Diabetes: How it affects Older People

Diabetes: How it affects Older People

Diabetes is a common condition in the older population – it affects approximately 20% of the people by the age of 75 years. The metabolism of diabetes in older adults differs from that in young people, and the management of the condition requires a different approach for each group. Here are some ways in which diabetes affects the elderly population.

 

Diabetes: Mental Health

Depression is more frequent in individuals with long-term conditions like diabetes. However, depression may go undiagnosed in senior persons with complex health conditions. Diabetes-related complications and the adverse effects of medication can lead to or aggravate depression. If untreated, depression may lead to challenges with self-care and healthier lifestyle decisions. Depression may also elevate the risk of dementia and mortality in individuals with diabetes. Early identification of mental health issues can help avert their long-term impact and help the patient successfully manage diabetes porno français.

 

Unique Nutrition Concerns

Nutrition is a vital aspect of diabetes management for all ages. Older adults, however, have extra nutritional considerations. While the body’s energy demands decline with age, micronutrient needs remain relatively constant throughout adulthood. Senior people find it challenging to satisfy micronutrient needs while adhering to a low-calorie diet. Consequently, they are prone to deficiencies. Anorexia, swallowing difficulties, altered taste and smell, functional impairments, and oral/dental issues in older adults can lead to undernutrition.

 

Diagnosis and Clinical Presentation

Diabetes: Diagnosis and Clinical Presentation

About 50% of older persons with diabetes do not know they have the condition – they may not present with the apparent symptoms. The symptoms (like lethargy, tiredness, and general) that show are often nonspecific, causing late diagnosis. Common symptoms include dehydration, dry eyes, dry mouth, incontinence, confusion, and diabetes-related complications like neuropathy. Diabetes diagnosis in elderly persons often occurs in hospitalized patients with  complications like stroke or myocardial infarction.

 

Functional Impairment

Diabetes and aging are risk factors for functional impairment. However, those living with the condition are less physically active. Consequently, they are more prone to functional impairment than are people without diabetes. The causes of functional impairment in diabetic patients are the interaction between comorbid conditions, vision and hearing difficulty, peripheral neuropathy, and gait and balance problems. Patients with peripheral neuropathy are more prone to postural instability, muscle atrophy, and balance problems, limiting physical activity and elevating the risk of falls.

 

Barriers to Care

Barriers to Care

Aside from age-related physical challenges, senior diabetes patients may also face challenges like isolation and financial difficulties that adversely affect their care. They may forget (with no one to remind them) to take their meals or drugs. Economic challenges may render them unable to afford quality food and medication. Some may opt to skip medicine doses to extend a prescription. Other factors that may hamper self-care in adults include changes in taste (sometimes caused by medication) and loss of interest and ability to shop for healthy food and make meals at home. Dental issues can also limit the food choices for these patients.

 

Vision and Hearing Impairments

Increases the risk of sensory impairments in older adults. About a fifth of elderly diabetic patients reports visual impairment. Hearing impairment affects twice as many people with this ill. Sensory impairments tend to occur due to vascular disease as well as neuropathy.

 

Comorbidities 

Persistent pain associated with neuropathy or other conditions and inadequate pain management in senior adults can lead to other conditions. For example, functional impairment, depression, anxiety, falls, slow rehabilitation, and sleep and appetite disturbances. Urinary incontinence sometimes occurs in elderly patients, particularly women managing diabetes. Pain can also lead to a higher cost of healthcare and utilization. 

 

 

 

 

5 Tips to Prevent Fractures After 50

Prevent Fractures

As the human body ages, the bones tend to lose density – osteoporosis. The condition can lead to painful fractures, deformities and disability. The good news is that protecting your bone health is very easy. You can prevent Fractures After, delay or reduce bone density loss through healthy living. Here are some tips.

 

Consume Foods Rich in Calcium

Calcium is a vital nutrient for maintaining healthy and strong bones. Unfortunately, most people fail to get enough calcium from their diets. As you age, your body does not absorb calcium efficiently. The recommended dose for adults between 19 and 50 years and men aged 51 to 71 is 1000 mg of calcium per day porno. The recommendation rises to 1200 mg per day for women aged 51 and older and for men of age 71 and older. Good dietary sources of calcium include milk and dairy products, kale, broccoli, almonds, sardines, canned tuna and soy foods like tofu. If you find it a challenge to get sufficient calcium from your diet, you can consult your healthcare provider about calcium supplements.

 

Vitamin D is Critical

Vitamin D is Critical Prevent Fractures

Your body requires vitamin D to absorb calcium. Remember, your body does not easily absorb calcium without vitamin D, and its deficiency can lead to loss of bone mass. Moderate exposure to the sun allows your skin to make vitamin D for the body. However, the ability of the skin to produce vitamin D diminishes with age. Furthermore, the sun is not strong enough during the winter months. Good dietary sources of vitamin D include fatty fish like tuna, catfish, sardines, mackerel, sardines, trout, and salmon. Some food products like milk, rice milk, yogurt, some types of soy, juice, cheese and nutrition bars are fortified with vitamin D. You can also consult your physician for advice and recommendation on vitamin supplements.

 

Avoid Smoking and Limit Alcohol

Smoking elevates the rate of bone loss, and those who smoke are more prone to fractures than non-smokers. Females who smoke tend to experience menopause earlier than non-smokers do. This implies fast bone loss occurs at an earlier age. While alcohol consumption will hardly affect your bones’ health, chronic heavy drinking can cause poor calcium absorption in the body. This can lead to a reduction in bone density and weaker bones that are prone to fractures. Young women who drink heavily during their teens and twenties are more susceptible to bone density loss.

 

Include Exercises in Your Routine

Include Exercises in Your Routine

Bones grow stronger with increased physical activity. Participate in weight-bearing activities like walking, climbing stairs, dancing, hiking and more and resistance exercises like weightlifting. These exercises will help strengthen your muscles and retard bone loss. Endurance exercises and exercises that help enhance posture and coordination (like yoga, flexibility exercises and tai chi) will help reduce the risk of falls and consequently prevent fractures.

 

Prevent Falls

Preventing falls is essential to avoid bone fractures as you age. Most fractures happen due to preventable falls. Some measures that can help avert falls include participating in exercise programs that focus on your abilities and wearing comfortable shoes that provide good support. Beware of uneven grounds, floors and sidewalks and do not rush to respond to a doorbell, catch a bus or answer a phone. Furthermore, get rid of clutter to free walking ways, secure or remove scatter rugs and do not walk in the dark; always use nightlights at night.

 

 

 

 

 

The Signs of Elderly Abuse Explained

As people grow older, they become dependent on others for care. This exposes the elderly persons to elder abuse and neglect. The term elder abuse refers to when another person inflicts harm or neglects a person of age sixty or older. Elder individuals experiencing abuse are often afraid or embarrassed to communicate about their experiences. Below are some signs of elder abuse, a knowledge of which can help create awareness and help you intervene to stop elder abuse – you can save a life and ensure the wellbeing of an older person.

Signs of Physical Abuse

The most obvious signs are visible physical injuries. The older person experiences pain or constrained movement. The elder may have unexplained injuries like sprains, black eyes, bruises, broken bones, dislocations, burns scars, laceration, swelling, or welts.Restrained elderswill have rope marks on their wrist.

The victim may lack arousal – they may lack awareness and may experience confusion and vagueness. The abused appeartired and sleepy. The victim may exhibit unexplained anger, fear, shutting down, and withdrawal behavior around the caregiver. He or she frequently calls for treatment and care even for minor conditions.

In a bid to cover, the caregiver does not allow you to see the elder in their absence. The afflicter (often the caregiver) is overly protective or controlling. He or she may narrate conflicting stories and show reluctance in seeking medical care or reporting elder injuries.

Signs of Sexual Abuse

The indicators of elder sexual abuse include torn or bloodstained clothes, particularly undergarments. The elder may have internal injuries, experience porno en francais frequent incontinence, difficulty in walking, and pain on touching. The casualty may have bruises such as scratches, burn marks, injuries to face, thighs, buttocks, breasts, and abdomen.

The victim may suffer from sexually transmitted illnesses and infections. Physical trauma may also cause bleeding around the genitalia, rectum, chest, or mouth. Behaviorally, the victim may exhibit fear, agitation, withdrawal, disturbed sleep, and lack of awareness.

The caregiver appears overly protective and controlling. Often the afflicter always attends appointments with the elder. The caregiver will often give conflicting narrations.

Signs of Psychological Abuse

The elder may exhibit symptoms of depression, including tearfulness, sadness, confusion, and disorientation. Social withdrawal or isolation is common, and video porno italiani they experience insomnia. The victim feels helpless and ashamed. Other signs included unexplained paranoia, anxiety, nervousness, fearful, and intimidation. There is change in self-esteem characterized by lack of confidence. The elder may show rocking behavior, anger, frustrations, and apathy. There is a marked change in behavior around the abuser.

The indicators of physical abuse may show improvement when the elder is in a company of some people. However, this is often temporary, and the symptoms revert in the presence of the abuser.

Signs of medication abuse

The symptoms of inappropriate administration of prescribed drugs include over-sedation, confusion, grogginess, and reduced physical as well as mental activity. The elder may show reduced or lack of therapeutic response to prescribed medication due to failure to abide by the doctor’s prescription. Scattered pills may indicate medical negligence or inappropriate use of drugs or alcohol. Medical reports that reveal drug overdose, missing prescription drugs, and not taking prescription medication indicate elder medication abuse. Poor medication management may cause repeated accidents and falls marked by frequent emergencies to the emergency department.

A complete guide to prevent elders’ abuse

Prevention for the Individual: from Stranger Abuse (although these tips are under the section of elder abuse, everyone can use them)

Do not leave your doors unlocked, even if you are home during the day.
When you leave the house, you can leave on a television or a radio.
Before going to bed at night, make sure the doors are locked and the windows are sealed.
Do not open the door to strangers.  And, don’t be afraid to ask for ID if they say they are a policeman.
If you receive many prank calls, you can get your address changed and you can have it unlisted.
If you feels someone is stalking (or watching) you, inform others.  Let family and friends know what is going on.
Find out if your neighbourhood is part of the NeighbourHood Watch program.  It’s where neighbours look after each other during the day and night.  The neighbours takes special notice of strangers prowling the neighbourhood.
Don’t take your wallet out while walking down the street.  It may get stolen.
When shopping in a store, make sure you get the correct change or receive your credit card back.  There have been incidences where cashiers will hand back the incorrect change on purpose, thinking that you won’t notice or that if you do notice you will think that you must have made the mistake.
Be careful of scams.  If someone asks you to put in money for an investment, seek advice from a professional such as a lawyer.
When having repairs for your car or home, you may want to get at least two estimates.  That way you will know that you are not being over priced.  For example, something that usually costs $50, should not be charged $300.

Prevention for the Individual:
From Family Member Abuse
Do not live with a family member who is or has been abusive to you or any one else in the past.
If your family member has a history of abuse, you may wish to have someone else assist you.
Speak to your friends, if you feel you are being taken advantage of, talk to someone about it.
Review your will. If you make changes, be sure it is because YOU want to, not because of pressure from family members.
Have friends and/or neighbours visit you often.
Seek legal advice when making decisions.
Have you social security or pension check deposited directly in to your account.
If you are going to Sign a Power of Attorney, speak to your lawyer first. Make sure you have listed out what you want to occur.
Do not sign anything until you have read it. If you have difficulty understanding the legal terms, seek out a lawyer and have him/her explain it to you.
Become involved with community, join clubs and activities.
Start early. Make as many arrangements as you can.

Prevention for the Individual:
Know Your Rights
You have the right to decide your own affairs to the best of your ability.
If you are going to have a Power of Attorney, make sure you choose the right person. If something should happen, your Power of Attorney has full say in your affairs.
You have the right to confidentiality. If you speak to an attorney, you do not have to tell your family what was said. You do not have to let others know what is included in a will.
If you are being abused, you have the right to seek out the authorities.
You have the right to be respected and to not be taken advantage of.
You have the right to take care of your own affairs for as long as you are able.

Lawmakers fail on oversight legislation

For years, New York lawmakers have tried — and failed — to pass a law that would regulate assisted living to protect the state’s frailest elderly residents, including the thousands who suffer from dementia.

Since 1997, advocates and lawmakers in Albany have debated how to oversee the growing industry, with particular focus on getting unlicensed centers on the radar screen of the state Health Department.

Because many places are not required to register with the state, health officials say they may not even know they exist.

There is no federal oversight of the industry, but most states have passed laws over the past few years that define it for consumers and require certain protections. However, that’s not the case in New York, where, since 1999, at least three sets of bills targeting assisted living have failed.

Last year, three separate proposals inching toward passage never resulted in a law, though many say the effort was the closest the legislators had ever come.

The reasons for the failure were complicated. The adult home industry, which includes many homes that currently offer assisted living, believed that aspects of the proposals could potentially undercut their business, and the governor’s office had concerns about how the bill would impact the state budget.

Additionally, lobbyists said the issue was just one of many put off after the historic fight over last year’s state budget, when the legislature enacted its own spending plan over Gov. George Pataki’s objections in May.

So, in typical Albany gridlock fashion, the three parties negotiating — the Assembly, Senate and the governor — were unable to hammer out a final measure that would please everyone. The session ended June 20 without an assisted living law in place.

While assisted living falls into an ambiguously gray area between nursing and retirement home, the facilities serve mostly middle- to upper-class people who need assistance with the rhythms of daily life. But as the population has aged and its residents have become more frail and in need of more intense care, the laws haven’t kept pace.

The 2003 legislative proposals would have called for a uniform definition of assisted living that critics say is crucial to regulating the industry. Advocates for the elderly, lawmakers and health officials agree that without a clear definition, regulators and consumers have no baseline to compare services and fees.

Giving assisted living a unique designation would allow the state to create new rules and standards for the specific residents served by this growing industry, experts say. While many adult care facilities, including adult homes, are already licensed and regulated, the rules were written years ago for a different population.

Additionally, consumers would know where to turn if problems arise with medical care, or if their relative is suddenly evicted because he or she is no longer medically appropriate to live there.

National advocates say New York’s spotty regulation of the industry is shameful.

“New York has the dubious distinction of having the worst assisted living regulations in all the states,” said Karen Love, the founder of the National Consumer Consortium on Assisted Living. “It’s because they largely don’t exist.”

Lobbyists on the state level agree. “It’s unbelievable people can be paying this kind of money into an [assisted living] system that has no definition, no consumer protections and no regulation,” said Fred Griesbach, a lobbyist in Albany for AARP. He said passage of such a law has been among the group’s top priorities.

Legislation sponsors are frustrated as well. “We’re not talking rocket science here,” said Assemb. Steve Englebright (D-Setauket), who sponsored the Assembly’s version of the bill.

“I’m appalled that this has been kicking around while the need becomes increasingly apparent,” added Englebright, who is chairman of the Assembly committee on aging. “We have a quite robust growth industry, especially on Long Island, where these are becoming quite commonplace.”

Over the past three days, Newsday’s series on assisted living has documented hundreds of cases in which residents with dementia were endangered because their centers were neither prepared nor regulated to protect them. In many instances, the elderly and frail either wandered away, sometimes with fatal consequences, or were victims of inadequate medical care, violence from other residents with dementia, or theft.

As far as addressing the problems of those with dementia, last year’s failed proposals would have required that facilities give health officials a written description of the specialized dementia services they provide, including staff training, work experience and professional affiliations of workers serving people with such needs. Currently, the health department only offers unenforceable guidelines, issued in January, on how to deal with those who reside in special dementia units.

Additionally, Wayne Osten, the director of the health department’s office of health systems management, said the governor proposed more comprehensive assessments of potential residents, as well as ongoing reviews of residents who are accepted into assisted living to determine if residents are appropriate to stay there.

Medical experts have said frequent assessments are particularly important in dealing with residents with dementia, many of whom have progressive Alzheimer’s disease.

All parties agree that whatever assisted living law was to emerge would have numerous consumer safeguards.

Pataki’s 2003 “Assisted Living Reform Act” called for “plain language” contracts that fully disclose a residence’s services, costs, fees and policies.

These contracts would have included written residency agreements, and full disclosure of fees and services so consumers can compare residences to make the best placement choices. Additionally, the proposals called for “individual service plans,” developed by the assisted living center and the resident or resident’s family, to identify the services the operator will provide. The protections also would have included having plans in place for alternative placement if a resident becomes too sick to continue living there.

A balancing act

State Sen. George Maziarz (R-North Tonawanda), the former chair of the Senate’s aging committee and original sponsor of the Senate’s assisted living legislation, said consumer protection is crucial.

But he said creating legislation like this can be a balancing act for legislators, weighing the needs of consumers against the bottom line cost concerns of the industry.

“People draw lines in the sand,” Maziarz explained. “You want to help the industry, not hurt the industry. You want to help seniors and give them the most consumer protections possible without making it untenable for any of these industries to move into New York.”

The many attempts to regulate the industry have a long and, some say, frustrating history. They began in 1999, when Pataki proposed a bill requiring registration instead of licensure for assisted living facilities that rely on private paying clients. Registration would have formally identified many centers that operate without licenses, but would not have substantially increased the rules with which these centers must comply.

The proposal primarily focused on financial issues involving consumers, including disclosures of services and fee descriptions; complaint-resolution; and referrals to other facilities if a contract was terminated. It addressed the question of health care in these centers by creating new criteria for both admission and discharge.

That bill never went anywhere because of legislative disagreement and because it was opposed by health care interest groups.

In 2000, Maziarz introduced new assisted living legislation, this time holding hearings upstate and on Long Island to get input on the bill’s framework.

Many of the representatives of local facilities said in the hearings they supported some form of state oversight, but the opinions varied. Atria’s vice president of governmental relations, Julie Harding, testified at the Mineola hearing that the company, which currently has five centers on Long Island, “strongly” supported the concept of a “two-tiered” model that included either licensure or registration. “Had this bill forced all assisted living providers into a licensed model, consumer choice and provider flexibility would have been sacrificed,” she testified at the time.

In June 2001, Maziarz tried again. This time, he pushed a refined bill that mirrored the governor’s initial proposal, offering the option of registration, rather than licensure for some assisted living facilities and requiring extensive disclosure, assessment and discharge-planning.

But Maziarz said some factions of the industry, including many companies that operate licensed adult facilities, balked at further regulation. “We knew we weren’t getting it passed,” Maziarz conceded in an an interview, “but we wanted to get the discussion moving.”

Finally, in late 2002, a bipartisan bill emerged, with Maziarz as the Senate’s sponsor and Englebright as the Assembly’s sponsor. The bill didn’t have much input from advocates, Englebright said, and didn’t pass because the legislature was busy with other issues and the clock ran out.

And finally, last year, three separate bills emerged, from the state Senate, the Assembly and the governor. The Assembly passed its version last summer, and the Senate is expected in coming weeks to pass its version.

Compromise’s pitfall

The ultimate death knell for a compromise among the three parties came when the governor’s budget office found that the latest proposals could create a shortfall in the state’s Medicaid budget.

Under last year’s proposed legislation, licensed adult care facilities, which must include about four hours of personal care a week as part of its room and board fees, could turn in their adult home licenses and become assisted living facilities, said Griesbach. This would open up the possibility that the homes, as well as other entities choosing to become designated assisted living facilities, could collect Social Security disability checks from some residents and bill Medicaid for their personal care, potentially creating a massive impact on the state’s already enormous Medicaid budget.

The governor’s office refused to put a dollar figure on the anticipated shortfall but lobbyists and legislators close to the negotiations said it was anywhere between $5 million and $10 million.

“Because of many assumptions and variables, there was no way to determine a specific amount,” said Ken Brown, a spokesman for Pataki’s budget division.

The largest association representing assisted living and adult homes in the state also had issues with the language of last year’s proposals, believing the legislation didn’t treat fairly the facilities that already were licensed.

Specifically, those homes — which are licensed as adult care facilities — would still have to follow very clear existing regulations that prevent them from keeping sicker, frailer residents. It wasn’t clear, however, if the new legislation would hold previously unlicensed centers to the same standard.

“It wasn’t creating a uniform standard,” said Lisa Newcomb, executive director of the Empire State Association of Adult Homes and Assisted Living Facilities. “It’s not a fair playing field.”

One of the major unlicensed chains offering assisted living on Long Island, Sunrise Senior Living Inc., is in favor of the pending legislation. “We were hopeful that we would have legislation passed this session,” said Maribeth Bersani, Sunrise’s national director of regulatory affairs.

Feds struggle as well

While New York continues to struggle with how to regulate assisted living, so too does the federal government.

In 2001, Sen. Hillary Rodham Clinton (D-N.Y.) testified before Congress, saying families often navigate a “complex terrain” when deciding what kind of facility is best for their families.”Under the current system,” she told Newsday this week, “many consumers lack the necessary information and the adequate standards to decide whether assisted living is appropriate for them or whether more care may be needed. I believe we must develop a true and comprehensive definition.”

Concerned about uneven state regulation, Congress appointed a work group made up of consumer advocates and industry members to examine the state of assisted living and come up with recommendations to improve it.

In its report presented to the Senate last April, the work group offered 110 recommendations and urged that states better inspect facilities before licensing them, especially when they attempt to serve those with dementia.

“Sadly, some facilities that serve people with Alzheimer’s disease and dementia do not even recognize the residents’ cognitive impairments or the need to adapt care to take account of those impairments,” Stephen McConnell of the Alzheimer’s Association testified last spring before the U.S. Senate’s Special Committee on Aging in Washington, D.C.

“They are not health care facilities and when someone develops real health care issues, they probably shouldn’t be in that facility,” said McConnell, vice president of advocacy and public policy for the Washington, D.C.-based group. “They should be somewhere else.”

Should legislation in New York ever materialize, advocates for the elderly say, the state will be pondering similar questions.

Nearly every state in the country has some form of assisted living legislation on the books, said Marvin LeRoy, a lobbyist for the Coalition of New York State Alzheimer’s Association Chapters Inc. “And New York State has been debating this for four or five years. Shame on them.”