Tag Archives: Education

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.

Advertisements

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.

Boosting Public Transport Supply to Meet Needs of India’s Aging Population

India’s elderly population is expected to rise by 360% between 2000 and 2050 and contributes to 20% of the total population. Due to population growth, infrastructure in India has to keep up with the demographic change by providing accessible and affordable public transportation, which is vitally important. India boasts of a well-connected transportation system with trains, buses, metro systems, auto rickshaws and taxis in urban as well as, to a lesser extent, rural areas. Despite the plethora of transportation options, many of these services are beyond the reach of the elderly population.

Mumbai
The large number of people utilizing public transportation is a major hindrance for the elderly. For example, in Chennai, a south Indian city, the elderly complain of how government buses are always crowded. While there are seats reserved for the elderly in these buses, it is hard to avail of these services. In Mumbai, another metropolis, trains are the preferred means of transport because they are fast, cheap and reliable. However, they are extremely crowded which makes it really difficult for senior citizens to get in the train. Like the buses in Chennai, these trains too have reserved seating for the elderly.

Another major issue is affordability. As Ravi Samuel of Vision Age India states, “If elderly people cannot afford private transport, it is very difficult for them to commute or attend social, religious and family functions.” Those who can afford it use the relatively expensive modes of transportation which include rickshaws and taxis. They can be hailed from anywhere, depending on the city.

There are national guidelines for age-friendly transportation in place. These include 2 reserved seats for the elderly in the front of the bus, fare concessions and subsidized bus passes, 30% concessions on trains, separate counters for senior citizens, ramps at stations for greater accessibility, disability-friendly train coaches and fare concessions by several major public and private airlines. It is heartening to see that many cities and/or states go above and beyond these guidelines.

For instance, Mumbai is currently petitioning for elderly-only compartments in all trains at the Bombay High Court. New Delhi, the country’s capital, has introduced low-floor buses. Since their introduction, the number of senior citizen bus passes has increased from approximately 255,000 in 2007-08 to 1,100,000 in 2013-14. These buses also display ticker messages on aboard buses, reminding passengers to not occupy or block the seats meant for the elderly.

Initiatives like these are great first steps towards accommodating the elderly population. Yet, it is important to remember that transportation is but one aspect of infrastructure that needs to be worked on. A cross-sectional approach, incorporating sectors such as housing, education, roads, law-enforcement and town planning, is necessary to provide an easier and holistic lifestyle for the elderly population in India.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health. 

 

Why Growing Old in the U.S. Sucks…and There is Nothing (Something) We Can Do About It

Women Celebrating Birthday
I am close to thirty years old. According to the latest data from the World Bank, I can expect to live another 45 to 50 years (Current U.S. life expectancy 78.7 years). However, the quality of those years is up for debate. Our current baby boomer population, on average, is sicker than their parents. The childhood obesity rate for children across the world, but especially in the US, has led many to the conclusion that this generation will become the “sickest generation” in the history of mankind. On top of this, with the population of Americans aged 65 and older expected to double within the next 25 years, there will no doubt be a strain placed on an already taxed healthcare system.

Of course many will argue that numerous aspects of our health are the result of our own personal decision making. This is very true but consider for a second that many individuals, maybe some within your own community, do not have a choice. Maybe they don’t have access to healthy eating options. Maybe they live in an area that exposes them to environmental pollutants. Maybe their occupation requires labor that over time will contribute to chronic pain. For many individuals, we live in a society where the choice has been taken from them or made on their behalf.

For all of us, aging can and possibly will be a difficult process. The unfortunate reality is that we live in a country that has the best intentions, but poor execution. I personally look forward to my next 40-50 years, but I know that many others are not. We must consider that the aging process is not created equal, and that there are many who are and will be unjustly dealt an unfair hand. Aside from the education and outreach initiatives conducted with regard to healthy living and chronic disease, there must be a greater emphasis on policy implementation that catches those at risk. According to the Global AgeWatch Index, Sweden is the best country in the world for the elderly. With reduced costs and an individualized approach, Sweden puts forth a strong effort to ensure the quality of life of its aging population. These efforts illustrate that it’s not impossible for strides to be made in improving or at least maintaining our country’s aging populace.

To give everyone a fair chance, there must be equality at the starting point. It is not enough to expect that public health interventions and education for those at risk for the development of chronic disease will suffice as a method to prevent potential long term health problems. There needs to be more of an effort to eliminate that “risk” to begin with to ensure that children born today, no matter location, race, or socioeconomic status are born with the same expectation of a healthy life. So maybe there is something we can do about it. With time, effort, and collective sacrifice, all Americans can have the opportunity to experience their potential 78.7 years in full health and vitality.

Udo Obiechefu is an E-Tutor for the Master of Health Promotion and Public Health program at Robert Gordon University.