Article Review: Elder Falls Related to Chronic Pain

Magazine: Duke Medicine Health News – February 2010 – Volume 16, No. 2 

Article Title:  “Elder Falls Related to Chronic Pain: Chronic pain may be an overlooked – and important – risk factor for falls in older adults.” 

Summary: 

Researchers studying older adults believe chronic pain plays a strong independent role in the number of falls occasioned.  The study showed that although impaired mobility and history of falling are the strongest precursors of falls, the link between pain and falls is independent of this.  The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILITY) study was conducted at the College of Nursing and Health Sciences, at the University of Massachusetts – Boston.  Suzanne G. Leville, PhD, RN studied 749 adults, aged +70, to determine if chronic musculoskeletal pain was associated with an increase in falls. Participants reported their daily pain incidences according to a provided scale for 18-months. Pain was evaluated according to location, severity, and interference with daily activities. Researchers discovered a correlation between self-reported pain one month and an increase in the number of falls the next. The pain-fall link was classified into three categories showing muscular weakness and attention distraction which lead to fall rate increase. Older people living with chronic pain not only live with their current level, but also actively avoid more of it. This avoidance appears to create a situation wherein they are more prone to falls due to mental distraction and muscular weakness. After adjusting findings to rule out the potential of fall increase based on pain due to underlying conditions and pain medications contribution, researchers believe pain, itself, was still a strong independent risk factor. More study is needed. 

Four Main Points: 

1. There is a correlation between pain reported one month and an increase in the number of falls the next.
2. Although impaired mobility and history of falling are predictive of falls, chronic pain cannot be overlooked as an independent contributing factor.
3. Neuromuscular effects weakness or delayed neuromuscular response to impending fall is a treatable cause because compensating for the pain can lead to unsteadiness and loss of balance.
4. Chronic pain causes structural and functional changes in the brain that can lead to deceased attention, and poorer executive function[1] resulting in falls.

  

Learn and Application to Clients and Self: 

Falling and chronic pain can be made easier through body maintenance. The three pain-falls association categories can be worked with to lessen their severity: 

1. Joint Condition: Osteoarthritis the main contributor. Working with their doctor to create an exercise plan to lessen the severity of osteoarthritis.
2. Neuromuscular effects leading to muscle weakness caused by lack of exercise due to pain: Create an exercise plan that strengthens the body gradually but evenly so that one part is not overcompensating for the other leading to body imbalance and fall potential.
3. Chronic pain causing decreased attention: Everyone feels this – when you hurt, you are distracted by the pain and more likely to fall. By increasing body awareness and confidence for the client that if they do feel themselves off balance, they are able to correct the situation, they will feel more in control of their pain and pay more attention in positive prevention rather than paranoid reaction.

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[1] Executive Function: The cognitive function responsible for control/regulation of other abilities and behaviors.

Article Review: Simple Steps to Staying Trim

Magazine: American Institute for Cancer Research Newsletter on Diet, Nutrition and Cancer Prevention – Fall 2009 – Issue 105

Article Title:  “Simple Steps to Stay Trim: If you want to lose a few pounds and reduce your cancer risk, try these simple steps before you spend money on a diet book or program.”

Summary:

A nice common sense article that reminds people that responsibility for one’s diet starts with being aware of what is being consumed. Although written in the American Institute for Cancer Research Newsletter, the suggestions are worthwhile for all people. The standard 30 minutes of physical activity daily and consumption of fruits, vegetables and whole grains is stated along with the suggestion of “three healthy meals and two nutritious snacks” is backed up with common sense approaches to make those meals and snacks count.

Four Main Points:

1. Losing weight and lowering cancer risks require following a few common sense steps that make healthy lifestyle changes.
2. in a world of “super sized” everything – Cut Portion Sizes
   1. Serve yourself a portion .25 the usual size. Use internal hunger to decide if you want more.
   2. Use smaller plates and bowls, cook smaller portions, don’t put serving bowls on the table,
   3. “In restaurants, ask for a take-out container to pack up extra food before you start eating.
   4. Consider the Ingredients of a Meal
      1. A salad covered with high fat dressing, cheese, bacon bits, croutons and other toppings loses the value
      2. Avoid cream sauces and cooking with fat.
      3. Start meal with a green salad or broth-based soup and finish with naturally sweet fruit
      4. Healthy Snacks to Avoid Hunger
         1. Avoid temptation of candy machines with fresh fruits, whole grain cereals and crackers, small amounts of cheese or yoghurt, and/or a bowl of carrots, celery sticks, bell pepper strips and other vegetables upon which to graze.

 

Learn and Application to Clients and Self:

I am going through a period where my diet, and complete lack of interest in eating, is under scrutiny. It was shown that serving sizes and containers (plates, bowls etc) have steadily increased over time, as has our obesity rate. These common sense approaches can be used to ease a client (and self) into healthier eating practices. Personally, however, I do not much care for the 3 to 2 mention. Five small meals through the day connotes conclusion to each o f the feeding period. “Snacking” is where people get themselves in trouble because it is justified as “just a snack” or “just a little something” without a lot of attention paid to exactly what it is.

Article Review: Binge Drinking is a Problem for Older Adults, Too

 Magazine: Duke Medicine Health News – November 2009 – Vol. 15, No. 11

Article Title:  “Binge Drinking Is a Problem for Older Adults, Too:  More than five drinks at a time can lead to accidents, falls, and negative interactions with medicines.”

Summary:

“Binge Drinking” connotes college parties therefore is not usually associated with senior citizens. The study surveyed over 10,000 adults, aged 50+.  It revealed that 22% of men and 9% of women age 50-64 report binge drinking with 14% of men and 3% of women aged older than 65 reported consuming five or more alcoholic beverages at a sitting during the previous month.  This is a serious problem within the aging population as although binge drinking potentially does not lead directly to the results of long-term alcohol abuse, alcohol interacting with prescription medications can lead to life threatening situations. Occasional binge drinking can become a habit leading to health issues associated with alcohol abuse. Getting help is paramount, but requires the individual to accept they have a problem. Friends and family interventions are useful, but medical professionals usually have the most authority.   

Four Main Points:

1. Binge Drinking is defined as having 5+ alcoholic beverages at one time. The health threats caused by even occasional binge drinking by older adults cannot be ignored.
2. Alcohol tolerance diminishes over time. Older adults do not metabolize alcohol as efficiently as their younger counterparts do so the alcohol remains in the system longer where interaction with medications is likely.
3. Self-awareness is necessary. We live in a society where people in this age bracket grew up with the “normalcy” of drinking. Intervention requires support from medical and home sources.
4. Suggestions to self moderate:
   1. Have a meal before drinking because less alcohol is consumed when full
   2. Set a limit of 1-2 drinks and STICK TO IT
   3. Alternate alcoholic drinks with water
   4. Limit the amount of alcohol in the house at any given time to limit temptation
   5. Only drink with friends/family and let them help with moderation. Choose your “drinking partners” wisely; if they have a problem, they are going to be no help to you.

 

Learn and Application to Clients and Self:

Although the article did not state this directly, it is important that the “intervention” group does not suffer from ignoring the same problem.  People who are used to “having a few drinks” when they get home to “unwind” will justify their drinks that way in order to avoid the stigma of alcohol related problems. Probably the best thing is to reflect a healthy lifestyle where alcohol is truly in moderation. Share with the client that “unwinding” with a few drinks is truly only temporary and that “unwinding” through stretching, taking a walk, or going to the gym leads to longer term happiness.

Article Review: Recognizing the Symptoms of COPD

If you know me, you know some of my closest buds have this. The article was tiny and scant, but not terrible. Before I get jumped all over, I couldn’t put in other causes etc because I had to go from the article…but you can always ask me for the original article …

L.

  

Magazine: The Johns Hopkins Medical Letter: Health After 50 – July 2009 – Volume 21, Issue 5

Article Title:  “Recognizing the Symptoms of COPD”

Summary:

Although chronic obstructive pulmonary disease (COPD) is the most common lung disorder in the United States, many people do not realize they have it.  COPD is a progressive condition affecting the lungs that makes every day tasks from walking to housework difficult to perform.  Breathing becomes increasingly difficult as the lung’s bronchioles become inflamed, mucus production is increased, and the walls between the smallest airways (bronchioles) breaks down. The cause of COPD is long-term exposure to environmental irritants, especially cigarette smoke. Through early detection and treatment, there is the potential of some reversal of lost lung function, but it is not a guarantee. Early detection is difficult because symptoms of COPD resemble common conditions like bad colds or respiratory infections, so doctor visits are rare. If symptoms last for more than a month, and there is long-term exposure to environmental irritants, pulmonary function tests will determine air consumption and lung efficiency in processing it and transferring oxygen to the blood.

Four Main Points:

1. Chronic Obstructive Pulmonary Disease (COPD) is the most common lung disorder in the United States. Although it is a chronic progressive disease, some of the lost lung function might be reversed through early diagnosis and treatment.
2. Environmental irritants, especially cigarette smoke, primarily cause COPD.
3. Most Common Symptoms
   1. Chronic “Smoker’s” Cough
      i.      A hard, phlegm-producing cough that starts deep in the chest, not at the back of the throat that is worse in the morning and during exertion
       ii.      Chronic is a condition lasting more than three week
   2. Dyspnea – Shortness of Breath during physical activity leading to exhaustion
   3. Wheezing
       i.      Narrowed airways causing a whistling sound during breathing.
4. Pulmonary function tests are required to determine lung function and oxygen transfer. Testing is required to rule out chronic bronchitis or COPD.

 Learn and Application to Clients and Self:

I have experience with people with COPD who are athletes. This is not a “death sentence” and a great deal more common than many people think.  The exposure to cigarette smoke is mentioned in the article, but there are people never exposed to cigarette smoke who have COPD. Symptoms will manifest during a workout session, so logging in their notes when they were having problems might help medical professionals. Early detection is the key. Treatment, including regular exercise, is key, but it all starts with accepting that a common cough might not be.

Article Summaries: Senior Exercising

Okey Dokey – I will create a place for these, but for class I’m having to write summaries of articles.  I think they’re pretty interesting.

Lizzy

NUMBER 1

Magazine: Duke Medicine Health News – November 2009 – Vol. 15, No. 11

Article Title:  “4 healthy Lifestyle Factors Help Ward Off Chronic Disease: Diet, exercise, low body mass index and not smoking can reduce the incidence of heart disease, diabetes, stroke and cancer.”

Summary:

A study group of over 23,000 German adults observed between 1994 and 1998 with a follow up in December 2006 showed significant proof that adults who participate in at least one of the four modifiable healthy behaviors show increased protection against developing chronic diseases over the participants who did not incorporate modifiable healthy behaviors in their daily life.  The study added maintaining a BMI < 30 to the already accepted list of modifiable behaviors. The authors do acknowledge a limitation of the study is finding ways of motivating at risk populations to choose incorporating the four modifiable behaviors into their daily life.

4 Main Points:

1. The German study added maintaining a body mass index of <30 to the list of top three modifiable behaviors which can have impact of mortality.
   1. The top FOUR Modifiable Behaviors are:
      i.      Regular physical activity
      ii.      A healthy diet
      iii.      No tobacco usei
      v.      A BMI < 30
2. The study of +23,000 German adults showed that participants with all 4 of the behaviors showed a relative risk for diabetes, heart attack, stroke, or cancer was 0.22 compared to participants with no healthy factors.
   1. “Participants with all four healthy factors at baseline had a 78% lower risk of developing a chronic disease than participants without a healthy factor.
      i.      Breakdown:
               a: Diabetes – 93% 
               b: Heart Attack – 81
               c: Stroke – 50
               d: Cancer – 36%
3. By just utilizing one of the healthy factors, the risk of chronic disease was cut in half.
4. BMI < 30 showed the largest reduction in risk of chronic disease, especially diabetes.

Article II:

Magazine: Duke Medicine Health News – December  2009 – Vol. 15, No. 12

Article Title:  “It’s Never Too Late To Start Exercising : Continuing – or beginning – physical activity in older age will help maintain independence far longer than a sedentary lifestyle.”

Summary:

Researchers found that adding physical activity lead to not only a longer life, but a better quality of life – even for those  beginning physical activity between the ages of 70 and 85.  Physical activity is defined as “a modifiable behavior associated with health, functional status, and longevity.  Using a baseline of 70 years, physically active individuals participate in more than minutes of continuous activity – walking, swimming or “other exercising” aside from activities of daily living (shopping, cooking, gardening, bathing, and dressing). This study conducted through the Department of Geriatrics and Rehabilitation at Hadassah Hebrew University Medical Center, Jerusalem, Israel followed a group of 1,861 individuals born between 1920 and 1921 between 1990 and 2008. Data was collected at ages 70, 78, and 85.   The purpose was to determine how physical activity is associated with survival rate, health status, and the maintenance of functionality and personal independence of individuals starting at age 70.  Researchers concluded that continuing, or even starting, physical activity among elderly people is beneficial. It is never too late to start.

Four Main Points:

1. Sedentary individuals average less than four hours of physical activity in a week. Physically active individuals participate in (A or B)
   1. Four hours of activity a week with vigorous activity (swimming, jogging, rapid walking) at least 2x/wk
   2. Regular exercisers who participate in exercise (walking etc) one hour a day or more
2. No matter when they start, physically active individuals maintain independent functioning longer over time.
   1. Physical deterioration is significantly less over sedentary individuals at 70-78 and 78-85 age groups
   2. Increased ease in performing activities of daily living and maintaining ease through age 85.
3. Physical activity is associated with lowering depression, loneliness and creating a positive self-image.
4. Health status is increased thereby causing less financial and mental strain on the individual and their family.
   1. Physically active participants:
      i.      Took less medications
      ii.      Reported fewer falls and fracturesiii.      Had less chronic joint and musculoskeletal pain
5. Data suggest that exercise related injuries decreased in frequency among frequent elderly exercisers.