Disabilities
Associated with Aging
Introduction:
Aging is the one thing that is universal and constant. No matter how rich, beautiful, nice, mean, short, fat, happy or sad you are, you will age. For some it is only an inconvenience with some negatives but for others it becomes much more than that. We age in many different ways, biologically, socially, physically, mentally and psychologically over our lifetimes. Each stage of life brings about new challenges in our lives.
Biologically, we start loosing functions as we age. Our senses like smell, taste, hearing, sight and smell start to dull or are lost completely. Losing any part of these senses can completely alter the way you live and even enjoy your life. Your normal physical abilities start to decline at a certain age, making even the simplest of daily activities difficult. The body that you have had since birth starts to fall short of what you are used to.
Being older also brings about social changes. Parents, family, friends, colleagues, peers, and spouses start to pass away. This leaves many holes in the social fabric in the lives of the elderly. Along with relationship changes, social standing also changes. After the constant grind of school, work, dating, marriage, family life, raising children, the lull of life after retirement can also put a strain on the elderly. Finding a meaningful life can be a bit of a struggle.
While dementia and Alzheimers only affect a percentage of the elderly, other symptoms that come with aging affects everyone universally.
Dementia
Definition
Dementia a disorder that comes from aging. It is characterized by: impairment of memory, impairment in the ability to organize thoughts and reason, the ability to use language, or the ability to accurately interpret visual senses- these impairments must all be severe enough to decline the normal level of functioning in the person.
** Dementia is not a disorder, it is a disorder that occurs in the brain as people age.
Alzheimer’s is the leading cause of dementia. They are not the same thing.
Alzheimer’s Disease
Definition
Alzheimer’s Disease (AD) is a slowly progressive disease of the brain that is characterized by impairment of memory and eventually by declining levels of reasoning, planning, language, and perception. This disease is the most common cause of dementia.
Causes
There is not one cause of Alzheimer’s Disease, but there are different factors that contribute to the contraction of this disease.
Age: This is the most significant cause of Alzheimer’s Disease. The approximate age of onset of AD is 65. The likelihood of developing AD approximately doubles every five years after age 65.
Genetic link: Studies have shown that people who have a parent or sibling with Alzheimer’s are two to three times more likely to develop the disease than those who do not. The more people in a family that have the disease, the more risk they have of contracting it as well.
Genetics: Scientists have found that there is one gene whose presence increases the risk of Alzheimer’s, but does not guarantee that the person will contract it. Scientists have also suspected one gene that when present, does guarantee the development of Alzheimer’s.
We do not know exactly what causes this disease, but we know that it is a combination of these factors that lead to the onset of Alzheimer’s.
Symptoms
The Alzheimer’s Association has a checklist of common symptoms that are associated with this disease. These can be warning signs to help identify the disease.
- Memory loss: This is one of the most common signs of Alzheimer’s. People often forget recently learned information. Other areas of memory loss include: forgetting important dates or events, asking for the same information repeatedly, increasingly needing to rely on memory aides such as notes, or relying on family members for things they used to be able to do on their own.
- Challenges in planning or solving problems: Some people have changes in their ability to develop and follow a plan or work with numbers. They may have trouble concentrating on simple tasks, such as following a recipe or paying monthly bills.
- Difficulty completing familiar tasks at home, at work, or at leisure: People with this disease often have difficulty completing daily tasks. They may forget locations, rules, or other things that they experience daily.
- Confusion with time or place: Many people lost track of dates, seasons, and passage of time. They may forget where they are and how they got there.
- Trouble understanding visual images and spatial relationships: Some people may have vision problems associated with Alzheimer’s, although this is not a sole indicator of the disease. Many people have trouble reading, judging distance and determining color or contrast, which may cause difficulty driving.
- New problems with words in speaking or writing: Many people with this disease may have trouble following or joining a conversation. They may struggle with vocabulary- having trouble finding the right word or calling things the wrong name.
- Misplacing things and losing the ability to retrace steps: People with Alzheimer’s may put things in different places than they normally would. They often lose things, but don’t have the ability to retrace their steps to acquire them. Sometimes they believe that others have stolen their items.
- Decreased or poor judgment: People with Alzheimer’s may have changes in judgment or decision-making. They may pay less attention when dealing with money, or to grooming and bathing.
- Withdrawal from work or social activities: Someone with this disease may begin to remove themselves from hobbies, social activities, work projects, or sports. They may even forget how to participate in their favorite hobby. They may also avoid being social because of the changes they have experienced.
- Changes in mood and personality: The mood and personalities of people with Alzheimer’s can change, sometimes drastically. They can become confused, suspicious, depressed, fearful, or anxious. They may become more easily upset than they normally would have.
Diagnosis
Because many of the symptoms of Alzheimer’s are normal for every aging person, the only definite way to diagnose AD is to find out whether there are plaques and tangles in the brain tissue. This can only be done through an autopsy, which only allows doctors to make an indefinite diagnosis while the person is still alive.
However, with the right technology, doctors can diagnose AD correctly up to 90% of the time. Doctors use several tools to diagnose “probable” AD, including:
- Questions about the person’s general health, past medical problems, and ability to carry out daily activities
- Tests to measure memory, problem solving, attention, counting, and language
- Medical tests such as blood tests, urine tests, and spinal fluid tests.
- Brain scans
These tests can also help the doctor find other possible causes of the person’s symptoms. These could include thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease in the brain- all of these can cause symptoms similar to Alzheimer’s. Some of these other conditions can be treated successfully, which would eliminate some of the symptoms.
Brain scans can be helpful in finding Alzheimer’s disease. A brain scan allows the doctor to see if the brain tissue has began deteriorating, which would indicate the Alzheimer’s is present.
There are 3 stages of Alzheimer’s disease:
Stage 1: Mild Alzheimer’s
- Difficulty learning and remembering new information
- Difficulty managing finances, planning meals and taking medications on time
- Depression
- Remembering familiar locations
Stage 2: Moderate Alzheimer’s
- Forgetting old facts
- Repeating stories and questions
- Making up stories to fill in the gaps
- Difficulty in performing regular daily tasks
- Agitation, restlessness and repetitive movements
- Wandering
- Paranoia, delusions, and hallucinations
Stage 3: Severe Alzheimer’s
- Groaning, screaming, mumbling, and talking gibberish
- Refusal to eat
- Failing to recognize family and faces
- Trouble with all essential activities of daily life
Prevention
Two of the main factors that contribute to Alzheimer’s are age and genetics. Unfortunately, one cannot do anything to prevent these factors from affecting your body.
However, there are some other factors that contribute to Alzheimer’s that can preventative measures can be taken to hinder.
Research strongly links brain health to heart health, since your brain is nourished by the richest network of blood vessels from your heart. This implies that if one’s heart is healthy, one’s brain is more likely to be healthy. Regular physical exercise can help a person’s heart be healthy, as well as lower the risk of Alzheimer’s. Along with exercise, a healthy diet is important to keep the heart and mind healthy. Avoiding bad cholesterol and other fats will help the blood vessels be more clear to transport good blood to the brain.
Studies also indicate that maintaining strong social connections and staying mentally active can lower the cognitive decline that Alzheimer’s takes. The brain needs to be continually stimulated in order to stay functioning at its highest level.
There is also a strong link between future risk of Alzheimer’s and serious head trauma. Protecting your head through the use of a helmet can greatly reduce the risk of getting Alzheimer’s.
Treatment
As of today, there is not a cure for Alzheimer’s Disease. However, treatments are available to help changes in memory, mood, and behavior that occur with this disease. While this disease cannot be treated completely, much can be done to maintain the quality of life of those with Alzheimer’s to help their lives be satisfying and happy.
Currently, there are five FDA-approved drugs to treat the symptoms of Alzheimer’s Disease.
- Donepezil (Aricept)- approved for all stages
- Galantamine (Razadyne)- approved for mild to moderate stages
- Memantine (Namenda)- approved for moderate to severe stages
- Rivastigmine (Exelon)- approved for mild to moderate stages
- Tacrine (Cognex)- approved for mild to moderate stages
These drugs work in 2 different ways:
Cholinesterase inhibitors work by slowing down the disease activity that breaks down a key neurotransmitter
Memantine works by regulating the activity of glutamate, which is a chemical messenger involved in learning and memory.
Although there is no cure for Alzheimer’s disease, these drugs can slow down the progression of the disease. There is no other treatment other than taking preventative measures such as socialization, intellectual stimulation, nutrition, and exercise.
TR Implications
While nothing can cure Alzheimer’s, TR can definitely help.
Tips:
- Be patient
- Watch for signs of agitation and irritation
- Incorporate activities that they enjoy
- Allow independence- don’t baby them
- Encourage activities that help with memory and motor skills
- Make them feel in control
- Make the process easier
Benefits of TR activities:
- Enjoy a happier life
- Increase feelings of self-worth
- Enhance gross and fine motor skills
- Reduce joint pain
- Increase joint mobility and flexibility
- Decrease depression
- Decrease wandering, pacing, restlessness
- Increase sleep
Activity ideas:
- Scrapbooking
- Bingo
- Visit museums
- Visit farms
- Make decorations
- Go for a walk
- Go to a sports event
- Make desserts
- Window shopping
- Plant a garden
- Dominos
- Bowling
- Miniature golf
- Wii sports
- Painting
Parkinson’s Disease
Definition: Parkinson’s disease is a degenerative disorder of the central nervous system. It was first described in 1817 byy James Parkinson, a British physician who published a paper on what he called the “shaking palsy”. Researchers believe that at least 500,000 people in the US currently have PD. The risk of PD increases with age.
What is Parkinson’s Disease?
Parkinson’s is a chronic, progressive disorder of the central nervous system that belongs to a group of conditions called motor system disorders. Parkinson’s is the direct result of the loss of cells in a section of the brain called the substantia nigra. Those cells produce dopamine, a chemical messenger responsible for transmitting signals within the brain. Loss of dopamine causes vertical nerve cells in the brain, or neurons, to fire out of control, leaving patients unable to direct or control their movement in a normal manner.
Causes
A person with Parkinson's has abnormally low dopamine levels. Dopamine-generating cells, known as dopaminergic neurons (types of nerve cells) in the substantia nigra part of the brain have died. Experts do not know why these cells die.
When dopamine levels are too low, people find it harder to get things done, to control their movements.
Dopamine levels progressively drop in patients with the disease, so their symptoms gradually become more severe. Dopamine is involved in the sending of messages to the part of the brain that controls coordination and movement.
The substantia nigra is in the midbrain and plays an important role in movement, reward and addiction
Although Parkinson's disease is not a direct cause of death, it is a progressive disease, and symptoms get worse over time. Parkinson's is:
- A chronic disease - a long-term disease. It is incurable.
- A progressive disease - a disease that gradually gets worse.
Symptoms
4 Main Motor Symptoms of PD
- Shaking or tremor at rest
- slowness of movement, called bradykinesia
- stiffness or rigidity of the arms, legs, or trunk
- Trouble with balance and falls, also called postural instability. Usually appears later with disease progression and may not be present with initial diagnosis
Secondary Symptoms of PD
- Small, cramped handwriting, called micrographia
- reduced arm swing on the affected side
- Slight food drag on affected side creating a shuffled walk
- Freezing- a term used to describe the phenomenon of being stuck in place when attempting to walk
- Loss of facial expression due to rigidity of facial muscles, called hypomimia
- Low voice volume or muffled speech, called hypophonia
- Retropulsion: Tendency to fall backwards
Parkinson's affects the voice - A British mathematician believes he has created a cheap and easy to carry-out test using speech signal processing algorithms to accelerate the diagnosis of Parkinson's disease. Max Little, who developed the algorithm at Oxford University, says that Parkinson's not only impacts on limb movement, but also on how people speak; on their voices.
Parkinson's affects sense of smell - Despite being incurable, doctors today can influence the course of the disease if Parkinson's is detected early enough; the destruction of brain cells can be slowed down - this means a better quality of life for the patient for many years. Scientists have recently discovered that hyposmia, losing one's sense of smell for no known cause, might be a marker for the non-motor signs of Parkinson's disease. The scientists said "Smelling tests in doctors' offices are suitable for detecting hyposmia, but so too are tests conducted in public places such as pedestrian zones."
Stages
Parkinson's disease stages include:
Stage one: During this initial phase of the disease, a patient usually experiences mild symptoms. These symptoms may inconvenience the day-to-day tasks the patient would otherwise complete with ease. Typically these symptoms will include the presence of tremors or experiencing shaking in one of the limbs.
Also during stage one, friends and family can usually detect changes in the Parkinson's patient including poor posture, loss of balance, and abnormal facial expressions.
Stage two: In the second stage of Parkinson's disease, the patients symptoms are bilateral, affecting both limbs and both sides of the body. The patient usually encounters problems walking or maintaining balance, and the inability to complete normal physical tasks becomes more apparent.
Stage three: Stage three symptoms of Parkinson's disease can be rather severe and include the inability to walk straight or to stand. There is a noticeable slowing of physical movements in stage three.
Stage four: This stage of the disease is accompanied by severe symptoms of Parkinson's. Walking may still occur, but it is often limited and rigidity and bradykinesia are often visible. During this stage, most patients are unable to complete day-to-day tasks, and usually cannot live on their own. The tremors or shakiness that take over during the earlier stages however, may lessen or become non-existent for unknown reasons during this time.
Stage five: The last or final stage of Parkinson's disease usually takes over the patients physical movements. The patient is usually unable to take care of himself or herself and may not be able to stand or walk during this stage. A patient at stage five usually requires constant one-on-one nursing care.
Diagnosis
No tests exist to diagnose Parkinson's disease. Your doctor will diagnose Parkinson's disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination. Your doctor sometimes may order tests to rule out other conditions that may be causing your symptoms.
In addition to your examination, your doctor may give you carbidopa-levodopa, the most effective Parkinson's disease medication. Significant improvement with this medication often will confirm your diagnosis of Parkinson's disease. You must be given a sufficient dose to show the benefit, as low doses for a day or two aren't reliable.
Treatment
Medications
Medications can help you manage problems with walking, movement and tremor by increasing your brain's supply of dopamine. However, dopamine can't be given directly, as it can't enter your brain.
You may have significant improvement of your symptoms after beginning Parkinson's disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms usually can continue to be fairly well controlled.
Your doctor may prescribe medications, which may include:
- Carbidopa-levodopa (Parcopa). Levodopa, the most effective Parkinson's disease medication, is a natural chemical that passes into your brain and is converted to dopamine. Levodopa is combined with carbidopa, which protects levodopa from premature conversion to dopamine outside your brain, which prevents nausea. In Europe, levodopa is combined with a similar substance, benserazide (Madopar). Side effects include nausea or a drop in blood pressure when standing (may result in faintness).
- After years, as your disease progresses, the benefit from levodopa may become less stable, with a tendency to wax and wane ("wearing off"). Also, you may experience involuntary movements (dyskinesia) after taking higher doses of levodopa. Your doctor may lessen your dose or adjust the times of your doses to control these effects.
- Dopamine agonists. Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic dopamine effects in your brain. They aren't as effective in treating your symptoms as levodopa. However, they last longer and may be used with levodopa to smooth the sometimes off and on effect of levodopa.
- Dopamine agonists include pramipexole (Mirapex) and ropinirole (Requip). A short-acting injectable dopamine agonist, apomorphine (Apokyn), is used for quick relief.
- The side effects of dopamine agonists are similar to carbidopa-levodopa, but also include hallucinations, swelling, sleepiness or compulsive behaviors such as hypersexuality, gambling and eating. If you're taking these medications and you start behaving in a way that's out of character for you, talk to your doctor.
- MAO B inhibitors. These medications include selegiline (Eldepryl, Zelapar) and rasagiline (Azilect). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme metabolizes brain dopamine. Side effects are uncommon, but may rarely include nausea or headaches. When added to carbidopa-levodopa, these medications can increase the risk of hallucinations. These medications can't be used in combination with most antidepressants or certain narcotics, due to potentially serious reactions. Check with your doctor before taking any additional medications with a MAO B inhibitor.
- Catechol O-methyltransferase (COMT) inhibitors. Entacapone (Comtan) is the primary medication from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down levodopa. The side effects are primarily those due to an enhanced levodopa effect, including an increased risk of involuntary movements (dyskinesias). Tolcapone (Tasmar) is another COMT inhibitor that is rarely prescribed due to a risk of serious liver damage and liver failure.
- Anticholinergics. These medications were used for many years to help control the tremor associated with Parkinson's disease. Several anticholinergic medications are available, including benztropine (Cogentin) and trihexyphenidyl. However, their modest benefits are often offset by side effects such as impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination.
- Amantadine. Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson's disease. It also may be added to carbidopa-levodopa therapy for people in the later stages of Parkinson's disease, to help control involuntary movements (dyskinesia) induced by carbidopa-levodopa. Side effects may include a purple mottling of the skin, ankle swelling or hallucinations.
Surgical procedures
- Deep brain stimulation. In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest that sends electrical pulses to your brain and may help improve many of your Parkinson's disease symptoms. Your doctor may adjust your settings as necessary to treat your condition. Surgery may involve risks, including infections, stroke or brain hemorrhage.
- Deep brain stimulation is most often a procedure to treat people with advanced Parkinson's disease who have unstable medication (levodopa) responses. DBS can help stabilize medication fluctuations, reduce or eliminate involuntary movements (dyskinesia), reduce tremor, reduce rigidity, and improve slowing of movement. DBS is very effective in controlling erratic and fluctuating responses to levodopa or for controlling dyskinesias that can't be controlled with medication adjustments. However, it's not helpful for treating problems that don't respond to levodopa therapy, apart from tremor (tremor may be controlled even if not very responsive to levodopa).
Prevention
Some factors may raise or lower the risk of developing Parkinson's
- Circumin - an ingredient found in the spice turmeric, is apparently effective in preventing the clumping of a protein involved in Parkinson's disease, according to scientists from Michigan State University.
- Flavonoids - adult males who regularly eat foods rich in flavonoids appear to have a considerably lower risk of developing Parkinson's disease, compared to others who do not, researchers in the USA and UK reported in the journal Neurology. Examples of foods include berries, apples, some vegetables, tea and red wine. In this study, the protective effects come from anthocyanins, a subclass of flavonoids.
- REM sleep disorder - people with REM (rapid eye movement) sleep behavior disorder may have twice the risk of developing Parkinson's disease or mild cognitive impairment, compared to others without the disorder, researchers at the Mayo Clinic reported inAnnals of Neurology.
- Neurologist and co-author, co-author Brad Boeve, M.D., said: "Understanding that certain patients are at greater risk for MCI or Parkinson's disease will allow for early intervention, which is vital in the case of such disorders that destroy brain cells. Although we are still searching for effective treatments, our best chance of success is to identify and treat these disorders early, before cell death."
- Some reheated cooking oils - aldehydes, which have been linked to Parkinson's, Alzheimer's and other neurodegenerative diseases, as well as some cancers, can be found in some oils, such as sunflower oil, when heated to a certain temperature, and then used again. Scientists from the University of the Basque Country found that aldehydes remain in cooking oils after they are heated.
TR Implications
The goal or TR with a person who has Parkinson’s Disease is to maximize independent leisure functioning in the least restrictive setting to facilitate the individual’s development of and appropriate, satisfying leisure lifestyle.
Some Ideas for TR classes or activities
- This exercise class is specifically designed for people with Parkinson's disease to increase flexibility, strength, balance and coordination and to also improve communication, voice power and speech clarity. The program is suitable for participants dealing with any of the limitations associated with Parkinson's disease.
- Tai Chi is a series of individual dance-like movements linked together in a continuous, smoothly flowing sequence. The easy to learn steps are progressive and choreographed, and they are coordinated with deep breathing exercises.
- Since you were diagnosed with Parkinson's disease has your golf game suffered or have you stopped playing golf all together?
- Just unleash your creative side, pick your most positive colors and paint away with us!
- Put on your dancing shoes and head out to the dance floor. The program is modeled, in part, on the Dance for PD program developed by the exemplary Mark Morris Dance Company. In chairs, at a barre or standing, professionally-trained dance instructors will help explore elements of modern dance, ballet, tap, folk and social dancing. Enjoy the movement and music in ways that are fun, energizing, engaging and creative.
- Tremble Clefs is a nation-wide singing program for people with Parkinson's disease and their partners.
- Walking rates high as a great form of exercise; it’s easy, everyone knows how to do it, it can be done most anywhere, and requires little equipment. But what happens if we add walking poles?
- Yoga practice encompasses physical movement, breath development, and mental focus, or mindfulness.
Resources
Wasatch Clinical Research
4001 S 700 E, Salt Lake City, UT
(801) 288-0607 · wasatchcrc.com
Parkinson’s Disease Foundation
1359 Broadway, Suite 1509
New York, NY 10018
Phone: (212) 923-4700
Fax: (212) 923-4778
APDA Utah Chapter
President
Reuben Jessop
1-801-226-5874
jessopr@ernesthealth.com
Vice-President
Other problems with Aging
Arthritis:
Definition: The definition of arthritis is an inflammation of one or more joints which results in pain, swelling, stiffness and limited movement. There are over 1000 different types of arthritis. Arthritis can occur in men and women of all ages, but ageing does increase the chances of arthritis. About 37 million people in America have arthritis of some kind, almost 1 out of every 7 Americans.
Causes: Arthritis is caused by the breakdown of cartilage, which usually protects the joint, allowing for smooth movement. Cartilage is also helpful in absorbing the shock when pressure is placed on the point, like walking. Although the breakdown of cartilage is the usual cause of arthritis, there are several other causes. You may have joint inflammation because of:
- An autoimmune disease
- Broken bones
- General “wear and tear” on joints
- Infection can all cause arthritis
Inflammation usually goes away after the injury healed, disease treated or infection treated. However, with some injuries and diseases, the inflammation does not go away and the damage results in long term pain and deformity. This is classified as chronic arthritis.
Osteoarthritis is the most common type and is a degenerative arthritis. This happens more with age and is seen in all joints but most commonly in hips, knees, fingers. If you are overweight, had a previous weight injury, or were involved in something that put mass amounts of pressure on your joints, the risk factors increase.
Symptoms:
- Joint Pain
- Joint Swelling
- Reduced ability to move the joint
- Redness of skin around joint
- Stiffness, especially in the morning,
- Warmth around joint
Treatments: Each individual case of arthritis brings about a different treatment plan. our age and occupation as well as lifestyle all plays into the treatment. Treatment focuses on eliminating the underlying cause of the arthritis, however, the cause might not be curable. Medications and lifestyle changes can help minimize arthritis symptoms. Exercise for arthritis is necessary to maintain healthy joints, relieve stiffness, reduce pain, and to improve muscle and bone strength. Low impact aerobic active, range of motion exercises and strength training can all help. Physical therapy also can be incorporated into the treatment plan. The following are a few of the medications used to combat arthritis;
Anti-inflammatory Painkillers (NSAIDs): Nonsteroidal anti-inflammatory drugs or NSAIDs are available both over-the-counter and by prescription. Almost everyone with arthritis has taken or is taking one of these drugs. Prescription doses can help curb joint inflammation.
Hyaluronan Injections: There are several versions of hyaluronan injections, also called viscosupplementation, that are used to treat osteoarthritis of the knee. They are injected directly into the joint.They have been shown to reduce pain in a knee affected by osteoarthritis, increasing mobility and allowing more activity.
Disease-Modifying Antirheumatic Drugs (DMARDs): These drugs are often able to alter the course of some forms of inflammatory arthritis -- diseases such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis -- that can destroy the joints. Often these drugs are the first ones used for these diseases.DMARDs work by interfering with or suppressing the immune system that attacks the joints in people with certain forms of inflammatory arthritis. Aggressive treatment of arthritis often involves using one or more DMARD.Although effective, DMARDs have a higher risk of serious side effects. It also often takes weeks for you to notice the benefits of taking a DMARD. Therefore, they are often combined with a faster working drug such as an NSAID, another painkiller, or steroids to help relieve some arthritis symptoms.
Hearing Loss:
Definition: Gradual hearing loss occurring as you age is called presbycusis. About ⅓ of Americans between the ages 65-75 and about half of those over 75 suffer from hearing loss.
Causes: Hearing loss can occur due to several different causes. For some, the buildup of earwax blocks the ear canal and prevents conduction of sound waves. However, in most cases hearing loss is a result from damage in the inner ear. Aging and extreme exposure to loud noises can induce wear and tear on the hairs and nerve cells in the cochlea that sends sound signals to the brain. When the hair or nerve cells are damaged, they can’t communicate with the brain properly, promoting hearing loss.
Treatments: Treatments depends of the specific cause and severity of the hearing loss. Some options include;
- Removing wax blockage: This is a simple process that is cured by removing earwax by loosening it with oil and then flushing, scooping, or suctioning the softened wax out.
- Hearing Aids: Is a small device that fits in or on the ear, worn by a partially deaf person to amplify sound. An audiologist can lay out the potential benefits of using a hearing aid as well as recommending a device that is suitable with you.
- Cochlear implants: Is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. Cochlear implants are often called bionic ears.For those with severe hearing loss, cochlear implants may be a good option.
Vision Loss:
Definition: Loss of vision among the elderly is actually a major healthcare problem. 1 in 3 elderly persons suffers from some type of vision reducing eye disease by age 65. Vision impairment leads to a decreased ability to function and perform daily activities, increasing risk of depression. Vision loss can create many problems for the elderly like;
- increased risk of falls and fractures
- increased risk of depression, 52% more than those without vision impairment
- difficulty identifying medications
- difficulty in bathing, dressing, and walking
Causes: Age-Related Eye Diseases is a major cause of vision impairment. The 4 different types of ARED’s are;
- Central Vision Loss (age related macular degeneration)
- Side (peripheral) vision loss (Glaucoma)
- Overall blurring, clouding of images, sensitivity to light, and decreased contrast (cataracts)
- Spotty field of vision (diabetic retinopathy)
Age -related macular degeneration is the leading cause of vision loss in the aging population and the leading cause of blindness in caucasian elderly. AMD is seen in about 1 in 10 while americans over the age of 80. AMD is a common eye disease that causes deterioration of the macula, which is the central area of the retina. When the macula is damaged, many daily activities such as reading and driving become very difficult. Age is a huge risk factor for age related macular degeneration. Cataracts are a symptom of macular degeneration, it clouds up the eye’s natural lens.
Treatments: The only effective treatment for cataracts is surgery.
Stroke:
Definition: A stroke occurs when blood flow to a part of the brain is interrupted because of a block or a burst. If blood flow is stopped for longer than a few seconds, brain cells start to die, causing permanent damage. When brain cells die during a stroke, abilities controlled by that area is lost. These abilities can include speech, movement, memory. How a stroke victim is affected depends on where the stroke occurs in the brain. The risk of stroke increases with age. After a person reaches the age of 55, stroke risk doubles for every decade a person is alive. Other risk factors of stroke:
- High Blood Pressure
- Atrial Fibrillation
- High Cholesterol
- Diabetes
- Atherosclerosis
- Tobacco use and Smoking
- Alcohol use
- Obesity
Symptoms: Symptoms of stroke very on the severity of the damage in the brain. In some cases, a person bay not even be aware that he or she has had a stroke. Symptoms can develop suddenly and without warning, or they may occur on and off within the first few days. Headaches may occur, especially if the stroke is caused by bleeding in the brain. Other symptoms that can occur:
- Muscle weakness in face, arm and leg (usually just on one side)
- Numbness or tingling on one side of the body
- Trouble speaking or understanding others
- Problems with eyesight
- Sensation changes
- Changes in hearing
- Changes in alertness
- Personality, mood, or emotional changes
- Confusion or loss of memory
- Difficulty swallowing
- Changes in taste
- Difficulty writing or reading
- Loss of coordination
- Loss of balance
- Clumsiness
- Trouble walking
- Dizziness or abnormal sensation of movement
- Lack of control over bladder or bowels
Treatment: Recovery from a stroke is a long process. For many people, formal rehabilitation, which can restore independence by improving physical, mental and emotional functions. Some brain cells may be only temporarily damaged and not killed, therefore actually fully recovering. In some cases different regions of the brain take over for the damaged part. Rehabilitation can help relearn basic skills. Rehabilitation can occur in hospitals, home therapy, and long-term care.
Glossary
Acetylcholine-a neurotransmitter in the striatum area of the brain. It is involved in many brain functions, such as memory and control of motor activity. There appears to be a interplay between the actions of acetylcholine and dopamine.
Acetylcholinesterase inhibitor-A medication that increases the level of acetylcholine in the brain and is commonly used to treat cognitive disorders.
Acupuncture-a form of complementary or alternative medicine that consists of inserting small needles into the skin in order to relieve pain and other symptoms.
Adjunctive-supplemental or secondary (but not essential) to the primary agent. Sometimes used to describe medications used to enhance levodopa therapy.
Advanced directive-These often come in two parts. The first, sometimes called a living will, advises your doctor and healthcare team of your wishes for end-of-life care, such as whether you want to be resuscitated or placed on a respirator if your heart or breathing stop. Some states refer to this decision as 'DNR' (Do Not Resuscitate); some label it more gently, 'AND' (Allow Natural Death). The second, often called a medical power of attorney, designates who you want to make your healthcare or end-of-life decisions should you become unable to do so for yourself.
Agonist-a chemical or drug that enhances the activity of a neurotransmitter such as dopamine.
Akinesia-delay in initiating movement; inability to move; 'freezing'.
Alzheimer's Disease-the most common form of dementia. Dementia is a term that is used to describe a group of brain disorders. These brain disorders cause memory loss and make it harder to carry out daily tasks.
Anticholinergic-A substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system.
Antidepressant-A medication used to treat depression.
Anxiety-a feeling of nervousness, worried thoughts and physical distress.
Anxiety attack-A very sudden, discrete period of intense anxiety, mounting physiological arousal, fear, stomach problems and discomfort that is associated with a variety of somatic and cognitive symptoms. The onset of this episode is typically abrupt, and may have no obvious triggers.
Anxiolytic-an agent or a class of medications that reduce anxiety.
Apraxia-a neurological disorder characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements.
Aromatherapy-the use of selected fragrances in lotions and inhalants in an effort to affect mood and promote health.
Ataxia-loss of balance.
Attention deficit disorder-a syndrome, usually diagnosed in childhood, characterized by a persistent pattern of impulsiveness, a short attention span, and often hyperactivity, and interfering especially with academic, occupational, and social performance.
Atypical parkinsonism-a group of brain disorders that initially look like Parkinson's disease, but differ in the course of the disease and response to antiparkinson medications. The term is used interchangeably with Parkinson-plus syndromes.
Auditory hallucination-A perceived voice or sound that is not real.
Basal ganglia-clusters of nuclei deep within the cerebrum, and the upper parts of the brain stem that play an important part in producing smooth, continuous muscular actions in starting and stopping movements.
Benzodiazepine-A class of anti-anxiety medication.
Blepharospasm-Spasmodic winking caused by the involuntary contraction of an eyelid muscle.
Botox-a neurotoxin that is injected into a particular muscle. The muscle becomes paralyzed for a temporary period—usually two to six months. It is used to treat a variety of conditions eyelid or eye muscle spasms, facial muscle imbalance, and/or facial wrinkles. It is also used to treat muscle spasms caused by neurological disorders.
Botulinim toxin-a neurotoxin that is injected into a particular muscle. The muscle becomes paralyzed for a temporary period—usually two to six months. It is used to treat a variety of conditions eyelid or eye muscle spasms, facial muscle imbalance, and/or facial wrinkles. It is also used to treat muscle spasms caused by neurological disorders.
Bowel impaction-stools (feces) that are firmly wedged in the bowel, and have become so hard and dry that they cannot be removed from the body naturally. Additional measures must be taken to allow them to be passed.
Bradykinesia-slowness of movement.
Bradyphrenia-slowness in thought processing.
Caregiver fatigue-Exhaustion and depression associated with taking care of a loved one with a chronic health condition.
Clinical trial-Depending on the type of product and the stage of its development, investigators enroll healthy volunteers and/or patients into small pilot studies initially, followed by larger scale studies in patients that often compare the new product with the currently prescribed treatment.
Cognitive remediation therapy-a therapeutic strategy that seeks to improve or restore a person's skills in the areas of paying attention, remembering, organizing, reasoning and understanding, problem-solving, decision making, and higher level cognitive abilities.
COMT-COMT is the second enzyme involved in the metabolism of levodopa to produce 3-O-methyldopa (3-OMD).
Continuous positive airway pressure-a method of respiratory ventilation used by people with sleep apnea. The CPAP machine was initially used mainly by patients for the treatment of sleep apnea at home, delivering a stream of compressed air via a hose to a nasal pillow, nose mask or full-face mask, splinting the airway (keeping it open under air pressure) so that unobstructed breathing becomes possible.
CT scan-a medical test that uses a computer linked to an x-ray machine to take pictures of the inside of the body.
D2 receptor-a subtype of dopamine receptor.
Deep brain stimulation-a surgical treatment for Parkinson's disease that involves putting electrical stimulators deep within the brain.
Delirium-a state of altered awareness with agitation, hallucinations and confusion.
Delusion-a false, fixed, idiosyncratic belief, not substantiated by sensory or objective evidence.
Dementia-a broad complex of symptoms such as disorientation, confusion, memory loss, impaired judgment, and alterations in mood and personality--symptoms can arise from a variety of causes.
Depression-a feeling of sadness and/or loss of interest or pleasure, usually with negative thinking.
Dopamine-a neurotransmitter that regulates movement and emotions.
Dopamine agonist-a class of medications used to treat Parkinson's disease and includes ropinirole (Requip®), and pramipexole (Mirapex®).
Dopamine transporter-a membrane-spanning protein that pumps the neurotransmitter dopamine out of the synapse and into its vesicles for storage until later use.
Dopaminergic medication-A medication that increases the level of dopamine in the brain and is typically used to treat Parkinson's disease (i.e. carbidopa/levodopa and dopamine agonists).
Double-Blind-Which means that neither patient nor investigator knows which drug a patient is taking. This is another way to prevent observer bias in evaluating the effect of the drug.
Drug-induced psychosis-psychosis induced by certain drugs leading to hallucinations and/or thought distortions.
Durable power of attorney-legal authorization for someone to act as your 'agent' in financial and business matters should you become physically or mentally unable to represent yourself. All adults should complete this simple form to designate who will hold your POA. Many forms allow you to name an alternate if your primary agent is unable or unwilling to serve. Once completed and notarized, the document should be registered in your county of residence. It is a simple matter to revoke or change a POA if necessary.
Dysarthria-Slurred speech due to inability to control articulation.
Dyskinesia-abnormal, involuntary body movements that can appear as jerking, fidgeting, twisting, and turning movements; frequently induced by medications taken by Parkinson patients. Dystonia, athetosis, and chorea are forms of dyskinesias.
Dysphagia-difficulty in swallowing.
Dystonia-involuntary spasms of muscle contraction, which cause abnormal movements and postures.
Electroconvulsive therapy-a treatment for severe depression that is usually used only when people do not respond to medications and psychotherapy. ECT involves passing a low-voltage electric current through the brain. The person is under anesthesia at the time of treatment.
Endogenous-originating internally; developing from within, rather than caused by external factors; the opposite of exogenous.
Essential tremor-a condition more common than Parkinson's disease, which often includes shaking of the hands or head, and an unsteady quality of the voice.
Freezing-temporary involuntary inability to take a step or initiate movement.
GABA-a neurotransmitter in the brain, which is considered to be involved in muscle relaxation, sleep, diminished emotional reaction and sedation.
Generalized anxiety disorder-an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry.
Globus pallidus-a sub-cortical structure of the brain. It is a major element of the basal ganglia system.
Hallucination-A deceptive sensory experience (involving seeing, hearing, tasting, feeling and smelling) that is not really happening.
Hallucinosis-a state of experiencing hallucinations.
Homocysteine-an amino acid used normally by the body in cellular metabolism and the manufacture of proteins.
Hyperhidrosis-excessive sweating.
Hypomimia-decreased facial expression due to rigidity of facial muscles.
Hypophonia-low voice volume or muffled speech
Idiopathic-of unknown origin.
Incontinence-involuntary urination or defecation.
Intercourse-Outercourse approach-a sexual therapy approach, which emphasizes both the importance of intercourse as well as outercourse activities defined as any erotic activity that does not involve the insertion of a penis into a vagina or anus.
Lewy body-a pink-staining sphere found in nerve cells, considered to be a pathological marker for Parkinson disease.
Limb dystonia-abnormal tone of muscle, characterized by prolonged, repetitive muscle contractions that may cause twisting or jerking movements of the body or a body part.
Livido reticularis-purplish or bluish mottling of the skin caused by certain medications taken by Parkinson's patients.
Living trust-Many financial planners feel like these alternatives to simple wills are the most over-sold and unnecessary document being marketed to senior adults. The goal of a living trust is to protect the heirs (called 'trustees') from certain estate taxes, and avoid lengthy and expensive probate procedures. Many states have streamlined probate procedures to be completed within 60 days of a death, and many Certified Financial Planners (CFP) advise clients to avoid them if all property owned is in the state of residence.
LRRK-2 Gene-There are genes that have now been implicated in the cause of a subtype of Young-Onset Parkinson's disease known as the LRRK-2 gene or Parkin 9 gene.
Lumbar puncture-a procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give drugs. Also called spinal tap.
MAO-B-an enzyme in our body that naturally breaks down several chemicals in our brain including dopamine.
Meditation-a mental discipline by which one attempts to get beyond the reflexive, 'thinking' mind into a deeper state of relaxation or awareness.
Micrographia-small, cramped handwriting.
Mini-Mental State Examination-the mini-mental state examination which is also known as the MMSE, standardized MMSE, SMMSE, or the Folstein, is a brief examination consisting of eleven questions intended to evaluate an adult patient's level of cognitive functioning.
Minor depression-refers to a less extreme form of clinical depression and does not meet the criterion of major depression.
Monotherapy-treatment that involves only one drug.
Montreal Cognitive Assessment-MOCA, a brief examination consisting of eleven questions intended to evaluate the level of cognitive functioning, tailored specifically for patients with Parkinson's disease.
MRI-a medical imaging technique that uses magnetic forces to obtain detailed images of the body. MRI is non-invasive and does not use radiation.
Multi-task-to handle multiple tasks at once.
Muscle wasting-also known as muscle atrophy, is a decrease in the mass of the muscle; it can be a partial or complete wasting away of muscle. When a muscle atrophies, it becomes weaker, since the ability to exert force is related to mass.
Myoclonus-abrupt, jerking movements of the arms or legs, commonly occurring during sleep and benign, but could be a separate movement disorder.
Neurodegenerative-a disease in which there is a progressive loss of structure or function of neurons, including death of neurons.
Neuroleptics-drugs that block dopamine receptors, usually prescribed to treat psychiatric symptoms.
Neuron-a cell that generates or conducts electrical impulses to carry information from one part of the brain to another.
Neuroplasticity-the changing of neurons, the organization of their networks, and their function via new experiences. According to the theory of neuroplasticity, thinking, learning, and acting actually change both the brain's physical structure anatomy and functional organization (physiology) from top to bottom. (also referred to as brain plasticity, cortical plasticity or cortical re-mapping)
Neuroprotective-mechanisms within the nervous system which protect neurons from apoptosis or degeneration, for example following a brain injury or as a result of chronic neurodegenerative diseases.
Neuropsychologist-a licensed psychologist with expertise in how behavior and skills are related to brain structures and systems. In clinical neuropsychology, brain function is evaluated by objectively testing memory and thinking skills.
Neurostimulator-a battery-powered device designed to deliver electrical stimulation to the brain.
Neurotransmitter-a biochemical substance (such as dopamine, acetylcholine, or norepinephrine) that carries impulses from one nerve cell to another.
Norepinephrine-a chemical transmitter involved in regulating the involuntary nervous system.
Obsessive-Compulsive Disorder-an anxiety disorder in which a person has an unreasonable thought, fear, or worry that he or she tries to manage through a ritualized activity to reduce the anxiety.
Obstructive Sleep Apnea-the more common form of sleep apnea in which throat muscles collapse preventing patient from breathing and culminating in the short episode of breathing interruption (apnea).
Off-On phenomena-changes in motor performance by patients on levodopa therapy.
Orthostatic hypotension-a drop in blood pressure upon standing; can cause fainting.
Palsy-paralysis of a muscle group.
Paranoia-extreme distrust or suspicion.
Parkin-9 Gene-There are genes that have now been implicated in the cause of a subtype of Young-Onset Parkinson's disease known as the Parkin-9 gene or LRRK-2 gene.
Parkinson's Disease-Parkinson’s disease is a neurodegenerative brain disorder that progresses slowly in most people. When approximately 60 to 80% of the dopamine-producing cells in the brain are damaged, and do not produce enough dopamine, the motor symptoms of Parkinson’s disease appear.
Perimenopausal-the years leading up to menopause, during which levels of female hormones fluctuate more widely than normal from month to month as hormone production gradually decreases and periods become irregular. Perimenopause usually lasts 2 to 8 years, with an average of 5 years
Positron emission tomography-(also called PET imaging or a PET scan)a type of nuclear medicine imaging that uses small amounts of radioactive material to diagnose or treat a variety of diseases.
Postural hypotension-a drop in blood pressure (hypotension) due to a change in body position (posture) when a person moves to a more vertical position from sitting to standing or from lying down to sitting or standing. Postural hypotension is more common in older people.
Postural instability-the tendency to fall without explanation, usually when pivoting.
Psychosis-a broad medical term used to describe a loss of contact with reality that involves hallucinations and/or delusions.
Psychotherapy-the treatment of people diagnosed with mental and emotional disorders using dialogue and a variety of communication techniques.
Randomization-a method used in clinical trials whereby study participants are assigned to a treatment group based on chance.
Rapid-Eye Movement-a normal stage of sleep characterized by the rapid movement of the eyes. REM sleep in adult humans typically occupies 20–25% of total sleep, about 90–120 minutes of a night's sleep. During a normal night of sleep, humans usually experience about four or five periods of REM sleep; they are quite short at the beginning of the night and longer toward the end.
Rapid-Eye Movement Behavior Disorder-a disorder in which people act out dramatic and/or violent dreams during rapid-eye movement (REM) stage sleep. Another feature of RBD is shouting and grunting. RBD is a type of parasomnia, which is a condition that occurs during sleep and creates a disruptive event.
Restless legs syndrome-a sleep disorder in which an uncomfortable or creepy-crawly feeling occurs in the legs while at rest, primarily at night, and causes an irresistible urge to move the legs.
Retropulsion-the tendency to fall backwards.
Rigidity-changes of the muscle tone associated with increased resistance noted to the passive movement of a limb.
Schizophrenia-a psychiatric illness that can involve hallucinations and delusions.
Seborrhea-oily skin.
Selective Serotonin Reuptake Inhibitors-also known as an SSRI, is an antidepressant drug that acts by blocking the reuptake of serotonin so that more serotonin is available to act on receptors in the brain.
Sensate Focus-a term usually associated with a set of specific sexual exercises for couples or for individuals. The term was introduced by Masters and Johnson, and was aimed at increasing personal and interpersonal awareness of self and the other's needs.
Serotonin-a neurotransmitter that regulates mood, emotion, sleep and appetite.
Shunt-a shunt is a hole or passage that moves, or allows movement of fluid from one part of the body to another.
Sialorrhea-drooling; increased salivation.
Sleep apnea-is a sleep disorder characterized by pauses in breathing during sleep. Snoring and daytime sleepiness are signs a person might have sleep apnea.
Sleep study-a test used in the study of sleep and as a diagnostic tool in sleep medicine.
Social avoidance-avoiding social situations due to feelings of anxiety, fear and/or embarrassment around others.
Speech-language pathologist-a specialist in the diagnosis and non-medical treatment of speech and language disorders.
SSRI-Selective Serotonin Reuptake Inhibitor. Is an antidepressant drug that acts by blocking the reuptake of serotonin so that more serotonin is available to act on receptors in the brain.
Striatum-the area of the brain that controls movement, balance, and walking.
Stroke-the sudden death of some brain cells due to a lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain.
Substantia nigra-an area of the brain where cells produce dopamine.
Subthalamic nucleus-a small lens-shaped nucleus in the brain where it is a part of the basal ganglia system.
Subthalmus-a region of the brain that sits below the thalamus and It receives input connections from the substantia nigra and striatum.
Synapse-the junction between a terminal of a neuron and either another neuron or a muscle or gland cell, over which nerve impulses pass.
Tai-Chi-Chinese system of slow meditative physical exercise designed for relaxation and balance and health.
Thalamus-a structure consisting of two egg-shaped masses of nerve tissue, each about the size of a walnut, deep within the brain. The thalamus is a key relay station for sensory information flowing into the brain and filters out information of particular importance from the mass of signals entering the brain.
Tremor-involuntary shaking of the hands, arms, legs, jaw, or tongue.
Trunk-the body of a human or animal excluding the head and limbs.
Urinary retention-a lack of ability to urinate.
Visual-perceptual skills-the capacity of the mind and the eye to 'see' something as it objectively exists.
Visuospacial function-pertaining to perception of the spatial relationships among objects within the field of vision.
Vivid dreaming-a dream state in which the dreams are vivid, lifelike and disturbing at times.
Wearing-off phenomena-waning of the effects of a dose of levodopa prior to the scheduled time for the next dose, resulting in decreased motor performance.
Yoga-a system of exercises practiced as part of the Hindu discipline to promote control of the body and mind.
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