Tag Archives: Prevention

The Flu in Focus: Epidemiology, History and Research of Global Influenza

I live in Baltimore, USA and it has been getting cold here. The nippy winds have been turning my nose red and when I come inside, I always need to have a tissue handy. With the cold weather, there is a looming fear of the flu.

Even if it is not winter where you live, the flu is a serious concern especially for older adults. The flu season in North America generally peaks in the winter months, somewhere between December – February. In tropical climates, however, the flu can strike at any time of the year. As you can see from the map, huge swaths of the world including Russia, Australia, and parts of Europe and the Middle East are experiencing higher levels of the flu, and areas in South America, and South Asia and North Africa are experiencing moderate flu levels. Most of the recent flu outbreaks, including the much-feared Middle East Respiratory Syndrome (MERS), were particularly deadly for older adults.

 Photo Credit: Sanofi Pasteur

                                                                                        Photo Credit: Sanofi Pasteur

For a healthy young or middle-aged adult, the flu will generally lead to physical discomfort and some sick days from work, but it is typically not a deadly disease. The flu can be very deadly for older adults. Older adults often have weakened immune systems that make it harder for them to fight off the flu virus. In addition, hospitals and nursing homes can provide an ideal environment for the transmission of the flu virus, even when nurses and doctors take proper safety precautions.

The flu is more than just a problem for older adults. For instance, the so-called “Spanish Flu” of 1918 was a worldwide killer that was particularly deadly for healthy young adults. The Spanish Flu resulted in the deaths of between 40- 50 million people worldwide, or approximately the modern population of South Korea. Take a moment to consider the implications of a virus so deadly that it could wipe out the population of a country in less than a year. With modern air travel, the danger of a new strain of the flu is even more acute. Approximately 250,000 to 500,000 people die in an average year with a normal flu season, according to World Health Organization (WHO).

The flu is a particularly challenging virus because it frequently mutates. Scientists originally believed that the 1918 flu mutated from a form of flu commonly found in pigs, and the “swine flu” has since been observed in different parts of the world. However, evidence has shown that the 1918 flu was likely an avian bird flu that transferred into humans. If you are interested in learning more about the scientific search for the flu virus, the book Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata is an excellent read.

WHO tracks the flu to try to predict the strain of flu that will be most common in a given year. In addition, WHO has a global action plan to increase the availability of the influenza vaccine. It is important that all countries, not just rich nations, have access to a flu vaccine. In India, Indonesia, Romania, Republic of Korea, and Thailand, new manufacturers are now producing the flu vaccine, thanks to WHO grants. Other developing countries such as Brazil, Mexico, and South Africa have also been given grants to improve flu vaccine manufacturing capabilities.

A flu pandemic should not keep you awake at night, but it is important that countries and international bodies are prepared for the possibility of a more deadly strain of the flu. Modern medical advances will likely increase the probability of surviving such a flu outbreak, but older adults and the immuno-compromised are always at higher risk of death or complications due to respiratory infections. The goal is to promote healthy-living strategies, such as good diet and exercise, to improve the immune system and protect at-risk populations from the flu virus and other infections.

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.


Aquatic Therapy Facilities: Focusing on Water Quality, Air Temperature and Noise

In October of 2015, Global Health Aging celebrated National Physical Therapy Month by publishing a weekly four-part series on aquatic therapy. Part 3 of the series touched on three major considerations when looking for aquatic facilities. Herein, the blog continues to examine other factors that may contribute to new participants’ decisions in selecting a facility, especially when there is more than one facility in close proximity to the patron. In December, be sure to look for suggestions on equipment for new patrons’ holiday wish list.

Photo Credit: Penn State
Photo Credit: Penn State

Air Temperature

It is very important for patrons to be comfortable and warm when exercising in the water. If a patron tends to get cold, he or she can purchase a partial wetsuit or wet vest. A less expensive option is to simply wear a snug-fitting long sleeve shirt (over the top of a swimsuit, if female). When air temperatures are significantly cooler than the water temperature, a swim cap or even a knit ski type cap can greatly reduce the amount of heat lost through the head. This will help insure that the participant remains comfortably warm in the pool.

Noise Level and Water Quality

These two considerations are rare options that patrons can control when selecting a facility, unless they are willing to pay or drive to destinations farther than what is locally available. Most often, if using a public facility like a YMCA or athletic club, there is little choice available to the participant. However, it is worth noting, just to be certain, that these conditions will not impede or hamper participation.

Regarding noise level, natatoriums tend to have a lot of extraneous noise. If multiple groups are working simultaneously in either different areas of the same pool or within the same room, noise interference between the groups may diminish a participant’s satisfaction and focus. In classes designed for senior citizens who generally may have more trouble hearing than children, classes for children, like swim lessons, should not be scheduled at the same time as classes for seniors. Children naturally want to scream, especially when splashed. Hence, it is fun for them and a good release of their anxieties, as they are not yet comfortable in the water. It is not fair to expect children to be quiet, nor is it fair to expect seniors to enjoy their classes when they cannot hear the instructor and focus on the work to be done.

When selecting a facility, water quality is another consideration that may be of concern Most pools today still use either a chlorine or bromine system to kill off harmful contaminants like bacteria. While salt pools and ion filters are more prevalent in smaller pools, they may also pose challenges to patrons with skin sensitivities. Water quality is not controlled by patrons in public facilities, therefore participants are better able to tolerate the harshness of the chemicals used in pools, by showering, prior to entering the pool. Most patrons consider showering an important responsibility to rid the body of oils, lotions, deodorants and perfumes that may add to the cloudiness of water. But few do not understand that they are doing themselves a disservice by not rinsing off before entering the pool. When a patron is already soaking wet, including their swimsuit and hair, he or she has saturated the oils etc., reducing the potential for chemicals to adhere to their skin, hair and swimsuit. By showering before entering the pool, a patron protects him or herself as well as the quality of the pool water.

Sound Systems

Sound systems deserve some brief mention as they can often be helpful when overcoming noise interference or hearing deficits. Sound systems are also good for playing music which not only adds to the enjoyment of many class programs, but the music sets the tempo and cadence for movement. There are some sound systems that play music over speakers outside the pool and the instructor may be either on the pool deck, leading the class or in the water. An instructor may wear a microphone headset that transmits a wireless voice signal to be broadcast through the speakers, if the sound system is waterproof. The choice of music can also induce relaxation in some cases.

If a patron of aquatic therapy returns to the pool to practice or perform assigned exercises without an instructor present, waterproof personal systems can add enjoyment and motivation to a patron’s aquatic therapy session. One of the most ingenious products on the market today is called a SwiMP3. The aquatic patron downloads a song list to a waterproof MP3 player and listens to the music through headphones that are actually placed adjacent to the ears on the jawbone, and the sound is perceived through bone conduction. Amazing!

Since touring an aquatic facility is exhaustive, it may be worth choosing to contract for a “trial” membership. If the patron chooses to no longer participate, the expense of a long-term membership commitment is not lost. Aquatic therapy and exercise are not only good for physical well-being, the socialization and relationships that are created in the water tend to last for years. As with most things in life, change is difficult. Choosing to begin an aquatic program is a huge investment of time and energy. Establishing a regular routine can be challenging, but when that commitment becomes routine, the benefits become SO evident that few will stop coming. Aquatics are good for life!

Felecia Fischell is an aquatic specialist with 25 years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor in and around Smith Mountain Lake, Virginia, USA. The Founder of FunLife Aquatics Consulting and Personal Training, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard Community College.








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 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.”


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?


“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.”


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.


“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.

Aquatics for Life

Inactivity in the elderly has become an ever increasing epidemic in the United States. Politicians as well as insurance and health care providers need to band together to reverse this trend to insure the longevity and quality of life. The elderly are not only at risk for lifetime diseases such as diabetes and heart disease; they are at risk for greater loss in bone density which translates into greater probability of falling and breaking bones.

Land-based physical activity is important for the elderly as it increases muscle and strength development, bone density and endurance which are both respiratory and cardiovascular. On the other hand, aquatic exercise benefits EXCEED land-based activities since it trains muscle parity and balance. Land-based exercise in the elderly is fraught with potential for injury. Likewise, unsupervised weight training can lead to torn muscle fibers, strained or torn ligaments, and unbalanced overtraining of some muscles while not sufficiently training the complementary muscles equally. Water exercise in a class format allows for participants to work at their own comfort level of perceived exertion. Good water instructors will always cue participants to work below the threshold of pain. In other words, participants can work to tension and ask for modifications of moves when in pain.

For the elderly, a good rule of aquatic exercise is to be mindful of aches and pains in advance of a water workout. If two hours later, the pain is greater than before training, then the participant has done too much. At this point, they can notify the instructor for modifications of moves that may affect their pain experienced. Because aquatic exercise trains complementary muscle pairs like biceps and triceps, the potential for injury in land-based exercise or activities of daily living (ADL) is reduced. Moreover, aquatic activities not only balance muscle pairs, they inherently strengthen the core muscles which provide for better over-all balance and strength. Core strength can show some correlation to immunity and overall health.

All seniors, especially those who are overweight, need to exercise in a muscle-balancing, core strengthening and reduced-risk-of-injury environment. Aquatic exercise is perhaps the ultimate life-time sport!

Felecia Fischell is an aquatic specialist with 25 years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor in and around Smith Mountain Lake, Virginia, USA. The Founder of FunLife Aquatics Consulting and Personal Training, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard Community College.

Singapore: Prevention is Better Than Cure

As we all know, in today’s world, people have longer life expectancies. In fact, 75% of the world’s population is older than 60 years of age (WHO). We live longer but the fact is the fact is that we are not aging very well. Once we reach a certain age, chronic diseases occur and hinder us from living a healthy long life; two out of three global deaths are due to chronic diseases such as heart disease or stroke. Due to the aging population, these chronic diseases and necessary expensive treatments put a financial burden on nations’ healthcare systems. As Dr. Lim states in the video, “the healthcare system in Singapore has worked well the last few decades, but was not built for such an aging population and a population that struggles with chronic diseases.”

                                                                                          Photo Credit: Niall Kennedy

Singapore has responded to the trend and puts emphasis on preventative health strategies rather than on just treating or curing the diseases. In Singapore, many fitness parks with workout stations have been built, which not only help the elderly to get active and stay physically healthy, but also to meet and get to know one another. With the increasing aging population possibly living alone, the social aspect of these fitness parks is important and improves the mental state of the elderly.

Public Health professionals can only hope that such preventative initiatives towards healthy living situations for the elderly, or better yet all age groups, will be continued not only in Asia. If we can persuade the entire family to get involved in these types of physical activities, we will have healthier children, adults, and elderly and can lessen the financial burden on the healthcare system. Other community organizations may get involved by offering exercise classes and promoting fitness among seniors.

In addition, local governments need to be convinced that building fitness parks has a positive impact not only on the elderly, but all residents’ physical and mental health. Governments overall need to rethink and focus on disease prevention, and not only treatment and cure.

What else can WE do to improve the health of our community members?

Martina Lesperance is a Health Educator and Screening Technician in El Paso, Texas.