In a recent Wall Street Journal article, writer Shirley S. Wang reported that medical science is finding more and more that psychological disorders are showing up as diseases in the body, not just in the mind. Diseases that would normally be associated with old age are showing up in younger individuals who have dealt with or who are dealing with depression, psychological stress and post – traumatic stress disorder for long periods of time. To name a few, these diseases include dementia, diabetes, heart disease and hypertension. (An earlier article, Mental Health in Later Life: A Guidebook, may be found on the Care for You website.)

At the cellular level, chromosomal changes are speeding up; better known as “accelerated aging”. This is alerting science to look at emotions as a symptom of the psychological issues affecting the body. Mood will be looked at as an indicator of some larger health problem.

According to Dr. Owen Wolkowitz, psychiatry professor at the University of California, San Francisco, we as a society will no longer look at depression as a mental illness. Along with his research colleagues, Dr. Wolkowitz wants to understand the connection of the mental with the physical so as to provide a better diagnosis/treatment of mental illness and help improve the memory of those with cognitive problems.

Recent studies are looking at the protective coverings at the end of chromosomes as indicators of problems. These coverings are called telomeres and as one ages, they become shorter. Clinical studies at UCSF and in Sweden show similar results in that there is a link between depression and the length of this protective covering.

Scientists and researchers want to continue working to find out how serious the psychological episodes must be to shorten the telomeres, as well as the genetics’ vs. life events’ effects on age-related diseases and why some stressed people don’t experienced shortened telomeres.

The enzyme telomerase protects the covering’s length and through research, Dr. Wolkowitz’ team has determined that some people have biological capabilities to produce higher anti-inflammatory proteins and antioxidant levels.

Lifestyle changes can also increase the levels of this enzyme, as proven by research involving patients diagnosed with prostate cancer. Dr. Dean Ornish, creator of the Preventive Medicine Research Institute, along with UCSF’s research group, worked with this group and after three months found that telomerase levels had increased. The increase occurred after lifestyle changes were made – including lowering psychological distress and cholesterol.

Since telomere length can be determined through a blood sample, current research at UCSF is comparing the test results of study participants with those of average people of the same age. Researchers will be tracking these participants to see if, after given this information, they have a greater desire to improve their lifestyles.

For people who are bedridden, common places for pressure sores are the back or sides of the head, rim of the ears, shoulders or shoulder blades, hip, lower back or tailbone, heels, ankles and skin behind the knees. For people who use a wheelchair, common places for pressure sores are on the buttocks, shoulder blades, spine, and backs of arms and legs where they rest against the chair.

Per the Nursing Home Abuse Center and others, there are four different stages of pressure sores.  A doctor should be consulted when any of the following symptoms are evident.

Stage I – The beginning stage of a pressure sore has the following characteristics: The skin appears red on people with lighter skin color, and the skin does not briefly lighten when touched. On people with darker skin, there may be no change in the color of the skin. The skin may appear ashen, bluish or purple, and does not briefly lighten when touched. The site may be painful, firm, soft, and warmer or cooler compared with the surrounding skin.

Stage II – The pressure sore is an open wound with damage to the outer layer of skin and part of the underlying layer of skin. The pressure sore may appear as a shallow, pinkish-red, basin-like wound. It may also appear as an intact or ruptured, fluid-filled blister.

Stage III – The sore is a deep wound, the loss of skin usually exposes some amount of fat; the ulcer has a crater-like appearance. The bottom of the wound may have some yellowish dead tissue. The damage may extend beyond the primary wound below layers of healthy skin.

Stage IV – The sore exhibits large-scale loss of tissue, the wound may expose muscle, bone and tendons. The bottom of the wound likely contains slough or dark, crusty dead tissue. The damage often extends beyond the central wound site below layers of healthy skin.

MedlinePlus, a service of the National Library of Medicine in Bethesda, Maryland, references an excellent article  that speaks to recognizing, preventing and caring for pressure sores or ulcers. The article offers advice in several important areas:  

• Skin Care (for intact or normal skin)
• Moving and changing position
• Nutrition and Hydration
• Relieving pressure on the area near the ulcer.

Communication and close coordination with the medical community are extremely important in dealing with pressure sores: first, to prevent the pressure sores from occurring, second, to recognize them early on, and third, to aggressively manage them when found.

Sleep helps the memory process, allows for cell regeneration and strengthens the immune system.According to the article “Sleeping Well as You Age”, many physicians usea senior’s ability to sleep as an indicator of his or her health status. With reduced sleep, there is a greater concern about the onset of depression, memory problems, excessive daytime sleepiness, weight problems, diabetes, cardiovascular disease and even breast cancer in women.

In the aging process, growth hormones and melatonin levels decrease. With the reduction of growth hormones there is less of a deep sleep or slow wave sleep, while the reduction of melatonin can cause a more broken sleep or faster sleep cycles. The circadian rhythm is the internal “clock” that tells you when it is time for sleep and when it is time to wake up. For seniors, as this “clock” is changing, bedtime and rising from sleep happens earlier and with the need to get up during the night, it may take more sleep time to satisfy the senior’s sleep requirement. Sometimes naps are required to satisfy a senior’s needs. It is normal for this to occur.

If  seniors want to improve their quality of sleep, there are easy ways to help, such as participating in social interactions during the day, speaking with a trusted friend about worries and problems, regular exercise and time in the sunlight whether outside or keeping your home bright and sunny. Exposure to light can help regulate melatonin levels.

According to a LiveStrong.com article, http://www.livestrong.com/article/279680-food-containing-melatonin/, another way of keeping melatonin levels up is by consuming trace amounts found in the following foods: olive oil, tomatoes, walnuts, beer and wines, tart cherries and grape skins. Before taking a melatonin supplement,in hopes of getting a sounder night’s sleep, it is recommended that a physician be consulted for directives.

The Better Sleep Council (http://www.bettersleep.org) provides tips on getting better sleep – from checking the mattress to making sure not to exercise or eat too close to bedtime. The Council even recommends having no television, computer or work materials in the bedroom.

According to Timi Gustafson, RD http://blog.seattlepi.com/timigustafsonrd/2010/02/22/the-importance-of-sleep-for-your-health/ , getting ample sleep is one of the greatest remedies for staying healthy and dealing with the stress of everyday challenges. Rested and relaxed seniors will have more energy and the ability to keep a positive outlook on life. When sleep is given high priority, the quality of life is better all the way around.

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“You are old, Father William,” the young man said,
“And your hair has become very white;
And yet you incessantly stand on your head –
Do you think, at your age, it is right?

“In my youth,” Father William replied to his son,
“I feared it might injure the brain;
But, now that I’m perfectly sure I have none,
Why, I do it again and again.”

“You are old,” said the youth, “as I mentioned before,
And you have grown most uncommonly fat;
Yet you turned a back-somersault in at the door –
Pray, what is the reason for that?”

“In my youth,” said the sage, as he shook his grey locks,
“I kept all my limbs very supple
By the use of this ointment — one shilling a box –
Allow me to sell you a couple?”

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“You are old,” said the youth, “and your jaws are too weak
For anything tougher than suet;
Yet you finished the goose, with the bones and the beak –
Pray, how did you manage to do it?”

“In my youth,” said his father, “I took to the law,
And argued each case with my wife;
And the muscular strength, which it gave to my jaw,
Has lasted the rest of my life.”

“You are old,” said the youth, “one would hardly suppose
That your eye was as steady as ever;
Yet you balanced an eel on the end of your nose –
What made you so awfully clever?”

“I have answered three questions, and that is enough,”
Said his father, “Don’t give yourself airs!
Do you think I can listen all day to such stuff?
Be off, or I’ll kick you downstairs.

In an article at Health.com , Dr. David Geldmacher, M.D., professor of neurology at the University of Alabama at Birmingham, states that “having high glucose is a stressor to the nervous system and the blood vessels. The emerging information on Alzheimer’s disease and glucose shows us that we do need to remain vigilant on blood sugar levels as we grow older.”

Diabetes is broken down into two categories, Type 1 which is insulin dependent and Type 2 which is non-insulin dependent. People with Type 1 give themselves daily injections to manage their illness, while people with Type 2 make their own insulin, but their cells do not respond to it properly.

Type 2 diabetes is the more common of the two, affecting 85-90 percent of reported cases. These people can keep their blood sugar levels under control with managed weight, exercise and oral medications.

One thought among researchers is that having diabetes may block the body’s effectiveness in breaking down an amyloid or protein, therefore clumping and creating the plaque associated with Alzheimer’s disease. Joseph R. Burdo, Ph.D., assistant professor at Bridgewater State College in Bridgewater, Mass., reports that everyone’s blood contains a small amount of the protein, but for diabetics, “there may be a synergistic toxicity between the amyloid and high level of blood glucose that is leading to the problems with proper blood vessel formation.”

Science has come to understand how insulin works throughout the body, but with the brain it is not clear. Nor is it clear as to how the insulin gets into the brain. According to Brown Medical School neuroscientist, Suzanne M. de la Monte, brain cells create their own insulin. Neurologist, Jeffrey M. Burns, director of the Alzheimer and Memory Center at the University Of Kansas Medical Center, believes that a portion of the insulin comes from the pancreas.

Wherever this insulin comes from, there is agreement that it is crucial for the “growth and survival of the neurons” that create the brain’s synapses; important for memory and learning. Lower brain insulin levels decreases one’s abilities in these areas.

After many studies and research, Ms. de le Monte stands on the premise that Alzheimer’s and diabetes come from the same disease – and refers to Alzheimer’s as Type 3 diabetes. Until further research is done, she supports exercising as a way to rev up blood flow to the brain and build insulin responsiveness throughout the body as a whole. “It won’t prevent Alzheimer’s…You’re making the brain work harder and delivering more nutrients to the brain.”

Now, Maryland and some other states have come out with a simple two-page form that begins to address this problem. Known by its acronym MOLST, this document gives the medical community information about patients’ wishes regarding whether and which life-sustaining treatments should be administered in the event of a medical emergency or end of life care.

“Maryland MOLST is a portable and enduring medical order form covering options for cardiopulmonary resuscitation and other life-sustaining treatments. The medical orders are based on a patient’s wishes about medical treatments. Effective October 1, 2011, a Maryland MOLST form must be completed for all individuals admitted to nursing homes, assisted living facilities, hospices, home health agencies, and dialysis centers. All hospital patients that are being discharged or transferred to one of these facilities above or another hospital must have a MOLST form completed.”

We stated above that the form begins to address the void of medical personnel not having information about patients’ wishes. However, it is only a beginning, because it is not required for admission to a hospital. Yet the hospital is one of the places where this information is most needed. In the event of a cardiac arrest, would you want cardiopulmonary resuscitation for example? What about having fluids and nutrition administered – indefinitely?

If you want to increase your likelihood that your wishes regarding life-sustaining treatment will be known and followed, the MOLST form is a good place to start. Together with a medical advanced directive and financial power of attorney documents, your medical community will be better equipped to address your medical needs.

Writers and philosophers have debated the topic for years. In his book, The Waterworks, E. L. Doctorow, in a fictional story set in the late 1800s, tells of a group of wealthy men who use nefarious means to promote their own longevity.

The writer, Jonathan Swift, in Gulliver’s Travels, has Gulliver visit the nation of Luggnagg where certain of its citizens are born immortal. They are known as struldbrugs. But lest he get too excited, Gulliver learns that being born a strudbrug is a curse. After about 30 years old, “They grew melancholy and dejected.” By 80, they had become, “not only opinionative, peevish, covetous, morose, vain, talkative, but incapable of friendship, and dead to all natural affection..”.

The tenor of these writings clearly argues against artificially extending our ‘natural’ life.

Yet as we shift away from storytelling, significant and exciting progress is taking place in genetic, stem cell and other medical research. Scientists are investigating aging from many different directions and coming up with ways to slow the process. Looked at another way, one could say they are researching ways to enhance our life quality, and in the process, extend our lives. And it’s not just for the elderly among us.

One exciting example comes from The Wake Forest Institute for Regenerative Medicine. Researchers there have successfully grown bladders in a lab and implanted them in children with spina bifida. Spina bifida is a condition that causes incomplete closure of the spine and, among other complications, subsequent bladder problems. The basic structures of the bladders were created using biodegradable material. The bladders were then filled with the patients’ stem cells. Once a bladder was grown, it was implanted into the patient. There was no problem with organ rejection since the bladder was made from the patient’s own cells. First performed in 1999, the researchers waited until 2006 to announce their achievement as they wanted to first satisfy themselves that the experiment had worked.

Organ printing is another innovative and exciting development underway. Think of a highly sophisticated printer but instead of being filled with ink, it is filled with cells. Then imagine that instead of paper, the printer is printing onto biodegradable material. The printer prints ‘pages’ of cells on top of one another to make a three dimensional shape. The company, Organovo, announced in 2010 that it had successfully created human blood vessels, and is now working on more complex and larger organs.

These examples are but a narrow glimpse of the diverse approaches to improving our life quality, and, in the process, allowing us to live longer. A Wall Street Journal article, Living to 100 and Beyond, from the August 27-28, 2011 Review, states, “gerontologist and scientific provocateur Aubrey de Grey claims that the first humans to live for 1,000 years may have already been born.”  Whether true or not, the astonishing developments in growing replacement organs suggests that far more of us will live to be 100 plus than we ever would have imagined.

Elders want to travel – to vacation, visit family and friends, fulfill a dream, go again to a place in memory. This may seem impossible or difficult at best. He’s blind. She has dementia. He has Alzheimer’s. She can’t go down the street without getting lost, how is she going to make it to the wedding 2,000 miles away?

Given, elder travel is different from the backpacking days of our youth, but it doesn’t have to be gone. Accompanied senior travel makes the world safer, larger, brighter, and a lot more fun for the individual.

A woman we’ll call Michelle contacted our office. Her husband Al had Alzheimer’s Disease and she needed someone with him so he would be safe while she was away at work. His car keys had been taken away, but Al was not one to sit around; he liked to go out and about. And he had one passionate desire: to see Pearl Harbor.

Born in 1925, Al’s father woke him the morning of December 7, 1941. Pearl Harbor had been bombed! “Boy,” he said, “you best go down to the post office and sign up to go fight.” Only 16, Al had to wait a couple of years before serving four years in the army. He later graduated from the University of Maryland, married and raised a family. He was involved in the Boy Scouts, sharing his pride in the “Great U.S. of A.” And someday, he said, he’d see Pearl Harbor.

When our Companion, Gary, met Al, they hit it off immediately. When Gary wasn’t available, his wife and fellow employee Bonnie filled in. (There has to be consistency of care givers or the Alzheimer’s victim gets confused.) Al knew one of them would be there if Michelle couldn’t be.

Al knew he’d never get to Pearl Harbor. Michelle knew differently. She knew she couldn’t handle Al alone, and that she needed a little ‘down-time’ herself. She and Al asked Gary and Bonnie if they would accompany them on a trip to Hawaii.  Four months later the four of them left for the two-week cruise. Unexpectedly, Al noticed a gravelly-voice singer on the beach, with a box in front that read, “If inquisitive to hear, put some $ in the box.” Al put money in and sat mesmerized as the singer sang.

Al passed away three years later. But for three years, he had pictures to look at and talk about – from a place in history, a place he always wanted to go to but feared he wouldn’t be able to – with family and friends.

What Gary and Bonnie did with Al and Michelle was a continuation of what they were already doing with their clients, accompanying them wherever they wanted to go. And why not? This trip was just a little longer.

Ella Wheeler Wilcox had it figured out when her poem, “Solitude”, was published in 1883. Here is the first stanza:

Laugh, and the world laughs with you:
Weep, and you weep alone;
For the sad old earth
Must borrow its mirth,
It has trouble enough of its own.

Especially as we age, it’s easy to get caught up in life’s daily stresses. Physical ailments, retirement worries, illness of a friend or elderly neighbor down the street –  the list goes on. Yet research has shown that people who laugh live longer. According to Sven Svebak of the medical school at Norwegian University of Science and Technology, adults who have a sense of humor outlive those who don’t find life funny, and the survival edge is particularly large for people with cancer.

He released his study of about 54,000 Norwegians, tracked for seven years, at the 2007 American Psychosomatic Society meeting in Budapest, Hungary. The greater a role humor played in their lives, the greater their chances of surviving the seven years. Adults who scored in the top quarter for humor appreciation were 35 percent more likely to be alive than those in the bottom quarter, he says.

In a subgroup of 2,015 who had a cancer diagnosis at the start, a great sense of humor cut someone’s chances of death by about 70 percent compared with adults with a poor sense of humor.

Like your muscles, your brain needs regular workouts to stay healthy and fit as you age. Because just as we lose some muscle as we get older, so can our brains atrophy The brain’s “cognitive reserve”— its ability to withstand neurological damage due to aging and other factors without showing visible signs of slowing or memory loss — diminishes through the years. That can make it more difficult to perform mental tasks. But, just as weight workouts add lean muscle to your body and help you retain more muscle in your later years, researchers now believe that following a brain-healthy lifestyle and performing regular, targeted brain exercises can also increase your brain’s cognitive reserve.

So, as Gerry Hopman says, “Keep learning: computer, languages, skills, crafts, whatever. Never let the brain be idle. An idle mind is the devil’s workshop, and the devil’s name is Alzheimer’s.”

And why shouldn’t we laugh? The way they’re playing with our social security we’re going to have to live longer just to get our money back!

You may ask: What is a caregiver? What does a caregiver do?

According to the Area Agency on Aging of Pasco-Pinellas, Inc., if you are you providing unpaid assistance to a spouse, relative, or friend who is ill, disabled, or needs help with basic activities of daily living you are a caregiver. If you help with rides to the doctor, shopping, meals, bill paying, bathing, grooming, dressing, walking or transferring to a wheelchair, housekeeping, managing medications, or arranging services to be provided by others, you are a caregiver.

Talk to your immediate family about you being the caregiver. Make sure they understand that you will not be able to spend a lot of time with them and let them be involved in your decision. Then reach out to the extended family.

Stage Two – Finding Help

If you have been a caregiver for months – or longer – on a regular basis, you are the primary caregiver. It has become clear that this is not going to be a short-term illness with a quick recovery. If you also hold a full-time job, caregiving may be exhausting you already. What is your loved one’s prognosis? How many more years of caregiving lie ahead?

Now is the time when you must find relief for you, the caregiver. Clearly, the loved one needs to have continuity of care, but if you do not find support for the person needing care there will soon be two people in need. As the flight attendants instruct, “put your mask on first.” If you don’t take care of your health you will not be able to provide the support your loved one needs.  Look to family, friends, faith communities, and caregiving agencies for additional assistance.

Stage Three: Heavy Care

You may have been providing care for years to someone whose mental or physical health is deteriorating – now at a more rapid rate. If the person for whom you are caring has Alzheimer’s disease or another degenerative disease, wandering at night may become a risk. But you cannot work ‘around the clock’. Your first responsibility must be to care for yourself. Caregiver burnout helps no one. Your second responsibility is to protect your care recipient, maintaining a safe and loving environment.

Stage Four: Letting Go

Letting go focuses on the meaningful and positive experiences you shared with your loved one.  It also acknowledges the grief that comes with loss of a loved one – whether through death, placement in a nursing home or mental deterioration. In this final stage, you have come to an end of the cycle of caregiving as you have known it. You will be experiencing grief in your loss, both of the care recipient and of your own role as caregiver. Still, your life must go forward as you reconnect with the world around you. No doubt, your caregiving experience will have given you new perspectives as you resume former activities and, quite possibly, pursue new directions as well.