Category Archives: North America

North America is bounded to the north by the Arctic Ocean, to the east by the Atlantic Ocean, to the west and south by the Pacific Ocean, and to the southeast by South America and the Caribbean Sea. It is the third largest continent by area and the fourth by population.

Menopausal Experiences Among Major Ethnic Groups in the U.S.

The world’s population is rapidly aging and women make up the majority of seniors in every country due to their higher life expectancy. There will be over 60 million peri- and post-menopausal women in the United States by 2030 and about 1.2 billion throughout the world.

Menopause Experiences in the United States

In the U.S., menopause often begins at the age of 51 with most women experiencing hot flashes and other symptoms like vaginal dryness and joint pain, according to the National Institute on Aging. While most studies have not focused on ethnic populations in the United States, a recent study by the Western Journal of Nursing Research found that certain ethnicities in the U.S. are more prone to menopausal symptoms. The study documented specific ethnic differences in the number and severity of symptoms among four major ethnic groups (Non-Hispanic Whites, Hispanic, African Americans, and Asians) and focused on women ages 40-60 since most women experience menopause around the age of 50.

According to the study, Hispanic women reported night sweats and hot flashes more frequently than non-Hispanic white women, although other symptoms were less common. Hispanic women also reported significantly larger numbers of total symptoms, physical symptoms, and psychosomatic symptoms than Asian women. African American women reported a significantly larger number of psychosomatic symptoms than Asian women, and non-Hispanic white women reported significantly larger numbers of total symptoms, physical symptoms, psychological symptoms, and psychosomatic symptoms than Asian women.

Osteoporosis and Menopause

Osteoporosis is a progressive form of bone loss common among postmenopausal women. About 70 percent of women in the United States have osteoporosis by the age of 80 and about 15 percent of non-Hispanic white women in the country eventually experience an osteoporosis-related hip fracture, according to the John Hopkins Arthritis Center. The development of osteoporosis is associated with lack of estrogen after menopause but hormone replacement therapy has been found to reduce the risk of the disease among women.

Interestingly, research has found that estrogen levels may be one factor that influences the development of osteoporosis in women, although ethnicity and lifestyle might be more important. For instance, 10 percent of Hispanic women over 50 have osteoporosis, according to the California Hispanic Osteoporosis Foundation. There are probably several explanations for the lower osteoporosis rates, aside from genetics. Ultimately, a more labor-intensive lifestyle and diet rich in phytoestrogens help guard against bone loss.

Photo Credit: Pain Pix
                                                               Photo Credit: Pain Pix

Conclusion

Specific differences exist for particular ethnic groups of menopausal women in the U.S. These differences are useful for targeting efforts to promote strategies to reduce menopausal symptoms and make best use of health promotion efforts such as adopting healthy-eating habits and leading an active lifestyle.

Sophie Okolo is the Founder and Editor-in-Chief of Global Health Aging.

Richard Gaines, MD is the President and Chief Medical Officer of HealthGains, a leading hormone optimization center founded in 2005. Dr. Gaines has more than three decades of experience as a healthcare executive and physician with a focus on hormone therapy and platelet rich plasma therapy.

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How Social Factors Affect Diabetes Prevalence Among U.S. Hispanic Subgroups

Early this month, Global Health Aging published an article about the dangers of type 2 diabetes among older Hispanics. The focus will now be on the prevalence of this disease among Hispanics including the impact of age, food habits, urbanization and length of stay in the U.S.

Photo Credit: lucianvenutian
                                                    Photo Credit: lucianvenutian

People of Latino and Hispanic descent are at a high risk of type 2 diabetes and related conditions. In the August 2014 issue of Diabetes Care, a study found that the risk varies a great deal among specific subgroups and even based on other factors like how long they have lived in the United States.

According to the study, the prevalence of diabetes (diagnosed and undiagnosed) among Hispanics and Latinos of all groups was 16.9 percent for men and women compared to 10.2 percent for non-Hispanic whites. Prevalence varied a great deal when looking at subgroups. For example, individuals of Mexican descent had the highest prevalence at 18.3 percent while those of South American descent had the lowest prevalence of 10.2 percent. People of Puerto Rican and Dominican descent had a diabetes prevalence of 18.1 percent and those of Central American descent had a rate of 17.7 percent. More than 13 percent of people with Cuban descent had diabetes. This shows a strong correlation between diabetes and people of Hispanic descent in the United States. Many factors are responsible for the diabetes prevalence including unhealthy eating habits.

In the United States, Houston makes a great case study because of the city’s makeup and close location to Mexico and the Deep South. David Napier of University College London (UCL) states that “People used food as not only a reinforcement of tradition and ritual but also as a way of connecting socially. You’ve moved here from somewhere else, it’s a way to reinforce your identity, it’s a real cultural asset to have, but in a biological sense it’s not the best thing.” Nutrition is complex when tackling diabetes or obesity in Hispanic subgroups. This is why a flexible and targeted approach about healthy eating is necessary for fighting these conditions. Ultimately, the goal is not to get rid of traditional foods, but to find ways to make those foods healthier or introduce better options.

Other factors contributing to the diabetes prevalence include age, urbanization and length of stay in the U.S. The study published by Diabetes Care stated that diabetes rates increased significantly with age to 50 percent among Hispanic and Latino women by the age of 70 and 44 percent for men between ages 70 and 74. The study also reported that the longer someone lived in the U.S., the more likely they were to develop type 2 diabetes. Moreover, urban areas of Venezuela, Chile and Argentina are experiencing rising diabetes rates partly to traffic, crowded living conditions, air pollution, and a more sedentary lifestyle, according to a report by the Center for Strategic and International Studies.

Type 2 diabetes is a serious global concern. Society needs to tackle the disease on all fronts because the consequences can be fatal. It is important to raise awareness of the complications and hope that medical professionals find new ways to reduce the burden of diabetes.

Sophie Okolo is the Founder and Editor-in-Chief of Global Health Aging.

Parul Patel, DPM is the lead physician of Infinity Foot and Ankle, a podiatry practice with three locations in Texas. She has more than 11 years of experience in podiatric medicine. Dr. Patel specializes in podiatric care such as diabetic podiatry, preventative care and surgical podiatry.

The Dangers of Type 2 Diabetes among Older Hispanics

Photo Credit: Pixabay
Photo Credit: Pixabay

Diabetes is a 5th leading cause of death among Hispanics and Latinos in the USA. Hispanics are 66 percent more likely to be diagnosed with diabetes compared to non-Hispanic whites and they have a 1.4 times greater risk of developing chronic kidney disease due to diabetes, according to the National Kidney Foundation. Moreover, there is currently an epidemic of diabetes among Hispanics and Latinos not only in the United States but also in Central America.

The Dangers of Type 2 Diabetes

Type 2 diabetes carries a number of dangers. While it may be easy to ignore, the disease affects the blood vessels, nerves, heart, kidneys and eyes. Complications of diabetes can eventually become life-threatening or disabling regardless of race. In fact, several studies have found that Hispanics and Latinos are at a greater risk of two of the most serious risks of diabetes: end-stage renal disease and foot amputation. Most cases of end-stage renal disease (ESRD) are caused by diabetes and these cases are on the rise throughout Central and South America, according to a study published in the Clinical Kidney Journal. The study reported that the highest incidence of diabetes-caused ESRD was found in Mexico and Colombia.

Research has found that Hispanics and Latinos are also at a higher risk of foot damage due to diabetes than non-Hispanic whites. Diabetes can lead to nerve damage in the feet and poor blood flow which raises the risk of a host of foot complications. In severe cases, toe, foot, or even leg amputation may be necessary. Diabetes is the leading cause of foot and leg amputations in the United States and Mexico. Between 2001 and 2004, the hospitalization rate for diabetes-related amputation among Hispanics and Latinos increased to 80 per 100,000 compared to roughly 28-31 per 100,000 for non-Hispanic whites.

Diabetics in developing countries are twice as likely to develop foot ulcers and require amputation than those in developed countries. In South and Central America, about 1.25 million diabetics undergo foot amputation. This number is expected to rise to 2.5 million by 2030, according to the International Diabetes Federation.

A great deal of the disparity is attributed to lack of health care and screening. Just 38 percent of adult Hispanics over the age of 40 with diabetes received the recommended annual foot, eye and blood sugar screenings compared to 47 percent for whites and blacks in the U.S. Hispanics were also 3.6 times more likely than non-Hispanic whites to be hospitalized for uncontrolled diabetes and 2.9 times more likely to be hospitalized for foot or leg amputation due to diabetes.

Controlling Type 2 Diabetes

Diabetes can develop at any age but it is most often diagnosed in middle-aged and older people. Screening for type 2 diabetes is especially important after the age of 40. Therefore, it is important to note that while diabetes complications can be very serious, they are avoidable. The best way to avoid serious foot problems, including gangrene and amputation, is by receiving regular diabetic foot care and maintaining a healthy blood sugar level. Seeking the care of a knowledgeable foot and ankle doctor should also be top priority for all diabetic patients to avoid potentially life-threatening complications that may seem benign at first.

Parul Patel, DPM is the lead physician of Infinity Foot and Ankle, a podiatry practice with three locations in Texas. She has more than 11 years of experience in podiatric medicine and specializes in podiatric care such as diabetic podiatry, preventative care and surgical podiatry.

The Hidden Health Crisis of Alzheimer’s Disease Among Older Adults

Alzheimer’s disease is “the most under-recognized public health crisis of the 21st century,” according to the Alzheimer’s Association. Only 45 percent of people with Alzheimer’s are told about their diagnosis by a healthcare provider, compared to more than 90 percent of people with the four most common types of cancer. And of the top 10 causes of death in the USA, Alzheimer’s is the only one that cannot be prevented, cured or slowed.

Photo Credit: Pixabay
Photo Credit: Pixabay

What is a public health crisis? The World Health Organization (WHO) uses the term “crisis” for a “situation that is perceived as difficult.” A crisis may at times elude public knowledge, contain different levels and layers of intensity, and have the potential to reach levels beyond what is predicted. For example, specific events such as the 2014 Ebola virus epidemic and 2001 anthrax attacks are characterized as public health crises. Issues like addiction and obesity often have the same distinction.

Alzheimer’s fits the definition of a public health crisis. People who have the disease are impacted, along with their loved ones and the entire healthcare system. In the coming years, the number of Alzheimer’s diagnoses and deaths is expected to increase. The financial toll of the disease on families and the economy is also expected to rise, worsening an already difficult situation.

What Is Being Done?

The CDC’s BRFSS Survey

The Behavioral Risk Factor Surveillance System (BRFSS) survey, by the Centers for Disease Control and Prevention (CDC), collects data at the state and local level to target and build health promotion activities. Because the data tracks the impact of cognitive decline and Alzheimer’s disease, it can be a strong tool for informing the community about these trends and how to respond. The survey can also help policymakers with decisions involving Alzheimer’s.

Initiatives Promoting Cognitive Health

Enhanced cognitive activity — along with good physical health, exercise, nutrition and social engagement — can potentially reduce the risk of cognitive decline and possibly prevent Alzheimer’s disease. The following initiatives represent some of the ways that federal agencies are addressing the crisis of Alzheimer’s disease.

Healthy Brain Initiative

The CDC and the Alzheimer’s Association organized the Healthy Brain Initiative, which seeks to better understand cognitive impairment. The initiative targets interventions to improve cognitive health and implementation of positive actions into public health practice.

According to the Public Health Road Map Report for 2013-2018, the initiative focuses on ensuring that people with dementia are aware of their diagnosis as well as reducing preventable hospitalizations among patients with dementia. Other action items are divided into four domains: monitor and evaluate public health data; educate and empower the nation about causes of disease, injury and disability; develop policy and mobilize partnerships on cognitive health; and assure a competent public health workforce.

Healthy People 2020

The Healthy People program establishes national health-related goals set by the United States Department of Health and Human Services. The most recent 10-year agenda for public health topics and objectives listed dementias, including Alzheimer’s disease, as a new topic area for the program.

The primary goal in Healthy People 2020 is reducing morbidity and costs related to dementia as well as maintaining or enhancing the quality of life for those with dementia. Other areas where progress is important include early diagnosis, interventions to delay and prevent onset of disease, better ways to manage Alzheimer’s when other chronic conditions are present, and understanding lifestyle factors that influence risk.

The Role of Education

Education is critical for the public health crisis of Alzheimer’s disease. This can lead to greater public understanding of the disease, resulting in more support for people with Alzheimer’s and their caregivers. Enhanced public education can also create additional momentum for research on Alzheimer’s. Hence, public health professionals who are trained to help with Alzheimer’s can make a difference, from investigating the disease to providing resources in their community.

The rest of the article, including the state of Alzheimer’s disease, is available on Rivier University Online.

Brian Neese has been writing about online education for more than five years, with specialties in health care, business and education. In his spare time, he enjoys sports, movies and spending time with family and friends.

12 Ways to Reach Out to Caregivers During National Caregivers Appreciation Month

Photo Credit: Marianne Scuccio
Photo Credit: Marianne Sciucco

Chances are you know someone caring for a loved one who is sick or has a disability. This could be due to an illness such as Alzheimer’s, Parkinson’s, cancer, stroke, or a variety of other conditions. Some family members provide live-in care, others visit daily or weekly, and some oversee care from a distance, or care provided by hired aides or a nursing facility.

No matter how the caregiver performs his or her role, caregiving is a tough job, requiring resources that are often scarce: time, money, support, and assistance. The Centers for Disease Control and Prevention (CDC) states that more than 34 million unpaid caregivers provide care to someone age 18 and older who is ill or has a disability, and an estimated 21 percent of households in the USA are impacted by caregiving responsibilities.

Almost all of this work is unpaid, typically provided by family members and often performed around the clock with no breaks. Also, many caregivers juggle other responsibilities such as jobs, raising children, and managing their own households.

November is National Caregivers Appreciation Month, and a great time to reach out to those providing care and help lighten their load. In recognition of those who work tirelessly and selflessly to care for a loved one, below are 12 ways to offer assistance and let caregivers know that you care. These people need support and often that support does not cost much, if anything, and takes little time.

  1. Ask if you can sit for them a little while so they can run errands, take a break, see the doctor, or attend church or a caregiver’s support group, whatever they need to do to take care of themselves.
  2. Going to the grocery store? Call and ask if there is anything you can pick up for them.
  3. If your employer allows, donate paid sick time, vacation days, or personal time to a coworker caring for a relative who is hospitalized or needs post-hospital care.
  4. Volunteer to mow the lawn, weed the garden, rake the leaves, or shovel the snow.
  5. Share the bounty, whether from your vegetable or your flower garden. Fresh produce and fresh flowers are cheerful.
  6. If you have the skills and tools, offer to change the oil in their car and rotate the tires.
  7. Again, if you have the skills and tools, offer a free haircut to the caregiver and/or their loved one.
  8. Walk their dog.
  9. Ask if they would like you to wash and clean out their car.
  10. Volunteer to take out the trash and bring the barrels out to the curb on trash day.
  11. Double cook a meal, preferably one of their favorites, and send over a dinner.
  12. Include them in your prayers.

For more information about caregiving and caregivers, please follow #AlzAuthors on Twitter during National Caregivers Appreciation Month in November 2015, or find AlzAuthors on Facebook.

Marianne Sciucco is not a nurse who writes but a writer who happens to be a nurse. A lover of words and books, she dreamed of becoming an author when she grew up, but became a nurse to avoid poverty. She later brought her two passions together and writes about the intricate lives of people struggling with health and family issues. Her debut novel, Blue Hydrangeas, an Alzheimer’s love story, is a Kindle bestseller, BookWorks featured book, IndieReader Approved, and winner of IndieReCon’s 2014 Best Indie Novel Award. A native Bostonian, Marianne lives in New York’s Hudson Valley and when not writing, works as a campus nurse at a community college. She can be reached via her website, Facebook, and Twitter.

Family Caregivers: The Unsung Heroes of Society

Photo Credit: Vicki Tapia
Photo Credit: Vicki Tapia

In 2004, my father was diagnosed with Parkinson’s-related dementia and a few months later, my mother with Alzheimer’s disease. That was the year I became a caregiver. While my parents did not reside with me, I was still intimately involved in their daily care for the next 4 and 5 years. Traveling down that rabbit hole of dementia with my parents was difficult and sad. I watched helplessly as this disease steadily and ruthlessly chipped away at their brains, one memory at a time. That said, it was also a time of considerable personal growth for me. I learned to parent my parents with patience and compassion, caring for them much as they had cared for me as a child so many years before. Interspersed with the challenges were times of fleeting lucidity as well as moments of poignant tenderness, which I still remember and cherish, even today. These are moments I would have missed forever, had I not been a family caregiver.

According to the Alzheimer’s Association’s 2015 Facts and Figures, 85 percent of unpaid caregiving help for older adults in the USA is provided by family members. Women make up two thirds of that number, and over half of women caring for people with dementia are taking care of parents.

How many people actually plan on being an unpaid caregiver? Whether it is a spouse, parent or well-loved aunt, it is unlikely that most of us will ever anticipate the reality of wearing the label “caregiver.” As the boomer population continues to age, the number of unsung heroes caring for a family member is on the upswing. According to the report, *Caregiving in the U.S. 2015, there is currently an estimated 34.2 million American adults caring for a loved one 50 years or older.

Caregiving can be overwhelming, both emotionally and physically, bringing with it a myriad of emotions, all of which I experienced at one time or another, including frustration, helplessness, anger, sadness, depression, and guilt. The experience can also be lonely. At times I remember feeling like I was on a deserted island, with nary a person who really understood what it was like.

While speaking at a caregivers meeting recently, two women approached me afterwards to share their stories. One woman told me that her spouse with Alzheimer’s is slowly becoming more than she can handle, but her children are insisting that she keep him at home. The other woman suspects that her elderly father who lives next door to her is showing signs of dementia, but he flatly refuses to go to the doctor. They were both searching for answers. Like growing old, caregiving is not for sissies.

I sensed in these two women what experts label caregiver burnout, a very real phenomenon and the number one reason why it is imperative for all caregivers to recognize the importance of self-care.

If you or someone you know is experiencing the below symptoms, I encourage you to please make time to see a doctor.

  • Anxiety
  • Irritability
  • Social withdrawal
  • Sleeplessness
  • Exhaustion
  • Poor concentration
  • More susceptible to illness

*Caregiving in the U.S. 2015 – A Focused Look at Caregivers of Adults Age 50+ was published by the National Alliance for Caregiving (NAC) and the AARP Public Policy Institute.


Over the past several months, four other authors from across the country and I have crossed paths, all of us affected in some way by Alzheimer’s disease/dementia. Two watched both their parents’ memories disappear and one is a nurse who was a caregiver for those affected. Another is a granddaughter that was forgotten by her beloved grandpa, and the other is experiencing the disease himself.

For the month of November, the 5 of us have joined together together in recognition of both National Caregiver Appreciation Month and National Alzheimer’s Disease Awareness Month to acknowledge those family caregivers who are unsung heroes. From each other, we learned that all of us felt compelled to write our books, eager to make a difference…hoping that we might make the pathway for others traveling this road a little less painful and lonely.

Check out this commentary for more information on these great books!

Vicki Tapia, long-time lactation consultant and published author of numerous lactation articles, found her energies redirected to the other end of life when both her parents were diagnosed with dementia in 2004. Her diary documenting their journey resulted in the publication of Somebody Stole My Iron: A Family Memoir of Dementia, a 2015 finalist for the High Plains Book Awards. The mother of three grown children and eight grandchildren, Vicki lives with her husband and Mini Schnauzer in South Central Montana.

The Science of Alzheimer’s: Where Are We Going?

The McMaster Health Forum, with support from the Labarge Optimal Aging Initiative, recently hosted a public talk to examine the latest research and evidence into risks, prevention and treatment of Alzheimer’s disease. This talk featured presentations by Jay Ingram, one of Canada’s best-known and most popular science personalities, and Dr. Christopher Patterson, an expert on the diagnosis and treatment of dementia.

“My experience is that when you talk to people about Alzheimer’s, they have three questions,” said Ingram. “The first one is always ‘am I going to get it?’ The second is ‘If it looks like I’m likely to get it, what can I do to lower that risk?’ And the third question is ‘if that doesn’t work and I do get it, what are the prospects?’”

Jay Ingram
Photo Credit: McMaster Health Forum

Will I get Alzheimer’s?

Early-onset familial Alzheimer’s

“There are two kinds of Alzheimer’s disease – early onset familial Alzheimer’s, which you inherit and is a dominant gene. If you had a parent with this kind of Alzheimer’s, you have a 50/50 chance of getting it yourself,” said Ingram.

But, he cautioned, “That’s so not the norm. There’s really only three genes that have been absolutely identified as early onset familial genes. They represent something less than 1% of all Alzheimer’s.”

Also, not every case of early-onset Alzheimer’s is genetic.

“Yes, there’s a risk but it’s a very tiny risk. For the most part, I think you could set that aside,” said Ingram.

Late-onset Alzheimer’s

“There’s really only one gene that has been unambiguously associated with late-onset Alzheimer’s (that is 65-70 years old and older),” said Ingram. “It comes in three varieties. One is bad, one is neutral and one is actually beneficial.”

“Let’s say, worst case scenario, I’m carrying two copies of the bad gene called APOE4. The most pessimistic of studies would say that that my risk is now 15-fold greater than it would have been. So you might think I’m terrified, but there are some other facts to consider. About half of the people who have the two bad genes never get Alzheimer’s. Plus, a good percentage doesn’t have those genes and do get it.”

“As far as late-onset, it’s so ambiguous for my money, it’s not worth worrying about.”

What can I do to prevent Alzheimer’s?

“There’s this whole constellation of effects, but when you put them together, I think they boil down to some pretty commonsense things,” said Ingram. “Exercise, watch your weight, watch your blood pressure, engage socially and keep your mind active. These are all sort of commonsense things that one should do in life.”

Education

“Education has been shown to be clearly related to your risk of dementia. The further you go in school, the less likely you are to become demented,” said Ingram. “If you continue on in what is defined as a mentally stimulating job, you’re also better off.”

Exercise

The single most important thing that older adults can do to prevent dementia is to walk 35 or 40 minutes a day.

“Exercise. Why is that important? Cardiovascular health, the health of your circulatory system and, maybe most importantly, your blood pressure are all risk factors, if they’re in decline, for Alzheimer’s disease,” said Ingram.

Be social

“There have been studies that show that it’s not even the kind of activities you do, its the number of them that you engage in and the number of people with whom you engage,” said Ingram.

Other factors

  • There is good epidemiological evidence that people who adhere to a Mediterranean-type diet are least likely to develop Alzheimer’s.
  • People who watch a lot of TV are more likely to become demented.
  • Obesity and diabetes are risk factors for Alzheimer’s

Does having diabetes increase the risk for Alzheimer’s disease?

“If you have diabetes, your risk of developing dementia is about twice that compared to if you don’t have diabetes. Certainly, management of blood sugar is important. Whether that actually changes the progression of the disease, I don’t think we know but we would suspect that it would because appropriate management delays other vascular complications,” said Dr. Patterson.

Can cognitive exercises help improve brain function?

“The evidence for enhancing your memory by doing those memory exercises is not nearly as solid as the evidence for physical activity,” said Ingram.

“The evidence is that, in earlier stages of cognitive impairment, you see improvements in those domains in which you practice. If you do memory tests, it may not necessarily improve executive function,” said Dr. Patterson.

How does dementia impact the quality of life for caregivers?

Dr. Patterson commented that in a research project, in which he was involved, quality of life did not diminish in individuals over different stages of the disease whereas for caregivers it clearly did.

“While we talk about memory loss so much , the most disturbing change to families is not the memory loss but the change of mood or affect or personality. That’s where people feel they’ve lost the person,” added Ingram.

If I do get Alzheimer’s, what can I do about it?

Education 

“Understanding the disease and what’s going to happen to that person overtime is extremely important,” said Dr. Patterson. “Also, learning how to deal with some of the behaviors that may evolve as the disease progresses is by far the most important part of management of individuals with dementia.”

Support

Dr. Patterson highlighted that it is important to recognize “that being a caregiver for an individual with dementia is extremely stressful.”

Case management is a way of supporting families through this journey.

Medications

“Of the whole management of individuals with dementia, medications really play the least part.”

“The single medication that is commonly prescribed these days, will stabilize cognition for 9-12 months,” said Ingram. “As the cells generating neurotransmitters die, to a degree, you can replace them chemically. But, the cells are still dying and eventually you can’t make it up chemically.”

Patients may be prescribed medications to help with other symptoms of the disease.

“In the future, there may be medications that can literally interrupt the sequence of the disease,” said Dr. Patterson.

“So what do we do in the meantime? We can do lots of things that make us healthier and happier people. We hope that with increasing general health, reduction of diabetes, and daily exercise slow down the obesity train. That may be, at least in the short-term, the most effective thing we can do,” said Ingram.

The rest of the summary is available here and the video below presents highlights from the event.

Steven Lott is the Senior Lead, Communications for the McMaster Health Forum. He leads the Forum’s communications initiatives including the dissemination of Forum products and information, coordination of public talks, social media engagement, media relations, and website management. Steven has worked with a variety of patient advocates, non-governmental organizations, think tanks, academics and other health system stakeholders in Canada, USA, South America, Europe and Africa to promote strategic health policies.

Who Are You? Where Am I?

In an effort to increase awareness for the first annual National Memory Screening Week held Nov. 1-7, Vicki Tapia, author of Somebody Stole My Iron, has joined with four other authors of books about dementia/Alzheimer’s. This article describes the campaign and presents a brief synopsis of their books.

Photo Credit: City of Overland Park

It was the weekend of our family reunion and almost everyone was gathered together at my parent’s condo to celebrate a milestone. Our patriarch, my dad, was turning 90. When the front doorbell rang, Mom opened the door, took one look at her oldest granddaughter and asked in a perplexed tone of voice, “Who are you?” After a moment of silence, we all laughed a little uncomfortably, but brushed it off, rationalizing the comment as a manifestation of Mom’s stress in caring for Dad, who had been diagnosed with Parkinson’s disease. It was not mentioned again.

Our family continued to somehow normalize or overlook the ever-increasing signs that something was not quite right with Mom’s behavior. Another two years passed before she finally agreed to be evaluated by her health care provider, around the same time Dad was diagnosed with Parkinson’s-related dementia. Although by this time, our family wasn’t completely surprised by Mom’s Alzheimer’s diagnosis, we were alarmed to hear she was already considered to be in the “moderate” stage of the disease. I later learned this scenario is typical.

Studies tell us that the delay in diagnosis can be attributed to the family’s own denial in not wanting to face the fact that something is wrong. In retrospect, this could be applied to our family, although in many ways, we were simply clueless in the beginning. Sometimes, a fear of diagnosis can result in reluctance on the part of the affected person to agree to an evaluation, particularly if it involves an adult child prodding an intractable parent. Healthcare costs may also be a factor in avoiding an assessment by a qualified health care provider (HCP). The oft-perceived stigma associated with a potential diagnosis of dementia/Alzheimer’s can be a barrier to evaluation for the entire family.

National Memory Screening Week

In an effort to promote the importance of early detection of memory problems, the Alzheimer’s Foundation of America (AFA) has launched the first annual National Memory Screening week scheduled for Nov. 1-7.

The screenings will be free and confidential, and if deemed necessary, refer people onto appropriate follow-up services. One of the goals of the screening is to work toward eliminating the stigma and fears associated with dementia. The AFA also hopes to alleviate fears for people who participate in the memory screening, but do not show a concerning memory problem.

For more information about the screening (date, time) and a list of participating sites, visit National Memory Screening.

Who should consider having a memory screening?

  • Anyone concerned about memory loss or experiencing any of the warning signs of dementia.
  • Anyone who feels they are at risk due to a family history of Alzheimer’s disease or another type of dementia.
  • Anyone who wants a baseline evaluation of their memory for future comparisons, even though they do not have a current concern.

If you or a loved one answer “yes” to any of the following questions provided by the AFA, it may be prudent to participate in the free memory screening.

  • Are you becoming more forgetful?
  • Do you have any trouble concentrating?
  • Do you have difficulty when performing familiar tasks?
  • Do you have trouble recalling names or words during conversation?
  • Do you sometimes forget where you are going or where you are?
  • Have friends or family told you that you are saying the same thing over and over or repeating questions?
  • Do you often misplace things?
  • Have you become lost when driving to a familiar place or walking in your neighborhood?
  • Have your family or friends told you they have noticed changes in your behavior, moods, personality, or desire to engage socially?

For more information, visit Information for Participating Sites on the National Memory Screening website.



The scene described in the opening paragraph of this blog post is based on an excerpt from my memoir, Somebody Stole My Iron, which details the daily challenges, turbulent emotions, and many painful decisions involved in caring for my parents. Laced with humor and pathos, reviewers describe my book as “brave,” “honest,” “raw,” “unvarnished,” as well as a “must-read for every Alzheimer’s/dementia patient’s family.” I wrote this story to offer hope to others whose lives have been intimately affected by this dreadful disease, and to reassure them that they are not alone.

Four other engaging books about dementia/Alzheimer’s disease that I am pleased to recommend include:

 

On Pluto: Inside the Mind of Alzheimer’s by Greg O’Brien

Greg’s story is not about losing someone else to Alzheimer’s, it is about losing himself. Acting on long-term memory and skill, coupled with well-developed journalistic grit, O’Brien decided to tackle the disease and his imminent decline by writing frankly about the journey. On Pluto is a book about living with Alzheimer’s, not dying with it.” 

Alzheimer’s Daughter by Jean Lee

Jean’s memoir details her journey caring for both parents who were diagnosed on the same day. It is written with wincing honesty about the cruel affects of the disease, but a World War II love story held together by faith and family is contained within the pages.

Blue Hydrangeas by Marianne Sciucco

Marianne describes herself as a writer who happens to be a nurse. She writes this work of fiction based upon her care for the elderly. It is a tenderly told love story about Jack and Sara, owners of a New England bed and breakfast. Sara is stricken with Alzheimer’s and Jack becomes her caregiver.

What Flowers Remember by Shannon Wiersbitzky

Shannon writes this work of fiction through the eyes of a young girl, perhaps not surprising, as her author bio notes that her own grandfather had Alzheimer’s. In the story, when thirteen-year-old Delia Burns realizes that her elderly neighbor is beginning to forget, she involves the entire town in saving his memories.

Vicki Tapia, long-time lactation consultant and published author of numerous lactation articles, found her energies redirected to the other end of life when both her parents were diagnosed with dementia in 2004. Her diary documenting their journey resulted in the publication of Somebody Stole My Iron: A Family Memoir of Dementia, a 2015 finalist for the High Plains Book Awards. The mother of three grown children and eight grandchildren, Vicki lives with her husband and Mini Schnauzer in South Central Montana, USA.

 

 

Aquatics Programming

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 4 in this series. Part 1 focused on the aquatic therapy marketplace, Part 2 focused on selecting an aquatic practitioner and Part 3 focused on selecting an aquatic facility. Thank you for reading!

Aquatics Programming may be found in a class format or individual, one-on-one, personal training. Variances occur when the instructor is in the water or on the pool deck; the instructor can be demonstrating moves or simply observing.  In one-on-one training, a physical therapist may demonstrate on the pool deck and then oversee land-based exercises to be performed in water. This article will present an overview of just aquatic therapy programming–oftentimes misconstrued by physicians and other healthcare providers as water aerobics, as they have not learned to differentiate between aquatic exercises and therapies.

Photo Credit: Pixabay
Photo Credit: Pixabay

Within aquatic therapies, class formats are usually considered “active” therapies, meaning the therapist is demonstrating moves to be performed by the participants using visualization or verbal cueing to effect the desired movement(s). “Passive” therapies require the therapist to be in the water with the participant, physically manipulating the participant in a one-on-one mode of care.

Active therapies are by far the more commonly observed practices in either class or personal format. In active therapies, the practitioner can be demonstrating the moves whether on the pool deck or in the water. Many participants prefer a practitioner on deck where moves can be easily seen and more closely modeled by the participant.  However, there are unknown advantages to having the practitioner in the water with the participant(s). The practitioner can more concisely cue the participant to specific considerations that may be experienced in water, not commonly observed or experienced when the move is performed out of the water. For instance, a leg lift to the side, when performed on deck, is more easily aligned when the buoyancy and resistance of the water is not altering the form of a truly lateral abduction. When a practitioner instructs from the water, he or she may lift the leg sideways but it may be forward of the midline of the hip joint. By cueing the participant to turn the toes inward, the outside of the ankle leads the abduction, effecting a more true lateral abduction. The slight turn inward of the toes strengthens the leg muscles needed to perform the movement, which then translates to a more stable leg lift on land. This is because the muscles have been trained more strongly against the added resistance of the water.

Physical therapists who do not have aquatic training may never come to understand this variance in experience between land and water. Therefore, they can not ever use the water to its fullest multi-planar or “omni-directional” benefit. To be fair, even people trained in aquatic therapy may not become fully aware of this omni-directional efficacy unless they have spent a lot of time in the water, performing the movements they instruct the participants to carry out.

In class formats, there are many kinds of therapies that can be conducted: Yoga, Aqua Stretch, Aqua Pilates, Ai Chi and Watsu are some examples. While Watsu is a “passive” therapy, meaning the practitioner is usually the one to move the extremities of the participant, a therapist can lead a class of paired participants and cue and observe each pair in their therapy. Likewise, Ai-Chi-Ne is a paired participant therapy class. For the purpose of example, a brief explanation for Ai Chi will be included in this article.

Ai Chi, a Japanese aquatic therapy, is oftentimes confused with the land-based Chinese Martial Art, Tai Chi. In a lot of ways, the practices are similar and the newer Ai Chi is based upon the martial art. However, when done in water, Ai Chi accomplishes different objectives of wellness and mind/body self-care. It has a very restorative, if not healing effect when practiced regularly. Moreover, Ai Chi coordinates controlled fluid movements with deep, diaphragmatic breathing in through the nose, but out through the mouth. Its relaxation effects are bridging the mind’s control of the body through the control of breath. It is said that, “the breath is the bridge between the mind and the body.” When practiced regularly, the healing effects of the therapy can be profound. Ai Chi is a cultivation of the energies in and around the body, drawing in healing energy and expelling toxic or harmful stressors.

In a one-on-one aquatic therapy session, a powerful bond is created between the practitioner and participant when both are in the water. Inexplicably, the shared common experience endears the participant to the practitioner, establishing a stronger trust and respect than when a practitioner stays dressed in street clothes, sits on a chair on the pool deck and perhaps keys entries on their computer, while the participant completes the instructed movement(s) or repetitions of a move.

In sports therapy pools, the trainer is like the therapist on the pool deck, but expensive underwater video and monitor equipment enables the trainer to observe the form and kinesiology of the participant. This insures proper  form and alignment therefore maximum potential for improvement. The trainer is also acutely focused on the athlete whose sole objective is to increase maximal performance. Non-professional athletes do not have the luxury of such intensive observation and performance monitoring…unless, of course, the therapist puts on a dive mask or goggles and watches closely with their head under water. Granted, some observations can be made by either the trainer or therapist from above the water’s surface. However, the added benefit of underwater observation can improve the outcomes. If not, sidewall windows in therapy pools would not be created with outside video cameras transmitting or recording the movements within.

Finding an aquatic therapist who is willing to get into the water and observe under the surface can be one’s best investment in personal aquatic programming as well as possibly insure the best possible outcomes for the participant. In many cases of aquatic therapy, it is not reasonable or justified to have a physical therapist treat patients on the same day he or she works as an aquatic practitioner. After all, their time is billable hours and transitioning from land to pool and back again is valuable billable hours lost. Aquatic therapy associations can do more to benefit participants and promote best possible outcomes by lobbying for changes in both insurance coverage and licensing for their members.

Another consideration for programming is music. In many therapy settings, a background accompaniment of soothing music can enhance the experience, aiding in relaxing the participant and helping to center and focus the mind. Quiet times in natatoriums are a rare occurrence in some facilities hence the use of soothing music necessitates the quiet environment.

Physical therapy practices that have therapy or warm water pools are far more likely to have opportunities for quiet times as well as access to sound systems and music that fit the therapeutic objective. Community pools, YMCAs and other athletic clubs are not likely to provide such experiences, except at some limited or designated times.  However, many physical therapy practices do not have pools, largely because of the expense. They may only offer aquatic therapy using other facilities where the noise must be tolerated, and therefore cannot offer therapies in quiet classroom formats.

When considering aquatic therapy, programming is one component of the total experience that needs consideration. The skills and credentials of the practitioner, along with the features of a facility, make aquatic programming play a significant role in the participant’s decision to pursue one of the most effective means of self-care currently available in 21st century America.

Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.

Selecting an Aquatic Facility

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 3 in this series. Part 1 focused on the aquatic therapy marketplace and Part 2 focused on selecting an aquatic practitioner. Click here to read Part 4.


Selecting an aquatic facility may be one of the most personal considerations for a prospective aquatic patron. Depending upon an individual’s circumstances, the choice of which facility is best for each patron may vary. At one extreme, there are classes in a resort location, on the shore of a beach or off the dock of a lake home. However, the most common facility is the community pool.

Different health considerations and performance or functional objectives may be central to any patron’s focus. Therefore, an aquatic consultant may be helpful in isolating a patron’s specific requirements. This article focuses on natatoriums (indoor swimming pools) that are open year round as well as some of the many important features of an indoor facility including Access and Water Temperature/Depth.

Access

  • Zero Depth Entry
  • Wide Stairs with Handrail(s)
  • Chair Lift
  • Pool Ladder

Getting into and out of a pool can be a problem for a large number of people who will benefit from aquatic therapy and exercise. In the bullet list above, Zero Depth Entry is the most desirable way to enter the water gradually. Consider wave pools designed with a wide cement slope into deeper and deeper waters of the pool.

In a cost-effective simulation to the wave pool design, a sloping ramp that may actually contain a turnaround or two is ideal. It is much like wading into the ocean, but without the risk of shells underfoot, jellyfish stings, or waves that knock one off balance. In essence, a patron may walk or move their wheelchair into the water using a gently sloping ramp.

Wide Stairs: Ideally, handrails on both sides are sufficient for at least 90 percent of patrons accessing the pool waters. These standard rise pool steps are very helpful in performing some types of therapeutic exercises; a definite plus for most patrons.

Chair Lift: This is very important to consider as land-based ambulation requires canes, walkers and especially wheelchairs. One note of caution to wheelchair-bound patrons: transition between wheel chair and chair lift can be challenging. In addition to a lifeguard on duty, a patron needs a caregiver to assist and perhaps even accompany the patron into the pool. Skill set, including licensing and certification requirements for practitioners and instructors, is  undefined in this circumstance. In other words, the patron’s aided entrance into the pool cannot be assumed to come from the aquatic practitioner.

Pool Ladder: Despite being the most difficult to use, pool ladders affixed to the poolside and deck can be quick and accessible for patrons with sufficient upper body strength and balance. Safe entry into the pool from a ladder attached to the pool deck requires backwards entry. Patrons should consider placing one foot on each subsequent rung although it is more important to focus on the distance between the bottom last rung and pool floor, especially if the patron is not “water safe” (able to float, swim or otherwise not panic when not grounded to the pool floor).

Emphasis must be restated on the requisite upper-body strength to hoist oneself up each rung of the ladder if no easier exit is available.

Water Temperature/Depth

  • Temperature
  • Depth

Temperature: In most circumstances, temperature and depth are equally important. Patrons can generally tolerate aquatic aerobic exercise at 78 degrees F and up to about 84 degrees F or perhaps 85 degrees F. Therapeutic water temperatures are best between 88 degrees F and 92+ degrees F. However, some medical conditions like multiple sclerosis need cooler temperatures even though temperature considerations can also affect certain people with diabetes and some neurologic or degenerative conditions. Arthritis patients have their own specific condition guidelines: 84-88 degrees F for exercise and 92-100 degrees F for therapy.
Note: Facilities that come close to the temperatures necessary for a patron’s specific use can still be considered when the patron invests in warm-water apparel such as a wet vest or aquatic wetsuit.

Depth: Manufacturers in the personal and therapy pool industry tend to hover around a 4-foot-8 to 5-foot-2 inches maximum depth for vertical exercise applications. These parameters seem to target patrons at or below 6-foot in height, which means that a waist belt or noodle is employed to support patrons adequately to achieve full range of motion (ROM) of extremities when suspended (not touching the pool floor) in water.

Depth, of course, is a specifically personal consideration, especially when a patron may not be “water safe.” Comfort in the water, where a patron is able to relax and not panic, is the ultimate consideration in patrons who are self-described as “afraid of the water.”

The choice of water depth is sometimes also a personal consideration. In therapy, if the focus is rehabilitating a joint on a lower extremity, the patron will begin in deeper water, somewhere between shoulder and chest or sternum depth, and progress to more weight-bearing, shallower water when the muscles and joints are stronger. However, depending upon an individual’s center of buoyancy or COB (as it relates to lean muscle mass), it may be difficult for some patrons to stay grounded on the pool floor. If the patron is not water safe, staying grounded will be necessary for the participant to remain relaxed. Fear induces muscular tension which can be counter-productive in aquatic therapies and exercise. Involuntary or unintentional rigidity of muscles may increase the chance of injury and it will make the patron more likely to sink. At a minimum, the tension may inhibit the participant’s ability to perform the exercises with proper form and control; thus making the time spent working not as effective as it can be.

Deep water exercise tends to encourage the use of flotation devices like noodles, hand buoys, and waist belts. By far, the waist belt is the most effective equipment to use in water when performing vertical workouts like cross-country skiing, deep water running, leaping, jumping jacks and other moves where all limbs may be working concurrently. A noodle may be straddled between the legs or wrapped around the back either at the waist or under the arms. Hence, deep water can be a very rigorous form of aerobic work, targeting not only muscle strength but also endurance. Deep water exercise can also enhance range of motion when performed slowly or with a hold between changes of direction of the limbs. One of the most important considerations about deep water work is that postural alignment is maintained with shoulders back (and down) over the hips. This alignment is critical in maintaining core strength and minimizing back strain.

The task of selecting a facility has so very many different considerations to review in making a choice. Often, an aquatic patron does not have the luxury of a large selection of facilities available to them. When visiting a facility and observing the staff and instructors, all these ideas will prepare the new patron to be watchful of conditions, which can make it necessary to plan and prepare ahead of their first aquatic therapy or exercise experience. A good question to always ask on a site inspection is whether towels are provided.

Water is, for most people, a therapeutic medium when comfort of the patron is properly addressed. Plan to heal, grow stronger and enjoy!

Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.