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How Caregivers Can Help Aging Parents Manage Their Medicine

SingleCare offers a free pharmacy savings card. Their mission is to help you get the best price possible for your prescription medications. Their latest resource guide on medication management for seniors includes tips for organizing prescriptions along with a schedule that you can download for free.

If your parent has been diagnosed with a chronic condition, you’re not alone. Two out of three older Americans are living with not just one, but multiple chronic illnesses. These conditions can require complicated treatment plans, usually including various medications. This can be overwhelming for the patient, but also for a caregiver.

If you’re caring for a parent who has been prescribed multiple medications, you share the responsibility of understanding exactly what each prescription is for, when it needs to be taken (or administered), and how to avoid dangerous interactions or side effects. Use these five tips for helping seniors manage their medication.

1. Learn how aging affects a patient’s response to treatment

As our bodies change, so does our response to medication. Even if your parent has taken a certain medicine before, its effectiveness could vary over the years. Metabolism, organ function (especially of the kidneys and liver), weight fluctuation, and an aging nervous system affect the way a drug works (or does not work) to treat a chronic condition. This can result in different side effects and efficacies of a drug.

Understanding the current state of your parent’s health as well as their medical history is crucial to their treatment plan. It will be important to raise questions or concerns to your parent’s doctor if you notice anything unusual during their treatment.

2. Be an active participant in your parent’s healthcare discussions

You play an important role in your parent’s health care, so you should feel empowered to educate yourself on your parent’s condition and treatment plan. You’ll help to provide feedback to the doctor, keep them informed on your parent’s progress, and raise questions as to whether medications should be adjusted.

Here are two important questions to ask at your parent’s next appointment:

  • How will this medication help my parent’s condition?
  • Are there any medications that my parent is taking that he or she no longer needs?
The less medications you need to juggle—and your parent needs to take—the easier medication management will be.

3. Understand drug labels and medication guides

Despite its size, there’s a lot of information on each prescription label. Here are eight critical details to pay close attention to:

    Pharmacy contact information
  • Patient contact information
  • Doctor’s contact information
  • Drug name and strength
  • Instructions
  • Prescription information
  • Drug manufacturer information
  • Federal caution statement
4. Keep multiple medications organized and stored properly

It goes without saying that a medication error (like forgetting to take a pill or taking the wrong pill) can be a dangerous and even fatal mistake. Staying on track with multiple medications can be complicated. Here are a few ways to navigate polypharmacy, which is the use of multiple drugs at once:

    Create a medication list by writing down each drug name and dose.
  • Take (or administer) medications at the same time everyday.
  • Set a reminder or alarm to remember to take (or administer) medication.
  • Try to fill all prescriptions at one pharmacy for easy pickup and to build a working relationship with your pharmacist.
  • Ask a pharmacist for a medication review to understand which drugs can be taken at the same time or how long to space doses apart.
  • Ask the doctor what could happen if your parent misses a dose, so you have an action plan if this should happen.
  • Read the full medication guide, ask questions if something doesn’t make sense, and don’t throw it away should you need to reference it in the future.
5. Follow up with your parent’s healthcare team and provide feedback

Take advantage of your parent’s next doctor’s visit to provide feedback on their progress, raise concerns, and ask questions. If your doctor suggests a new medication, remember to ask what it’s for and if there are other medications your parent can stop taking. By educating yourself and staying organized, your parent may have better results as medication mistakes are avoided.

3 Conversations You Need to Have with Your Ageing Parent

Guest author, Adam Pike, is the Founder of SuperCarers. SuperCarers helps families in the UK find the best care professionals in their local area, as well as providing the tools needed to easily manage the care. Their belief is that the best care is about more than practicalities. It’s about making a real connection between people.

As your parents get older there are some challenging conversations that you would rather avoid but having them ahead of time can make a world of difference when the time comes that they need to be made.

In this article we will explore some of the questions that you should ask and how they can help you ensure your parents receive the best care during later life.

1. Do you still feel comfortable living in your home?

It’s important to consider your parents living arrangements as they get older. As they age, their mobility may decline and their house may no longer be suitable to their needs. It also be the case that it is difficult to maintain up-keep of the family home as well.

Talking about living arrangements with your parents can ensure that if the time comes that they need to move home, that you can help them move somewhere that meets both their wants and needs. Having this discussion will also allow you to cover other important questions, such as whether home improvements are necessary to ensure your parent’s safety or whether they need home care.

When having this conversation with your parents it may be useful to ask some of the following questions:

2. What are your preferred care options?

There are numerous elderly care options available if your parent needs care in the future, including part-time home care, live-in home care residential care, and nursing care. With all of these in mind, if your parent decides that they need care, what option would they prefer?

It can help to consider the different options available to ensure that they receive the care that they want when they need it and to ensure you respect their decisions. It isn’t an easy task to discuss or arrange care and it can help talking to an Independent Care Advisor in order to ensure your parent receives the care that meets their specific wants and needs.

3. What is your financial situation like now and moving forward?

Whether you need to know about your parent’s financial situation for funding care and home improvements or for the upkeep of their current home and daily expenses, understanding their financial situation can help you to plan for future expenses. Your parents may be fiercely independent regarding their finances, which is understandable, so it’s important to go about this conversation sensitively.

You will need to find out how they plan to fund care if they need it. Are they eligible for local authority support or do they have sufficient savings to cover any eventual costs? You may also want to explore different options with them, such as equity release and down-sizing. In any case, it is advisable to discuss any financial issues with an independent financial advisor to ensure that your parent manages their finances appropriately. If your parents already have a financial advisor, it is important to know who they are in case you need to speak with them in an emergency.

It’s understandable that some of these conversations can be difficult to have but it can take a weight off your shoulders in the future. Knowing what your parent’s wishes are can also make the decision making process that much easy.

What Mesothelioma Patients Caregivers Need to Know

Guest author, Christopher Visser, is the Founder of Mesothelioma Treatment Community and is passionate about raising awareness on the dangers of asbestos while offering guidance and palliative care to all those who are suffering from mesothelioma cancer.

When a loved one is diagnosed with mesothelioma, a parent, a close friend, or a spouse usually takes the role of a caregiver. Since they are usually not paid to provide care, they are known as family caregivers or informal caregivers. Generally, some of them have very little or no experience in taking care of mesothelioma patients as it is a rare form of cancer. If you have taken on this responsibility, it’s important to know your responsibilities. Here are some tips, advice and resources to get you started.

What To Expect
As a caregiver, you should expect to assist and/or take over the responsibilities that the patient can no longer complete on their own. Such responsibilities include but not limited to:

  • Dressing
  • Bathing
  • Feeding
  • Managing medications
  • Monitoring patient for health changes
  • Scheduling appointments with the doctor
  • Transportation
  • Liaison for legal issues
It’s important to note that roles of a caregiver will change if the mesothelioma symptoms increase or decrease.

Common Responsibilities
The responsibilities of a mesothelioma patient caregiver vary depending on the stage, age, and general health of the patient. Regardless of the above, here are some of the common responsibilities:

    Health Monitoring: Caregivers for mesothelioma patients are responsible for managing medications, reporting health changes to the doctor, managing appointment schedules and providing details of the patients to their medical team.
  • Emotional Support: Companionship is usually very crucial to a patient’s well-being.
  • Decision Making: Patients usually need assistance in making important decisions. I.e. Financial decisions, mesothelioma treatment options, health insurance, and sometimes with legal issues as well.
In addition to these responsibilities, a caregiver has to deal with their own personal uncertainties and emotions. It’s critical to acknowledge the fact that caregivers occasionally feel lost, burnt out and frustrated.

Tips For Caregivers
Frustration and stress are common emotions that caregivers deal with and on occasion, this stress can cause disagreements and miscommunication between the caregiver and the patient. Here are some tips that can help you along the way:

    Acknowledge your differences

    Every patient is different and so is his or her close friends and family. All possess unique skills, strengths and personalities. Therefore, don’t jump to any conclusions but simply expect these differences. A family member may prefer doing physical things around the house rather than accompanying the patient to the bathroom and vice versa. A caregiver needs to cater to patient as well as family members but never at the cost of the patient’s health. Contact the patient’s doctor if such a problem arises.

  • Involve the patient in care-related discussions

    Don’t assume that the patient needs or wants something. Assumptions will cause misunderstandings and stress for you and the patient.

  • Stay as organized as possible

    Keep treatment schedules, medical paperwork and other crucial documents organized. This will enable you to always be prepared in a time of crisis.

  • Know how to manage stress, YOUR stress

    You must know how to detect stress signals and manage it without interrupting the comfort of the patient.

  • Seek help

    If you feel completely overwhelmed, seek assistance. Seeking help does not mean you failed. It only enables you to provide the best care to your mesothelioma patient.

Resources for caregivers
There are many obstacles that both mesothelioma patients and caregivers will face. Here are valuable resources to help minimize these obstacles:

    Consultation services

    There are consulting and financial services that are offered by financial planners and accountants which will provide support and guidance on how to pay for treatment and medical bills. With that said, next is…

  • Legal compensation

    One of the major responsibilities specifically for caregivers of mesothelioma patients is to make decisions on legal issues. This is a whole other topic and if you care to learn more, it is vital to know what to look for in a mesothelioma law firm before allowing them to take control over your loved one’s case.

  • Support organizations

    There are many private organizations that provide palliative care and support to mesothelioma patients and caregivers. One such organization is the Mesothelioma Treatment CommunityMesothelioma Treatment Community of

  • Mesothelioma literature

    There are many publications and books that provide useful information about mesothelioma. Being a caregiver for a mesothelioma patient is not an easy task. However, being aware of what to expect, the responsibilities at hand as well as using the tips and resources available could absolutely ease any caregiver through the process..

5 Physical and Mental Health Boosters for Seniors

Guest author, Marie Villeza, is passionate about connecting seniors with the resources they need to live happy, healthy lives. So she developed ElderImpact to provide seniors and their caregivers with resources and advice.

Seniors are at risk of developing depression, but they and their family members often assume it is a normal part of growing older and often fail to discuss their symptoms with a healthcare professional or take steps to treat it. If a senior citizen feels sad, has unexplained aches and pains, has lost interest in socializing or pursuing hobbies, has a lack of motivation and energy, or neglects personal care, there is a good chance that he is depressed. One way to combat depression is to boost physical and mental health; we share five tips for doing so below.

1. Make Activities Fun and Humorous.
One of our favorite studies shows that seniors who participate in exercise programs that include laughter strengthen their aerobic endurance, mental health, and confidence when performing physical activities. Who wouldn’t want to exercise if it were based on laughter?

The trick is finding a program that stimulates laughter. Some senior centers and home care services offer these types of programs. Seniors may also find that working out with friends gives them a good laugh, especially when they try new activities such as Wii bowling or line dancing. We know that being social is better than being isolated when it comes to warding off depression, and spending time having fun while being active with others is a good way to ensure overall health and well-being.

2. Get Creative.
he more creative you are with your activities, the better your mental health will beT because you will be challenging your brain. You can socialize while getting creative at your senior center by joining a quilting club, a knitting circle, or a fly-tying class. Seniors who participate in songwriting, creative writing, crocheting, creating new recipes, painting, drawing, sketching, and performing music improve their overall well-being. Creative tasks also promote eye-hand coordination and relieve stress, which can lead to better heart health and protect against depression.

3. Spend More Time with Dogs.
Spending time with dogs helps seniors in several ways. Dogs often keep seniors from sitting too long and get them up and moving around even in winter . If you don’t have a pup of your own, not to worry. Many people need help making sure their dogs get enough exercise. Taking up dog walking or pet sitting are great ways for you to stay active while also making a little extra money to use in your retirement.

It’s important to note, too, that the benefits of spending time with dogs go beyond physical health. There also are many mental health benefits to spending time with dogs. Being outside in the sunshine with dogs increases a senior’s level of vitamin D, which helps fight depression and heart attacks. Additionally, petting or grooming a dog is a comforting task that reduces stress and helps reduce blood pressure and cortisol levels. Moreover, spending time with a dog keeps seniors’ minds occupied and off their worries and troubles. One of the best benefits of spending time with a dog is that it provides companionship and reduces feelings of loneliness, which also helps combat the symptoms of depression.

4. Volunteer.
Volunteering has been known to have physical and mental health benefits for seniors. First, volunteering increases social interaction and gives seniors a sense of purpose, which helps combat depression. Volunteers also have improved physical and mental health because of the physical activity and brain function that is required for volunteering. Volunteers feel good about helping others and become happier the longer they volunteer, which reduces stress levels and risk of depression.

5. Join a Card Club.
Seniors who join card clubs increase their social interaction and make new friends. The card club serves as a sort of support group because seniors discuss their lives while playing games. Various games also require planning and strategizing, which strengthens seniors’ cognitive abilities as well. If card players live close enough to one another, they can walk to the one another’s houses to hold card club and enjoy spending time outdoors while getting in some physical activity at the same time.

Don’t assume that the blues are a normal part of growing older. If you are feeling symptoms of depression, talk to your healthcare provider and engage in activities that can boost your physical and mental health.

Top 2017 Caregiver Resolutions to Keep Loved Ones Safe

We’ve collected the best caregiving tips from our 2016 resources.
These are easy to implement and can go a long way towards keeping your loved ones safe and healthy throughout 2017.

Resolution #1: Make quality sleep a priority.
Ensure you and your loved ones consistently get the recommended hours of quality sleep for their age. This is one of the best ways to protect yourself and your loved ones from stress, anxiety, obesity, depression, suicide, various medical conditions, such as diabetes, hypertension, heart attacks, atrial fibrillation and strokes, and accidental injuries including falls and motor vehicle accidents. Consistent quality sleep is also essential for the brain to effectively retain and process information; especially for our younger family members in school and our older family members trying to prevent “senior moments” or being challenged with dementia.

You can promote quality sleep by creating a “pre-sleep routine”. Start the routine approximately 3 hours after the last meal of the day by dimming the lights, cooling off the bedrooms, and turning off electronics. This prepares everyone in the home mentally to get a good night’s sleep.

Watch out for signs like snoring, waking up numerous times during the night and/or waking up earlier than normal that might indicate poor sleep. These signs may also signal an onset of mental disorders (e.g. depression, anxiety) or physical problems (e.g. advancing chronic pain, enlarging prostate in men) that should be brought to the attention of and addressed by a licensed healthcare professional. Learn more in our articles, 5 Health Risks to Your Family Caused by Inadequate Sleep and 3 Ways Sleep Improves Memory.

Resolution #2: Promote physical activity.
Sedentary behavior is one of the greatest risks to your loved ones health and well being. A study found that more than 4 hours a day of “recreational screen time” (e.g. TV, smartphone, PC) increases the risk of death from any cause by 50% and the risk of a cardiovascular event (e.g. angina, heart attack) by 125%. According to Dr. James Levine form the Mayo Clinic, “Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death.” Lack of activity promotes obesity, diabetes and can exacerbate conditions such as chronic pain and depression.

It’s important to address the most common sources and times of the day that sedentary behavior occurs. Place countdown timers set to an hour next to TVs and PCs to remind your loved ones to get up and move. Place pedal exercisers under desks and an exercise trampoline in the den – be creative. Schedule a short (e.g. 30 minute) leisurely “required family evening walk” after dinner. These are all excellent way to reduce sedentary activity and stave off diabetes, obesity and depression in every member of your family. See more detail on these tips in our article Stop the Hidden Killer in Your Family.

Look out for decreases in activity in your loved ones. They could be a sign the new onset or worsening of existing pain (e.g. arthritis), depression, dementia, Parkinson's’ or some other illness and should be addressed by a licensed healthcare professional as soon as possible.

Resolution #3: Make water a family staple.
Younger and older family members and those with certain conditions (e.g. swallowing disorders, arthritis, Parkinson’s, Alzheimer's) are especially vulnerable to dehydration. Nearly 20% of pediatric emergency room visits and over 30% of elder emergency room visits present with dehydration. Numerous studies have associated dehydration with kidney stones, constipation, asthma, cardiovascular disease, diabetic hyperglycemia, and some cancers. Dehydration can also prevent loved ones medications for either working properly or cause dangerous levels of their medications to build up in their bodies. Once set in, dehydration can cause a lack of appetite, fatigue, and irritability in both age groups which makes rehydration a challenge thus further worsening the dehydration.

Our tips to prevent dehydration in your loved ones include:

    Keep a pitcher of water in the fridge and make it the centerpiece of every meal.
  • Increase the water content of every meal by incorporating more vegetables, fresh fruit and lean meats, which can provide up to two-thirds of your loved ones daily fluid requirement.
  • Introduce alternative fluid options (e.g. popsicles, puddings, jello) for loved ones who are stubborn about drinking plain water or have difficulty swallowing.
  • Encourage the habit of drinking a full glass of water with every medication in loved ones with decreased thirst response.

These tips can go a long way towards ensuring your loved ones are properly hydrated. See more detail on these and other tips in our article, Don’t Let Dehydration Put a Damper on Your Family’s Summer.

Resolution #4: Be sun savvy.
Repeated unprotected exposure to the sun’s ultraviolet (UV) rays can cause skin damage, eye damage, immune system suppression and skin cancer. Suffering one or more blistering sunburns in childhood or adolescence more than doubles a person’s chances of developing potentially-deadly melanoma later in life and over 60% of skin-cancer related deaths occur in persons age 65 or older. Our youngest and oldest family members are more sensitive to the sun’s rays and more susceptible to their damaging effects because of increased exposure, thinner skin and sun-sensitizing medications (e.g. benzoyl peroxide for acne, thiazide diuretics for high blood pressure) typically taken by family members in these two age groups.

Knowing which sun-sensitizing medications your loved ones are taking, teaching and following the “short shadows - seek shade” rule, limiting outdoor activity when UV index is at its highest, and encouraging the regular use of “sun-safe” clothing and broad-spectrum sunscreen that blocks both UVA and UVB are all easy ways to keep your family safe in the sun year round. See more detail on these tips in our article Keep Your Family Safe in the Sun with these 6 Tips.

Resolution #5: Schedule vaccinations.
Vaccine-preventable diseases are responsible for limb amputation, paralysis, hearing loss, convulsions, brain damage, and even death in children. Every year, approximately 50,000 US adults die from vaccine-preventable diseases in the US. You can keep your loved ones safe from dangerous and potentially life-threatening diseases by simply ensuring their are and get regularly vaccinated. Aside from the annual flu vaccine, which is recommended for all age groups starting as young as 6 months of age, the varicella vaccine and pneumococcal vaccine are especially important for our older loved ones to protect them from the life-threatening chickepox and/or painful shingles and deadly pneumonia respectively.

Download the CDC Vaccine Schedule for those 0-18 years of age and those 19 years or older or the vaccine schedule app for iOS or Android, bring it to your next doctor visit and ask if you family is as protected as it can be. Learn more about the flu shot and the diseases that vaccines prevent in our articles, The Flu Shot: Protect your family this Holiday Season, and 17 Diseases Vaccines Prevent.

Resolution #6: Make the most of doctors.
The average total time spent on a doctor’s visit is over 2 hours - which includes 37 minutes traveling to and from the office, 64 minutes in the waiting room and 20 minutes actually seeing the doctor at an average rate of $11 per minute. The time spent seeking a doctor’s care - instead of working - results in an additional hidden cost of $43 per visit which does not take into account your per-visit-copay, any prescriptions costs and what you pay annually for your health insurance coverage. In an environment where doctors are forced to see more patients in less time, it is even more important now to know how to get the most of your loved ones’ doctors, nurses and pharmacists.

Open unassuming honesty with your loved ones’ healthcare providers is an important first step. Seemingly unimportant things like changes in sleep, activity and appetite can be important early signs of serious conditions like cancer and depression. Give your loved ones’ doctors the opportunity to detect potentially life-threatening conditions by providing them a full history and not filtering out things you may think are unimportant. This honesty includes providing an accurate and complete list of medications and supplements - and how often they are truly taken - so your loved one doctors and/or pharmacists can determine if they are at risk for life-altering drug-drug interactions or side-effects. Lastly, bring a list of concerns and/or question to help the nursing staff take care of some things even before you enter the exam room and allow the doctor to focus on the things that truly need a physician's attention. Read 5 Simple Tips to Make the Most of Your Loved One’s Next Doctor Visit to learn more.

We hope these simple tips help keep you and yours happy and healthy throughout 2017 and beyond.

The Flu Shot: Protect your family this Holiday Season

The flu causes millions of illnesses, hundreds of thousands of hospitalizations and thousands or tens of thousands of deaths each year in the United States (1).
Although a majority of hospitalizations and deaths occur in people 65 years and older about 100 deaths from influenza among children are reported each year to CDC (2).

Not to be confused with the common cold, the flu, caused by the influenza virus, spreads easily and can cause serious problems especially in young children, older adults, pregnant women and people with certain long-term medical conditions like asthma and diabetes. Even healthy children and older adults are hospitalized and/or die from flu complications every year in the US.

According to the CDC, An annual flu vaccine is the best way to protect against this potentially serious disease and can reduce flu illnesses, doctor visits, pneumonia, need for antibiotics, missed work and school due to flu, as well as prevent flu-related hospitalizations. Even if you or your loved ones get sick, the flu vaccination can make your illness milder and shorten its course.

Unfortunately too many people are still not getting vaccinated. Flu vaccination coverage has been essentially flat among children, at only 59% of those ages 6 months to 17 years being protected over the last 3 flu seasons. Flu vaccination coverage among adults 18 years of age or older has dropped to its lowest since the 2011-12 flu season with only 41.7% getting vaccinated.

Even more troubling, over half of millennials (18 - 34 year olds) don’t plan on getting the flu vaccine this year. In a recent interviewed by the New York Times, one millennial cited multiple misguided reasons - shared by many of his fellow millennials - for not getting vaccinated including; never having gotten the flu, being too healthy to get the flu, not trusting the effectiveness of the vaccine and/or believing it will make them sick.

Those who refuse to get vaccinated don’t realize that they are not only putting themselves at risk but also putting everyone they come in contact with at risk as well. A young unvaccinated healthy person, like a millennial, may get infected with influenza but only suffer mild symptoms if any. In fact, a recent study suggests that most influenza infections are asymptomatic allowing infected persons to continue to interact with people both at work and at home unknowingly spreading the virus to those who may be more vulnerable to the flu and its complications.

The unpredictable nature of the flu season, the lack of people getting vaccinated, and the gathering of family and friends for the holidays is a “perfect storm” for the flu to wreak havoc on the health of our loved ones. Now, more than ever, it is important to give your loved ones the gift of life by making sure you and they are vaccinated against the influenza virus.

It takes about two weeks after vaccination for antibodies to develop in the body that protect against influenza virus infection and flu activity is usually highest between December and February; lasting as late as May, so don’t hesitate and get your family protected today.

In addition to getting vaccinated, there are simple Everyday Preventive Actions you can take to slow the spread of germs that cause respiratory (nose, throat, and lungs) illnesses, like the flu. These include: limiting contact with others if you feel sick, covering your nose and mouth with a tissue or the crook of your elbow when you cough or sneeze, washing your hands often, regularly disinfecting or avoiding unnecessarily touching of commonly contaminated objects or surfaces (e.g. doorknobs, toys etc) and avoid touching your eyes, nose and mouth.

Not sure which vaccine is right for each member of your family? Read about the Different Flu Shots For Different Loved Ones for the 2016-17 flu season in our recent newsletter. Not sure where to get your family vaccinated? Find a place near you to get a flu vaccine with the HealthMap Vaccine Finder.

Family Caregiving Takes Caring for Yourself

Providing care to your loved one, in and of itself, will not make you sick or kill you;
in fact, it may make you live longer.
Ensuring your peace of mind as a caregiver is utterly important.

In 2012, President Barack Obama proclaimed the month of November National Family Caregivers Month. affirming, “Family members, friends, and neighbors devote countless hours to providing care to their relatives or loved ones...All of them give selflessly to bring comfort, social engagement, and stability to those they love. Family caregivers have an immeasurable impact on the lives of those they assist, but their hours are long and their work is hard. Many put their own lives on hold to lift up someone close to them.”

Caregiving comes in many forms: daughters and sons balancing the work of caring for aging parents with the demands of raising their own children, aging spouses and partners caring for their loved one as they navigate their own age-related health challenges, mothers and fathers caring for children with special needs or families and friends coming together to care for those wounded warriors returning home with disabilities - to name just a few.

Caregiving is loving commitment that, in a recent survey, an overwhelming majority of caregivers report that caregiving has strengthened their personal relationship with the person they care for and has been, overall, a positive experience. That being said, the same survey also shows that over half of caregivers report experiencing stress in their family, secondary to caregiving, regardless of marital status and family income.

In the US today there are some 90 million caregivers. Caregiving can be physically and emotionally demanding on these unsung heroes. While some research suggests that caregiving is associated with increased mortality and other negative physical health effects (e.g. “caregiving can take as much as 10 years off a family caregiver’s life”, “spouse caregivers have 63% higher mortality rates than noncaregivers”) a review of the many studies conducted worldwide on the impact of caregivers’ health suggests that family caregiving is not directly associated with poorer health or an increased risk of death in the caregiver. In fact, one consistent finding across five population-based studies was that caregivers, as a general group, have significantly reduced mortality rates compared to their respective noncaregiving reference groups.

More importantly, there is considerable evidence that caregivers experience symptoms of emotional distress …(as) a result of observing a family member struggling with a serious or disabling medical condition and not because of any stress involved in providing care to that person. This may explain why some research seems to find an association between caregiving duties with caregiver illness or death. The studies that do report an association tend to be small (i.e. non-population based) studies of caregivers providing care to loved ones with severe and/or progressively disabling conditions and thus are exposed to greater emotional distress than the average caregiver.

This underscores two important points: (1) Providing care to your loved one, in and of itself, will not make you sick or kill you, in fact, it may make you live longer; and (2) Ensuring your peace of mind (i.e. reducing your stress) as a caregiver is critical to a positive caregiving experience.

Caregivers Must Take Care to Give Care
The theme for this year’s National Family Caregiver Month is: “Take Care to Give Care”, an important thing to remember because the emotional distress experienced by caregivers can have serious consequences.

According to the American Institute of Stress, There are numerous emotional and physical disorders that have been linked to stress including depression, anxiety, heart attacks, stroke, hypertension, immune system disturbances that increase susceptibility to infections (e.g. common cold, herpes) certain cancers, as well as autoimmune diseases like rheumatoid arthritis and multiple sclerosis. Among the common signs and symptoms of stress are pain (e.g. head, neck and back), increased emotionality (e.g. anger, frustration, hostility, worry, guilt, sadness etc), disturbed appetite, and poor sleep (e.g. insomnia, nightmares, disturbing dreams, etc) all which diminish a caregiver’s ability to look after their loved ones.

The Caregiver Action Network (CAN) has the following 10 tips for Family Caregivers with links to additional resources to ensure you are and stay at your healthiest best both physically and mentally for your loved ones:

Finding and keeping peace of mind in your role as a caregiver will ensure that you can continue being, as President Obama said back in 2012, “the humble heroes who do so much to keep our families and communities strong”.

Physical Therapy: The Key to Treating Bone, Joint and Muscle Pain

Osteoarthritis, neck pain, and low back pain are among the top 25 conditions that cause the most years of “health life” lost to disability (1).
A sound physical therapy regimen can reduce the need for opioid painkillers and improve the muscle weakness, joint stiffness and decreased range of motion that commonly afflict those with musculoskeletal conditions (2).

October 12 - 20 is Bone and Joint National Action Week, an annual global event to increase awareness, education and promote activities to address musculoskeletal disorders and their most common symptom, musculoskeletal pain. The week, which spans two calendar weeks in October, is highlighted by days dedicated to specific musculoskeletal conditions including World Arthritis Day on October 12th, World Spine Day on October 16th and World Osteoporosis Day on October 20th.

According to the National Health Interview Survey (NHIS) in 2012, more than half (54%) of persons age 18 and over have a musculoskeletal medical condition - this is 76% greater than those with coronary and/or heart conditions, and nearly twice as many as those with a chronic respiratory condition. With age the incidence increases dramatically with nearly 3 out of four (70%) of persons age 65 and over suffer from a musculoskeletal medical condition.

The pain, weakness, stiffness, and decreased range of motion common in musculoskeletal conditions accounted for millions of cumulative years lost lost due to ill-health, disability or early death in 2010 globally. In fact, osteoarthritis, neck pain, low back pain and other musculoskeletal disorders (e.g.lupus (SLE), rheumatoid arthritis (RA), fibromyalgia) ranked among the top 25 causes of disability-adjusted life years (DALYs) - a measure of overall disease burden, expressed as the number of potential “healthy years” lost due to ill-health, disability or early death - in the United States.

Opioid Therapy Alone is Not the Answer
Opioids such as hydrocodone (e.g. Vicodin®), oxycodone (e.g. OxyContin®), oxymorphone (e.g. Opana®), methadone (e.g. Dolophine®), and fentanyl (e.g. Duragesic®) are commonly prescribed as oral medications or patches to manage the pain associated with musculoskeletal disorders. Unfortunately, a recent study found no evidence that opioids provide a meaningful effect on chronic non-specific lower back pain - one of the most common musculoskeletal causes of disability. Despite this, opioid prescriptions have quadrupled since 1999 and, by 2012, 259 million prescriptions for opioids were being written - more than enough to give every American adult their own bottle of pills. This is alarming given the fact that as many as 1 out of 4 people receiving long-term opioid therapy in a primary care setting struggles with addiction, 78 Americans die everyday from opioid overdose and at least half of all opioid overdose deaths involve a prescribed opioid.

For those that don’t become addicted or die from an overdose, improper long-term opioid use can worsen the already significant disease burden of their musculoskeletal condition. Some prescribed opioid medication are a combination of an opioid with another over-the-counter (OTC) medication that can cause its own problems over time. For example, Vicodin® is a combination of hydrocodone and acetaminophen, the active ingredient in Tylenol®. if taken in excess or improperly the acetaminophen alone can lead to liver damage, liver failure or death. The ibuprofen found in Vicoprofen® - a combination of hydrocodone and ibuprofen, the active ingredient in Advil® - can increase the risk of kidney damage, kidney failure, heart attacks and stroke. Because OTCs or so readily available, it is easy to inadvertently create these and other dangerous combinations or overdoses with opioids. Read the Don’t Blow a Tire with Too Many OTCs section of our Optimizing Pain Management article to learn more about the dangers of improper OTC medication use.

In response to the dangers of this opioid epidemic, the Centers for Disease Control and Prevention (CDC) has developed a Guideline for Prescribing Opioids for Chronic Pain. The first step to these new guidelines includes selecting non-opioid therapies including cognitive behavioral therapy, exercise and physical therapy.

Physical Therapy is Key
October is National Physical Therapy Month, and this year the American Physical Therapy Association (APTA) is highlighting the risks of opioid use and that physical therapy is a safe, nonopioid alternative for managing pain.

Whether alone or in conjunction with properly prescribed medications, physical therapy (aka “PT”) is essential to manage both short-term and chronic musculoskeletal pain. Unlike opioids which only address, and often mask, the pain, PT can not only address the pain but also help treat the weakness, stiffness, and decreased range of motion common in musculoskeletal conditions.

Studies have shown that exercise reduces sensitivity to pain. An analysis of 25 different studies concluded that short bouts (5 - 30 minutes) of aerobic (e.g. walking), isometric (e.g. muscle flexing) and dynamic resistance (e.g. bench pressing) exercising were all were capable of producing significant decreases in perceived pain. Moreover, this pain relief was seen in those with regional chronic pain when a distant muscle was exercised and in those with fibromyalgia when exercising at low-to-moderate intensity. This may be due in part to the fact that exercise can reduce chronic low-grade systemic (aka “body-wide”) inflammation and cause the release of endorphins which act as “natural pain relievers” and mood enhancers by activating some of the same receptors that opioids do with less deleterious effects; thus reducing or even eliminating the need for opioid painkillers.

PT exercise not only reduces pain and enhances mood, but a sound physical therapy regimen can help strengthen weak muscles, reduce stiffness and increase range of motion over time. In cases of musculoskeletal disorders that dramatically alter the functional anatomy of a person, such as the hands in rheumatoid arthritis, PT and occupational therapy (OT) can help individuals find different ways to efficiently and effectively accomplish their daily tasks.

Properly planned and practiced PT and/or OT empowers a person to actively participate in their treatment. This can further enhance their mood, help mitigate their symptoms and possibly reduce their need for potentially dangerous pain medication.

Don’t Let the Stigma of Depression Put Your Loved Ones At Risk

Major depression is one of the most common mental disorders in the United States (1).
It is the leading cause of disability worldwide but only about 29% of people who are depressed get the help they need (2)(3).

October 2nd - 8th is Mental Illness Awareness Week and October 6th is National Depression Screening Day®; a time to help break the stigma around mental illness and learn how to keep your family safe from depression.

Negative stereotypes of people with mental illness can lead to active discrimination by those around them and can make healthcare providers less likely to refer patients to needed consultations or treat effectively. More importantly, our loved ones with mental illness may begin to internalize the stigma created by others of their mental illness and think of themselves as undeserving of care, dangerous, or responsible for their illnesses; resulting in feelings of shame, low self-esteem, and an inability to accomplish their goals. Some may even feel that treatment is useless and recovery is unattainable and develop a “why try?” attitude; denying or hiding their problems and refusing to seek care to avoid being discriminated against and labelled “mentally ill”.

The devastating consequences of this stigma surrounding mental illness was embodied in the heart-wrenching story of a Gold Star Wife, Amanda Souza. At the CNN Presidential Town Hall: America's Military and the Commander in Chief, Mrs. Souza fought back tears as she recounted the loss of her husband, not to enemies in the battlefield, but to suicide at home because of untreated posttraumatic stress disorder (PTSD). Mrs. Souza said her husband failed to seek treatment stating, “...he was too scared to go get help because he did not want to risk being labeled as unstable or weak.” Acknowledging the problem of stigma surrounding mental illness, President Barack Obama, made an enlightened point, “If you break your leg, you’re going to go to the doctor to get that leg healed. If, as a consequence of the extraordinary stress and pain...something inside you feels like it’s wounded, it’s just like a physical injury. You’ve got to go get help. There’s nothing weak about that. It’s strong.”

As our adolescent and older loved ones grow older they may be exposed to stress and pain that put them at risk for a host of mental illnesses, including eating disorders, anxiety and depression. According to the World Health Organization (WHO), an estimated 350 million people of all ages suffer from depression - the leading cause of disability worldwide. The WHO has published a short video, I Had a Black Dog, His Name Was Depression, that uses the metaphor of a black dog to illustrate the struggles someone with depression goes through. They also published another short video, Living With a Black Dog: A Guide for Partners to help caregivers better understand how best to help their loved ones.

The key to keeping our loved ones happy and healthy is to approach depression as we would any other medical condition, such as diabetes or hypertension, by knowing the risk factors, encouraging healthy lifestyle choices, staying alert to the signs and symptoms and, if they do develop depression, get our loved ones professional treatment as soon as possible.

Is my loved one at risk for depression?
According to the National Institute of Mental Health (NIMH) major depression is one of the most common mental disorders in the United States. Among adolescents screened in 2014, one in every eighteen (5.7%) 12-year-olds suffered at least one major depressive disorder episode. This number increases to one in eight (13%) among 15-year-olds and one in six (15.1%) among 17-year-olds; with adolescent girls being three times more likely to suffer a major depressive disorder than boys. Hispanic (11.5%), white (12.0%) and mixed-race (12.5%) adolescents were among the highest to screen positive for depression. A similar screening of adults in 2014, showed only one in twenty (5.2%) of adults age 50+ experienced a major depressive episode, however that number rises to one in seven (13.5%) in those who require home healthcare.

Regardless of age, gender or ethnicity certain genetic and medical factors as well as life-events and lifestyle choices increase the risk of depression in our loved ones. A family history of depression, having a chronic medical condition (e.g. cancer, diabetes, brain disease, heart disease) or the disability resulting from a medical condition can all increase the risk of depression. Also, certain medications can increase the risk of depression including heart medications (e.g. beta-blockers, calcium channel blockers), seizure medication (e.g. ethosuximide, methsuximide), sleep/anxiety medication (e.g. benzodiazepines, barbiturates) and hormonal contraception, especially among adolescent girls. Stressful life events including bullying, loss of a spouse, divorce or taking care of someone with chronic illness can increase the risk of depression. Moreover, being socially isolated, misusing alcohol or drugs and getting poor sleep either by choice or consequence all increase the risk of depression in our loved ones.

Is my loved one depressed?
Depression can manifest itself differently in our younger loved ones than it does in our older loved ones, however, there are a few signs and symptoms that, if they are persistent, can be an indication of developing depression including: social isolation or withdrawal, frequent complaints of illness or vague pain, major changes in eating habits or sleep patterns, decreased interest in activities and increased irritability, anger or hostility. Depression can be so difficult to recognize that some don’t realize they themselves are depressed for years. Dr. Priyanka Wali recently recounted in an article in Women’s Health that she didn’t realize until medical school that she had been experiencing symptoms of depression since high school.

Because depression can be so elusive, it is a good idea to include with your loved ones’ annual medical check-ups at least an annual depression screening. It’s as easy as going to the Help Yourself. Help Others. website and taking a quick 15-question anonymous self-screening survey. Once you complete it, you will be told whether your screening results are consistent with symptoms of depression, and provided you with resources and guidance

What if I suspect depression in my loved one?
If your loved ones’ screening results is consistent with depression or you notice any of the signs and symptoms in them that are suggestive of depression, don’t hesitate to act - let your loved one’s healthcare provider know as soon as possible. Addressing depression earlier on in its course provides your loved ones healthcare providers with more treatment options and improves the chance of shortening its course and reducing its severity.

If you feel your loved one’s healthcare provider is not taking your concerns seriously or addressing them to your satisfaction, find a second opinion. Recent research has found that only about 29% of people who are depressed get the help they need, whether it's therapy or medication. So be relentless until you feel your loved one is being provided the care they need and deserve.

If we treat depression as we would any other medical condition that we can prevent, identify and treat we not only help destigmatize mental illness it but more importantly keep our loved ones from falling victim to it.

AFib: A Flutter In The Heart Can Lead To A Stroke To The Brain

Afib increases the risk of stroke - the leading cause of disability in adults - by 500% (1)(2).
Approximately 1/3 of people with AFib in the U.S. are still not diagnosed (3).

September is National Atrial Fibrillation Awareness Month and September 29th is World Heart Day an great opportunity to take stock in your loved ones heart health and make heart-healthy choices to reduce their risks of atrial fibrillation (aka “AFib”) and stroke.

It is important not to ignore even the subtlest potential signs of AFib in our loved ones because it increases the risk of death, heart failure, hospitalizations and thromboembolic events (e.g. stroke). By 2030 the 12.1 million people will have AFib and 12 million will die from strokes each year.

AFib is an irregular heartbeat caused by an uncoordinated twitching or quivering of the muscles that make up the two upper chambers of the heart - the atria. When this happens, blood doesn’t pass smoothly to the lower chambers of the heart - the ventricles - and limits the heart’s ability to distribute blood back to the lungs and the rest of the body.

A loved one with AFib is at 5-times greater risk of suffering a stroke - a "brain attack" that occurs when blood flow to an area of brain is cut off and the brain cells are deprived of oxygen and begin to die. This occurs because the disruptive flow of blood in the heart caused by AFib promotes the formation of small clots that then can travel from the heart to the brain. One person dies from a stroke every four minutes, making it the 5th leading cause of death in the U.S. Moreover, strokes are the leading cause of adult disability.

The good news is that most AFib-related strokes - up to 75% of them - can be prevented by knowing the risk factors for AFib, identifying them in our loved ones, partnering with their healthcare provider to get them on the right treatment regimen and ensuring they stick to that regimen.

Know the Risk Factors for AFib.
Having a family member with diagnosed AFib puts blood-relative loved ones at greater risk for developing AFib. Independent of a family history of AFib, being over 60 years of age is also a risk factor. In fact, men and women without AFib at 40 years of age had a 26% and 23% likelihood, respectively, of developing AFib by age 80.

Conditions that commonly develop in our older loved ones also increase their risk for AFib. If your loved one snores loudly at night and feels tired, even after a full night's sleep, they may be suffering from sleep apnea - which can increase the risk of AFib by 400% by not only triggering irregular heartbeats (aka “arrhythmias”) but also increasing the risk of other AFib risk factors. Chronic obstructive pulmonary disease (aka “COPD”), which includes conditions like emphysema and chronic bronchitis, creates an accumulation of free radicals and inflammation that can change the structure and function of the atria. Similarly, poorly managed high blood pressure (aka “hypertension”) and coronary artery disease and congestive heart failure can also cause structural and functional changes in the heart that make the atria susceptible to fibrillating.

Other chronic medical conditions that tend to develop in older loved ones, especially if poorly controlled, can also increase their risk of AFib. Diabetes can cause swelling, irritation and thickening of the heart muscle which may cause changes in the heart’s electrical system resulting in disorganized contraction of the atria. Thyroid disease, causing both hyper- and hypothyroidism, can result excess stimulation of the heart and interference with the heart’s natural electrical impulses in different ways. In poorly controlled hyperthyroid conditions, the overstimulation of the heart is caused by the excess thyroid hormone produced by an overactive thyroid gland. In poorly managed hypothyroid conditions - where the thyroid gland is not producing sufficient thyroid hormone - the overstimulation of the heart can be caused by over-medicating with hypothyroid medication levothyroxine (aka Synthroid®, Levoxyl®), a synthetic form of thyroid hormone.

Certain events, procedures, or lifestyle choices can also increase our loved ones’ risk for AFib. Heart muscle that is damaged by a heart attack or the altered by the inflammation of a serious illness or infection can put our loved ones at risk for developing AFib. The surgical manipulation of the heart muscle and the associated postoperative inflammation are among some of the factors that can increase the risk of AFib after open-heart surgery. There is also research that supports that alcohol consumption is a risk factor for AFib, especially heavy drinking - 7+ drinks/week in women and 14+ drinks/week in men. Binge drinking - 4+ drinks in a row in women or 5+ in men - can cause AFib within days of the drinking session.

Identifying AFib.
AFib may feel like the heart is skipping a beat, fluttering, or beating too hard or fast. Because of the disruptive blood flow in the heart, it is often described as “butterflies” or a “flopping fish” in the chest. Depending on when and for how long the AFib occurs, a person may experience confusion, shortness of breath, fatigue, chest pain, dizziness, fainting, weakness or problems exercising. Unfortunately, AFib is often subclinical and goes unnoticed (i.e. without any signs or symptoms).

Therefore, it is important to regularly check the pulse of your loved ones with any risk factors for AFib. It is especially important to check it if and when they complain of or you notice any of the abovementioned signs or symptoms. See this short video from the British Heart Foundation to learn how to easily and properly check for a pulse and identify AFib in your loved ones.

AFib Treatment is a Shared Decision-Making Process.
There are various treatments for AFib. The right approach to dealing with AFib depends not only on clinical factors (e.g. age, health status, concurrent medical conditions, etc.) but also which treatments best “fit” your loved one and their lifestyle in order to ensure they can and will follow their treatment regimen. For this reason it is important to partner with your loved one’s healthcare team and provide them with a complete a picture as possible of your loved one’s AFib. The following Atrial Fibrillation Treatment: A Decision-Making Tool provided by Mended Hearts™ and the National Stroke Association® is a great resource to print and fill out prior to your visit with your loved one’s healthcare provider to ensure an optimal AFib treatment regimen is agreed upon.

The 3 goals of an optimal treatment for AFib include all the following: (1) control heart rate (2) control heart rhythm, and (3) prevent clot formation. This is achieved through one or more of the following: medications, nonsurgical procedures and surgery. Inevitably, taking medications as prescribed and without fail is utterly important for successful AFib treatment, whether they are medications taken to treat the AFib or one of its risk factors. Because of this, the National Stroke Association® has provided a Medication Adherence and Compliance brochure that explains why medication adherence and compliance matters, how to take medicines safely, how to read medicine labels and how to get help paying for medications.

Mended Hearts™ and the National Stroke Association® have developed an online game called Beating Your Odds, a fun and engaging way to get the whole family or circle of care around your loved one up to speed on AFib and its treatment options.

Know how to identify a stroke F.A.S.T..
Not all strokes, even AFib-related strokes, can be prevented, but the faster you can identify when a loved one is having a stroke and get them help the better their chances of not only surviving the stroke but limiting any possible disabilities from the stroke. F.A.S.T. is an acronym to easily remember how to identify the warning signs of a stroke and act quickly.

    F is for Face droop…
    ask your loved one to smile. Does one side of their face droop?
  • A is for Arm weakness…
    ask your loved one to raise both arms. Are they unable to raise an arm or does one arm drift down?
  • S is for Slurred speech…
    ask your loved to say a simple phrase like “It is sunny out today”. Is their speech slurred or strange?
  • T is for Time to call 9-1-1…
If you notice ANY of the above, do not hesitate, call 9-1-1 immediately and tell the dispatcher that your loved one is having a stroke.

Seeing your loved one have a stroke can be a scary - as dramatized in this video - but by recognizing the signs, acting quickly and properly informing the paramedics can make the difference between life and death.

Aging Healthily and Preventing Falls

The physical and mental changes that occur with age can cause serious problems (1).
Help your loved ones age healthily and empowered them to grow old gracefully and safely.

September is Healthy Aging® Month an annual obser­vance month designed to focus national atten­tion on the pos­i­tive aspects of grow­ing older and pro­mote tak­ing per­sonal respon­si­bil­ity for one’s health be it phys­i­cally, socially, men­tally or financially.

With advancing age comes various physical and psychosocial changes that put the well-being of our loved ones at risk. These changes can occur subtly over time and often our older loved ones don’t report any problems because sometimes they just don't think it's important or they are in denial that something is really wrong.

Increasing Age = Increased Health Risks.
Aging is characterized by a progressive set of changes to the body that increase the risk for a number of conditions and illnesses including cancer, diabetes, cardiovascular disease, neurodegenerative diseases (e.g. Alzheimer’s Disease, Parkinson’s, etc.), infections and falls. These age related changes not only increase their risk but can also make it more difficult to recognize if and when our loved ones are suffering from or at risk for one of these conditions.

Simple physical changes that occur with age can cause serious problems. For example, as our loved ones grow older their immune system does not work as well and is slower to respond. This makes vaccines less effective and them more susceptible to serious infections. Moreover, with age comes a decrease in the ability for the body to regulate its temperature and mount a fever response to an infection. When an older person is unable to produce a higher temperature to battle an infection, it is difficult to know they are sick making it important to check other vital signs, as well as any symptoms and signs of infection such as changes in their activity.

A complex mix of physical and psychosocial changes associated with aging can also increase the risk of our older loved ones suffering from preventable life-altering events such as falls. As our loved ones age it may take longer for their heart rate to increase appropriately and their blood vessels to constrict sufficiently to maintain an adequate blood pressure when they get up from a resting position; resulting in them feeling dizzy or even passing out upon standing (aka “orthostatic hypotension”). This can be made worse by the polypharmacy - the taking of multiple medications - common in our older loved ones.

More frequent visits to the bathroom at night, common in our older loved ones, increase their need get up from a resting position at night and the development of arthritis can make it more difficult for them to hold themselves up if they do find themselves feeling lightheaded when they get up.

Moreover, with age comes an increased risk of depression, anxiety, and anger as our older loved ones retire, lose their spouse or see their social circle shrink due to deaths. This can can further contribute to our older loved ones getting less than 5 hours of quality sleep which can double their risk of a fall during the day.

Aging Healthily and Preventing Falls
The natural physical decline and common psychosocial changes that come with age may make it seem inevitable that your older loved ones will get sick and suffer from a life-altering fall. However, there are some simple things you can do to promote healthy aging in your loved one and keep them safe.

Ensure regular vaccinations.
Since vaccines don’t work as well or protect as long in older adults, it is important to ensure that you’re older loved ones get regularly vaccinated to prevent a simple seasonal flu from putting them in the hospital. Because of their increased susceptibility to infections and the difficulty in detecting infectious illnesses in older adults, it is also important to ensure other family members they interact with are properly vaccinated and up to date with their immunizations to ensure your older loved ones’ well-being (see 17 Diseases Vaccines Prevent).

Make regularly scheduled checkups.
Given the natural physical changes that occur with age, it is important to ensure that older adults have, at the very least, an annual medical checkup. For our older loved ones with specific medical conditions (e.g. diabetes, kidney disease, etc.) more frequent checkups may be merited. Read 5 Simple Tips to Make the Most of Your Loved One’s Next Doctor Visit to make sure you get the best possible care and guidance from your loved ones’ nurses and doctors.

Keep ‘em hydrated.
Over 30% of older adults present in the emergency room with dehydration. Our older loved ones’ risk for dehydration stems from having less total body water, decreased sensation of thirst and aging kidneys that don’t concentrate urine as well. This risk is exacerbated by certain medications that either increase fluid loss or fluid requirements (e.g diuretics, antihypertensives) and physical or cognitive conditions that make it challenging to consume sufficient fluids (e.g. swallowing disorders, arthritis, Parkinson’s, Alzheimer's, etc.). Read Don’t Let Dehydration Put a Damper on Your Family’s Summer for ways to ensure your loved ones are properly hydrated.

Increase protein intake.
New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, maintain functionality and offset the inflammation and cellular breakdown associated with chronic and acute diseases that occur commonly with aging. The PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. A higher protein intake (ie, ≥1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active and a lower intake may be necessary for those with kidney disease. Consult your loved one’s doctor before changing their protein intake.

Ensure adequate quality sleep.
Poor inadequate sleep has been linked to suicide attempts, motor vehicle accidents and can increases the risk for hypertension, diabetes, obesity, depression, heart attack, stroke, and falls (See 5 Health Risks to Your Family Caused by Inadequate Sleep). Ensuring adequate sleep can not only reduce these health risks but also can optimize brain function and memory in your loved ones (See 3 Ways Sleep Improves Memory).

Eliminate life threatening sedentary behaviors.
According to Dr. James Levine from the Mayo Clinic “We are sitting ourselves to death”. Over 70% of older adults spend in excess of 8.5 hours a day sitting increasing their risk of death from any cause by 50% and a cardiovascular event (e.g. angina, heart attack) by 125%. Read Stop the Hidden Killer in Your Family and Keeping Seniors Active In Their New Housing Community to understand the sedentary behavior in your loved ones and, how to promote physical activity and replace sedentary behavior with active behavior.

Actively prevent falls.
September 22nd is Falls Prevention Awareness Day (FPAD) a day to raise awareness about how to prevent fall-related injuries among older adults. According to the CDC, every year one out of every three adults over the age of 65 is at risk for experiencing a fall and once they fall their chances of falling again doubles. Falls are the leading cause of fatal and non-fatal injuries including traumatic brain injuries, in older Americans. Read 10 Tips to prevent falls in your loved one to help keep your loved ones from suffering a life-altering fall.

Stay engaged, connected and positive.
The physical changes associated with age can cause a low sense of personal control in your loved ones leading to depression, anxiety and anger. These negative perceptions can be self-fulfilling prophecies and predictive of worse cognitive and physical outcomes. On the other hand, engaging with your loved ones in ways that enhances their feelings of control has shown to substantial improve their health. Therefore, by helping your loved ones age healthily you can make them feel supported and empowered to grow old gracefully and safely.

Optimizing Pain Management

1 out of every 2 US adults suffers some level of pain some, most or every day (1).
Pain relievers are the leading cause of human exposures to potential poisoning (2).

September is Pain Awareness Month, a time to understand how pain, especially chronic pain, affects our loved ones and the best way to help them safely address their pain.

Approximately 100 million Americans suffer chronic pain and nearly 50 million American adults live with significant chronic pain or severe pain. One study found that chronic pain was associated with an increased risk of death; specifically in those who have physical limitations due to their pain. Moreover, according to the American Association of Poison Control Centers’ 2014 Annual Report, analgesics (aka “painkillers”) are the most frequent reason for calls to their centers for cases resulting in serious injury or death.

A Person with Chronic Pain is Like a Car with Four Flat Tires.
The American Chronic Pain Association has a great short video that asks you to think of a person with chronic pain like a car with four flat tires to better understand the way one should approach pain management.

A well-devised and carefully followed pain medication regimen, created in partnership with your healthcare provider, can provide some pain relief - the equivalent of filling one flat tire with air. But just like a car can’t be driven on just one air-filled tire, someone can’t properly manage their chronic pain with just a medication regimen. The remaining three tires need to be “filled” with a combination of therapies and interventions that are based on each person’s individual needs.

Working with their healthcare provider a person can fill their remaining three tires with the appropriate mix of biofeedback, physical therapy, counseling, pacing of daily activities, nutritional counseling, a support group, life coaching, and a host of medical modalities. The ACPA Resource Guide to Chronic Pain Treatment: An Integrated Guide to Physical, Behavioral and Pharmacologic Therapy is a great resource to not only learn about and understand the options available to fill those other three tires but also how to help your loved one “run” as best as they can with their pain.

Don’t Blow a Tire with Too Many OTC’s.
Adding more air to the same tire (i.e. increasing the frequency of dose of medication to get more pain relief) is not the answer. The increased availability of over-the-counter (OTC) pain medications and the overwhelming trust consumers put in OTCs to work with minimal side-effects has resulted in many misconceptions and mistakes in the safe use of OTC painkillers. Of the total 271,737 therapeutic errors resulting in calls to US Poison Control Centers in 2014, the most common scenarios for all ages included: inadvertent double-dosing (29.2%), wrong medication taken or given (17.2%), other incorrect dose (14.8%), and doses given/taken too close together (11.6%).

Many people choose OTCs based on the symptoms they want to treat (e.g. pain, indigestion, cough, etc.) and not the active ingredients. What they don’t realize is that these ingredients can be found in hundreds of different OTC preparations and brands advertised for different ailments. For example, acetaminophen is found in over 600 medications, both OTC and prescription, including Tylenol®, Alka-Seltzer Plus® and Robitussin®. So someone who is trying to treat their pain, indigestion and cough with all three of these medications can easily and inadvertently take more than the 4,000 mg/day maximum of acetaminophen recommended by the FDA.

Chronic and inappropriate use of acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) - such as ibuprofen, naproxen and aspirin can lead to liver damage/failure, kidney damage/failure, heart attacks or strokes, serious bleeding. Moreover, the most common OTC drugs used to treat pain - acetaminophen (the active ingredient in Tylenol®), ibuprofen (the active ingredient in Advil®) and naproxen (the active ingredient in Aleve®), and acetylsalicylic acid (aka “aspirin”) - ranked 6th, 13th and 14th, respectively, among the top 25 substances associated with the largest number of fatalities.

Maintaining the Car to Keep the Tires Working Optimally.
The source of a person’s pain can often be due to a medical condition (e.g. diabetes, rheumatoid arthritis, Lupus) that needs to be managed properly. Just like you would take your car in for it regularly scheduled maintenance and oil changes, it is important visit your healthcare provider as often as necessary to manage your health - just like older cars may need more maintenance to run optimally our older loved ones and loved ones with certain chronic conditions may need more regular checkups as well.

Moreover, when the “check engine” light comes on in our cars to let us know something is wrong, we make a special visit to the mechanic. Similarly, it is important to keep an eye out for our loved ones “check engine lights”. These warnings are subtle and can come in the form of decreasing activity and changes in sleep as their condition worsens and/or their pain management is becoming ineffective.

Because pain can influence virtually all aspects of a person’s quality of life and optimal treatment requires multiple social, psychological and medical interventions, the burden of addressing pain falls most heavily on those in pain and their caregivers. Thus, working as a team to stay educated and involved is the best way to empower your loved one to live more fully in spite of their pain.

Proactively Prevent Suicide: Understanding Risk Factors

Every 68 minutes a 65+ old adult takes their life (1).
Every 1.5 hours someone between the ages of 10 and 24 takes their life (2).

Suicide rates have reached an all time high in the United States. According to CDC, there has been a 24 percent increase in suicides between 1999 and 2014. In 2014, a person in the US killed themselves every 12.3 minutes resulting in 27 more deaths per day than those caused by car accidents.

Unlike a car accident that occurs with little to no warning, suicide does not simply occur out of the blue. Like many medical conditions, suicide comes with its own set of signs and symptoms that evolve over time - and prevention is key. In his TEDx Talk, Preventing Suicide before we see the Signs, Timothy Lawson (a Marine Corp veteran and survivor of suicidal behavior) makes a powerful parallel between suicide and heart disease stating, “I do not need to show symptoms for my doctor to be proactive about my physical health, yet the culture around mental health, specifically suicide prevention, is currently reactive. We wait until we see the signs, then we act”.

Treat suicide as a health threat.
It should be noted that, clinically speaking, “suicide” itself is not a true “medical condition” - it is the terrible consequence of a host of many possible medical and mental health conditions. By approaching it as you would a medical condition, we can optimize suicide prevention as we would with any medical condition like heart disease or diabetes. To prevent suicide, it is important to understand the potential risk factors that affecting the health and quality of life of you and your loved ones.

Know the risk factors.
Suicide does not discriminate, affecting people of all genders, ages, ethnicities and backgrounds. However, just like heart disease and diabetes, certain people are at greater risk than others.

Males are more likely to die by suicide than females even though women are more likely to attempt it. This is due, in part, to the fact that men are more likely to use deadlier methods (e.g. firearms, suffocation) than women (e.g. poisoning).

Older Adults (65+ years old) have had the highest rate of suicide for decades with over 80% of late-life suicides being carried out by white males. Recently, suicide rates for middle-aged adults has increased to comparable levels. Suicide is the second leading cause of death for adolescents (ages 10 - 19) and young adults (ages 20 - 34).

Whites, American Indians & Alaskan Natives have the highest rates of suicide. Hispanics, African Americans and Asian/Pacific Islanders each have suicide rates that are about half that of their non-Hispanic White, American Indian and Alaskan Native counterparts. Among American Indians and Alaskan Natives, a complex mix of poverty, unemployment, domestic violence, sexual assault, alcoholism and drug addiction all play a role in their higher rates of suicide. On the other hand, the higher rate of suicide among Whites, who tend to have fewer life burdens, may be due to white older men being less psychologically equipped to deal with the normal challenges of aging.

A family history of suicide (or attempt), mental disorder or substance abuse is a risk factor for suicide. Much like diabetes and breast cancer, having an afflicted family member increases the risk of suffering the same condition. Moreover, a parental history of violence, drug and alcohol abuse, divorce and hospitalization for a major psychiatric disorder (see below) also predispose someone for suicide or suicidal behavior.

A personal history of self-harming, suicidal thoughts (aka suicidal ideation), suicidal behavior, suicide attempts or substance abuse is also a risk factor, independent of family history, even if the behavior has changed or appears to no longer be present. There is also an increased risk of suicide for anyone suffering from a major psychiatric disorder especially a mood disorder (e.g. depression, bipolar disorder), an anxiety disorder (e.g. panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder), an eating disorder (e.g. anorexia, bulimia), body dysmorphic disorder, conduct disorder, or schizophrenia.

Traumatic brain injury (TBI), injury to the brain from such things as a motor vehicle accidents, physical abuse, contact sports, etc., is an independent risk factor for suicide. Over 2 out of every 10 of those suffering from TBI are at increased risk of death by suicide, a higher frequency of attempts and clinically significant suicidal ideation. This increased risk can be due to a number reasons including the association of TBI with psychiatric disorders, impaired problem solving, and aggression as well as increases impulsivity and emotional distress.

Insomnia, defined as a difficulty in falling asleep and/or staying asleep resulting in poorer quality or less sleep, is considered an “acute risk factor for suicide” - meaning, it is a associated with suicide attempts within 12 months of the onset of insomnia. Even though insomnia is associated with other risk factors for suicide, specifically mood and anxiety disorders, insomnia is a risk factor for suicidal thoughts and behaviors regardless of any depression, drug-use, alcohol-related problems, PTSD, hopelessness and anxiety. Moreover, frequent nightmares are associated with a nearly a four-fold risk of suicide attempts among men and a nearly doubling of risk among women. If these sleep problems are consistent (i.e. occurring almost every night) there is almost a 5 times increased risk for suicide.

Suicide prevention is a family affair.
Every suicide has more than one victim. Suicide is extremely traumatic for friends, family and loved ones (aka “survivors”) who may feel guilt, resentment, remorse, confusion and distress over unresolved issues. Moreover, the stigma surrounding suicide can result in survivors feeling isolated. This is a dangerous mix, especially for family members who share the same genetic and experiential history as the suicide victim.

Therefore, take the time to have a conversation about suicide with all your loved ones. It is a myth that talking about suicide, even to teens, makes them more likely to kill themselves. Stay engaged in your loved ones lives and keep on the lookout for risk factors.

3 Ways Sleep Improves Memory

More than a third of Americans don’t get enough sleep (1).
Lack of sleep or waking up several times during the night may increase the risk of Alzheimer’s disease (2).

September is World Alzheimer’s Month.
Every 3 seconds someone in the world develops dementia which is marked by a slow decline in memory, thinking and reasoning skills.

Adequate sleep is not only important to keep your family healthy (read 5 Health Risks to Your Family Caused by Inadequate Sleep) and prevent falls in your older loved ones (read Greater than 5 hours of sleep a night can help keep your elderly loved one upright) but also essential for the brain to effectively retain and process information; especially for our younger family members in school and our older family members trying to prevent “senior moments”.

Unfortunately, these two age groups are notorious for not getting sufficient, quality sleep (i.e. staying up late, not being able to fall asleep, waking up multiple times, etc.); only 15% of teens report sleeping the necessary 8.5 hours and half of older adults (≥65 years of age) find it difficult to fall asleep or maintain quality sleep.

Here are three important reasons to ensure your loved ones are getting enough quality sleep.

#1 Sleep optimizes memory retention.
It has been well established through studies that sleep optimizes the retention of newly acquired information through a process called “consolidation”. A recent study in Nature Neuroscience describes how during sleep the brain goes through a selection process of actively forgetting certain things and remembering others. What is retained versus what is forgotten during sleep depends on emotional factors and cues that occur while awake and being exposed to information.

For example, if a student knows they are going to be tested on a given piece of material, during the sleep that occurs after studying said material, the brain selectively consolidates that information over other pieces of information that the student may have been exposed to during the rest of that day. Recent studies have found that sleep can improve this consolidation process in children with autism (aka autism spectrum disorders) and in older adults at risk for cognitive decline and dementia.

#2 Sleep improves problem solving.
Cognition, the mental process of acquiring knowledge and understanding, includes not only remembering new information but also being able to use the information appropriately. Deactivation of consciousness during sleep seems to allow the brain to better process information for complex problem solving.

Back in 2011, Dr. Michael K. Scullin conducted an experiment with 2 groups of undergraduate students with no previous exposure to economics. One group received a lecture on supply and demand in the morning and came back in the evening to take the test while the other group received the very same lecture in the evening and came back in the morning to take the test. Those that slept between the lecture and the test scored 32% higher than their counterparts on questions that tested their ability to understand and apply the information from the lecture. In fact, a recent study found that the more challenging the mental exercise the more benefit sleep can have.

#3 Sleep flushes the brain of toxins.
A recent study suggests that sleep helps restore the brain by flushing out toxins that build up while you are awake. When you sleep the brain cells reduce in size - increasing the space between them - allowing an increased flow of fluid past the cells and elimination of toxins that can make it more difficult to think clearly. Too little sleep over time results in a buildup of these toxins which has been associated with numerous conditions including headaches, depression, heart disease, and diabetes. One “toxin” that is cleared during sleep is β-amyloid (beta-amyloid), which, when it accumulates, has been implicated as a cause of Alzheimer’s plaques in the brain.

Review the updated National Sleep Foundation sleep duration recommendations for every member of your family. Whether to excel in school, stave off dementia or help those with cognitive challenges, ensuring consistent adequate sleep helps stack the cards in favor of you and your loved ones.

5 Simple Tips to Make the Most of Your Loved One’s Next Doctor Visit

The average doctor spends only 13 to 16 minutes per patient (1).
15 minutes with your doctor costs on average $11 per minute (2).

Doctors don’t have enough time with their patients.
Over 70% of doctors report spending 20 minutes or less with each patient. It’s not that they don’t want to spend more time with each patient; it’s that they can’t. Dr. Suzanne Koven recently shared a heart wrenching story in the New England Journal of Medicine that describes an all too common dilemma facing doctors. A sobbing and distraught young woman comes to her with a medical problem that is most likely tied to a deeper psychological pain, but the time she had with the woman was barely enough to examine her, write some orders, prescribe medication, suggest dietary modifications and only briefly mention psychotherapy.

Doctors are strapped for time. Whether they are in private practice or employed by a hospital system, doctors’ financial survival depends on the number of patients they are able to see in a day. Moreover, each patient encounter comes with additional administrative tasks, such as billing and obtaining insurance approval, and up to 25 minutes documenting the encounter into an electronic health system.

Make the most of your time and money.
A study last year conducted by Harvard Medical School found that the average total time spent on a doctor’s visit was 121 minutes - over 2 hours - which included 37 minutes traveling to and from the office, 64 minutes in the waiting room and 20 minutes actually seeing the doctor. This time spent seeking a doctor’s care - instead of working - results in an additional hidden cost of $43 per visit. This does not take into account your per-visit-copay, which can range from $15 - $25, any prescriptions costs and what you pay annually for your health insurance coverage.

Given the challenges facing your family’s physicians, the cost to you and your family, and how important each visit to the doctor is, especially for our younger and older family members, it is crucial to partner with your doctors to get the most out of your time with them.

Whether it is an annual physical exam or an unexpected trip to the emergency room follow these 5 simple tips to make sure you get the best possible care for your family.

#1 Be open, upfront and 100% honest.
According to a recent survey Nearly half (46%) of Americans avoid telling their doctor about a health issue because they were embarrassed or afraid of being judged and up to 30% either told a “white lie” or omitted information. It might be hard to trust a doctor you don’t know well, but trust the profession they have dedicated their life to. It’s important to give your doctor the benefit of the doubt that they are not there to judge you and grant them the opportunity to use all their training to help you and your family by being as open, upfront and honest as possible.

#2 Don’t assume anything about your health.
64% of Americans 65 and older avoided bringing up issues with their doctor because they didn’t think it was that serious or worth discussing. Seemingly unimportant things like changes in sleep, activity and appetite can be important early signs of serious conditions like cancer and depression. Give your loved ones’ doctors the opportunity to detect potentially life-threatening conditions by providing them a full history and not filtering out things you may think are unimportant. It’s better to overshare than under share.

#3 Bring a complete list of drugs, including OTCs, supplements, herbal and recreational drugs.
70 percent of parents have given their child an over-the-counter (OTC) medication to treat a sudden symptom and 1 in 6 older adults now regularly use potentially deadly combinations of prescription, OTC and dietary supplements. Even commonly used OTC medications such as Advil (aka ibuprofen) and Tylenol (aka acetaminophen) - if taken chronically, in excess or in combination with alcohol, other drugs or supplements - can cause liver or kidney damage resulting in failure, respectively. Providing an accurate and complete list of medications and supplements and honestly reporting how often they are taken can help doctors determine if any of your loved one's ills are due to drug-drug interactions and if they are at risk for life-altering side-effects.

#4 Ask if vaccinations are up to date.
Ensuring that your family members are properly vaccinated can keep your family safe from dangerous and potentially life-threatening diseases. This is especially true for our younger and older family members who are more susceptible to vaccine-preventable diseases. Ask your provider for any records of vaccinations and keep a log that you bring to every doctor's visit.
(Read about the 17 Diseases Vaccines Prevent in your loved ones)

#5 Bring a prioritized list of concerns.
Given the little time you have with your loved ones’ doctors, bringing a list of concerns with you can help the doctors and nurses better structure your visit. Some of the items on your list can be taken care of by the nursing staff even before you get into the exam room and allow the doctor to focus on the things that truly need a physician's attention.

What You Should Know About Zika

Zika may become a “reproductive game changer”; the first time a mosquito bite has been known to be linked to a birth defect (1).
As of July 28th, 2016 in the US and its territories, Zika has been linked to birth defects in 15 babies and 6 pregnancy losses (2).

Zika is not a new virus.
In fact, it was discovered in 1947 by scientists researching yellow fever in the tropical Zika Forest of Uganda (3). G.W.A. Dick first described the virus and the harm it can cause in 1952 in his paper Zika Virus (II) Pathogenicity and Physical Properties.

From the first human cases detected in Uganda in 1952, the Zika virus began spreading west across Africa reaching the island nation of Cape Verde in the central Atlantic Ocean in 2015 (4). On May 7 2015, Brazil's National Reference Laboratory confirms Zika virus is circulating in the country - the first report of locally acquired Zika disease in the Americas - prompting an alert from the World Health Organization (WHO) and the Pan American Health Organization (PAHO) (5). On December 31, 2015 - 68 years after its discovery - the first confirmed case of locally acquired Zika was reported on U.S. soil in the Commonwealth of Puerto Rico (6). On February 26, 2016 two cases where Zika was transmitted through sexual contact were reported in Texas (7). In the first week of August, 2016 the neighborhood of Wynwood in Miami, Florida became ground zero for locally acquired Zika as 15+ reported cases caused the CDC to issue travel restrictions for sexually active adults and pregnant women and advice for those living in the area.

Initially, Zika exposure was not considered life threatening.
Most infected children and adults don’t show signs or symptoms of the infection, and those that do, present with minor viral flu-like signs and symptoms such as fever, rash, joint pain, muscle pain, headache and conjunctivitis (aka “pink eye”) (8). Illness due to Zika rarely leads to death or even requires hospitalization and according to Dr. Anne Schuchat, the Principal Deputy Director of the CDC, “we do think that an infection with Zika virus will confer immunity” - meaning that once a person recovers from exposure to Zika they are protected from future infections (9).

Zika is more menacing than originally thought.
By mid-April 2016 Brazil’s Ministry of Health, the CDC and the WHO all had strong evidence that Zika infection in pregnant mothers plays a role in their infants being born with Guillain-Barré Syndrome (GBS), a very rare potentially paralyzing nervous system disorder, and microcephaly, a rare condition in which the baby's head is significantly smaller than expected, resulting in defects in vision, hearing and brain development (10)(11)(12). Although an association has been made with Zika, the actual cause of both these conditions is still unclear (13)(14).

Zika may not be working alone.
In an interview with Public Radio International in August of 2016, Oliver Brady, an epidemiologist with the London School of Hygiene and Tropical Medicine, said that although “Zika’s still probably the leading hypothesis for why there’s this increase in microcephaly” it may be that Zika is not working alone to cause the microcephaly. Fatima Marinho, Director of Information and Health Analysis at Brazil’s Ministry of Health, seems to agree “that something more than Zika virus is causing the high intensity and severity of cases” of birth defects because in other countries like Colombia, thousands of pregnant women have been diagnosed with Zika but there has been only 21 cases of microcephaly linked to Zika (15). With this in mind, Brazilian researchers are even investigating the possibility that Zika allows other viruses that normally don’t infect humans, like the Bovine Viral Diarrhoea Virus which causes serious birth defects in cattle, to infect and affect humans (16).

Zika may prove devastating to future generations.
For those babies born with microcephaly the struggles begin almost immediately as a barrage of serial tests are conducted to determine if they can see, hear or even swallow. This is followed by frequent physical therapy appointments to maintain any vision, hearing or mobility they may have (17). This is the beginning of lifelong caregiving for a child with microcephaly that may never show emotion, be able to walk or eat on their own, or even recognize their own parents.

Aside from the uncertain future of babies born with microcephaly and the burden on families due birth defects, Zika - and the its associated scare - has also affected family planning, especially in areas of high risk. For most people in these high risk areas, delaying 1 to 2 years to have a child is the only option to ensure a pregnancy safe from Zika infection. As Dr. Sanjay Gupta said in a CNN piece on Planning a family in the age of Zika: “It is difficult to imagine entire towns, even countries, with hardly any new babies for 2 years. Hard to imagine the loss economically, socially and culturally. No babies crying or laughing.”

Zika spreads in more ways than one.
Zika, like most viruses, is simply a strand of genetic material without the ability to reproduce or spread on its own. In order to survive it needs to invade healthy cells to reproduce and vectors (any living creatures that can transmit an infection to another) in order to spread (18).

The main vectors for Zika are two types of mosquitoes, the female Aedes aegypti and Aedes albopictus; both aggressive daytime biters that can also bite at night and can carry not only Zika but also Chikungunya and Dengue viruses as well. The entire lifecycle of these mosquitos, from an egg to an adult, takes only 8 to 10 days. As soon as the adult female hatches, it detects the carbon dioxide exhaled by humans up to 50 meters away (over half a football field) and zeroes in using sight, heat and moisture sensors to feed on human blood (19). After feeding, the female seeks any stagnant pool of water - water collected in a bottle cap is sufficient - to lay its 100 to 200 eggs; after which it will seek out another human to feed on and the cycle repeats. If at any feeding the mosquito bites a person infected with Zika, the female will retain the virus in its system and transmit it to all subsequent humans it bites.

The good news is that mosquitos, like the Aedes aegypti, live on average only about 2 - 4 weeks, rarely fly further than a few blocks from where they hatch and are such weak fliers that they can be kept at bay with a large house fan (20)(21)(22). The bad news, is that humans can also serve as vectors; transmitting the virus to other humans via close sexual contact, blood transfusion and from mother to child during pregnancy (23). Human-to-human transmission allows Zika to be transmitted distances far greater than the mosquitos ever could, and because most infected humans show no signs or symptoms if the infection, gives Zika the ability to infect unwitting humans over a longer period of time. A study in the Lancet detected the Zika virus in the semen of a 27 year old man 93 days after the onset of his Zika-induced fever symptoms.

Protecting your family from Zika.
As of May 2016, the National Institute of Health has been “actively pursuing multiple vaccine candidates to prevent Zika virus infection” with possible early-stage human trials to begin in the fall of 2016 (24). With a fully licensed Zika vaccine several years away the best way to protect your family is to test for infection and prevent transmission.

The most effective way to avoid not only Zika but also Chikungunya, Dengue and West Nile viruses is to prevent mosquito bites (27). The CDC has developed a Mosquito Bite Prevention (United States) informative that outlines all the preventative measures you should take to protect yourself and your family. The document includes a list of EPA-registered insect repellents, how to safely protect babies and children, clothing recommendations and how to mosquito-proof your home.

Zika is not the first, nor will it be the last, viral outbreak we will see in our lifetime. The key to keeping your family safe from any viral outbreak is to stay informed.

17 Diseases Vaccines Prevent

Vaccine-preventable diseases are responsible for limb amputation, paralysis, hearing loss, convulsions, brain damage, and even death in children (1).
Every year, approximately 50,000 US adults die from vaccine-preventable diseases in the US (2).

August is National Immunization Awareness Month in the U.S. and with summer vacations winding down and school starting soon it is a perfect time to learn about and understand how vital it is to ensure your entire family is properly vaccinated.

Let’s say your neighborhood was struck with a string of home invasions. If you had the ability to provide the police with a description of the likely culprits before they attacked your home, would you? Most likely you would so that the police force could be on the lookout for the culprits and better prepared to prevent a potentially deadly attack of your home.

That is how vaccines work. The “police force” is your body’s immune system and the “culprits’ description” comes in the form of a vaccination. Every vaccine that is administered provides your immune system a description of the the various bacterial and viral “culprits” that can cause debilitating and even deadly disease; better preparing your immune system to protect you.

It is true that vaccines have nearly eradicated certain devastating diseases in the U.S., such as measles which was eliminated from the U.S. in 2000 (2), but some of these diseases are still common in many parts of the world including Europe, Asia, the Pacific and Africa (3). According to Dr. Doug Campos-Outcalt of the American Academy of Family Physicians “just one unvaccinated U.S. resident traveling abroad and coming home infected could cause an epidemic” (4). Between December 28th 2014 and February 8th 2015 - in the span of only 11 days - there was an outbreak of measles that originated at two Disney theme parks in Southern California and ultimately affected 125 people - ages 6 weeks to 70 years old - across seven states and Canada (5). In fact, this outbreak contributed to the greatest number of measle cases, since its declared “elimination” in 2000, with 667 cases reported in 27 U.S. states in 2014 (6).

Of the 98 California residents afflicted in the Disney theme parks outbreak, 91% of those old enough to have received the vaccine had either not gotten the recommended doses of the vaccine or had no documentation of being vaccinated. Moreover, 78% of those eligible for the vaccine were intentionally unvaccinated because of personal beliefs (7).

You can keep your family safe from dangerous and potentially life-threatening diseases by simply ensuring they are properly vaccinated. If the recommended vaccinations for for the diseases described below were not administered as recommended or a dose is missed, consult your family’s physician to get you or your loved ones on a “catch-up” schedule to ensure you and your family members are properly immunized.

In this article we will review the following 17 vaccine-preventable diseases: hepatitis A and B, rotavirus, diphtheria, pertussis and tetanus, Haemophilus influenza Type b, pneumococcal disease, polio, influenza, measles, mumps and rubella, chickenpox and shingles, human papillomavirus, and meningococcal disease.

Hepatitis A and B
Of the five viral hepatitides, Hepatitis A (HepA) and B (HepB) are the only ones that have vaccines available. Viral hepatitis is especially insidious because they not only can infect with minimal or vague symptoms it can also can lead to fatal liver failure, cirrhosis (aka scarring) of the liver and liver cancer. See last week’s article, What You Should Know About Hepatitis, for more detail on all five forms of viral hepatitis.

The HepB vaccine consists of 3-doses and is one of the earliest recommended immunizations. The first dose is typically given at birth followed by two more doses administered at 1 to 2 months of age and 16 to 18 months of age, respectively (8). The 3-dose series is also recommended in those 19 years of age and older with medical, occupational or lifestyle risk factors, even if they received the abovementioned 3-dose series as a baby. These risk factors include diabetes and kidney disease, working in the healthcare or public safety, sexual promiscuity and living with a HepB-positive person (9).

The HepA vaccine is a 2-dose series, in those 18 years of age and younger, typically given between the ages of 12 and 23 months with the doses separated by 6 to 18 months. In adults, it can be a 2-dose vaccine with doses separated by 6 to 18 months and is recommended in those at high risk of contracting HepA including men who have sex with men, users of illicit drugs, persons with chronic liver disease, travelers to countries where HepA is prevalent and those who anticipate close personal contact with an international adoptee (10).

For adults seeking immunization to both HepA and HepB at the same there is a 3-dose or 4-dose combination vaccine, calledTwinrix®, which is given over 6 and 12 months, respectively (11).

This is a virus that can cause severe diarrhea and vomiting in babies and young children resulting in dehydration that, if not treated, can be deadly (12). Although rare in adults, there have been reported outbreaks in retirement communities leading to severe illness and hospitalization in older adults (13).

The vaccine is a 2- or 3 dose series, depending on the brand of vaccine, given at 2 and 4 months of age or 2, 4 and 6 months of age respectively. There is no recommended vaccination schedule for adults.

Diphtheria, Tetanus and Pertussis
Diphtheria is a very contagious bacterial disease that can spread like the common cold. The bacteria produces a toxin (poison) that causes a thick coating to form in the back of the nose or throat making it hard to breathe or swallow and can result in heart failure, paralysis or death to young and old alike (14)(15).

Tetanus is a bacterial disease and is often referred to as “lockjaw” because the bacteria produces a toxin (poison) that stiffens the muscles of the neck and abdomen causing painful muscle stiffness resulting in difficulty opening the mouth and swallowing. The toxin can also cause breathing problems and seizure-like muscle spasms and can be fatal if left untreated. The bacteria is commonly found in soil and typically enters the body through a deep wound such as stepping on a rusty nail (16).

Pertussis, also known as “whooping cough” because of the distinctive coughing sound it produces in babies, is a very serious infection of the lungs and breathing tubes. It can cause periods of apnea (cessation of breathing), especially in babies, and result in death. Older adults have milder symptoms, and as such, can carry the infection and pass it on like the common cold (17).

These three diseases can be prevented with the diphtheria-tetanus-pertussis (DTaP) vaccine. It is a 5-dose series of vaccinations in children given at 2, 4 and 6 months followed by a fourth dose between 15 and 18 months and a fifth dose at 4 to 6 years of age (18).For those over the age of 18 the recommendation is to receive one dose of the adult vaccination, tetanus-diphtheria-pertussis (Tdap), followed by a tetanus and diphtheria toxoid (Td) booster every 10 years (19).

In the event that a person suffers an injury that breaks the skin, depending on depth and cleanliness of the wound and how long it has been since the last Td booster, another Td shot may be recommended as a preventative measure (20).

Haemophilus influenza Type b (Hib)
Hib is a serious bacterial disease that spreads like the common cold and can become invasive - meaning it can infect parts of the body that are normally “germ free” like the brain and spinal cord causing lifetime disability and even death (21). Hib can infect the lining of the brain and the spinal cord, causing meningitis, swelling of the throat, pneumonia, and infection of the joints, skin and bone (22).

The Hib vaccine is administered in 2-doses at 2 and 4 months of age or 3-doses at 2, 4 and 6 months of age. This is followed by a booster (3rd or 4th dose, respectively) at 12 - 15 months of age to complete the immunization (23). In adults the vaccine is only given in certain situations such as prior to having their spleen removed or receiving a stem cell transplant (24).

Pneumococcal Disease
Pneumococcus is a bacteria that can cause infections of the ears, sinuses, bloodstream (aka bacteremia) lining of the brain and spinal cord (aka meningitis) and the lungs (aka pneumonia) (25). It is often mild, but in younger children and older adults in can cause serious symptoms, lifelong disability and even death (26).

The pneumococcal vaccine is 4-dose series typically given at 2, 4, 6 months of age with the fourth dose administered between 12 and 15 months of age (27). For those age 65 and older it is recommended that they receive two different forms of the pneumococcal vaccine (28). These vaccines are also recommended in adults of any age with medical conditions in which their immune system is compromised or are undergoing certain surgical procedures.

Polio (aka Poliomyelitis)
The poliovirus lives in the throat and intestines of infected persons and spreads through contact with feces (stool) or droplets from a sneeze or cough (29). It can cause lifelong weakness or paralysis in the arms, legs or both and some of those afflicted may die because the virus can affect the muscles that assist in breathing (30).

The polio vaccine is given in 4 doses. The first two at 2 and 4 months of age. The third dose between 6 and 18 months of age and the fourth dose at 4 to 6 years of age (31). There is no recommended vaccination regimen for adults over the age of 18.

Influenza (aka The Flu)
Not to be confused with the common cold, the flu, caused by the influenza virus, spreads easily and can cause serious problems especially in young children, older adults, pregnant women and people with certain long-term medical conditions like asthma and diabetes (32). Every year in the U.S. health children and older adults are hospitalized and/or die from flu complications (33).

Even though young health adults typically have a mild illness, the danger of spreading it to more vulnerable members of the community is very high. Therefore, the annual vaccine is recommended for all age groups starting as young as 6 months of age (34)(35).

Measles,Mumps and Rubella
Measles is a very contagious virus that can spread just by being in a room where a person with measles has been, up to 2 hours after that person has left the room (36). 1 out of every 4 people in the U.S. who got measles between 2001 and 2010 had to be hospitalized and in children it can lead to pneumonia, lifelong brain damage, deafness and death (37).

Mumps is also a contagious virus that spreads easily via coughing and sneezing causing 7 to 10 days of fever, headaches, muscle aches, tiredness, loss of appetite and painful swelling of the salivary glands under the ears or jaw (38). In young children mumps can cause permanent deafness or swelling of the brain. In male and female teens it can cause swelling of the testicles and ovaries, rarely causing infertility. Mumps can be most severe in adults causing inflammation of the lining of the brain and spinal cord (aka meningitis), swelling of the pancreas (pancreatitis) and, on rare occasions, death (39).

Rubella (aka German Measles) is a contagious virus that only causes mild illness in infants and children. In pregnant women, however, it can cause a miscarriage or serious birth defects with devastating, lifelong consequences (40).

All three viruses can be prevented with the measles-mumps-rubella (MMR) vaccine. It is a2-dose vaccine with the first dose administered between 12 and 15 months of age and the second dose given at 4 to 6 years of age (41). Indication for the MMR vaccine in adults depends on various factors including the year they were born, occupational risks and pregnancy status. It is important to consult your family physician about what elements of the MMR vaccine may be necessary depending on these factors (42).

Varicella-Zoster (aka Chickenpox and Shingles)
The varicella-zoster virus (VZV) is a very contagious virus and is spread much like the common cold. The first time it infects a person it causes chickenpox with fever, headache, tiredness and an itchy rash of blisters that have a potential to leave permanent scars (43). Although in children it is self limiting, in adults, chickenpox can result in hospitalization and death (44). After recovering from an episode of chickenpox, the VZV stays dormant (inactive) in the body until a later date when the VZV reactivates and causes shingles (aka herpes zoster). Because of this, shingles typically is seen in older adults and causes a burning painful blistering rash on one side of the body along the rib cage, shoulder or side of the head (45).

In children, the varicella (VAR) vaccine is given in 2-doses. The first between 12 and 15 months of age and the second between 4 to 6 years of age (46). In adults the 2-dose VAR vaccine is recommended for anyone who either didn’t get chickenpox or the VAR vaccine as a child. Additionally a single dose of a different zoster vaccine is recommended for adults age 60 and older (47).

Human Papillomavirus (HPV)
HPV is the most common sexually transmitted infection affecting nearly all sexually active men and women at some point in their lives (48). In most cases it comes and goes without causing any health problems but other cases it can cause genital warts, and cancer of the cervix, vulva, vagina, penis or anus.

It is recommended that adolescent males and females receive the HPV vaccine in 3 doses over 6 months between 11 and 12 years of age (49). Different forms are recommended for males and females ages 19 to 26 years who were not vaccinated as adolescents. All adult forms of the HPV vaccine should be delivered in 3-doses over a 24 week period with a minimal interval of 12 weeks between doses (50).

Meningococcal Disease
Caused by the bacteria, Neisseria meningitidis, it comes in 5 different forms or “serogroups” distinguished by a different letter (A, B, C, W and Y). These serogroups can lead to inflammation of the lining of the brain and spinal cord (aka meningitis) and infection of the blood (aka bacteremia and septicemia). It spreads from person to person through close contact (coughing or kissing) or lengthy contact such as people living in the same household. Even with treatment it kills 10% to 15% of those infected and of those who survive 10% to 20% suffer disabling hearing loss, brain damage, amputations, nervous system problems or severe tissue damage requiring scarring skin grafts (51)(52).

A single dose of the vaccine for serogroups A, C, W and Y is recommended between the ages of 11 and 12 with a booster dose at age 16 (53). Young adults (16 to 23 years of age) may be given a vaccine for serogroup B at the discretion of their doctor (54).

This is a very basic overview of the diseases and their associated vaccines. For more information, you can download the CDC Vaccine Schedule for those 0-18 years of age and those 19 years or older that has more detail and information. The CDC also has a vaccine schedule app for iOS and Android that you can download to your phone and stay current on the recommended vaccination schedules. Bring the vaccine schedule with you into your next doctor visit and ask if you family is as protected as it can be.

What You Should Know About Hepatitis

The majority of children with Hepatitis A do not have symptoms or have an unrecognized infection (1).
Baby boomers are 5 times more likely to have Hepatitis C and most don’t know they are infected (2).

In 2010, the World Health Assembly resolved that July 28 should be designated as World Hepatitis Day - an opportunity for education and greater understanding of viral hepatitis as a global public health problem, and to stimulate the strengthening of preventive and control measures of this disease by nations around the world (3). This year’s World Hepatitis Day theme is “elimination” as the World Health Organization (WHO) has set a goal to eliminate viral hepatitis as a public health threat by 2030 (4). “Hepatitis” comes from the Greek hepatos - meaning “liver” and the latin itis - meaning “inflammation” (5). Hepatitis, aka “inflammation of the liver”, can be caused by many things including viral infections, parasites, bacterial infections, excessive alcohol consumption, drugs (e.g.acetaminophen aka Tylenol), herbal remedies and dietary supplements (6).

Viral hepatitis - the most common form of hepatitis - can be caused by 5 different viruses: Hepatitis A virus (HAV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), Hepatitis D virus (HDV) and the Hepatitis E virus (HEV). These viruses differ in the way they get into the body and how long they stay in your body. Some viral hepatitis comes and goes like the common flu while others stick with you for life causing severe illness, liver cancer and even death. Moreover, many people infected with viral hepatitis have either no symptoms or vague ones that can be confused with something else including fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, joint pain, grey-colored stool, darkened urine and jaundice - yellowish pigmentation of the skin and whites of the eyes (7).

Our younger and older family members are especially susceptible to hepatitis and with more and more generations living under the same roof (8) are at an increased risk of infecting each other with viral hepatitis. You should know the following things about the various types viral hepatitis, how to prevent them and how to safely live with family members who have already been infected.

Hepatitis A.
The HAV is highly contagious and typically transmitted by the fecal-oral route - meaning it is spread from person to person through contact with feces (stool) of people who are infected (9). This can happen either by coming in contact with an infected person who does not wash their hands properly or consuming food or water they have prepared or handled. Traveling to developing countries, even in urban areas with “standard” tourist accommodations, increase your risk of infection (10) as does swimming in polluted quarries or coastal waters - especially in the first 72 hours after a rain due to urban runoff contaminating the water with sewage (11).

It is not clear if alcohol-based hand sanitizers are effective against HAV, so hand washing with soap and water is advised especially for those who attend or work at child daycare and assisted living facilities where contact with contaminated diapers is possible (12). According to the CDC and the WHO the best way to prevent Hepatitis A is to ensure that every member of your family that can gets the Hepatitis A Vaccine, which is effective in 95% of cases (13) and protects for at least 15 years (14). Your loved ones’ doctors can determine if the Hepatitis A Vaccine is appropriate for them.

If an unvaccinated family member either comes in contact with a person who is later identified as being infected with HAV or becomes infected themselves alert their doctor immediately. If exposed, their doctor will be able to determine if post-exposure treatment to prevent infection is warranted. If infected, children and young adults are typically able to fully recover from HAV infection in 2 - 6 months with minimal supportive treatment. In adults age 50+, however, there is an increased risk of the HAV causing fatal liver failure (15).

Hepatitis B.
The HBV can only be transmitted from person to person when infected blood or other bodily fluid (e.g. semen, vaginal fluids, tears or urine) enters the body of someone who is not infected (16). HBV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing or sneezing (17). Despite it being harder to contract than HAV, estimated new infections of HBV in 2014 was over 7 times that of HAV (2,500 vs 19,200 cases) (18).

Risk for chronic HBV infection is based on the age at which the person is infected. 90% of those infected as infants end up having chronic Hepatitis B while only 2% - 6% of those infected as adults end up with chronic HBV infection (19). Those with chronic Hepatitis B are at increased risk for cirrhosis (aka scarring) of the liver and liver cancer. As with HAV, the best way to prevent Hepatitis B is to ensure your family is properly vaccinated. According to the CDC and the WHO, all newborns should be given the first of three doses in the Hepatitis B Vaccine series prior to discharge from the hospital. Moreover, vaccinated caregivers who perform tasks that may involve exposure to blood or body fluids (e.g. nurses, doctors, patient care technicians, etc.) should be tested for levels of Hepatitis B surface Antibody (HBsAb) to ensure they are sufficiently protected from incidental exposure to HBV infected blood. If their HBsAb levels are too low they should receive another series of Hepatitis B Vaccine doses.

As with HAV, if you suspect exposure to or infection by HBV alert your family’s physician immediately. There is no specific treatment for short-term HBV infection and, like HAV, only requires supportive therapy until the body clears the infection. Those who develop chronic Hepatitis B should be seen and monitored by a doctor with expertise in liver disease (e.g. gastroenterologist, hepatologist) who can decide if and when to begin antiviral therapy (20). Because the HBV can survive outside the body (e.g. in a drop of blood) for at least 7 days and still be capable of causing infection, sharing items such as razors or toothbrushes with an infected family members is not recommended.

Hepatitis C.
The HCV is typically only transmitted by direct contact with infected blood and today most people become infected by sharing needles or other equipment used to inject drugs (21). However, the baby boomers in your family (i.e. those born between 1945 and 1965) are at increased risk of unknowingly having Hepatitis C, even if they never engaged in injectable drug use, because widespread screening for HCV of blood banks didn’t begin until 1992 (22). Moreover, those infected with HCV can live with the infection for decades without feeling sick.

The longer someone lives with untreated HCV the greater the risk of developing life-threatening liver disease, liver cancer and death. Unlike HAV and HBV, There is no vaccine to prevent infection with the HCV but there have been many advances in life-saving medications for those with HCV. Depending on the the genetics of the virus, the extent of current liver damage and how compliant the person is with taking their medication, HCV antiviral therapy can slow any existing inflammation and scarring of the liver, reduce the chances of developing further scarring and liver cancer and even clear the HCV from the bloodstream altogether (23).

The first step to protecting your family is by ensuring the baby boomers in your family get tested for HCV and, if positive, gets educated on and treated for Hepatitis C. Then educate the entire family about the HCV and how it is spread mainly through contact with blood. The HCV-positive family member should make sure to keep open cuts or sores on the skin bandaged or covered until they have fully healed and instruct family members not to borrow personal care items (e.g. razor, toothbrush, toothpicks, etc) from their family member (24).

Hepatitis D.
HDV, also known as “delta hepatitis” is uncommon in the US and only occurs in those who are infected with HBV because HDV is an incomplete virus and requires the presence of HBV to replicate (25). In simplified terms, think of HDV as a powerful car without any gas in the tank; HBV provides the gas for HDV to “run”. As with HBV, Hepatitis D can be a short-term or long term chronic infection. Unlike HBV, there is no vaccine for HDV. The best preventative mechanism for HDV is getting the Hepatitis B Vaccine series, because without HBV in the body HDV can’t thrive.

HDV is the smallest virus known to infect humans and causes the most severe form of chronic viral hepatitis - dominating the concurrent HBV infection. For those infected with HDV, treatment options are limited to certain antivirals, specifically interferon-alpha (26).

Hepatitis E.
Like HAV, the HEV is transmitted from the ingestion of fecal matter, is usually associated with contaminated water supplies in countries with poor sanitation (27). It is the most common cause of short-term (aka acute) hepatitis in the UK and, as with HAV, causes a mild illness that doesn’t require any treatment. Unlike HAV, There is no FDA-approved vaccine for HEV, so prevention depends on reducing risk when traveling to developing countries by not drinking unpurified water and avoiding raw pork and venison (28).

Testing, vaccination and prevention are the keys to keeping your family safe from viral hepatitis. Knowledge and care are essential to living with loved ones who are infected.

Keep Your Family Safe in the Sun with these 6 Tips

Suffering one or more blistering sunburns in childhood or adolescence more than doubles a person’s chances of developing potentially-deadly melanoma later in life (1).
Over 60% of skin-cancer related deaths occur in persons age 65 or older (2).

According to the Cleveland Clinic, 80% of a person’s lifetime sun exposure is acquired before age 18 (3) and repeated unprotected exposure to the sun’s ultraviolet (UV) rays can cause skin damage, eye damage, immune system suppression and skin cancer. According to Dr. Perry Robins, president of the Skin Cancer Foundation, “the sun’s rays are strongest during the summer months” when family members tend to spend more time outdoors (4).

Our youngest and oldest family members are more sensitive to the sun’s rays and more susceptible to their damaging effects because of increased exposure, thinner skin and sun-sensitizing medications typically taken by family members in these two age groups (5). Our older family members are at even greater risk for skin cancer as their body’s natural ability to repair DNA damaged by the UV rays diminishes with age (6).

Following just a few guidelines can help prevent the damaging and even life-threatening effects of the sun, including skin cancer which, according to the American Cancer Society, is one of the most preventable forms of cancer (7).

#1. Teach and follow the Shadow Rule: “Short Shadows--Seek Shade”.
Studies have shown that the the intensity of UV rays from the sun is directly related to how high the sun sits above the horizon (8). A good rule of thumb is, when the shadow you cast is shorter than your body seek shade and avoid direct sunlight; an easy rule to teach to even the youngest of your family members (9). If your shadow is taller than you are (in the early morning and late afternoon), your UV exposure is likely to be lower (10). It is important to remember that UV rays still penetrate clouds on cool, windy, overcast days and can reflect off sand, water and even concrete (11). So just because you can’t see your shadow doesn’t mean that you and your family aren’t exposed to damaging UV rays.

#2. Limit outdoor activity when UV index is at its highest.
The suggestion to avoid the sun between 10 am - 4 pm - in order to avoid UV exposure - is only accurate for those who live north of the equator and observe daylight savings time during the late spring and early summer. In fact, if you live in Sydney Australia your UV index is at its lowest May through July and highest November through February (12). A better way to plan an outdoor event is to check your local paper’s weather forecast or search on’s UV Forecaster, for US locations, to see what time of the day the UV index is greatest in your area. Avoid outdoor activities during the hours the UV index is 8 or greater - when unprotected skin and eyes can burn in minutes - and limit activities during the hours where the UV index is 3 to 7 (13).

#3. Dress the family in “Sun-Safe” Clothing.
Generally the more skin you cover with clothing the better (e.g. long sleeves are better than a tank top), however, not all clothes are created equally in their protective effect from UV rays. You want to make sure to dress your family in dry, loose fitting, tightly woven, colorful, non-reflective synthetic fabrics. Dry clothes provide better protection than wet ones (14). The tighter the weave of the clothing the smaller the holes and the less UV rays that can get through. Washing new garments made from cotton two or three times can often permanently raise its protective effect by tightening its weave through the garment’s shrinkage. Synthetic fibers (e.g. polyester, lycra, nylon and acrylic) are more protective than bleached cottons and the more vivid the color the more protective. (15).

#4. Accessorize properly for the sun.
A wide brimmed hat (3-inches or greater) made of similar “sun-safe” material is the best way to protect areas that are often overlooked or difficult to apply sunscreen (e.g. scalp, tops of ear, back of neck) (16). UV-blocking sunglasses are as important for children as they are for older adults to protect the eyes from the formation of cataracts, growths on the eye (e.g. pterygium) and cancer (17). The Mayo Clinic recommends wrap-around, close-fitting sunglasses with wide lenses that block 99 to 100% of both UVA and UVB rays and screen out 75% - 90% of visible light (18).

#5 Do sunscreen right.
The FDA and the World Health Organization recommend a broad-spectrum sunscreen that blocks UVA and UVB rays with a sun protection factor (SPF) of at least 15 while the Skin Cancer Foundation suggest an SPF of at least 30 is best for children. Get all family members used to applying a golf-ball sized dollop (approximately 2 tbs) of sunscreen at least 30 minutes before going outside, concentrating on all exposed areas especially those often overlooked (e.g. ears, neck, tops of feet and hands) and reapply at least every two hours or after swimming or sweating. (19). For family members with sensitive skin look for “PABA-free” sunscreen or consider products with titanium oxide instead (20). When purchasing sunscreen assume each family member will use over 1 fluid ounce every two hours. If the average summer day where the UV index is greater than 2 lasts approximately 6 hours, each family member will need at almost 4 ounces of sunscreen for a day in the sun - if they don’t swim or sweat a lot. So each family member should go through - at the very least - half an average size 8 oz bottle of sunscreen during a day-long outing to the zoo or on the golf course.

#6 Review your family’s medications.
There are many drugs that can increase your loved ones’ sensitivity to the sun reducing the protective effects of sunscreen and cause either phototoxic or photoallergic reactions. Phototoxic reactions resemble a sunburn with redness, inflammation and sometimes brown or blue-gray discoloration in the areas of skin that have been briefly exposed to sunlight. Photoallergic reactions appear as redness, scaling, itching and sometimes blisters and spots that resemble hives (21). Medications commonly used by our loved ones to treat acne (e.g. benzoyl peroxide), itching (e.g. Benadryl Itch-Stopping Gel), depression (e.g. tricyclic antidepressants), high blood pressure (e.g. thiazide diuretics), osteoarthritis (e.g. piroxicam) and psoriasis (e.g. methoxsalen), just to name a few, can increase their sensitivity to the sun's rays. A list of some of these drugs can be found in this Consumer Report article and the consumer version of the Merck Manual. Review all your loved ones’ current medications, both prescription and over-the-counter, for sun sensitivity with their physician or pharmacist. In addition to medications, some non-medicinal substances including perfumes, alcohol (both topical and consumed) and certain plants (e.g. limes, celery and parsley) can also increase one’s sensitivity to the sun’s UV rays.

Following these 6 simple guidelines will allow you to enjoy the warmth of the summer sun while reducing the risks associated with its harmful rays.

5 Health Risks to Your Family Caused by Inadequate Sleep

40% of school age children get less than the recommended 9 hours of sleep (1).
49% of teens get less than the recommended 8 hours of sleep (2).
50% of older adults complain about difficulty initiating or maintaining sleep (3).

Those who forgo sleep with the excuse, “I can sleep when I’m dead” don’t realize that they are actually distorting the original intent of Benjamin Franklin’s statement against laziness in Poor Richard’s Almanack, “Up, sluggard, and waste not life; in the grave will be sleeping enough.” In fact, Ben Franklin actually believed in the value of sleep; so much that he coined the proverb, “Early to bed and early to rise, makes a man healthy, wealthy, and wise.

Numerous recent studies have found that sacrificing sleep can have profound and life-threatening short-term and long-term adverse effects on the health and well-being of your loved ones, both young and old. Poor sleep can cause an inability to concentrate, anxiety, depression and thoughts of suicide (4) and has been linked to suicide attempts, motor vehicle accidents, industrial disasters and occupational errors (5). Inadequate sleep can not only hinder mental and physical functions but also increases the risk for various medical conditions including hypertension, diabetes, obesity, depression, heart attack and stroke (6).

Among the various health risks caused by inadequate sleep, there are some you may not have known can affect both the younger and older members of your family.

#1. Decreased mental acuity.
Inadequate sleep affects concentration, attention and memory. In younger family members, this can lead to difficulties in school, frustration with school work and poor grades. In older loved ones, these side effects of inadequate sleep can make it seem that your elder loved one is suffering from a cognitive disorder (e.g. Alzheimer’s, dementia) or worsen an existing cognitive disorder (7). More importantly, recent studies have shown that fragmented sleep (i.e. sleep interrupted by arousals or awakenings) can increase the risk of actually developing Alzheimer’s disease (8).

#2. Increased likelihood of Depression, Anxiety & Suicide.
Several studies of adolescents have found that inadequate sleep is associated with higher levels of depressed mood, anxiety, behavior problems, lower self-esteem, alcohol use and attempted suicide (9). In our elderly loved ones, sleep disturbance is a significant risk factor for depression especially if they also have a disability, a newly diagnosed illness, or are in bereavement (10).

#3. Accidental Injury.
The Centers for Disease Control and Prevention (CDC) has recognized that sleep loss and sleep disorder affects individuals performance and safety (11). Almost 20% of all serious car crash injuries in the general population are associated with driver sleepiness, independent of alcohol effects (12) - a serious consideration for driving teens and older loved ones. In our older loved ones, insufficient sleep and poor sleep quality can double the risk of suffering a life-altering fall during the day (13).

#4. Increased risk of Obesity.
There is an inverse relationship between sleep loss and obesity, meaning, the shorter the sleep, the greater the obesity (14). Studies have shown that inadequate sleep decreases levels of certain hormones that suppress appetite (e.g. leptin) increases levels of other hormones that stimulate appetite (e.g. ghrelin) and alters hormones that preserve muscle and store fat (e.g. cortisol) in both younger and older family members alike (15) (16). A vicious cycle can ensue as central obesity (obesity around the waist) worsens, the risk of (obstructive sleep apnea) (OSA) increases. OSA, marked by loud snoring and restless sleep, in turn, further reduces adequate sleep.

#5 Potential to Develop Diabetes.
Inadequate sleep can cause the body to become insulin resistant - meaning the insulin produced by the body right after eating isn’t sufficient to transfer enough sugar from the bloodstream to the cells in the body. This results in elevated levels of sugar in the blood, for longer periods of time, until the pancreas is able to produce enough extra insulin to bring the blood sugar down. This abnormal processing of sugar is known as impaired glucose tolerance (IGT) or borderline diabetes and is a risk factor for obesity. IGT can ensue after only 5 continuous days of less than 4 hours of sleep a night in adults (17). If IGT goes uncorrected, in up to 70% of cases the pancreas “gives up” producing insulin and the body goes into full-blown diabetes (18).

Ensuring your family is getting enough sleep is one of the most important preventive health care measures you can take. Use your Care|Mind app to track your loved ones’ sleep patterns and alert you to any sleep related issues in your loved ones.

Don’t Let Dehydration Put a Damper on Your Family’s Summer

Nearly 20% of pediatric emergency room visits are due to dehydration (1).
Over 30% of elder emergency room visits present with dehydration (2).

With the onset of summer weather and outdoor activities our younger and older family members are especially vulnerable to dehydration for different biological reasons. Kids sweat less than adults, have smaller bodies and higher metabolic rates all which contribute to them needing proportionally greater volumes of water than adults to stay properly hydrated. Our older loved ones’ risk for dehydration stems from having less total body water, decreased sensation of thirst and aging kidneys that don’t concentrate urine as well. This risk is exacerbated by certain medications that either increase fluid loss or fluid requirements (e.g diuretics, antihypertensives) and physical or cognitive conditions that make it challenging to consume sufficient fluids (e.g. swallowing disorders, arthritis, Parkinson’s, Alzheimer's, etc.).

Dehydration is part of a vicious cycle in both age groups. Numerous studies have associated dehydration with kidney stones, constipation, asthma, cardiovascular disease, diabetic hyperglycemia, and some cancers (3). Dehydration can cause a lack of appetite, fatigue, and irritability in both age groups which makes rehydration a challenge thus further worsening the dehydration (4),(5).

Follow these easy tips to make sure your whole family is properly hydrated and stays out of the ER this summer.

Remind your loved ones to drink fluids periodically.
Family reminders to consume fluids was one of the three strategies suggested by older adults participating in a study to reduce risk of dehydration in our elder loved ones (6). Whether it is the reduced thirst response in our older loved ones or the distractions of summer activities in our younger family members, reminders are a great way to ensure adequate hydration.

Make fluids easily accessible.
Place containers such as sports bottles, sippy cups, small bottles of spring water or flavored water within reach throughout the day and drop a straw in them. This will encourage both young and old to consume more fluids despite their distractions, arthritis or difficulties with swallowing.

Provide options that can substitute for water.
Popsicles, juice, Italian ice, sherbet, gelatin desserts, and puddings may be more palatable to your older loved ones and popular with your children. In families with risk of diabetes look for “diabetic-friendly” or low sugar versions.

Increase the water content of your meals and snacks.
Meals can provide two-thirds of a person’s daily fluids. The water content of vegetables is approximately 90%, fresh fruit about 85% and lean meats about 60%. Incorporating more of these foods in your meals and snacks can help boost the overall fluid consumption of your family.

Optimize meals for fluid consumption.
Take the time to eat as a family. Make a pitcher of water the center-piece to the table. Ensure the “right cup” is set at each family member’s seat (e.g. sippy cup for the younger kids, plastic cup with a long straw for grandma whose arthritis makes it difficult to lift a glass). Cut foods in small enough pieces to allow family members, young and old, challenged with chewing. All these techniques have shown to organically increase fluid consumption at mealtimes.

Ensure outdoor activities are safe from dehydration risks.
It is a common misconception that if the kids are playing in the sprinklers or grandpa is lounging in the pool that dehydration is not a risk. Just because they are “in” water doesn’t mean they are “consuming” water. In addition to reminding family members to drink fluids and making fluids readily accessible during outdoor family gatherings, make sure you there is sufficient shade for every member of the family.

Make fluid part of ANY physical activity.
Whether it is a walk with the grandparents or a trip to the park with the kids, getting a water bottle to bring with you should be part of the preparation, like tying your sneakers, before going out. According to the American Academy of Pediatrics a child around 90 pounds should drink 10 gulps every 20 minutes, teens around 130 pounds should drink 20 gulps in the same time (7). In older adults it has previously been suggested to aim for 1500 mL of oral liquids per day, unless there is a special medical condition (e.g. congestive heart failure, kidney disease), but more recent studies recommend encouraging them to consume an amount that is comfortable for them (8),(9).

Encourage consumption of fluids with certain daily tasks.
Place a clean unbreakable cup by the medicine cabinet, in the bathroom and kitchen sink and encourage family members to consume a cupful of water every time they take their meds and/or brush their teeth. These are prime and easy opportunities for young and old to get in an extra glass of water. One study found that drinking a cup, instead of a just gulp, of water with each medication dosing made the difference between adequate and inadequate daily fluid intake in some older adults (10).

Make fluids the center of attraction.
Having a summer family gathering? Get creative! Replace the labels of your average water bottle with customized labels to celebrate the event. Better yet, write the name of the family member on the water bottle so there is no argument whose water is who’s. has some great ideas to make fluids the life of your party.

Don't make fluid consumption a "chore" for your family. Instead, make a plan to integrate it into their lives organically. If you have family members who have special conditions such as diabetes, kidney disease and heart disease, check your hydration plan with their doctors before going forward to ensure your whole family stays happy, healthy and hydrated this summer.

Stop the Hidden Killer in Your Family

A study found that more than 4 hours a day of “recreational screen time” (e.g. TV, smartphone, PC) increases the risk of death from any cause by 50% and the risk of a cardiovascular event (e.g. angina, heart attack) by 125%.

Dr. James Levine from the Mayo Clinic – who coined the mantra “sitting is the new smoking” – said in an LA Times interview back in 2014 “Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death.” This caused a flurry changes in the office workspace to combat sedentary behavior including employees replacing their desks with standing treadmill desks and employers providing their employees amenities such as gyms and more frequent “activity breaks”.

Unfortunately, the same enthusiasm was not placed on the home or family where teens are spending 9 hours a day consuming recreational screen-based media and over 70% of our elder loved ones spend in excess of 8.5 hours a day sitting. In today’s tech-filled world, life-threatening sedentary behavior is even more sinister and harder to combat outside the office. Follow these tips to root out and battle this hidden killer in your family.

Take an inventory of the sources of sedentary behavior in your home.
Before you battle an enemy you need to know how many “troops” you are up against. TVs in the home are the first and most obvious candidate as a source for sedentary behavior. But what about the number of PCs your family have access to? Streaming media has converted your family’s desktops or laptops into as much of a source sedentary behavior as your TVs, if not more, especially for those family members who like to binge-watch entire seasons of shows on Netflix. Next add up the number of game consoles (e.g. PlayStation, Xbox, etc.) in the home. Especially for younger family members, game consoles can encourage hours of video game playing and many also stream media as well now. Now count up all the smartphones and tablets. With the dawn of social media and game apps these so-called “mobile” devices have become one of the biggest sources of sedentary behavior for all members of the family as they spend hours playing their favorite game or responding to their friends and family on Facebook.

Understand your family’s sedentary behavior.
Once you know the number of “troops” you are up against, you need to know how they infiltrate your family. Dr. Levine says “we lose two hours of life for every hour we sit”. Does your teenage son come home from school and spend a few hours playing on his PlayStation? Does grandma spend a lot of time at her PC in the evenings emailing or on Facebook? Does your adolescent daughter Snapchat with her friends for hours on the weekend? Does grandpa spend most of his day sitting watching TV? You can’t expect to battle sedentary behavior in your family if you don’t know when and where it usually occurs and for how long.

Promote physical activities in the home.
Once you know how it infiltrates your family, build up a defense against sedentary behavior. Schedule a short (e.g. 30 minute) leisurely “required family evening walk” after dinner. It is an excellent way to pull everyone away from their sources of inactivity, promote communication and stave off diabetes, obesity and depression in every member of your family. Place countdown timers set to an hour next to TVs and PCs to remind your family to get up and move. Make sources of activity just as accessible in your home as the sources of sedentary behavior such as placing pedal exercisers under desks and an exercise trampoline in the den – be creative.

Replace sedentary behavior with active behavior.
Once your defenses against sedentary behavior are built, start taking out the enemy. Recent studies have shown that just adding activity isn’t enough, you must reduce the sedentary activity as well. Setting “media-free” zones in the house and times during the day where family members are not able or allowed to use these sources of sedentary behavior is a good start. For the young gamers in your family, encourage “motion gaming”. The Nintendo Wii, Xbox Kinect and the Sony Move add-on for PlayStation allow players to interact with the system through body movement instead of the controller.

Remember this a war against sedentary behavior in which you may lose some battles along the way. But if you are creative and stick to your guns the only casualties of this war will be the obesity, high blood pressure, diabetes, heart disease and cancer that currently threaten your family’s health. As Dr. Levine said, “The impact of movement — even leisurely movement — can be profound.”

8 Tips to Battle Obesity in Your Family

About 1 in 3 American kids and teens is overweight or obese.
More than 1/3 of older adults aged 65+ are obese.

Regardless of age, obesity negatively affects the majority of organs and body systems. It predisposes both young and old to developing diabetes, hypertension, high cholesterol, heart disease and certain cancers. In older adults, obesity can also lead to physical disability and increased risk of falling due to the effect of excess weight on their joints.

For those taking care of both young and older family members, battling obesity may seem an overwhelming challenge. Fortunately, there are some simple suggestions you can follow to get and keep the whole family into shape.

8. Make adequate sleep a family priority.
Multiple studies have associated shortened or disturbed sleep with weight gain in all age groups. Medicinal sleep aids are not recommended in either children or older adults. It’s not enough to just set a “bed time” but also create a consistent “pre-sleep routine” in the home that includes dimming the lights, cooling off the bedrooms, turning off electronics. This prepares everyone in the home mentally to get a good night’s sleep.

7. Schedule a daily family walk after dinner.
It is a great precursor to or part of your “pre-sleep routine” that helps burn off any lingering stress hormones from the day which will help everyone sleep better and longer and prevent these stress hormones from telling your body to store fat – a natural stress response. Moreover, this sort of social activity is a great deterrent to depression and helps your older loved ones maintain their muscle mass and gets your younger ones away from the TV and their game console.

6. Update the foods in your fridge and pantry.
It makes sense that the most accessible foods in the house are the ones that are most often eaten during meals and snacking. Set your family up to eat healthier by restocking your home’s food stores with foods higher in protein and complex carbohydrates and lower in simple carbohydrates (i.e. sugars).

5. Set and stick to an early family dinner time.
Numerous studies have shown that simply changing the time you have your last meal of the day to at least 3 hours prior to bedtime can be an easy and effective way to lose weight and promote restful sleep at night. It also helps with bed-wetting issues in smaller children and gastrointestinal issues (e.g. indigestion, reflux) that often plague our older loved ones. Find a time that works with the schedule of your hectic day and then plan to start your “pre-sleep routine” approximately 3 hours after that.

4. Replace “bad” sugars in the house with “good” ones.
Simple sugars (i.e. carbohydrates) such as those found in cereals and soda are detrimental to weight loss, cause energy crashes and can predispose your family to diabetes. Replace sodas with sparking water sweetened with flavored stevia, artificial syrups (e.g. pancake syrup) with a natural sweetener (e.g. honey, agave nectar) and potato-based foods such as french-fries and potato chips with sweet potato fries and baked veggie chips. Look for “low carb” versions that are becoming more and more available in your grocery stores of some of your standard family staples like white rice, white bread, white pasta and tortillas. If not available, consider using their whole grain counterparts (e.g. brown rice, whole grain bread).

3. Make protein a central part of every meal .
Studies have shown that the body burns more calories to process proteins than carbohydrates and it promotes fat burning. Moreover, protein makes you feel fuller longer and curbs the highs and lows associated with pure carbohydrate meals. Simple changes like adding Greek yogurt to your family’s breakfast menu and meatballs or tofu to a meatless pasta meal can slow down the absorption of sugar from the stomach into the bloodstream and provide your older loved ones with protein they desperately need to maintain muscle mass.

2. Bump up the fiber in your family’s diet .
High fiber foods tend to be lower in calories and more filling than low-fiber foods. Moreover, soluble fiber (i.e. fiber that dissolves in water) can slow absorption of sugars and cholesterol. Insoluble fiber can also help prevent and ameliorate digestive tract issues such as constipation, hemorrhoids and diverticulitis which tend to affect our older loved ones. Adding fiber to your family’s menu can be as simple as sprinkling ground flax seed on morning cereal, replacing nuts for the snacks in your home, using whole wheat flour in to prepare meals and including a vegetable (e.g. green beans, cauliflower) at every dinner.

1. Make drinking water a priority in the home.
Our bodies are about 60% water and it is an important part of all body functions and processes including digestion and elimination. Unfortunately, most people don’t drink nearly enough water. In younger family members, mild dehydration is often interpreted as hunger and leads to over-eating. In older family members, dehydration can cause or worsen constipation, reduce the effectiveness of medications and even cause cognitive issues in our oldest adults. Make drinking water readily available by putting a pitcher of clean filtered water front and center in the refrigerator, set the pitcher in the middle of the table at every meal, have a glass of water at every place setting and provide easily portable drinking water to your children for school.

If anyone in your family suffers from any chronic conditions (e.g. diabetes, heart disease, kidney disease, etc.) please consult your loved ones’ physicians before implementing any of these tips in your home. You will find with just a few conscious changes in the home you can start winning the battle against obesity in your home and keep your family happy and healthy.

Top 8 Risks to Men's Health

Men are less likely to visit a doctor and more likely to play down their symptoms.
This can prove to be a deadly combination.

Men tend to put their own health last; behind the support and wellbeing of their partner and family. As they get older they are even less likely to address their own health issues because they don’t want to burden their partner or family.

To keep the brothers, husbands, dads and grandfathers in our lives as healthy as possible for as long as possible it is important to be aware of the following risks:

1. Prostate cancer.
According to the American Cancer Society, about 1 in 7 men will be diagnosed with prostate cancer during their lifetime and it is the second leading cause of death. Early detection is key. Keeping track of changes in ability to urinate (e.g. increased need to get up at night to urinate) and an annual visit to the doctor for screening are recommended.

2. Depression and Suicide.
Men experience depression differently than women demonstrating signs of irritability and fatigue. Older men are less likely to acknowledge they are depressed making it even more difficult to detect. Loss of interest in socializing or hobbies, sleep disturbances and decreased in overall activity are warning signs.

3. Respiratory disease.
Lung cancer is a leading cause of cancer death among men second only to prostate cancer. Pneumonia consistently accounts for the majority of combined pneumonia and influenza deaths. Aside from stopping to smoke, getting an annual flu and pneumococcal vaccine are key to preventing avoidable respiratory illnesses and deaths among older men.

4. Skin cancer.
According to the Skin Cancer Foundation, men, especially those over the age of 50, are twice as likely as women to develop skin cancer due to more frequent sun exposure and fewer visits to the doctor. As men age changes in skin (e.g. “liver spots”) may mask skin cancer. Any new spot on the skin should be shown to the doctor at their annual checkup.

5. Unintentional Injuries and Accidents.
According to the CDC, unintentional injuries or accidents was the fourth leading cause of death in 2013 behind heart disease, cancer and respiratory disease. Older men are at even greater risk because of their increased risk of falling and refusal to address issues with walking or use canes or walkers. Decreased hours of sleep and participation in activities often precede a fall or unintentional injury.

6. Diabetes.
Uncontrolled diabetes can contribute to nerve damage, kidney failure, heart disease, stroke and vision problems. It can also pose a unique set of complications for men including sexual impotence and lower testosterone levels which can lead to or exacerbate depression and/or anxiety. Diabetes often causes fatigue, increased urination and trouble sleeping.

7. Liver disease and alcohol use.
High levels of alcohol and tobacco use put men at risk for liver disease. Moreover, men experience higher rates of alcohol-related deaths and hospitalizations than women. According to the CDC drinking alcohol increases the risk for mouth, throat, esophagus, liver and colon cancers and interferes with testicular function and hormone production.

8. Cardiovascular disease.
According to the American Heart Association, 1 in 3 men have some form of cardiovascular disease. An estimated 2.8 million men experience a stroke every year. Keeping active, eating healthy, and controlling diabetes, blood pressure and cholesterol are keys to prevention.

No one can avoid all possible risks and some risk factors are difficult to control (e.g. quitting smoking). However, keeping track of health, activity, sleep, diet and making an annual physical exam a priority can help minimize all the aforementioned risk factors.

10 Tips to prevent falls in your loved one

Every 20 minutes an older adult dies from a fall in the United States.
Many more are injured. Take a stand to prevent falls.

According to the CDC, every year one out of every three adults over the age of 65 is at risk for experiencing a fall and once they fall their chances of falling again doubles. Falls are the leading cause of fatal and non-fatal injuries including traumatic brain injuries, in older Americans.

Falling is not a normal part of aging, but unfortunately, for many of our elder loved ones falling is not a matter of “if” but “when” a fall will occur. Fortunately, most falls are preventable. Consider following these simple suggestions to help keep your loved ones from suffering a life-altering fall.

1. Regularly ask your loved one if they have “tripped” or lost their balance recently.
Embarrassment can prevent your loved one from volunteering this information and the fear produced by a near-fall (e.g. tripping) can increase the risk of your loved one suffering and actual subsequent fall.

2. Keep track of changes or decreases in regular activity.
Older adults will start avoiding or changing activities in which they experienced a loss of balance or fall. Less active older adults start to lose strength in the muscles used for balance and increase their risk of suffering a fall.

3. Look for signs of insufficient sleep such as snoring or nodding off during the day.
Address these issues with your loved one’s physician. Lack of sufficient restful sleep can double the chances of your loved one suffering a fall.

4. Conduct medication reviews annually.
Changes in medications and in your loved one’s metabolism over time can increase their risk of falling due to side-effects and/or drug-drug interactions. Review meds at each visit to the doctor and after every hospital discharge as well.

5. Have your loved one’s vision and eyeglasses checked annually.
Older adults with poor vision are twice as likely to suffer a fall. Poor vision is also a barrier for your loved one engaging in outdoor activities (e.g. walking) so if they wear bifocals ask the optometrist for prescription distance glasses.

6. Regularly inspect and address fall risks in the home.
Most falls occur in the home and are due to clutter, throw rugs and poor lighting. Painting outdoor steps with non-slip paint and placing grab rails in areas of high fall risk (e.g. bathrooms, stairs, etc.) provide your loved one with additional support in these areas.

7. Invite your loved one to a regularly scheduled activity.
Activities such as walking and Tai Chi can increase mobility and protect them from falls. Joining them in these activities reassures your loved one and gives you an opportunity to observe any issues in their mobility.

8. Give your loved one a pair of walking sneakers.
This is a good way to invite them to join you in a regularly scheduled activity and the proper footwear can optimize safety and reduce the risk of falls throughout their day.

9. Encourage the use of devices to assist them in walking.
Some seniors either avoid walking or risk walking without assistive devices (e.g. cane, hiking stick, walker) because they don’t want to be seen as debilitated. Walk with them using a device as well.

10. Make fall prevention a team effort.
Include family, caregivers, healthcare providers and even your elder loved ones in the abovementioned strategies to increase awareness and prevent a life-altering fall.

Remember, most accidental falls in seniors are preventable but it takes a concerted and continuous team approach to minimize all the possible risk factors through exercise, medication management, annual vision checks, and creating a safer living environment.

Celebrate Fall Prevention Awareness Day in the US on the first day of Fall (no pun intended) every year.

Is your loved one taking too many medications?

When was the last time your loved one’s medications were reviewed? Do you know what each medication is supposed to treat in your loved one?

Polypharmacy – the taking of more than 5 medications or more medications than is medically necessary – is all too common among our elder loved ones and can cause them injury or even death. Once a year and every time your loved one sees their doctor or is discharged from the hospital, take the time to review their medications with their nurse and/or physician. Specifically ask their nurse or physician:

    What is each medication supposed to do for your loved one?

  • Are all the medications they are taking still necessary?

  • Are there any lifestyle changes (e.g. diet, exercise, etc.), alternative therapies or over-the-counter medications that could eliminate or reduce the need for any of your loved one’s prescription medications?

Even if your elder loved one is at the peak of health, an annual checkup and medication review with your loved one’s nurse or physician is warranted. As your elder loved one ages, changes in their body composition (e.g. reduced muscle mass) and liver and kidney function tend to increase their sensitivity to medications. So a medication that was originally prescribed to keep your loved one’s heart rate from going too high may, as they age, cause dangerously low heart rates given their increased sensitivity to said medication.

Your elder loved one is at greatest risk from suffering an adverse drug reaction (ADR) when different or new medications are added to their regimen after a visit to the doctor or a discharge from the hospital. You loved one’s healthcare provider has various tools to help determine the right medications for your loved one and if any are potentially inappropriate.

Prescription cascade is the inappropriate prescribing of a drug to address an ADR incorrectly assuming the ADR is a symptom of a new medical problem. If left unchecked this can create a vicious cycle dangerously increasing the polypharmacy in your elder loved one, especially if there is more than one doctor involved in their care.

As a caregiver, you can play a valuable role in preventing medication issues in your loved one by:

1. Maintaining a current and accurate list of all your loved one’s vitamins, supplements and medications, both prescription and non-prescription. Remember some supplements can be come in the form of liquids, powders, teas and food itself – read the labels!

2. Reviewing this list at least annually and anytime your loved one sees their physician or is discharged from the hospital,

3. Revisit this list with your loved one’s physician if you notice any changes in your loved one’s heart rate, level of activity and/or sleep; and

4. Challenging your loved one’s physician to find the best mix of therapies, prescription and over-the-counter medications to optimize your loved one’s quality of life.

Benefits of Tracking Activity and Sleep Infographic

Keeping Seniors Active In Their New Housing Community

Getting settled at a senior housing community isn’t just about moving in furniture and unpacking boxes. The best way to ensure your loved one will be happy in their new home is to get them involved in their community. And with all the activities senior residences have to offer these days, it is easier than ever.

Some seniors will jump at the chance to be active and make friends. Others may have a harder time getting involved. Today’s senior communities are very aware of that challenge and offer a diverse menu of activities to appeal to a wide range of interests, as well as to residents with physical and cognitive limitations.

Here are just some of the activities you may find on any given day. With a little encouragement from you, there is truly something for everyone.


Many senior housing communities host outings in and around the area. Seniors visit museums, concerts, sporting events, movies and plays. Even simple nature walks in the fresh air offer great benefits and a chance to socialize. Check the community calendar for specifics.


Often senior communities bring in people with special talents to entertain residents. Musical performances, comedy, opera, bands and children performance groups from local schools are just a small example of entertainment you’ll probably find on the calendar. You can even encourage you loved one to participate by joining them.

Old Favorites

There are almost always games to join in on. Look for organized card games, bingo, board game tournaments and even poker. There are also plenty of residents that get together for knitting, crafting, needlepoint or a rousing game of mahjong. If your loved one has a particular game or craft they’d like to take part in, check the activities calendar or simply ask about other residents who many share their interest.


Simple exercise and movement is invaluable for both mental and physical health. These days, communities work harder than ever to keep seniors moving. Tai chi, yoga, water aerobics (some communities have pools!) and low impact aerobic exercises are just a few of the offerings. With the help of an easy to operate video game (like Nintendo Wii), many seniors also enjoy a game of virtual bowling or golf.


Dancing is another popular way to stay fit in a senior housing community. Many have regular dance classes in line dancing, ballroom, swing and others. There is nothing like music to get people moving. You can even find residents in wheel chairs joining in for a spin on the dance floor.


Many communities bring in guests to teach classes and workshops. It can be about a particular topic (like world affairs and newsworthy headlines), or it can be a watercolor or oil painting class. Some even bring in guest professors from local universities.
Book clubs are also popular in many senior communities. Some community activity directors bring in a guest facilitator to lead a lively discussion on a monthly book club choice.

Theme Parties

Often, you’ll find monthly themed parties and events at a senior housing community. Everything from a “Hawaiian night” complete with a luau and belly dancers, to a barbeque themed event with outdoor eating and line dancing. Mexican themes are also popular complete with sombreros, entertainment and a taco bar.

As you can see, today’s senior communities have a wide variety of ways to get involved. If you’d like to see something in particular take place at your loved one’s community, talk to the director. Chances are, it’ll be simple to implement and a great chance for to get them involved and invested in their new home’s community.

National Family Caregivers Month Infographic

Getting Out of Hip or Knee Surgery is Only Half the Battle…

An elder adult may find themselves going through rehabilitation after either needing or choosing to undergo orthopedic surgery to correct a hip fracture or replace a knee that has rendered them unable to carry out their activities.

Advances in surgery have made even elective surgery a viable option even for relatively healthy older adults well into their 80’s. Hospital stays average only about 3 to 5 days after surgery with recovery takes about 3 to 6 months - which usually occurs in the home or skilled nursing facilities (SNFs). Recent studies, however, show that there is 3 to 5 times increased risk of death in the first year after surgery with the highest risk of dying being within the first 3 months, especially in women after hip fractures. A study, conducted by Kaiser Permanente and funded by the National Institute of Health, listed immobility - along with hospitalization and surgery - as possible causes that led to complications that ultimately resulted in death. In fact, early mobilization and rehabilitation are essential to minimize postoperative pain and discomfort, prevent postoperative pneumonia and stave off postoperative depression - all common postoperative complications and potential causes of suboptimal recovery and possible risk factors for death.

Given the move of postoperative care from the hospital to the home or SNF setting, the family/friend non-professional caregiver (FNPC) plays a key role in the successful rehabilitation of their elder loved one. Aside from the obvious assistance a FNPC can provide their mobility-challenged loved one in accomplishing their daily activities, the FNPC can serve as a constant source of encouragement and purpose. Moreover the FNPC can be a valuable source of information of past medical history, current functional status and important changes in their loved one’s physical and emotional state.

By tracking activity and sleep, Care|Mind allows the FNPC to still be the “eyes and ears” for their rehabbing loved one’s doctor while concentrate on “being there” for their loved one and addressing their day-to-day needs.

Care|Mind will automatically alert caregivers if their loved one has had a decrease in step activity over a 5 day period which can be associated with inadequate pain control and/or postoperative depression. In addition it allows caregivers to set any number of daily activity goals for their rehabbing loved one and alerts them when they don’t reach their goals. All of their activity is also captured and allows an FNPC to review the history of their loved one’s activity and have a saved account of their rehabilitation.

Care|Mind also allows the FNPC to quickly see how well their loved one is sleeping and alerts them if their loved one’s sleep efficiency is altered - a potential sign that overnight pain management is insufficient or if they are starting to feel depressed. Moreover, insufficient restful sleep at night can prevent a loved one from carrying out their rehabbing activities during the day.

Having and tracking this information allows the FNPC to be the best possible advocate and historian for their rehabbing loved one without taking them away from the quality time they need with their loved ones.

Greater than 5 hours of sleep a night can help keep your elderly loved one upright

Do but consider what an excellent thing sleep is...that golden chain that ties health and our bodies together. ~Thomas Dekker

The 17th Century English Dramatist Thomas Dekker probably didn’t realize how right he truly was about the importance of sleep; especially for the health and well-being of our elderly loved ones. A recent study published by Dr. Katie Stone and her colleagues in the Journal of the American Geriatrics Society demonstrated that elderly men who failed to get sufficient quality sleep at night were at an increased risk of suffering a potentially debilitating fall during the day.

Our elderly loved ones don’t need more sleep than the 7 to 9 hours typically recommended for their younger adult counterparts, however they often get less quality sleep than they need. Anxiety due to retirement concerns or loss of spouse, arthritic discomfort, sleep apnea, frequent urination at night and/or urinary incontinence, all can contribute to the difficulty in falling asleep, the decreased time spent in deep sleep and the increased number of awakenings, 3 - 4 on average a night, experienced by our elderly loved ones. As many as 50% of older community-dwelling men and women surveyed in the 2003 National Sleep Foundation Sleep in America Survey reported some form of sleep disturbance and The National Institute on Aging’s Established Populations for Epidemiological Studies of the Elderly estimates that nearly half of all adults in the U.S. over the age of 60 suffer from insomnia.

The actual number of older adults suffering from sleep disturbances, however, could be significantly higher. First, the reported numbers in these studies rely on the elderly participants to self-report accurately and honestly on their sleep, an activity during which they are not conscious. Second, it has been traditionally thought, until recently, that decline in sleep need and quality with age was normal. As such, many elderly may not report their sleep issues because they think that it is just part and parcel with getting older. Lastly, some elderly loved ones may not report their ailments because they simply don’t want to be a burden.

The extent of poor quality sleep being experienced by a large proportion of our elderly loved ones is alarming given associated increase risk of falls revealed in Dr. Stone’s study.

One out of three of our elderly loved ones falls each year, less than half of which are reported, and these falls are the leading cause of both fatal and nonfatal injuries. Falls are the most common cause of hip fractures and traumatic brain injury (TBI) among the elderly and about half of the fatalities due to fall are because of TBI.

Participants in Dr Stone’s study who had 5 hours or less of actual measured sleep had twice the risk of suffering recurrent falls during the day while those who slept 5 to 7 hours still had 1.4 times greater risk of experiencing falls compared to those elderly participants who slept 7 to 8 hours. The study also found that even disturbed sleep can increase the risk of recurrent falls in our elderly loved ones. Those elderly participants in the study who experienced restlessness for greater than 30% of their total sleep time (eg. approximately 2 hours of restlessness during 6 hours of sleep) had a 56% greater risk of recurrent falls than those who did not. Unfortunately, these objective sleep symptoms are difficult to catch because they happen at night when no one is watching your elderly loved ones. Moreover, as described above, many older adults may not want to report these symptoms or be able to report on them accurately. Dr Stone’s study also suggests that if your elderly loved complains of excessive sleepiness during the day they may be at a 52% to 73% increased risk of falling.

Sleep in our elderly loved ones is as important as any therapy, activity or medication they take to keep them healthy and safe from potentially debilitating and/or fatal falls.

The healthcare system fails our elderly loved ones

Absolutely, resources should be diverted to the young! And I’m a geriatrician. The young are the future. Sorry but it’s the truth.

This was one of the candid response highlighted in Medscapes Ethics Report 2014 where it asked physicians, “Would you devote scarce or costly resources to a younger patient rather than an older patient?”

But it’s just not expensive or scarce resources that are being withheld from our elderly loved ones but simple preventative healthcare measures such as exercise, home safety and proper use of medications, according to Ronald D Adelman, MD, co-chief of the Division of Geriatrics and Palliative Medicine at Cornell University’s Weill Medical College and New York-Presbyterian Hospital. In short, “the healthcare system fails older people,” according to Dan Perry, executive director of the Alliance for Aging Research in Washington, DC. But why?

In her article from February 19, 2015 titled: Are Doctors Neglecting Their Older Patients? Leigh Page puts a spotlight on the pervasive ageism in the healthcare system that is ignoring our elderly loved ones even though “Many people at age 75 are functionally much like many middle-aged patients,” according to Dr Adelman. According to Page the discrimination against the elderly population in the healthcare industry is due to a lack of time, curiosity and training.

In an environment where doctors are forced to see more patients in less time, either at the direction of the hospital or in order to keep their practice afloat, there is just not enough time for physicians to truly work up an elderly patient. Nearly 91% of those over the age of 65 suffer from at least one chronic condition, over 37% have disabling hearing loss and about 11% suffer from Alzheimer’s. In addition, the elderly population takes, on average, over seven medications per day, both prescription and over-the-counter. Elderly patients present "various obstacles to getting the whole story, getting the truth out…(they) don't remember, and sometimes they just don't think it's important, and sometimes they're just in denial of what's really wrong." According to Robert Stall, MD, a geriatrician from Amherst, NY, “just going through the meds takes time”.

This complexity of patient with an ever shrinking availability of time has created a disinterest or lack of curiosity on the part of physicians towards their elderly patients. When an elderly person brings up a legitimate and important health concern such as fatigue, decreased activity, difficulty sleeping or staying asleep a typical response from their physician is “what do you expect at your age?” says Dr Stall. This stereotyping of our elderly population is furthered by advertising. According to Julie P.W. Bynum, MD, a geriatrician who is associate professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, "ads for adult diapers make it seem that this is a normal part of aging," when in fact only a minority of older people suffer from urinary incontinence and it is most often treatable without the need for adult diapers.

This lack of curiosity by physicians and the undue influence the media has on them is not surprising given the lack of formal training the doctors of tomorrow get in geriatrics. At last count, the number of medical schools in the US with a full-scale department of geriatrics that required a mandatory rotation in geriatrics was three. According to an article in a 2010 edition of Health Affairs, “Much of today's physician workforce is inadequately trained to provide complex chronic care. Few young physicians are prepared to screen for, recognize, or manage the common and devastating problems in older patients.”

So what are we to do about their elderly loved ones who present in this failing healthcare system with multiple chronic illnesses, many medications, disinterested doctors, atypical disease presentation and unreliable clinical histories secondary to cognitive issues, movement problems, impaired hearing and vision and stonewalling of questions regarding depression, incontinence and sex? Some geriatricians like Dr. Adelman are starting to reserve 1 hour for an initial visit and 30 minutes for follow-ups with his elderly patients but that is not the norm. The effectiveness of a visit can be dramatically improved when the elderly patient, or their caretaker, can provide the physician with organized and historically accurate information about the elderly patient’s medications, activities and sleep patterns. This requires keeping an up-to-date log of all their medications, observing or asking your elderly loved one about changes in their daily activities and sleep patterns and providing this information to the geriatrician so s/he can quickly build a more robust clinical story and identify important clinical trends.