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.

For the U.S., results from the 2007 Aging, Demographics, and Memory Study (ADAMS), funded by the National Institutes of Health, Bethesda, Maryland, found that about 3.4 million Americans aged 71 years and older — almost 14% — have dementia, and 2.4 million (9.7%) have Alzheimer’s disease. ADAMS was the first population-based study of dementia to include people from all regions of the country.

Dementia is the general term used for the variety of brain afflictions that cause its sufferers not to be able to remember – continually losing their train of thought and experiencing changes in behavior. The most common form of dementia is Alzheimer’s disease which affects up to 70 percent of dementia victims. More than half of this population live in countries of low to medium income.

According to the WHO report, only 20-50 percent of dementia cases are being recognized, even in richer countries, thereby making it evident that better diagnosis is needed. Oleg Chestnov, WHO’s assistant director general of Noncommunicable Diseases and Mental Health, would also like to see health and social care added to better detection, as he feels that many healthcare workers are not properly trained to recognize this disease.

Currently, there are eight countries that have programs in place to approach the issues of dementia on a national level. Those countries are Britain, France, Netherlands, Norway, Denmark, South Korea, Japan and Australia. Germany and Sweden are providing their citizens with lists of recommendations of how citizens can proceed.

WHO’s report also emphasizes that there is an overall lack of understanding and information, creating fear. Therefore, people resist asking for help. The recommendation is that health care professionals need to:

• help reduce that fear,
• give better care to the victims, and
• provide support for those that care for the dementia sufferer.

In summary, Shekhar Saxena, head of the mental health department at WHO, reports that as people live longer: 1 in 8 people over 65 years of age, and 1 in 2.5 people over the age of 85 will be affected by this disease. Dementia is a disease that cannot be cured but, if dealt with properly, its progress can be slowed.

The olfactory system, being one of the oldest sensory systems, is the first to be affected with the onset of dementia or Alzheimer’s. US researchers have created a list of scents used to help make the determination. These smells include cheese, clove, fruit punch, leather, lemon, lilac, lime, menthol, orange, pineapple, smoke and strawberry. If an individual cannot recognize three of the ten given, then they are five times more likely to develop Alzheimer’s.

But what about people who have had a bad sense of smell all of their lives or have lost the ability to smell in their 20s, 30s, 40s or 50s; ages too young to be given an Alzheimer’s diagnosis? Medical science’s term for this inability, called hyposmia, can be associated with zinc deficiencies (if a cold or sinus infection has been ruled out), smoking, elevated blood alcohol levels or misuse of some cold remedy nasal sprays.

Recommendations include eating more zinc rich foods (lentils, oysters, pecans and sunflower seeds), taking a multivitamin with at least 7 mg. of zinc, exercise, decreasing mucus inducing foods (ice cream, milk and cheese) and increasing moisture either with a humidifier or a saline spray.

Other common causes of smell disorders are:

• Sinus and other upper respiratory infections
• Polyps in the nasal cavities
• Frontal head injuries
• Hormonal disturbances
• Dental problems
• Exposure to certain chemicals, such as insecticides and solvents
• Numerous medications, including some common antibiotics and antihistamines.

Then there are the people who are born without a sense of smell. Many are missing their olfactory bulb which is the most crucial part of brain’s olfactory system. These people are diagnosed with ICA or isolate congenital ansomia. According to Ilona Croy of the Smell and Taste Clinic at the University of Dresden Medical School in Germany, people with ICA can still taste but not in the same way that can be distinguished when one is able to smell.

If you have experienced a sudden loss of smell, please visit with your physician to help determine whether it’s a simple cold or an indicator of something more serious. Our modern medical science can help nip it in the “bulb” and hopefully when you “stop to smell the roses” you’ll really be able to smell them.

Robert Siegel of National Public Radio talked with Frank Moretti, director of research at the nonprofit research group TRIP. Mr. Siegel brought up the problem of left turns. Here is Mr. Moretti’s response:

As you come to a left turn, particularly if there’s not an actual left turn lane, you’re now in a fairly stressful environment. You’re trying to keep track of the vehicles coming at you, trying to gauge their speed, you’re conscious that there are vehicles behind. So, you’re under a fair amount of pressure. And those are the types of environments that are going to be the greatest challenge for someone: that maybe their reflexes aren’t what they once were, that maybe there’s some diminishment of cognitive abilities, their vision might not be as quite as good as it once was.

But it turns out that seniors are not the only ones at increased risk making left turns. UPS, the package delivery company, noticed that left turns were causing its drivers to spend more time in traffic. So, in 2005, the company began implementation of a $600 million “route optimization system” to provide faster, more efficient delivery. In the process, the company minimized the number of left turns. Quite simply, the time and gas cost of sitting at a light waiting to make a left turn was much higher than making a few more right turns. And as Greg Karbowski, UPS engineer, stated, “Our most dangerous accidents are the ones that occur in intersections where trucks are turning left.”

In 2007, for example, the Federal Highway Administration reported there were 2.4 million crashes at intersections, representing 40 percent of all crashes, and one-fifth of all fatal crashes.

So, what should the conscientious senior driver do? It turns out there are several options. The most severe of which is to stop driving. Although this may seem extreme, Edmunds notes that every year, 600,000 drivers 70 or older do just that. A less severe approach is to limit driving by avoiding crowded thoroughfares, driving only during daylight hours and avoiding rush hour traffic.

AARP offers various courses in driving improvement, both on-line and in classroom settings throughout the country.

And finally, a Yale University study found that certain physical activities and exercise were effective in improving flexibility, coordination and response times in traffic situations.

Having a conversation with a person with Alzheimer’s disease can be quite difficult. Some people with Alzheimer’s disease can speak but not understand and others can understand but are unable to speak. You may need non-verbal cues using prompts, gestures and smiles. Lots of smiles! It is important that one continue to speak with a person with Alzheimer’s even if they cannot speak. A patient, gentle communicator shows care and can be a comfort.

What can be done?

• Approach a person with Alzheimer’s disease from the front, in the direct line of sight and address them by name.
• Talk slowly and use simple words. Once a conversation has been initiated, give the person time to respond.
• Maintain eye contact. Demonstrate a calm demeanor by being gentle and smile. Use body language and non-verbal cues to reinforce what you are saying. They may not understand your words, but they will get a sense based on your facial expressions and body language.
• Refrain from negative statements. Don’t correct mistakes. This causes agitation and confusion.
• Avoid trying to get a person with Alzheimer’s to perform a task, keep your directions simple. Give the directions one step at a time. Sometimes it is helpful to draw a picture or write what you would like them to do. The ability to read is one of the last things to go.
• Finally, use all the patience you can muster. A person with Alzheimer’s may ask the same question many times. Answer the question twice and then offer the person reassurance that everything is alright. Tell them that you are there to help.
• If you find you are becoming frustrated stop the conversation.

These thoughts are based on the article, “Keep on Talking,” Ashleigh B. Egan, in the fall 2006 edition of “Care ADvantage” magazine which is published by the Alzheimer’s Foundation of America.

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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.”