Drug Reactions in the Elderly

January 6, 2012 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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There are four medications used alone or together that are felt to be responsible for drug reactions resulting in the most emergency room visits in the elderly. They are Coumadin (Warfarin); aspirin, Plavix (Clopidogrel), or other antiplatelet drugs; Insulin; and oral diabetes drugs. All of these medications or medication groups are commonly prescribed to older adults. In addition, they are difficult to use correctly. Some of them require regular blood testing and dose changes, and the correct therapeutic index is a narrow one.

Every year in the United States, approximately 100,000 individuals 65 years and over are taken to the hospital for adverse reactions to medications. These visits may be a result of an accidental overdose or because the amount of medication prescribed for them was too much and resulted in an adverse reaction. Common factors among the drugs responsible for these visits are they are difficult to use, require blood testing to adjust their doses, and a small dose can have a powerful effect.

Coumadin or Warfarin, a blood thinner, tops the list. It is one of the drugs which requires regular blood monitoring and dose adjustment. Its therapeutic range is narrow and it can interact with many other drugs and foods. Insulin injections are next on the list. Blood sugars are difficult to control in people with diabetes. A diabetic who takes a slightly larger dose of insulin than needed can send themselves into shock. Antiplatelet drugs, such as aspirin and Plavix are next on the list, followed by oral hypoglycemic drugs used to control diabetes. These medications are critical for many older adults, yet none of these drugs are typically listed as “high risk.” The medications usually listed as high risk are the over the counter drug Benadryl and powerful narcotic painkillers such as Demerol. These drugs, though,  account for fewer emergency room visits.

When individuals show up at the emergency room as a result of drug misuse or abuse, it provides an opportunity to reach out with counseling or exploring other options that could help prevent it from being repeated or further consequences. Often times this opportunity is missed. Data suggests focusing on safety initiatives on a few medicines that commonly cause serious harm can improve care for many older adults. Individuals need to work with their physicians and their nurses, pharmacies, or a geriatric care manager to make sure they are receiving appropriate testing and taking the correct dose of their medications.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York.   We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care.  Please contact us in our Ramsey or Ridgewood Office to schedule a consultation.   201-587-5283.

145 N. Franklin Turnpike, Suite 311, Ramsey, NJ  07446

45 N. Broad St., Suite 503, Ridgewood, NJ  07450

Dealing with Diabetes

November 11, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | 1 Comment
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Diabetes mellitus is a set of related diseases where the body cannot regulate the amount of sugar or glucose in the blood. Glucose supplies your body energy to perform daily activities, like walking. In healthy individuals, blood glucose levels are regulated by hormones, such as insulin. Insulin allows glucose to move from the blood into the cells of the body’s organs where it is used for fuel. In diabetes, glucose in the blood cannot move into cells so remains in the blood. This harms both the cells who need glucose for fuel and the organs and tissues which are exposed to the high glucose levels in the blood.

In type 1 diabetes, the body stops producing insulin or produces too little to regulate blood glucose levels. Type 1 diabetes is usually discovered in children or adolescents. Individuals with type 1 diabetes will require insulin treatment to survive. In type 2 diabetes the pancreas secretes insulin, but the body is partially unable to use it. The body will try to overcome this resistance by secreting more and more insulin. Type 2 diabetes can occur in younger people, but is typically recognized in adulthood. It can be controlled with diet, weight loss, exercise and oral medications. Some may require insulin to control their blood sugar levels like those with type 1 diabetes.

About 17 million Americans have diabetes. One million new cases occur each year and diabetes is the cause of at least 200,000 deaths each year. The increase in diabetes cases is due to many factors, including the increase in obesity and sedentary lifestyle. Other risk factors for developing type 2 diabetes include high blood pressure, a high fat diet, increased alcohol intake, and high blood triglyceride levels. If diabetes is not treated properly it can lead to blindness, kidney failure, heart disease and nerve damage.

Some of the common symptoms of both types of diabetes are fatigue, weight loss, excessive thirst, excessive urination, poor wound healing, infections, altered mental status and blurry vision. Once diagnosed with diabetes you should be checked regularly for early signs of complications. Your blood pressure and cholesterol should be regularly screened to check for heart disease. To help control blood sugar and minimize complications of diabetes, eat a healthy, well-balanced diet that is low in saturated fat and sweets, and high in fiber; exercise on a regular basis; eliminate or consume alcohol in moderation; stop smoking and check blood sugar levels frequently.You should have your eyes checked at least once a year by an ophthalmologist to screen for diabetic retinopathy, which is the leading cause of blindness. To protect your kidneys from failure, urine should be checked on a regular basis for protein. An individual with diabetes should be regularly screened for any cuts, blisters or lesions that are not healing, and that could become infected.

Meet with your health care provider to set goals for lifestyle changes, blood sugar control and the best treatment. An individual’s prognosis depends on the type of diabetes, the degree of blood sugar control and the development of any complications.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York.   We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care.  Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Healthy Aging

November 4, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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Most of us are all trying to find that “fountain of youth” that delays the natural aging process. The signs of aging include wrinkles, memory loss, decreased brain function and an increased risk for chronic diseases, such as heart disease, osteoporosis and cancer. Healthy aging means living a longer, healthier lifestyle. A healthy lifestyle includes regular exercise, adequate rest, avoiding tobacco and eating a diet full of healthy foods. Some foods and beverages contain a substance called phytonutrients, which are antioxidants. Antioxidants help cells fight off damage from free radicals and minimize aging. Aging may be reversed by consuming foods that are rich in a variety of compounds, such as cold water, fish, and vegetables. Adding whole grains, legumes, nuts, yogurt and at least 3-4 glasses of water daily will also reduce the signs of aging. Eating large amounts of saturated or trans fatty acids, sugar, and starches accelerate the aging process. Stress, hormones, ultraviolet light and a weakened immune system all contribute to aging. Dermatologists recommend staying out of the sun and wearing daily sunscreen to ward off aging.

Make physical activity a part of everyday life. Exercise can make you feel better and enjoy life. Regular exercise can prevent or delay diseases like cancer, heart disease, and diabetes. It can help you stay independent and prevent depression. Keep your mind active also. Challenge your intellect on a daily basis by reading, learning a new activity, solving crossword puzzles, or playing a game. Stress can take a toll on your body and mind. You can decrease your stress with physical activity and meditation. Supplements such as melatonin are also believed to have antioxidant effects which help slow down aging. Melatonin is a hormone produced in the pineal gland of the body. Darkness signals the pineal gland to release melatonin into one’s bloodstream which helps an individual to sleep. Sleep allows the cells of our body to rejuvenate and stave off the effects of aging. As we age though, melatonin production decreases. The lack of sleep can lead to many health problems which can contribute to the aging process. In addition to helping to get a good night’s sleep, melatonin may also stimulate the immune system. Studies have shown that melatonin can diminish the effects of hormones that trigger certain cancers. Melatonin can reset the body’s age clock and slow down aging. As with any medication, it is best to check with your doctor prior to starting melatonin. Start turning back the clock by eating healthy, exercising your body and mind, and getting plenty of sleep.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York.   We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care.  Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Breast Cancer Awareness for the Older Adult

October 20, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
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During the month of October, we celebrate breast cancer awareness. The American Cancer Society (ACS), states there is no age limit for having mammograms.  The society urges individuals who are in good health to get an annual mammogram regardless of age. The ACS feels women should begin in their 20’s with breast self-examination.  Then by her 40’s receive annual mammography and clinical breast examinations.  Screening should continue for as long as a woman is in good health and would be a candidate for treatment “if life expectancy is > 5 years.”

The American Geriatric Society encourages women to have a mammogram every two or three years past the age of 75. The United States Preventive Services Task Force feels strongly to continue with mammograms at older ages, either annually or every two years, as long as their life expectancy is not decreased by another serious illness.

These guidelines I listed are just three of many societies/organizations that doctor’s use to screen patients for breast cancer by either performing a clinical breast exam or from regular mammograms. It has always been a rule of thumb that early detection is what saves lives from breast cancer.  Breast screening for older women and men should be based on the individual, their health, and other serious illnesses, such as congestive heart failure, end-stage kidney disease, chronic obstructive pulmonary disease, and moderate to severe dementia.  An individual’s age alone should not be the reason to stop having regular screenings and mammograms.  As long as an individual is in good health and would be a candidate for treatment, they should continue to be screened with clinical breast exams and mammograms.

As we age, we are placed in a moderately higher risk factor of developing breast cancer.  Our risk for breast cancer increases as we age.  The American Cancer Society states that about 77% of women diagnosed with breast cancer each year are over age 50, and almost half are age 65 and older.  Breast cancer in men is rare, accounting for only 1% of all breast cancers.  Most cases of male breast cancer are detected in men between the ages of 60 and 70.  Older women and men need to be equipped with the knowledge and confidence to detect breast changes and get them checked by a doctor.

The most common sign of breast cancer is a new lump or mass.  Other possible signs of breast cancer include:

  • Swelling of all or part of the breast (even if no lump is felt).
  • Skin irritation or dimpling.
  • Breast or nipple pain.
  • Nipple retraction (turning inward).
  • Redness, scaliness, or thickening of the nipple or breast skin.
  • Nipple discharge.

Those who opt to continue to go for regular breast examinations and mammograms regardless of their age are doing right for early detection.  If you feel strongly about having a mammogram done, tell your doctor.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York.   We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care.  Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Breast Cancer Awareness

October 14, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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October is Breast Cancer Awareness Month. Have you seen all the pink around, from pins to umbrellas, even on the NFL football field? All are joined in the fight to find treatments to eradicate breast cancer. Often there are no symptoms of breast cancer, but signs can include a lump in the breast or an abnormal mammogram. Breast cancer is cancer arising in breast tissue. Cancer is simply a group of abnormal cells that have abnormal growth patterns. Cancer stages range from early curable breast cancer to metastatic breast cancer, where the cancer has spread from the breast into other tissues.

Although breast cancer is primarily a women’s disease, about 1% of breast cancer does occur in men. Fewer individuals are dying from breast cancer today due to the advances in screening and treatment. The earlier breast cancer is detected the better it is for a patient’s long-term health. For women at normal risk of developing breast cancer, self exams, clinical exams, and mammograms starting at age 40 will screen for breast cancer. For high risk women, earlier screening and additional test, such as breast ultrasound or MRI may be indicated.

Do you do regular self exams? Most cancers are too small to feel and not all lumps are cancers, but self exams of the breast are a proactive way to care for yourself. Risk factors include gender, age, race and family history. First degree relatives including mother, sister or daughter are the most important in estimating risk. Since we can do little about some of these risk factors, regular screening is important. The American Cancer Society recommends breast exams by trained health providers once every three years starting at age 20, and then yearly after 40 years of age. Mammograms are recommended every 1-2 years starting at age 40. Women or men at high risk should have mammogram screening at an earlier age. Obesity after menopause and excessive alcohol intake may increase the risk of breast cancer. Physical activity may lower the risk. Hormone replacement therapy, linked to increased breast cancer, should be limited and given only if medically required.

Coping with breast cancer can be stressful, with increased fatigue being a common problem. It may be difficult dealing with the many changes in your body, such as hair loss from chemotherapy treatments. Cancer may cut your appetite, so good nutrition is very important. There are more than two million breast cancer survivors in the United States. Due to improved screening and awareness, death rates from breast cancer have continuously declined since 1990. It is important to remember breast cancer is a treatable disease and that screening for it enables the detection of tumors at their earliest stages. So do your monthly self exams, get your mammogram when it is due and do not ignore a lump.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York.   We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care.  Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

The Facts of White Fruits for Stroke Prevention

October 13, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
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Last month a new study was released by a Dutch researcher by the name of Linda M. Oude Greip, with evidence that fruits and vegetables that are mostly white in color may lower your risk of stroke more than any other fruits and vegetables.  It stated that for every 25 grams per day of white fruits and vegetables consumed there was a 9 percent decrease in the risk of stroke.  Apples and pears were the most commonly consumed “white fruit” according to the study, published in this month’s issue of Stroke (American Heart Association/American Stroke Association).

Oude Greip said that they are not exactly sure what components in white fruit might be protective means for stroke, but she suspects that the dietary fiber and the flavonoids are the main reason for their findings.  Apples and pears are high in flavonoids called quercetin.  Flavonoids are antioxidants and they are biologically the trigger to produce a natural enzyme that fights disease.  It is important to eat all kinds of fruits and vegetables, of all colors.  Many others may protect you against other chronic diseases. She stressed to continue to have a variety of fruits and vegetables in your diet, and that you should be eating at least 3-4 of them throughout each day.   Fruits and vegetables that are listed in the white category were apples, pears, bananas, cauliflower, chicory, cucumber and mushrooms.  If you would like to read more about this new study, you can read about it in November’s issue of Stroke.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York.   We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care.  Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

The Obesity Epidemic

October 1, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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Since 1970, the number of Americans who are overweight or obese has increased. By 2030 there may be 65 million more adults who are overweight or obese than there were in 2010. The many health consequences of the rise in obesity are staggering. This could result in eight million more cases of diabetes, 6.8 million more individuals with heart disease and stroke, and 500,ooo more cases of cancer. The treatment costs of obesity related illnesses already in the billions would be even greater.

Obesity is a chronic condition defined by an excess amount of body fat. We all need a certain amount of body fat for storing energy, heat, insulation and shock absorption. When a person eats more calories than they can burn, that person gains weight and the body stores this excess as fat. There are many factors that can contribute to obesity. They include genetics, overeating, slow metabolism, physical inactivity, medications, and psychological factors. Obesity increases the risk of developing a number of chronic diseases including diabetes, hypertension, hypercholesterolemia, stroke, heart attack, congestive heart failure, cancer, gout, and sleep apnea.

The treatment of obesity cannot be a short-term fix. It has to be an ongoing  life-long process. Even modest weight loss can be beneficial.  A modest weight loss of 5% to 10%, with longterm maintenance of that weight loss will bring significant gains. They will include lower blood pressure and blood levels of cholesterol, reduced risk of diabetes, and chance of stroke and heart disease. Most important it will decrease overall mortality. The weight loss program you choose should be geared to a slow and steady approach, and be monitored by a doctor. You want your weight loss program to be not only successful but safe. Once weight is lost, maintaining your weight is a balancing act between food consumption and calories your body needs for energy. To achieve this goal eat a variety of foods. Choose a diet with plenty of grains, vegetables and fruits, low in saturated fat, moderate in sugar and salt, and drink alcohol in moderation.

One does not need to achieve an ideal weight to derive health benefits. The goal should be to reach a healthier weight and reduce risk factors by eating more wisely and increasing physical activity. As the saying goes, you are what you eat!

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York.   We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care.  Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Relief for the Older Adult Who Experiences GERD

September 15, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
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Many older adults take food or medications that after short or long term use may cause epigastric discomfort or pain. This is defined as dyspepsia, and the medical diagnosis is called GERD. GERD stands for “gastroesophageal reflux disease.” People tend to describe it as heartburn, or regurgitation of acid from the stomach up into the esophagus(throat). We tend to try common over the counter medications to help treat heartburn and GERD, and use antacids that contain calcium carbonate. These antacids dissolve in the stomach acid, freeing the calcium compounds to neutralize the extra acid. There are other natural nutrients from food that can also be considered to help alleviate the symptoms of GERD:

  • Licorice extract: It has been shown that licorice helps by enhancing the production of mucus in the stomach. Mucus coats and protects the lining of the stomach and esophagus. I love black licorice.
  • Radish extract: It has been shown in many studies by S. Jeong, from Wonkwang University of Korea, to increase the motility throughout the digestive tract which then results in faster stomach emptying.

Kenneth Devault provided researchers with findings in 1996 showing that as many as 20 percent of people who suffer from GERD may find relief from lifestyle changes alone. Here are some lifestyle changes that I found that could be effective for you:

  • Weight reduction.
  • Quitting smoking.
  • Avoiding fatty foods.
  • Avoiding irritating foods and beverages, such as tomatoes, garlic, onions, chocolate, peppermint, coffee, and citrus fruits.
  • Avoid eating large meals, which could stimulate sensors that may increase acid upwards into the esophagus. Eat smaller meals more frequently.
  • Avoiding eating for at least two or three hours before bedtime.
  • Elevating your upper body at least 6 inches, by raising the mattress, to help lessen pressure on the esophageal sphincter (opens and closes to let food enter in the stomach). I had a friend do this and that was all he needed to do to prevent his acid reflux.
  • Limitating aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs inhibit the production of prostaglandin, thus promoting reflux. Prostaglandins block gastric acid secretion and stimulate mucus and bicarbonate to reduce the effects of acid reflux, like I mentioned above about the benefits of mucus production.
  • Avoiding chewing gum or hard candy and talking while eating. All three of these can increase the amount of oxygen that we swallow and can lead to belching any bringing up acid into the esophagus.

I hope this week’s blog on prevention of GERD is helpful to you or an older adult you know. As a GERD sufferer, I am always looking for healthy and helpful tips to feeling good and preventing further harm to my body. As I always mention, please consult with your physician on any new medical symptoms that you are experiencing. He/She should be the one to diagnose and treat any new medical condition that you may have. If you would like to read and learn more about GERD or gastric reflux, here are some websites that I found very useful for my blog;

Health in Aging and Livestrong.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

The Most Dangerous Room in the House

September 2, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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As we age, the incidence of sustaining an injury in the home increases, especially after age 85. The higher rate of injury is the result of decreased mobility, decreasing eyesight and decreased strength. Studies show that most of these injuries occur in the bathroom, around the tub or shower, and more than half near the toilet. Many emergency room visits are the result of injuries sustained in the bathroom, and a large percent of these have to be hospitalized.

Women have a higher rate of bathroom injury than men. The most dangerous activity for both men and women, though, is bathing or showering. Injuries can occur either getting out of the bathtub or shower, or getting into the tub or shower. A large percent seem to be suffered while getting out of the shower. Another large percentage of injuries occurring in the bathroom are related to getting on or off the toilet.

Injuries in the bathroom can be the result of slipping, tripping, or fainting. The head and neck make up the greatest percent of bodily injuries, followed by the lower torso, the upper torso, and the leg and foot. The least amount of injuries are to the arm or hand. Injuries in the bathroom can never be totally eliminated, but they can be reduced by the installation of grab bars by the toilet or shower. Other helpful hints to prevent injuries in the bathroom are to place nonslip mats in the bath or shower, to prevent slipping; remove throw rugs in the bathroom, to prevent tripping; and installing a shower chair or bath benches, which assist an individual to get into the tub itself.

There are many agencies which will also come into your home and provide an assessment and offer suggestions on how to make your bathroom and home safer. At Distinctive Care Geriatric Care Management, part of the client’s assessment evaluation involves assessing the individuals living environment and performing a home safety evaluation. The client’s individualized care plan will include suggestions on ways to make their living environment safer. Included in the care plan may also be the recommendation to have an evaluation from a home safety specialist such as Back Home Safely, with Gregg Frank, 973-489-7790. So watch your step while in the bathroom.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York.   We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care.  Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Safe Storage of Medications

August 26, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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Where do you store your medications? Do you know what extreme heat or cold can do to your medications? No drug should be exposed to temperatures greater than 80 degrees or below freezing. Extreme temperatures will affect both over the counter medications and prescription drugs. The pharmaceutical companies recommend most medications be stored at a temperature of 68 to 77 degrees. Medications can physically change, lose their potency, and threaten your health if stored in locations that go over and below these ranges. One should be particularly cautious during heat waves and cold snaps.

Medicine cabinets are probably not the best place to store your medications. The high humidity in a bathroom can damage many medications. It can cause medications to dissolve or degrade. Storing medications over a sink can increase the chance of losing a dose down the drain. The best place to store medications is a cool, dry place like a hallway linen closet, bedroom closet, or even a cabinet in the kitchen which is away from the stove. Make sure all medications, prescription and over the counter, are also out of the reach of children and pets.

If you have a chronic disease, such as diabetes or heart disease, a damaged dose of a crucial medication can be life threatening. Insulin can lose its effectiveness if it freezes. Antibiotics can decay and cause stomach upset and kidney damage. Hydrocortisone cream can separate and become useless if exposed to increased heat. If medications need to be refrigerated, do not place in door of refrigerator as the repeated opening and closing may cause temperature variations. Other medications affected by temperature changes are thyroid medications, birth control, and other hormones. They are protein based and prone to temperature changes.

When traveling, it is best to keep medications in a separate bag and do not leave in a car or allow to be transported in a baggage compartment in an airplane. These compartments can become too hot or freezing cold. Keeping your medications stored properly will keep them in the condition that helps them work the best. Never take medications that have changed color, consistency, smell, or expired. Medications that are stored properly and not expired will work the best for you. If medications are damaged, disposed of them properly. Do not flush them down the toilet, as they can end up in our water supply and harm the environment. To dispense of them properly, mix them with coffee grounds or kitty litter and put them in an empty can or sealed bag before placing them in the trash. Some pharmacies will also collect unused medications and may even replace medications damaged free of charge.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York.   We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care.  Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

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