO to issue a warning that a sedentary lifestyle could very well
be among the 10 leading causes of death and disability in the world. Sixty to
eighty-five percent of people in the world-from both developed and developing
countries-lead sedentary lifestyles, making it one of the more serious yet insufficiently
addressed public health problems of our time. Physical inactivity, along with
increasing tobacco use and poor diet and nutrition, are increasingly becoming
part of today's lifestyle leading to the rapid rise of diseases such as cardiovascular
diseases, diabetes, or obesity. 16
AARP reports the number one fear of older people with disabilities is losing their independence. Chronic conditions can impact the functional ability of older adults. Study participants, age 50+, indicated that at some point they may need assistance with their daily activities and thought their family would help them. But those of lower economic status were found to be at a higher risk. The key components for all people needing assistance include a physical environment and social network that would support them.17 Judy Heumann, co-founder of the World Institute on Disability said, "Independent living is not doing things for yourself, but having the control over how things are done."18
1Retrieved on March 1, 2004 from http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm#visualContent
2"The Problem: About Chronic Conditions," Partnership for Solutions, July 24, 2002, Retrieved on March 1, 2004 from www.partnershipforsolutions.org/program
3Retrieved on March 1, 2004 from www.chronicdisease.org/0602-general chronic disease.html
4Retrieved on March 1, 2004 from www.cdc.gov/nccdphp/overview.htm
5Chartbook on Trends in the Health of America, Centers for Disease Control and Prevention, National Center for Health Statistics, DHHS Publication No. 1231-1, August 2002
6"The Problem: About Chronic Conditions," Partnership for Solutions, July 24, 2002. Retrieved on March 1, 2004 from www.partnershipforsolutions.org/program
7Reed, M.C. & Tu H.T., "Triple jeopardy: Low income, chronically ill and uninsured in America" (Issue Brief No. 49), Washington, DC: Center for Studying Health System Change, 2002.
8"Medicare: Cost and Prevalence of Chronic Conditions," Partnership for Solutions, July 2002
9Gitlin, Laura N., "Assistive Technology in the Home and Community for Older People: Psychological and Social Considerations," Assistive Technology: Matching Device and Consumer for Successful Rehabilitation, Scherer, M. J. (ed). 2002.
10Wolff, J. Starfield, B .Anderson, G. (2002). Prevalence, Expenditures, and Complications of Multiple Chronic Conditions in the Elderly, Archives of Internal Medicine. 162:2269-2276.
11"Challenges for the 21st Century: Chronic and Disabling Conditions," National Academy on an Aging Society, Number 1, November, 1999, p.1, 5. www.agingsociety.org
12"Chronic Care in America: A 21st Century Challenge," Robert Wood Johnson Foundation, November 1996, pg. 11. Retrieved on March 1, 2004 from http://www.rwjf.org/publications/publicationsPdfs/Chronic_Care_in_America.pdf
13"Chronic Care in America: A 21st Century Challenge", Robert Wood Johnson Foundation, November 1996, pg. 20. Retrieved on March 1, 2004 from http://www.rwjf.org/publications/publicationsPdfs/Chronic_Care_in_America.pdf
14"Chronic Care in America: A 21st Century Challenge," Robert Wood Johnson Foundation, November 1996, pg. 22. Retrieved on March 1, 2004 from http://www.rwjf.org/publications/publicationsPdfs/Chronic_Care_in_America.pdf
15Prevalence of Disabilities and Associated Health Conditions Among Adults - United States, 1999, MMWR 2001:50(7): 120-5. Retrieved on March 1, 2004 from http://www.cdc.gov/nccdphp/arthritis/index.htm#graph1.
16Physical Inactivity a Leading Cause of Disease and Disability, World Health Organization Press Release, WHO/23, 4 April 2002. Retrieved on March 1, 2004 from http://www.who.int/mediacentre/releases/release23/en/
17American Association of Retired Persons. Retrieved on March 1, 2004 fromhttp://research.aarp.org/il/beyond_50_il.html
18Rehabilitation Research and Training Center or Independent Living Management (2003). Independent Living Philosophy and History. Quote from interview with Judy Heumann.
19Prevalence of Disabilities and Associated Health Conditions Among Adults - US, 1999, MMWR 2001: 50(7): 120-125. Retrieved on March 1, 2004 from http://www.cdc.gov/nccdphp/arthritis/index.htm#graph1
WebMD provides drug information gathered from databases provided by Multum Information Services, Inc. The types of information available about medications include: a description of the medication and its appearance, a description of who should not take it, possible side effects, use of the medication, topics to discuss with a doctor before taking the medication, how the medication should be taken, what to do if a dose is missed, symptoms of an overdose, what to avoid when taking the medication, other medications that may interact with the medication, and brand names of the medication.
To use WebMD for medication information go to http://www.webmd.com/ and click on WebMD Health. Under Medical Info, click on drugs and herbs. Under look up drugs and supplements, click on start here. The user must agree to the conditions of use and then may search for a particular medication by typing the name or clicking on the letter the medication starts with and choosing it from a list presented.
The information provided at this site is written in easy to understand terms and is based on the FDA approved information that is available in the Physician's Desk Reference. The types of information available about medications include: use of the medication, important facts about the drug, how the medication should be taken, potential side effects, warnings/ precautions, possible food and drug interactions with the medication of interest, recommended dosage, overdose symptoms, and the appearance of the medication.
To use PDR Health, go to http://www.gettingwell.com/ and click on drug information. Then you can either type in the name of the drug or click on the type of drug (prescription, over-the-counter, herbal, or a supplement). After clicking the type of drug, click on the letter the drug begins with and its name.
This website is sponsored by the U.S. National Library of Medicine and the National Institutes of Health. It contains information on medications and contains a medical encyclopedia and dictionary. The site utilizes MedMaster from the American Society of Health-System Pharmacists (ASHP) and the USP DI Advice for the Patient from the United States Pharmacopeia (USP) to provide information on prescription and over-the-counter medications. The type of information available on medications includes: brand names in the U.S. and Canada, use for the medication, available forms of the medication (liquid, capsules, tablet), precautions, warnings, proper use and dosing of the medication, what to do if a dose is missed, storage of the medication, potential side effects, and precautions while using the medication.
To use Medline Plus, go to http://www.nlm.nih.gov/medlineplus/druginformation.html and click on the first letter of the medication. Then locate the name of the medication in the list and click on either MedMaster or USP DI below the name to view information.
The leading cause of death of Americans is heart disease. Heart disease is a type of cardiovascular disease that includes various heart conditions, such as high blood pressure and stroke. Stroke is the third leading cause of death. According to the American Heart Association, approximately half of stroke deaths occur before the person reaches the hospital.1 Heart disease and stroke involves the heart and its arteries.
Coronary heart disease is a result of the narrowing of the heart arteries, which can decrease the blood and oxygen supply to the heart. This leads to a heart attack or chest pain. A heart attack occurs when there is a sudden blockage to the coronary artery, usually by a blood clot. If cholesterol and fatty deposits build up in the heart's arteries, less blood reaches the heart muscle. This damages the heart muscle, and the healthy heart tissue that remains has to work harder. The person experiences chest pain when the heart does not receive enough blood. According to the CDC, "two of the major independent risk factors for cardiovascular disease are high blood pressure and high blood cholesterol. About 90% of middle-aged Americans will develop high blood pressure in their lifetime, and nearly 70% of people with high blood pressure do not have it under control."2
Another type of heart disease is a heart rhythm disorder commonly known as arrhythmias. It is due to an interference of the regular beating rhythm of the heart. This includes disorganized, disrupted and fast beating of the heart, heart murmurs and other undetermined disorders. Two-million Americans live with atrial fibrillation with little consequence while in others it can lead to heart disease, stroke or heart attack.3
Congestive heart failure (CHF) is also a type of heart disease. It is often considered the end-stage of heart disease. It is a condition where the heart cannot pump enough blood to the body's other organs.4 Uncontrolled blood pressure doubles a person's risk of developing heart failure. When pressure within the blood vessels is too high, the heart has to pump harder than normal to keep the blood circulating. This takes a toll on the heart, and over time the heart chambers become larger and weaker. When performing daily activities, the individual with CHF will fatigue easily and experience shortness of breath.
Nearly 5 million Americans are living with heart failure with 550,000 new cases diagnosed each year. Although more than half of the population with heart disease is under the age of 65, the elderly are affected to a much greater extent.5 The elderly are more likely to experience heart attacks and chest pains. The prevalence of heart disease is greater in older men, males of African-American descent, those from lower economic status, and people who have less than a high school education.
A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked or bursts. When that happens, part of the brain cannot get the blood and oxygen it needs and starts to die. As part of the brain dies from the lack of blood flow, it affects the part of the body controlled by the dying portion of the brain. Strokes can cause paralysis, affect language and vision, and cause various other problems. One side of the brain controls the opposite side of the body. For example, if the stroke occurs in the brain's right side, the left side of the body (and the right side of the face) will be affected, which could produce any or all of the following:6
• Paralysis on the left side of the body
• Vision problems
• Impulsive, inquisitive behavioral style
• Memory loss
If the stroke occurs in the left side of the brain, the right side of the body (and the left side of the face) will be affected, producing some or all of the following:
• Paralysis on the right side of the body
• Speech/language problems (slurred speech, word finding problems)
• Slow, cautious behavioral style
• Memory loss
Elders diagnosed with heart disease and stroke are more likely to have difficulties with every day activities. These activities include self-care (i.e. bathing, dressing, eating, and toileting), mobility skills (i.e. use of toilet, walking, getting in and out of bed), and other skills (i.e. communication, vision, memory). Those with heart disease spend five or more days in bed due to fatigue and shortness of breath.
High blood pressure, diabetes, smoking and a sedentary lifestyle are contributing factors to heart disease and stroke. "Although many cardiovascular diseases (CVDs) can be treated or prevented, an estimated 17 million people die of CVDs each year. A substantial number of these deaths can be attributed to tobacco smoking, which increases the risk of dying from coronary heart disease and cerebrovascular disease 2-3 fold. The risk increases with age and is greater for women than for men. In contrast, cardiac events fall 50% in people who stop smoking and the risk of CVDs, including acute myocardial infarction, stroke and peripheral vascular disease, also decreases significantly over the first two years after smoking cessation."7
|
Blood Pressure Category |
Systolic (mmHg) |
Diastolic (mmHg) |
|
|---|---|---|---|
|
Normal* |
Less than 120 |
And |
Less than 80 |
|
Pre-hypertension |
120 -139 |
Or |
80 - 89 |
|
Hypertension, Stage 1 |
140 - 159 |
Or |
90 - 99 |
|
Hypertension, Stage 2 |
160 - higher |
Or |
100 - higher |
*Unusually low readings should be evaluated for clinical significance, chart available, see reference #8.8
Hypertension usually affects people later in life, age 55 and over. Blacks and elderly women are more susceptible to developing hypertension. Those with hypertension are reported to be more ill with chronic conditions and use more health care services than those without hypertension.
1American Heart Association. Heart and Stroke Statistics 2003 Update. Available at www.americanheart.org
2National Center for Chronic Disease Prevention and Health Promotion. Available at http://www.cdc.gov/nccdphp/aag/aag_cvd.htm
3Cleveland Clinic Heart Center. Available at http://www.clevelandclinic.org/heartcenter/pub/atrial_fibrillation
4American Heart Association. Available at www.americanheart.org
5Heart and Stroke Facts Booklet, pg.13 & 41, American Heart Association. Available at http://www.americanheart.org/downloadable/heart/1056719919740HSFacts2003text.pdf
6National Stroke Association. Available at www.strokeassociation.org
7Dr. Derek Yach, Executive Director, Non-Communicable Diseases and Mental Health Cluster, CVD Prevention and Control: Missed opportunities, World Health Organization.
8Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7 Express) NIH Publication No. 03-5233, May 2003.
Uses: For relief of chest pain due to coronary artery disease.
Potential side effects: Vertigo, dizziness, weakness, palpitation, headache, nausea, vomiting, weakness, sweating, fainting, flushing, rash
Medications that may interact: High blood pressure medications, beta-adrenergic blockers, phenothiazines, calcium channel blockers, alcohol, aspirin, alteplase, ergotamine, heparin, dihydroergotamine, viagra
Uses: Relieves chest pain and used for high blood pressure
Potential side effects: Edema, headache, flushing, dizziness
Medications that may interact: Alfuzosin, grapefruit juice, digoxin, cimetidine
Uses: A beta-blocker, for the treatment of high blood pressure, chest pain, irregular heart beats; helps prevent migraines; and relieves severe tremors
Potential side effects: Decreased sexual ability, drowsiness, trouble sleeping, tiredness, weakness, slow heart beat, dizziness, difficulty breathing, swelling, depression, cold hands and feet
Medications that may interact: Reserpine, calcium-channel-blocking drug, haloperidol, aluminum hydroxide gel, alcohol, phenytoin, phenobarbitone, rifampin, chlorpromazine, antipyrine, lidocaine, thyroxine, cimetidine, theophylline
Uses: To treat long-term chest pain associated with coronary artery disease.
Potential side effects: Headache, dizziness
Medications that may interact: Other vasodilators, calcium channel blockers, alcohol
Uses: Used for high blood pressure and congestive heart failure
Potential side effects: Hypotension, dizziness
Medications that may interact: Diuretics, non-steroidal anti-inflammatory drugs, lithium, potassium salts
Uses: Congestive heart failure and irregular heart rhythms (atrial fibrillation)
Potential side effects: Anorexia, nausea, diarrhea, vomiting, blurred or yellow vision, headache, weakness, dizziness, apathy, confusion, anxiety, depression, delirium, and hallucination.
Medications that may interact: Diuretics, calcium, quinidine, verapamil, amiodarone, propafenone, indomethacin, itraconazole, alprazolam, spironolactone, erythromycin, clarithromycin, tetracycline, propantheline, diphenoxylate, antacids, kaolin-pectin, sulfasalazine, neomycin, cholestyramine, certain anticancer drugs, metoclopramide, and Rifampin
Uses: To lower blood cholesterol on those at risk of stroke or heart disease
Potential side effects: Headache
Medications that may interact: Erythromycin, cyclosporine, niacin, fibrates, cholestyramine, colestipol, gemfibrozil
Uses: A calcium channel blocker, for the treatment of high blood pressure
Potential side effects: Constipation
Medications that may interact: Alcohol, cyclophosphamide, oncovin, procarbazine, prednisone, vindesine, adriamycin, cisplatin, doxorubicin, aspirin, beta-blockers, digitalis, vasodilators, angiotensin-converting enzyme inhibitors, diuretics, prazosin, disopyramide, flecainide, quinidine, lithium, carbamazepine, rifampin, phenobarbital, cyclosporine, theophylline
Uses: Congestive heart failure and irregular heart rhythms (atrial fibrillation)
Potential side effects: Anorexia, nausea, diarrhea, vomiting, blurred or yellow vision, headache, weakness, dizziness, apathy, confusion, anxiety, depression, delirium, and hallucination.
Medications that may interact: Diuretics, calcium, quinidine, verapamil, amiodarone, propafenone, indomethacin, itraconazole, alprazolam, spironolactone, erythromycin, clarithromycin, tetracycline, propantheline, diphenoxylate, antacids, kaolin-pectin, sulfasalazine, neomycin, cholestyramine, certain anticancer drugs, metoclopramide, and Rifampin
Uses: Relieves chest pain and used for high blood pressure
Potential side effects: Headache, dizziness
Medications that may interact: Beta-blockers, cimetidine, digoxin, anesthetics, carbamazepine, alfuzosin, astemizole, cisapride, grapefruit juice, pimozide, and terfenadine
Uses: Relieves chest pain and used for high blood pressure
Potential side effects: Edema, headache, flushing, dizziness
Medications that may interact: Alfuzosin, grapefruit juice, digoxin, cimetidine
Uses: Relieves chest pain and used for high blood pressure, heart failure
Potential side effects: Tiredness and dizziness, depression, mental confusion, bradycardia, shortness of breath, diarrhea, rash
Medications that may interact: Reserpine, monoamine oxidase (MAO) inhibitors, quinidine, fluoxetine, paroxetine, propafenone, and clonidine
Note: this medication should not be stopped abruptly
Uses: Used for high blood pressure and congestive heart failure
Potential Side Efftects: Hypotension, dizziness
Medications that may interact: Diuretics, non-steroidal anti-inflammatory drugs, lithium, potassium salts
Uses: Used for high blood pressure
Potential side effects: Dry mouth, drowsiness, fatigue, headache, lethargy, sedation, localized skin reactions and rashes, fever, and pallor
Medications that may interact: Alcohol, barbiturates or other sedating drugs, tricyclic antidepressants, digitalis, calcium channel blockers and beta-blockers, amitriptyline
Uses: Used for high blood pressure
Potential side effects: Dizziness, edema, palpitations, flushing, tachycardia, headache, edema, dizziness, palpitations, and gastrointestinal disturbances
Medications that may interact: Cimetidine, rifampicin, fentanyl anesthesia, alfuzosin, grape fruit juice
Uses: Used for high blood pressure and heart failure
Potential side effects: Dizziness, fatigue, coughing, hypotension
Medications that may interact: Diuretics, potassium salts, tetracycline, lithium
Uses: Used for high blood pressure, relieving chest pain, and to prevent migraines
Potential side effects: Dizziness, nausea, bradycardia, hypotension
Medications that may interact: Verapamil, diltiazem, reserpine, calcium channel blockers, clonidine, and indomethacin
Note: this medication should not be stopped abruptly
Uses: Used for high blood pressure and to relieve chest pain
Potential side effects: Headache, edema
Medications that may interact: Alfuzosin
Uses: Used to treat water retention, swelling, high blood pressure
Potential side effects: Dizziness, headache, fatigue, weakness, nausea, vomiting, diarrhea, constipation, increased hunger or thirst, increased urination, swelling, sun sensitivity
Medications that may interact: Potassium salts, chlorpropamide, indomethacin, anti-inflammatory drugs, lithium, methenamine
Uses: Used for high blood pressure and heart failure
Potential side effects: Cough, headache, dizziness, fatigue, asthenia, hypotension
Medications that may interact: Diuretics, indomethacin, potassium salts, lithium
Uses: Used to lower cholesterol
Potential side effects: Constipation, flatulence, dyspepsia, and abdominal pain
Medications that may interact: Cyclosporine, fibric acid derivatives, niacin, erythromycin, azole antifungals, and digoxin
Uses: Used for high blood pressure, swelling
Potential side effects: Dry mouth, increased thirst, headache, dizziness, constipation, rash, jaundice, sun sensitivity, and nausea
Medications that may interact: Aminoglycoside antibiotics, ethacrynic acid, salicylates, tubocurarine, succinylcholine, lithium, sucralfate, indomethacin, and anti-inflammatory drugs
Uses: Used for coronary artery disease and related chest pain
Potential side effects: Headache, dizziness
Medications that may interact: Calcium channel blockers, organic nitrates, and alcohol
Uses: Used for high blood pressure
Potential side effects: Sedation, headache, asthenia, and weakness
Medications that may interact: Other anti-hypertensive drugs, anesthetics, lithium, ferrous sulfate, ferrous gluconate, and monoamine oxidase (MAO) inhibitors
Uses: Relieves mild to moderate pain, used to thin blood to reduce the risk of heart attack or stroke
Potential side effects: Stomach pain, stomach ulcer, diarrhea, constipation, nausea, vomiting, gas, heartburn
Medications that may interact: Alcohol, alendronate, antacids, anti-inflammatory medications, prednisone, cortisone, other blood thinners, diabetes medications, gout medications, methotrexate, Pepto-Bismol, medications for seizures
Uses: Prevents and treats blood clots
Potential side effects: Hemorrhage, paralysis, numbness, tingling, pain, dizziness, shortness of breath, swelling, weakness, low blood pressure, purple toes syndrome, hepatitis, jaundice, fever, rash, abdominal pain, fatigue, nausea, vomiting, diarrhea, headache, hair thinning, cold intolerance
Medications that may interact: Other blood thinners, cholesterol medications, alcohol, allopurinol, amiodarone, antibiotics, anti-inflammatory medications, aprepitant, acetaminophen, azathioprine, barbiturates, bosentan, cimetidine, cyclosporine, disulfiram, female hormones, fish oil supplements, influenza virus vaccine, male hormones, cancer medications, heart rhythm medications, blood pressure medications, quinidine, quinine, seizure medications, thyroid medications, tolterodine, vitamin K
Uses: To prevent future stroke or heart attack with people who have already experienced a stroke or heart attack
Potential side effects: Chest pain dizziness, hemorrhage, bruising, rash
Medications that may interact: Anti-inflammatory medications, warfarin, phenytoin, tamoxifen, tolbutamide, torsemide, fluvastatin
Uses: Prevents blood clots and keeps existing clots from getting bigger
Potential side effects: Hemorrhage, local irritation at injection site, chills, fever, rash, decreased number of platelets, osteoporosis, hair thinning
Medications that may interact: Warfarin, dicumarol, acetylsalicylic acid, dextran, phenylbutazone, ibuprofen, indomethacin, dipyridamole, hydroxychloroquine, digitalis, tetracyclines, nicotine, antihistamines
Uses: Used to treat water retention, swelling, high blood pressure
Potential side effects: Dizziness, headache, fatigue, weakness, nausea, vomiting, diarrhea, constipation, increased hunger or thirst, increased urination, swelling, sun sensitivity
Medications that may interact: Potassium salts, chlorpropamide, indomethacin, anti-inflammatory drugs, lithium, methenamine
Uses: For high blood pressure, swelling
Potential side effects: Dry mouth, increased thirst, headache, dizziness, constipation, rash, jaundice, sun sensitivity, and nausea
Medications that may interact: Aminoglycoside antibiotics, ethacrynic acid, salicylates, tubocurarine, succinylcholine, lithium, sucralfate, indomethacin, and anti-inflammatory drugs
Uses: For high blood pressure and swelling
Potential side effects: Dizziness, headache, nausea, weakness, vomiting, hyperglycemia, excessive urination, hyperuricemia, hypokalemia, excessive thirst, hypovolemia, impotence, esophageal hemorrhage, and dyspepsia
Medications that may interact: Salicylates, nonsteroidal anti-inflammatory agents, indomethacin, cholestyramine, probenecid, lithium, aminoglycoside antibiotics, ethacrynic acid
Uses: For high blood pressure and swelling
Potential side effects: Weakness, hypotension, pancreatitis, jaundice, diarrhea, vomiting, cramping, constipation, gastric irritation, nausea, anorexia, anemia, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenia, anaphylactic reactions, angina, respiratory problems, sun sensitivity, fever, rash, electrolyte imbalance, hyperglycemia, glycosuria, hyperuricemia, muscle spasm, vertigo, paresthesias, dizziness, headache, restlessness
Medications that may interact: Alcohol, barbiturates, or narcotics, antidiabetic drugs, other antihypertensive drugs, cholestyramine and colestipol, corticosteroids, norepinephrine, tubocurarine, lithium, non-steroidal anti-inflammatory
Uses: For high blood pressure and swelling from congestive heart failure and kidney disease
Potential side effects: Chest pain, orthostatic hypotension, depression, dizziness, drowsiness, weakness, restlessness, rashes, vomiting, nausea, diarrhea, constipation, anorexia, muscle cramps
Medications that may interact: Furosemide, other antihypertensive drugs, alcohol, barbiturates, narcotics, digitalis, corticosteroids, lithium, tubocurarine, salicylates, other non-steroidal anti-inflammatory medications, anticoagulants
Uses: For high blood pressure and swelling resulting from heart, kidney, and liver disease
Potential side effects: Anaphylaxis, rash, sun sensitivity, hyperkalemia, hypokalemia, nausea, vomiting, diarrhea, weakness, fatigue, dizziness, headache, dry mouth
Medications that may interact: Lithium, indomethacin, nonsteroidal anti-inflammatory agents, antihypertensive medication, other diuretics, anesthetics, muscle relaxants, low-salt milk, potassium-containing medications, salt substitutes, chlorpropamide, hypoglycemic agents
Uses: For potassium deficiencies, which affect normal functioning of the heart, muscle, and nerves
Potential side effects: Upper and lower gastrointestinal problems and discomfort, too much potassium in blood, nausea, vomiting, gas, diarrhea
Medications that may interact: Anti-inflammatory medications, cisplatin, digoxin, heparin, blood pressure medications, medications for movement disorders, medications for digestive system problems, penicillin G, sodium polystyrene sulfonate, diuretics
Uses: To prevent kidney stones
Potential side effects: Dizziness, diarrhea, confusion, high blood pressure, headache, increased thirst, muscle cramps, swelling, nausea, vomiting, rectal burning, stomach cramps
Medications that may interact: Antacids, corticosteroids, corticotrophin, cyclosporine, estrogens, digoxin, digitoxin, heparin, iron supplements, blood pressure medications, pain medications, potassium supplements, sucralfate, testosterone, vitamin D supplements, zinc supplements
Cancer is a family of diseases caused by the uncontrolled growth of abnormal cells in a part of the body. The uncontrolled growth spreads beyond the original site. The type of cancer is named from the site of origin. According to the U.S. National Center for Health Statistics' National Vital Statistics Report (2002), cancer is the second leading cause of death in the United States. It is responsible for one of every four deaths in the United States. The number of cancer cases is expected to increase as the aging population increases. According to Georgetown University, "cancer is caused by both external factors (tobacco, chemicals, radiation, and infectious organisms) and internal factors (inherited mutations, hormones, immune conditions and mutations that occur from metabolism)."1
Lung cancer is the most common and deadly form. It is very difficult to detect early and treat. Tobacco and alcohol use increases the risk of getting lung or oral cancer. The more a person consumes alcohol, the higher the person's risk. Combining tobacco with alcohol drives the risk even higher. About 87% of lung cancer deaths are caused by smoking.2 Based on data collected from 1995 to 1999, the CDC estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.3
*Average annual number of deaths, 1995-1999.
Source: CDC. Annual smoking-attributable mortality, years of potential life
lost, and economic costs-United States-1995-1999. MMWR 2002; 51(14):300-3.
Stopping tobacco use, or not starting, is the single most important thing a person can do to avoid cancer and other chronic conditions.
In 2002, the Center on Aging Society reported the most common cancer types by gender were: breast, prostate, uterine, cervical and colorectal. Occurrence of cancer increases with age with men having a higher risk of developing cancer than women. African-Americans have a higher incidence of cancer and are about one-third more likely to die from it than whites.4
According to the American Cancer Society, some people are at a greater risk of developing cancer due to hereditary factors. For example, a woman with a mother or sister who has had breast cancer or an individual with a relative who has had colon cancer is at higher risk.
To learn more about specific types of cancer and treatment such as: lung, prostate, cervical, go to the American Cancer Society's website: www.cancer.org.
1Center on an Aging Society, Georgetown University, "Cancer: A major national concern," Data Profile, Number,1 July 2002. Available at http://ihcrp.georgetown.edu/agingsociety/pubhtml/cancer/cancer.html
2American Cancer Society, http://www.cancer.org
3Centers for Disease Control, Annual smoking-attributable mortality, years of potential life lost, and economic costs-United States-1995-1999. MMWR 2002; 51(14):300-3.
4Center on an Aging Society, Georgetown University, "Cancer: A major national concern," Data Profile, Number,¹ July 2002. Available at http://ihcrp.georgetown.edu/agingsociety/pubhtml/cancer/cancer.html
Uses: For breast cancer
Potential side effects: Hot flushes, swelling, vaginal discharge, endometrial changes (hyperplasia and polyps), endometriosis, uterine fibroids, ovarian cysts, weight loss, fatigue, cough, hair thinning dizziness, lightheadedness, headache, depression, nausea, anorexia, abdominal cramps, eye changes, visual disturbances, muscle pain, bone pain. Increased risk of uterine cancer, pulmonary embolism, deep-vein thrombosis, stroke
Medications that may interact: Warfarin, Phenobarbital, bromocriptine, cytotoxic drugs, cyclophosphamide
Uses: Used in combination with other drugs to treat many types of cancer, including: testicular, ovarian, bladder, head, neck, cervical, lung, advanced malignant pleural mesothelioma, esophageal, melanoma, brain
Potential side effects: Bone marrow suppression, low platelet count, low white blood cell count, renal impairment, electrolyte disturbances, nausea, vomiting, anorexia, ear ringing, hearing loss, tingling or loss of sensation in hands and feet, gait difficulties, weakness, seizures, slurred speech, loss of taste, memory loss, tremor, cortical blindness, aphasia, seizures, anemia, facial swelling, flushing, wheezing, difficulty breathing, rapid heart rate, low blood pressure, sweating, stuffy nose, runny nose, conjunctivitis, generalized redness, tight chest, high blood pressure, postural hypotension, mild hair thinning, fatigue, hiccups, muscular pain, fever
Medications that may interact: Amphoteracin, amikacin, gentamicin, neomycin, streptomycin, tobramycin, digoxin, furosemide, torsemide, ethacrynic acid, bumetanide, dofetilide, dypiridamole, warfarin, coumadin, mesna, methotrexate, other chemotherapy agents, probenecid
Uses: Treatment of enlarged prostate, also for hair loss
Potential side effects: Breast enlargement or tenderness, dizziness, diarrhea, painful urination, skin rash, sexual difficulties, stomach pain
Medications that may interact: Blood pressure medications, testosterone
Uses: A chemotherapy that treats many types of cancer, also to treat diseases related to immune system
Potential side effects: Missed menstrual periods, decreased white blood cell count, infection, fast heart rate, fever, chills, shortness of breath, dizziness, confusion, agitation, tiredness, weakness, joint pain, low back pain, painful urination, anemia, loss of appetite, nausea, vomiting, darkening of skin and fingernails, diarrhea, stomach pain, flushing, headache, sweating, rash, hair loss
Medications that may interact: Allopurinol, colchicines, probenecid, sulfinpyrazone, anti-coagulants, bone marrow depressants, radiation therapy, cocaine, cytarabine, daunorubicin, doxorubicin, hepatic enzyme inducers, azathioprine, chlorambucil, corticosteroids, glucocorticoid, cyclosporine, mercaptopurine, muromonab-CD3, lovastatin, succinylcholine, vaccines with killed virus, vaccines with live virus
Uses: Used to reduce size of prostate gland and to treat some male hair loss
Potential side effects: Breast enlargement or tenderness, dizziness, diarrhea, painful urination, skin rash, sexual difficulties, stomach pain
Medications that may interact: Blood pressure medications, testosterone
Uses: For high blood pressure and prostate problems
Potential side effects: Weakness, postural hypotension, impotence, blurred vision, dizziness, nasal congestion, nausea, swelling, palpitations, drowsiness
Medications that may interact: High blood pressure medications, diuretics
Uses: Laxative and stool softener
Potential side effects: Diarrhea, rash, throat irritation, stomach cramps
Medications that may interact: Mineral oil
Uses: Relieves pain and inflammation from arthritis
Potential side effects: Diarrhea, heartburn, abdominal pain, constipation, gas, nausea, dizziness, headache, rash, swelling, ear ringing
Medications that may interact: Warfarin
Uses: For treatment of heartburn and stomach ulcers
Potential side effects: Headache, dizziness, constipation, and diarrhea
Medications that may interact: No drug interactions have been found
Uses: Prevents acid production in stomach, helps to relieve symptoms and injury from acid reflux and stomach ulcers
Potential side effects: Abdominal pain, diarrhea, constipation, nausea
Medications that may interact: Theophylline, sucralfate, ketoconazole, ampicillin esters, iron salts, digoxin
Uses: For nausea, vomiting, schizophrenia, anxiety
Potential side effects: Drowsiness, dizziness, blurred vision, skin reactions, low blood pressure, jaundice, decreased white blood cell count, agitation, insomnia, muscle spasms, tongue protrusion, difficulty swallowing, shuffling gait, drooling, mask like face, involuntary movements of the mouth, seizures, brain swelling, dryness of mouth, nasal congestion, headache, nausea, constipation, sexual problems, urinary retention, catatonic like state, cardiac arrest, anemia, skin disorders, increased appetite, weight gain
Medications that may interact: Alcohol, bromocriptine, dofetilide, lithium, pain medications, medications for movement disturbances, medications for digestive system problems, medications for seizures and epilepsy
Uses: For heartburn
Potential side effects: Headache, rash, dizziness, constipation, nausea, diarrhea
Medications that may interact: Diazepam, warfarin, phenytoin, ketoconazole, ampicillin esters, iron salts, clarithromycin
Uses: For nausea, vomiting, dizziness associated with motion sickness or vertigo
Potential side effects: Drowsiness, dry mouth, blurred vision
Medications that may interact: Alcohol, barbiturates, injectable antibiotics, digoxin, alprazolam, diazepam, temazepam, allergy medication, depression medication, medications for movement disorders, medications for digestive system problems, pain medications, muscle relaxants
Uses: For chronic constipation
Potential side effects: Gas, cramps, nausea, vomiting
Medications that may interact: Antacids
COPD is the fourth leading cause of death in the United States.1 What is COPD? Chronic obstructive pulmonary disease (COPD) is a term used to describe the obstruction of airflow in the lungs. Primarily, it is associated with two conditions, known as emphysema and chronic bronchitis.
A. Emphysema causes permanent damage to the lungs by weakening and breaking the lungs' air sacs. As a result, the lung tissue looses elasticity, causing the airways to collapse and obstruct airflow.
B. Chronic bronchitis is an inflammatory disease that initially
begins in the lungs smaller airways and gradually progresses to the larger airways.
Mucus increases in the airways and bacterial infections increase in the bronchial
tubes, making it difficult for air to flow in and out of the lungs.2
Long-term smoking is the most frequent cause of COPD. It accounts for 80 to 90 percent of all cases. A smoker is 10 times more likely than a non-smoker to die of COPD. Other risk factors are: hereditary, second-hand smoke, exposure to air pollution at work and in the environment, and a history of childhood respiratory infections.
The symptoms of COPD include: chronic cough, chest tightness, shortness of breath, an increased effort to breathe, increased production of mucus, and frequent clearing of the throat. COPD decreases the lungs' ability to take in oxygen and remove carbon dioxide. As the disease progresses, the lungs small airway walls and alveoli lose their elasticity. The airway walls collapse, closing off some of the smaller air passages and narrowing larger ones. The passageways become blocked with mucus. When the lungs expand during inhalation, air continues to reach the alveoli; however, because the airways tend to collapse while exhaling, it is often unable to escape, trapping the "stale" air in the lungs.³
A typical course of COPD is gradual. It might begin after a person has been smoking for 10+ years, during which symptoms are usually not very noticeable. Then the individual begins developing a productive, chronic cough. Usually, after age 40, the person may complain of shortness of breath during exertion, which continues and worsens over time. Eventually death occurs when the lungs and heart can no longer adequately deliver oxygen to the body's organs and tissues.4 Though the severity of the disease may vary, all persons with COPD have some degree of airway obstruction. Many patients with severe COPD-related lung damage have so much difficulty breathing when lying down that they sleep in a semi-sitting up position.
Cigarette smoking is the most common cause of COPD. But long term exposure to other lung irritants like pollution, dust, paint or other chemicals may cause or contribute to COPD. There is no cure for COPD. Once the damage is done to the lungs and airways, it cannot be reversed. The severity of the symptoms the person has depends largely upon how much lung tissue has been destroyed. The quality of life for the individual diminishes as the disease progresses.
The first and foremost, best treatment to slow or reduce the effects of COPD is to stop smoking. Treatment is always based upon the symptoms, whether they are mild, moderate or severe. Medications and pulmonary (lung) rehabilitation are often recommended to help relieve the symptoms. Flu and pneumonia vaccines are recommended for those with COPD to reduce the chance of getting the flu or pneumonia. For mild cases, short-acting bronchodilators are prescribed. For moderate to severe cases, regular treatments using one or more inhaled short-acting and long-acting bronchodilators and oxygen therapy is generally recommended. In some cases, steroids are prescribed to help reduce inflammation. As a last resort, surgery may be indicated when there is no improvement from medication and the person has difficulty breathing most of the time.
According to the American Lung Association, the annual cost to the country for COPD is about $32.1 billion, $18.0 billion for healthcare expenditures and $14.1 billion for indirect costs.5
1National Center for Health Statistics, Report of Final Morbidity Statistics, 1998. Information cited in: American Lung Association, Trends in Chronic Bronchitis and Emphysema: Morbidity and Mortality, December, 2000.
2National Heart, Lung, Blood Institute: Diseases and Conditions Index, US Dept. Health & Human Services, National Institute of Health; Available at: http://dci.nhlbi.nih.gov/Diseases/Copd/Copd_WhatIs.html
3Ibid.
4Ibid.
5American Lung Association. http://www.lungusa.org/diseases/copd_factsheet.html
Uses: Used to open airways and decrease the difficulty of breathing associated with chronic obstructive pulmonary disease, chronic bronchitis, and emphysema
Potential side effects: Tachycardia, paresthesias, drowsiness, coordination difficulty, itching, hives, flushing, alopecia, constipation, tremor, and mucosal ulcers, dry throat, cough
Medications that may interact: Atropine, hyoscyamine
Uses: For relief from symptoms of upper respiratory allergies, runny nose, sneezing, itchy, watery eyes, itching of the nose or throat
Potential side effects: Drowsiness, dry mouth, dry eyes
Medications that may interact: Alcohol, sedatives, and tranquilizers, Monoamine oxidase (MAO) inhibitors, other allergy medications, sleeping and anxiety medications,
Do not use with any other product containing diphenhydramine, including one applied topically.
Uses: Asthma, emphysema, chronic bronchitis
Potential side effects: Tachycardia, palpitations, urticaria, angioedema, rash, bronchospasm, headache, tremor, nervousness, and paradoxical bronchospasm
Medications that may interact: Monoamine oxidase inhibitors, tricyclic antidepressants, and beta blockers
Uses: For the treatment of asthma
Potential side effects: Irritation and burning in the nose, sneezing
Medications that may interact: Prednisone
Uses: For asthma and chronic bronchitis
Potential side effects: Tachycardia, palpitations, urticaria, angioedema, rash, bronchospasm, headache, tremor, nervousness, and paradoxical bronchospasm
Medications that may interact: Other short-acting sympathomimetic aerosol bronchodilators, beta-blockers, nonpotassium-sparing diuretics, digoxin, and monoamine oxidase inhibitors
Uses: Chronic asthma, emphysema, chronic bronchitis
Potential side effects: Nausea, vomiting, headache, insomnia, diarrhea, irritability, restlessness, tremors, and transient diuresis
Medications that may interact: Cimetidine, erythromycin, tacrine, carbamazepine, rifampin, diazepam, enoxacin, ephedrine, halothane, interferon, lithium, mexiletine, thiabendazole
Uses: For hives and hayfever
Potential side effects: Agitation, nervousness, excitability, insomnia, heart palpitations
Medications that may interact: Bosentan, erythromycin, clarithromycin, cisapride, ziprasidone, pimozide, nefazodone, fluoxetine, paroxetine, sertraline, fluconazole, itraconazole, ketoconazole, voriconazole, grapefruit juice
Uses: For hayfever and hives
Potential side effects: Dry mouth, headache, drowsiness
Medications that may interact: Clarithromycin, erythromycin, fluconazole, itraconazole, ketoconazole, voriconazole
Accidental injuries are the eighth leading cause of deaths among adults age 65 or older, and they are the major cause of disabilities and hospitalizations. Fall and fall-related injuries are the leading cause of accident in people over age 65 and the leading cause of injury death among those 85 or older. Hip fractures are one of the most serious outcomes associated with falls. Half of all older adults hospitalized for hip fractures cannot return home or live independently after their injuries.1 Most falls and injuries occur where older adults spend the majority of their time in the home. Research has determined that most fall-related injuries occur on the same level (not while walking on stairs) and from a standing position (such as tripping while walking). AARP's Public Policy Institute reported 14% of falls took place on stairs or steps, 9% while rising or sitting on a bed, chair or other furniture and 4% took place in the bathroom.2
Several factors can cause an older adult to fall such as age-related changes including poor eyesight or poor hearing. Chronic conditions and illnesses can affect coordination, balance and strength. Extrinsic environmental conditions such as, poor lighting, clutter, certain shoe styles, or throw rugs can increase the risk of falling. Certain medications can affect balance, vision, cognition and reaction time. According to the American Academy of Family Physicians, falls are likely to occur in persons taking four or more medications or if they have had a change in their medication within the past two weeks. Falls can also be an indicator of poor health and functional decline.3 Researchers have determined that those elderly persons who do fall experience more difficulty in performing activities of daily living, participating in physical and social activities and have a greater risk of institutionalization. A recent study compared two groups of individ uals that fall with those that had not fallen while receiving in-home health care services. Those that reported falling had a history of falling three times more often, had a history of cardiovascular and neurological impairments, and took more medications that were known to contribute to a higher risk for falls compared to those that had not fallen.4
Another disability caused by falls is the fear of falling again. People who have fallen often cope by restricting their activity. Between 10 and 25 percent of people who have fallen admit to avoiding activities such as shopping or housekeeping because of their fear of falls.
Family members and other caregivers may also discourage certain activities. It is important that the person receives emotional support. Decreased activities lead to de-conditioning in which muscles become weaker. Severe immobility can lead to complications such as contractures of the joint. This cycle increases the older person's risk of falls and contributes to functional decline.
Task-oriented service delivery systems tend to promote learned helplessness in elders, therefore promoting this vicious cycle. Many elders are afraid to tell anyone they have fallen for fear of a change in lifestyle, such as, losing independence. A rehabilitation model that promotes assistive technology strategies can assist the older person toward completing a task safely, independently and in a timely manner. Using assistive technology and home modification strategies are important in terms of quality of life and cost effectiveness.
Note: Start with letter A. and go clockwise ending back at letter A.
For the elderly, fractures are the most serious problem associated with falls. Hip fractures are the most serious and create the greatest number of health problems and death. The number of hip fractures increase with age. Women have a greater risk of hip fractures due to thinning of the bones, hormonal changes, osteoporosis, etc. Direct treatment of a hip fracture is very costly. In the U.S., it may cost in excess of $70 million dollars. This figure does not take into consideration the additional cost for long-term or post-hospitalization care.
|
Intrinsic Factors |
Extrinsic |
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|---|---|---|---|
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Factor type |
Factors |
Factor type |
Factors |
|
Physiological |
neurological |
Environmental |
obstacles |
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Pathological |
alcohol |
||
Falls for the most part are preventable and should not be regarded as an expected outcome of aging. Even older people who appear to be healthy and strong can fall. Falls are a threat to older people's ability to live on their own. Below are some strategies that are recommended for anyone working with the elderly to help prevent falls.
• Provide education and information on gait training and appropriate use of assistive devices used for balance.
• Encourage them to participate in a regular exercise program that promotes balance and strength training.
• Medications should be reviewed regularly to check for side effects and possible drug reactions. Older people taking more than four medications are susceptible to falls.
• Screening for conditions that can affect balance and coordination, such as, osteoporosis, postural hypotension, other cardiovascular disorders and other irregular rhythm to the heart. Those detected should be treated.
• Consider bone-strengthening medications such as hormone replacement therapy (HRT), calcium or vitamin D to reduce risk of fall-related fractures.
• Evaluate the home environment for hazards such as scatter rugs, clutter, or poor lighting. (See environment section for more details).
• Recommend shoes that are supportive with non-slip soles.
• Recommend using anatomically designed external hip protectors to help decrease the risk of hip fractures.5
• Involve the family.
1Center for Disease Control, Department of Health and Human Services, "Health Aging: Preventing Disease and Improving Quality of Life Among Older Americans (2003)." Available at http://www.cdc.gov/nccdphp/aag/aag_aging.htm.
2"Don't Let Falls Get You Down," Dynamic Living Newsletter, Feb 2004, Vol.60. Available at www.dynamic-living.com.
3Fuller, George F., "Falls in the Elderly," American Family Physician, 2000. Available at: http://www.aafp.org/afp/20000401/2159.html.
4Lewis CL, Moutoux M, Slaughter M, Bailey SP. "Characteristics of individuals who fell while receiving home health services," Physical Therapy, 2004; 84(1): 23-32.
5Kannus, P., Parkkari, J., Miemi, S., Pasanen, M., Palvanen, M., Javinen, M., Vuori, I. Prevention of hip fracture in elderly people with use of a hip protector. New England Journal of Medicine (2000): 343: 1506-13.
Check for Safety, A Home Fall Prevention Checklist for Older
Adults. Centers for Disease Control, U.S. Department of Health and Human Services
Available at: http://www.cdc.gov/ncipc/pub-res/toolkit/checkforsafety.htm
Safety for Older Consumers Home Safety Checklist. Consumer Product Safety Commission. Available at: http://www.cpsc.gov/cpscpub/pubs/701.html
Home Safety Checklist. Rebuilding Together. Available at: http://www.rebuildingtogether.org/home_modifications/Checklist.pdf
Diabetes is a metabolism disorder. This disease affects more women than men. It is more prevalent among African Americans and Hispanics than among Caucasians. Most of the food we eat is broken down into a form of sugar called glucose. The body uses it for growth and energy. Glucose is found in the blood and serves as the body's main source of fuel.
After digestion, glucose passes into the bloodstream, where it is used by the cells for growth and energy. The pancreas produces a hormone called insulin that must be available to help glucose cross over into the cells.
The pancreas automatically produces the correct amount of insulin to move glucose from the blood into the cells. But for people with diabetes, the pancreas either produces little or no insulin or the cells don't respond correctly to the insulin that is produced. This causes glucose to build up in the blood, overflow into the urine, and pass out of the body. When this happens, the body loses its main fuel source. If this isn't controlled, the glucose and fats remain in the blood, which overtime damages vital organs.
According to the Centers for Disease Control, diabetes is the sixth leading cause of death among Americans. It is most common in older people, women, overweight and sedentary people, African Americans, Alaska Natives, American Indians, Asian and Pacific Islander Americans, and Hispanic Americans.
Diabetes can affect almost every part of the body. This disease often leads to blindness (diabetic neuropathy), heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage (peripheral neuropathy). Women with uncontrolled diabetes can experience complicated pregnancies and birth defects.
There are two types of diabetes: Type 1 and Type 2
Type 1 diabetes is an autoimmune disease that occurs when the body's own immune system turns against a part of the body when it is fighting infection. The immune system attacks the insulin producing cells in the pancreas and destroys them. This causes the pancreas to produce little or no insulin. Persons with Type 1 diabetes need to take insulin (oral, injection, or pump) daily to live.
Some of the symptoms the person with diabetes will experience are increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person can fall into a life-threatening diabetic coma.
Healthy eating, physical activity, and insulin via injection or an insulin pump are the basic therapies for Type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking.1
Type 2 diabetes is the most common form of diabetes. About 90 to 95 percent of people with diabetes have Type 2. It usually develops in adults, age 40 and older and is most common in adults over age 55. Reports indicate about 80% of people with Type 2 diabetes are overweight. Those with Type 2 diabetes often are diagnosed with a metabolic syndrome that includes obesity, elevated blood pressure, and high levels of blood fats.
With Type 2 diabetes, the pancreas is able to produce enough insulin, but cannot use the insulin effectively. This is called insulin resistance. After a number of years, insulin production decreases. The result is the same as for Type I diabetes, glucose builds up in the blood and the body cannot make efficient use of it.
The symptoms of Type 2 diabetes develop overtime. They are not as sudden in onset as in Type 1 diabetes. Some people have no symptoms. When symptoms are present they may include: fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. Some of the complications of diabetes for the mature adult are: heart disease, stroke, high blood pressure, blindness, kidney disease, nervous system disease, high cholesterol, amputations, and dental disease.
As with Type 1 diabetes, healthy eating, physical activity, and blood glucose testing are the basic management tools for Type 2 diabetes. In addition, many people with Type 2 diabetes need oral medication and insulin to control their blood glucose levels.
It is very important that people with diabetes take responsibility for their day-to-day care. This involves keeping blood glucose levels from getting too high or too low. When the glucose level drops too low it is known as hypoglycemia. The person will become nervous, shaky, and confused. Judgment can be impaired. If blood glucose falls too low, a person can faint. A condition known as hyperglycemia occurs if the blood glucose levels rise too high. The person can become quite ill.
"The risk for death among people with diabetes is about two times that of people without diabetes."2 People with diabetes should see a doctor who can help them learn to manage and monitor their diabetes. An endocrinologist is one type of doctor who may specialize in diabetes care. In addition, people with diabetes often see ophthalmologists for eye examinations, podiatrists for routine foot care, and dietitians and diabetes educators to help learn the skills of day-to-day diabetes management.3 According to the American Diabetes Association, in 2002, there were an estimated 12.1 million people in America diagnosed with diabetes. For the U. S., this disease cost about $132 billion in medical expenditures and lost productivity. Due to the high incidence of diabetes, it is estimated that over $92 billion was spent for direct medical care costs.
1http://diabetes.niddk.nih.gov/
2http://diabetes.org/main/info/facts/facts_natl.jsp
3http://diabetes.niddk.nih.gov/
Uses: For diabetes to control blood sugar
Potential side effects: Hypoglycemia associated symptoms: sweating, dizziness, palpitation, tremor, hunger, restlessness, tingling, lightheadedness, decreased concentration, headache, drowsiness, sleep disturbances, anxiety, blurred vision, slurred speech, depression, irritability, abnormal behavior, unsteady movement, personality changes, disorientation, unconsciousness, seizures, death; diabetic acidosis symptoms: fatigue, flushing, thirst, decreased appetite, and fruity smelling breath
Medications that may interact: Corticosteroids, thyroid replacement therapy, oral hypoglycemics, salicylates (aspirin), sulfa antibiotics, and some antidepressants
Uses: For management of diabetes
Potential side effects: Visual disturbances, hypoglycemia and diabetic acidosis (as with Humulin)
Medications that may interact: Nonsteroidal anti-inflammatory agents, salicylates, sulfonamides, chloramphenicol, probenecid, monoamine oxidase inhibitors, beta blockers, fluoroquinolone antibiotics, coumarin derivatives, thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid
Uses: For management of diabetes
Potential side effects: Gastrointestinal disturbances, nausea, hypoglycemia and diabetic acidosis (as with Humulin)
Medications that may interact: Barbiturates, alcohol, nonsteroidal anti-inflammatory agents, salicylates, sulfonamides, chloramphenicol, probenecid, coumarins, monoamine oxidase inhibitors, beta blockers, thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid
Uses: For management of diabetes
Potential side effects: Diarrhea, nausea, vomiting, flatulence, asthenia, indigestion, abdominal discomfort, headache
Medications that may interact: Alcohol, nifedipine, amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, vancomycin, thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid
Uses: For management of diabetes
Potential side effects: Nausea, diarrhea, skin rash, sun sensitivity, dizziness, drowsiness, headache, hypoglycemia (as with Humulin)
Medications that may interact: Nonsteroidal anti-inflammatory agents, salicylates, sulfonamides, chloramphenicol, probenecid, coumarins, monoamine oxidase inhibitors, beta blockers, thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid, oral miconazole and oral hypoglycemic agents, fluconazole
Uses: For management of diabetes
Potential side effects: Swelling, headache, nausea, vomiting
Medications that may interact: Astemizole, fexofenadine, terfenadine, carbamazepine, cisapride, cyclosporine, alprazolam, diazepam, midazolam, triazolam, diltiazem, felodipine, lidocaine, nifedipine, quinidine, verapamil, cholestyramine, lovastatin, simvastatin, donepezil, erythromycin, indinavir, other medicines for diabetes, saquinavir, voriconazole
Uses: For management of diabetes
Potential side effects: Dizziness, fatigue, headache, heartburn, stomach discomfort, sun sensitivity, nausea, vomiting, skin rash, hypoglycemia (as with Humulin)
Medications that may interact: Alcohol, beta-blockers, cisapride, clofibrate, diazoxide, itraconazole, miconazole, voriconazole, metoclopramide, rifampin, warfarin
According to the American Lung Association, pneumonia is a serious infection or inflammation of the lungs. Pus and other liquid fill the lung's air sacs making it difficult for oxygen to reach the blood. Without enough oxygen in the blood, the body cells cannot work well. Because of this and the spreading of infection through the body, pneumonia can cause death. The lungs can be affected two ways: 1) lobar pneumonia affects a section (lobe) of a lung and 2) bronchial pneumonia affects patches throughout both lungs.1
Pneumonia is not a single disease. It can have over 30 different causes. The five main causes of pneumonia are: bacteria, viruses, mycoplasmas, fungi, and various chemicals.
There are two types of pneumonia: bacterial and viral:
Any age group (young and old) can be diagnosed with bacterial pneumonia. But some have a greater risk than others, such as alcoholics, the debilitated, post-operative patients, people with respiratory diseases or viral infections and people who have weakened immune systems.
Pneumonia bacteria can be found in some healthy throats. When body defenses are weakened in some way, either by illness, old age, malnutrition, general weakness or impaired immunity, the bacteria can multiply and cause serious damage. Usually, when a person's resistance is lowered, bacteria work their way into the lungs and inflame the air sacs. The onset can vary from gradual to sudden.
The lungs have five lobes. Bacterial infection can attack any part of the lungs' tissue, part or all the lobes which will cause the lobes to fill with fluid. Very little time is needed for the infection to spread through the bloodstream to other parts of the body.
Streptococcus pneumoniae is the most common cause of bacterial pneumonia. It is one form of pneumonia for which a vaccine is available. Once a vaccine is taken, it is good for life.
The Lung Association states, that "in severe cases, the patient may experience shaking chills, chattering teeth, severe chest pain, and a cough that produces rust-colored or greenish mucus, increased breathing and pulse rate, body temperature may rise as high as 105ºF and bluish colored lips or nails due to lack of oxygen."2
Almost half of all pneumonias are believed to be caused by viruses, yet most of these pneumonias are not serious and last a short time. Through research, numerous types of viruses are being identified as the cause of respiratory infection. Though most affect the upper respiratory tract, some do produce pneumonia.
The most severe and occasionally fatal virus that aggressively invades the lungs and multiplies is the influenza virus. There are almost no physical signs that fluid fills the lung tissue. Those with pre-existing heart or lung disease or are pregnant are most effected.3
Initially the symptoms of viral pneumonia are similar to influenza symptoms: presence of fever, a dry cough, headache, muscle pain, and weakness. But within 12 to 36 hours, the person will have increasing difficulty in breathing and develop a high fever. The cough becomes intense and produces a small amount of mucus. The lips will appear blue.
According to the Lung Association, those with extreme symptoms will have a desperate need for air and extreme breathlessness. Viral pneumonias may be complicated by an invasion of bacteria, with all the typical symptoms of bacterial pneumonia.4
How can pneumonia be prevented? Because pneumonia is a common complication of influenza (flu), getting a flu shot every fall is good pneumonia prevention.
A vaccine is also available to help fight pneumococcal pneumonia, one type of bacterial pneumonia. Usually, it is given only once to those individual at high risk of getting the disease and its life-threatening complications.
Those people who are at the greatest risk of pneumococcal pneumonia:
• Have chronic illnesses such as lung disease, heart disease, kidney disorders, sickle cell anemia, or diabetes.
• Are recovering from severe illness.
• Are in nursing homes or other chronic care facilities.
• Are age 65 or older.
• Have history of respiratory problems such as reactive
airway disease or asthma.
Good health habits, proper diet and hygiene, rest, regular exercise, etc. increase resistance to all respiratory illnesses and help promote fast recovery when illness does occur.
Flu is a contagious disease caused by a virus that affects the respiratory system primarily the ears, nose and throat. Since it is caused by a virus, an antibiotic is not recommended for treatment. It is different from the common cold. It attacks the body very quickly and the person may start to experience some or all of the symptoms listed below:
• Fever
• Headache
• Tiredness (can be extreme)
• Dry cough
• Sore throat
• Nasal congestion
• Body aches
Recovery time varies among people but usually lasts between one to two weeks. Some people may be prone to develop pneumonia, a life-threatening condition, as a result of the flu. According to the CDC, about 10% to 20% of the population will get the flu each year. The flu can attack anyone at any age. Those people over age 65 with chronic conditions and those who are very young can develop complications from the flu. Three types of complications that occur are bronchitis, pneumonia, sinus and ear infections. Chronic conditions such as asthma and congestive heart failure can become much more serious.5
The flu virus spreads from person to person. The infected person can transfer the virus through the air by sneezing, coughing, or speaking to another person. The other person contracts the illness by inhaling the virus through the nose. For some people, symptoms can occur within one to three days after exposure to the virus while others may not show any symptoms but still be carriers of the virus. The virus can spread to others for 3-7 days after an adult shows symptoms and longer than 7 days for children. Since the flu is caused by a virus, antibiotics will have no effect on it. The best treatment for the flu is to:
• Rest
• Drink plenty of liquids
• Avoid using alcohol and tobacco
• Take medication to relieve the symptoms of flu6
According to the American Lung Association, pneumonia and influenza combined ranked as the seventh leading cause of death for the year 2000.
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Group of People |
When to Get YOUR Vaccine |
|
|---|---|---|
|
High Risk of Severe Illness •
65 years old or older | ||