Archive for the ‘geriatrics’ Category

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Centenarian Filipina Reveals Secrets to Longevity

Thursday, July 29th, 2010

Excerpt from Marjorie Gorospe, loQal.ph

115-year-old I-Apayao native Rufina Daluyon reflects the healthy lifestyle of the I-Apayao tribe and despite her age, the centenarian shows no signs of serious illness.

Apo Rufina can still talk and can still walk but she only speaks Ilocano. She shares her stories to willing listeners through her great granddaughter Susan.

1. Lifelong Physical Activity
The I-Apayao tribe is related to Isneg tribe and both tribes are known as good farmers.

2. Diet – mostly vegetables
Susan says being a member of the I-Apayao tribe, Apo Rufina is very fond of vegetables.

3. Good Genes
Apo Rufina’s husband lived for 126 years. Apo Rufina has three children, but only one among the three is still alive at a still remarkable age of 90.

4. Spirituality and Gratitude

5. Discipline
“Napakahigpit nya (Rufina) lalo pagdating sa pag-uwi ng maaga sa bahay at tamang pagkain. (She is very strict, particularly on curfews and eating the right food),” says Susan in jest.

Centenarian Northern Philippines

Centenarian Northern Philippines

“Minsan tinatanong na rin nya kung bakit di pa sya namamatay at mukha daw nalimutan na siya ni Lord sunduin. (She often wonders why she’s still alive and that the Lord probably has forgotten about her),” says Susan who often visits her great grandmother and gives her a shower.

For her part, Susan says she is thankful for the life that God has granted Apo Rufina.

But Susan admits that things are getting harder for Apo Rufina. Susan says all they can do is to give her the love that she deserves while she is still alive.

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Folic Acid Does Not Prevent Memory Decline

Sunday, July 18th, 2010

The addition of folic acid to the list of vitamins and supplements for the prevention of memory decline is addressed in this meta-analysis. Wald et al conducted a meta-analysis of 9 randomized controlled trials on folic acid, with or without vitamin B and its effect on memory, speed of information processing, language and executive function (decision making). The median duration per study is 6 months and the median age of participants is 75 years.

The results showed no effect of folic acid in the prevention of cognitive decline (memory, speed of information processing, language and decision making) among individuals without preexisting dementia.

The pooled standardized mean difference
in cognitive function test scores was 0.01 (95% CI,
-0.08 to 0.10) after a median treatment of 6 months; an
increase of 1% of a standard deviation of a cognitive
function test score, with confidence intervals excluding
an improvement or a deterioration greater than 10% of 1
standard deviation.

Studies of longer duration are needed in order to address the role of folic acid in the prevention of cognitive decline.

Source: The American Journal of Medicine (2010) 123, 522-527

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Implementing Expanded Senior Citizens Act of 2010

Saturday, July 10th, 2010

The Implementing Rules and Regulations (IRR) of Republic Act 9994 (Expanded Senior Citizens Act of 2010) went into effect on July 6 granting the full 20 percent discount – privileges to senior citizens.

Secretary Soliman emphasized that senior citizens who have queries and complaints may call the DSWD hotlines 951-7120 and cellphone number 0999-314-7425 or visit the National Coordinating and Monitoring Board (NCMB) website at http://ncmb.dswd.gov.ph and email at ncmb@dswd.gov.ph

“We also plan to set-up Help Desks at the DSWD Central Office and in all DSWD Regional Offices for senior citizens without access to phone lines and the internet,” Secretary Soliman added.

Secretary Soliman appealed to senior citizens to refrain from abusing the privileges under RA 9994. “The law is the government’s way of acknowledging and giving praise to senior citizens who contributed to nation building, and is designed for the sole enjoyment of the senior citizens, so please do not abuse these privileges,” Secretary Soliman stated.

DSWD Sec Dinky Soliman

DSWD Sec Dinky Soliman

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Medical Profession Needs to Prepare for the Rapidly Growing Elderly Population

Thursday, June 17th, 2010

The Philippines needs to prepare for the burgeoning population of older persons. The population 60 years and above has grown at a very rapid rate, increasing from 3.2 million in 1990 to 4.6 million in 2000. By the year 2030, ten percent of our population will be composed of senior citizens. The National Institutes of Health (NIH) study “Status of Geriatric Education in Philippine Medical Schools” presented during the NIH Forum 17 June 2010, looked at how Geriatrics (the study of health and disease in old age) is taught in Philippine Medical Schools and the perception of graduating medical students on how well they can take care of old patients after receiving their MD diplomas.

The study revealed that most medical schools do have Geriatrics as part of a required course and 61% enjoy institutional support for developing said course. However, although 70% of the graduating medical students believe they are prepared to take care of the elderly in outpatient clinics and hospitals, only 61% of their teachers think they possess the necessary KAP (knowledge, attitude and practice) for such a job!

Some of the contributors to the lack in KAP of fresh graduates include the crowded medical course schedule and the lack of a curricular map of subjects that teach them how to take care of the elderly. Medical students learn the basics during the first three years of med school (classroom) but may not possess the skills in the final clinical years called internship (hospital exposure). The lack of clinical teachers and researchers were also identified as obstacles to the development of a good Geriatric program.

This study also contains recommendations as to how the situation can be rectified; how we can mold our future doctors into providing excellent and compassionate healthcare for the elderly. We can begin by increasing the number of doctors that are trained and dedicated to teaching, and by establishing a well mapped curriculum in Geriatrics. We also need to support researches that lead to improvement of the health and quality of life of the aging Filipino. The Association of Philippine Medical Colleges, DOH, DSWD, NIH and CHED can help lead this change.

About the NIH and Aging Study Group:

The National Institutes of Health (NIH) was created on January 26, 1996 by the UP Board of Regents as an institutional home of a network of various research and extension units specializing in health and socio-biomedical concerns. This thrust is consistent with the country’s vision of “Health for All”.

Currently, the NIH has various research institutes and active study groups that continue to develop and produce outputs that serve as vital guideposts in shaping national programs and policies. The Aging Study Group and the Committee on Aging and Degenerative Diseases (COMADD) has contributed greatly to current clinical and educational programs and policies on Aging. The vision of COMADD is “The Filipino elderly enjoying a healthy body, mind and spirit, being treated with dignity, and valued as a productive member of society, in a dynamic process unique to himself, and beginning a life of unlimited possibilities”.

Principal Investigator:
Shelley F. de la Vega, MD., MSc
Chair, Aging Study Group
Institute of Health Policy and Development Studies
UP Manila-NIH

Co-Investigators:
Jose Alvin Mojica, M.D., MHPEd
Chair, Department of Rehabilitation Medicine
Philippine General Hospital

Josephine Agapito, PhD
College of Arts and Sciences
UP Manila

Click here to view related post in Manila Bulletin Online

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Age ≥65 yr Highest Case Fatality Rate for AH1N1 Swine Flu Pandemic

Monday, June 7th, 2010

Source: Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza
Downloaded from www.nejm.org on May 6, 2010

Risk Factors for Complications of or Severe Illness with 2009 H1N1 Virus Infection.

Risk Factor Examples and Comments
1. Age <5 yr Increased risk especially for children <2 yr of age; highest hospitalization rates among children <1 yr
2. Pregnancy Risk of hospitalization increased by a factor of 4 to 7, as compared with agematched nonpregnant women, with highest risk in third trimester
3. Chronic cardiovascular condition Congestive heart failure or atherosclerotic disease; hypertension not shown to be an independent risk factor
4. Chronic lung disorder Asthma or COPD, cystic fibrosis
5. Metabolic disorder Diabetes
6. Neurologic condition Neuromuscular, neurocognitive, or seizure disorder
7. Immunosuppression Associated with HIV infection, organ transplantation, receipt of chemotherapy
or corticosteroids, or malnutrition
8. Morbid obesity – but not yet proved to be an independent risk factor for complications requiring hospitalization or ICU admission and possibly for death
9. Hemoglobinopathy Sickle cell anemia
10. Chronic renal disease Renal dialysis or transplantation
11. Chronic hepatic disease Cirrhosis
12. Long history of smoking Suggested but not yet proved to be an independent risk factor
13. Long-term aspirin therapy in children Risk of Reye’s syndrome; drugs containing salicylates should be avoided in children with influenza
14. Age ≥65 yr Highest case fatality rate but lowest rate of infection

* COPD denotes chronic obstructive pulmonary disease, HIV human immunodeficiency virus, and ICU intensive care unit.
† Morbid obesity is defined as a body-mass index (the weight in kilograms divided by the square of the height in meters)
of 40 or more.

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Preventing Alzheimer’s Part 2: The NIH Consensus 2010

Tuesday, May 4th, 2010

Part 2: Cognitive Engagement and Physical Activity

1. Cognitive Engagement.

Cognitive Training – modest benefits on cognitive functioning and a small but statistically significant effect on reducing the extent of age-related decline in cognitive function at a 5-year follow-up. Very small but statistically significant benefit on instrumental activities of daily living—for example, managing finances, managing medications, keeping house, and, in a subgroup analysis, benefit on driving performance in the elderly.

However, these results from a single trial must be replicated to confirm the benefits of cognitive engagement on preventing
cognitive decline over a longer time period and in study subjects with varying levels of baseline cognitive abilities before a firm recommendation can be made.

2. Physical Activity. Increased physical activity, including walking, may help maintain or improve cognitive function in normal adults.

Tai chi PGH Geriatric Clinic

Although encouraging, these data should be viewed as preliminary. Work is ongoing to further investigate the benefits of
physical activity.

Factors associated with decreased risk of Alzheimer’s disease and cognitive decline were cognitive engagement (as indicated by literacy and social enrichment), physical activities in later life, and a diet low in saturated fat and high in vegetable intake. Light to moderate alcohol intake
is reported to be associated with reduced risk of Alzheimer’s disease, but results are inconsistent for cognitive decline

Source: NIH State-of-the-Science Conference:
Preventing Alzheimer’s Disease and Cognitive Decline
April 26–28, 2010

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Preventing Alzheimer’s Part 1: The NIH Consensus 2010

Tuesday, May 4th, 2010

Part 1: Supplements and Medicines for Alzheimer’s Prevention

Available scientific evidence is inadequate to conclude that any known preventive strategies are effective. This conclusion is based on a review of published literature of randomized, controlled trials (RCTs), the most rigorous, highest quality evidence.

Summary of Detailed Interventions:
1. Vitamins, Nutrients, and Dietary Supplements.
Vitamin E – no evidence that this factor altered the onset of the Alzheimer’s disease.

Gingko biloba – A recent, large long-term RCT showed no reduction in the incidence of Alzheimer’s disease, leading to the conclusion that there is not sufficient evidence to support the efficacy of gingko biloba.

2. Medications
Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) – this class of drugs is not effective in preventing Alzheimer’s disease.

Anti-hypertensive medications – negative with insufficient evidence for protection against Alzheimer’s disease.

NSAIDs—rofecoxib, naproxen, and celecoxib—suggest an increased incidence of Alzheimer’s disease with treatment.

Conjugated equine estrogen, one combined with methyl progesterone – suggest an increased incidence of dementia (including Alzheimer’s disease) with treatment.

Together, these trials suggest that no known medication can be said to reliably delay the onset of Alzheimer’s disease.

Source: NIH State-of-the-Science Conference:
Preventing Alzheimer’s Disease and Cognitive Decline
April 26–28, 2010

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Tips to Reduce Clutter and Hoarding

Sunday, March 28th, 2010

Hoarding

Some people will hoard or save numerous items, including dirty clothes, food, and papers. Losing a meaningful role in life, work, friends, family, and a good memory can have an impact on a person’s need to hoard and or to “keep things safe”. Hoarding in this population is oftentimes triggered by the fear of being robbed.

When working with persons who have dementia, it is essential that you keep their safety in mind. Order, routine and simplicity are most helpful. A house or room that is relatively uncluttered is the ideal environment.

Ten Tips to Consider

1. Let go of ideal notions of cleanliness. Your patient may value items that appear to you as worthless. Parting with their belongings (even used paper cups) can cause severe emotional distress.

2. Ask your patient if they can donate or sell their belongings to charity.

3. Focus on fall prevention. Create pathways free of debris, loose cords or slippery rugs. Some frail patients hold onto furniture or other items while moving through the room; preserve their “props” until other assistive devices (canes, walkers) can be introduced.

4. Focus on fire prevention. Red flags include newspapers stored on top of or inside a hazardous area.

5. Be creative and negotiate. Consider photographing belongings, as this may help the patient part with things and preserve memories.

6. Begin by reorganizing a small corner of a room, a single table, or just a section of the table.

7. Have a friend or relative present during a major cleanout, preferably one who already has a supportive relationship with the patient. Clean-outs can be overwhelming to people with severe hoarding behavior. Have a back-up plan in case emergency psychiatric services are needed.

8. Discuss how to safeguard valuables in the cleaning process. Have a written contract. Agree on what to do with valuables that turn up, such as money, jewelry, or collectibles.

9. Consider relocating an individual to a new room if the clutter is the result of physical or mental frailty. A new environment can provide a fresh start and enable the patient to receive needed services sooner.

10. Plan for on-going maintenance and supervision to maintain a decluttered environment.

Adapted From: Weill Medical College of Cornell University

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Protect Seniors from Heat Stress

Tuesday, March 9th, 2010

Heat exhaustion is a form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids.

Warning signs vary but may include the following:

* Heavy sweating
* Paleness
* Muscle Cramps
* Tiredness
* Weakness
* Dizziness
* Headache
* Nausea or vomiting
* Fainting
* Skin: may be cool and moist
* Pulse rate: fast and weak
* Breathing: fast and shallow

To protect yourself from heat stress and heat stroke, follow these tips:

# Drink cool, nonalcoholic beverages. (If your doctor generally limits the amount of fluid you drink or has you on water pills ex. furosemide or hydrochlorothiazide, ask him how much you should drink when the weather is hot. Also, avoid extremely cold liquids because they can cause cramps.)
# Rest.
# Take a cool shower, bath, or sponge bath.
# If possible, seek an air-conditioned environment. (If you don’t have air conditioning, consider visiting an air-conditioned shopping mall or public building to cool off.)
# Wear lightweight clothing.
# If possible, remain indoors in the heat of the day.
# Do not engage in strenuous activities.

seniors swim
If you are living with or taking care of an older person

* Visit older adults at risk at least twice a day and watch them for signs of heat exhaustion or heat stroke.

* Encourage them to increase their fluid intake by drinking cool, nonalcoholic beverages regardless of their activity level.

Warning: If their doctor generally limits the amount of fluid they drink or they are on water pills, they will need to ask their doctor how much they should drink while the weather is hot.

* Take them to air-conditioned locations if they have transportation problems.

If You Don’t Have Air Conditioning:
• Take a cool shower, bath or sponge bath.
• Create cross-ventilation by opening windows on two sides of your house.
• Keep windows open at night.
• Keep curtains, shades or blinds drawn during the hottest part of the day.
• Cover windows when they are in direct sunlight.
• Electric fans may help, but when the temperature reaches the high 90s, fans won’t prevent heat-related illness.
• Go somewhere that’s air-conditioned like the shopping mall, the movies, the library, a senior center or a friend’s house. If you don’t have a car or no longer drive, ask a friend or relative to drive you. If necessary, take a taxi. Don’t stand outside waiting for a bus.

More heat stroke and heat stress information from the CDC link: Centers for Disease Control and Prevention USA

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Comatose Patient Answers YES or NO thru MRI

Sunday, February 14th, 2010

Authors: Martin M. Monti, Ph.D., Audrey Vanhaudenhuyse, M.Sc., Martin R. Coleman, Ph.D., et al published by the New England Journal of Medicine February 2010.

In this study, 5 out of the 54 comatose patients were able to modulate their brain activity using functional MRI testing.

One patient was able to answer YES or NO using the technique described.

While in the functional MRI scanner, all patients were asked to perform two imagery tasks. In the motor imagery task, they were instructed to imagine standing still on a tennis court and to swing an arm to “hit the ball” back and forth to an imagined instructor. In the spatial imagery task, participants were instructed to imagine navigating the streets of a familiar city or to imagine walking from room to room in their home and to visualize all that they would “see” if they were there.

This technology may be developed further to help comatose patients communicate their need for pain medication, manipulate their environment, express their feelings and choices, and improve their quality of life.

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