Tips for Controlling Type 2 Diabetes

Older adults often experience chronic health conditions, in part because of a combination of lifestyle habits and the aging process. Type 2 diabetes is a very common chronic health problem in older adults. As many as 33% of adults age 65 and older have this diagnosis. 1 Controlling type 2 diabetes is critical to your overall health.

If your doctor has told you that you are pre-diabetic or have type 2 diabetes, there are ways you can improve your health and reduce your risk of complications due to diabetes. It requires commitment and new healthy habits, but with consistent effort, you can live a full and active life.

What is type 2 diabetes?

In type 2 diabetes, the pancreas, which is responsible for making insulin, does not do it well. Usually, in response to blood sugar increases, insulin is released to control these spikes. With type 2 diabetes, blood sugar remains too high. This can cause several complications, some of them serious.

Older adults are at higher risk of diabetes due to a combination of changes in the pancreas due to aging, as well as inactivity and sometimes, being overweight. 2

Symptoms of type 2 diabetes

Type 2 diabetes can develop slowly, and it’s easy to overlook symptoms or dismiss them as part of getting older. The Centers for Disease Controls (CDC) lists the following symptoms: 3

  • Increased thirst
  • Frequent urination, especially at night
  • Increased hunger
  • Losing weight without trying to
  • Blurry vision
  • Dry skin
  • Fatigue
  • Numbness and tingling in the hands or feet
  • Sores that heal slowly
  • More frequent infections than usual

Complications of type 2 diabetes

Type 2 diabetes is known to cause several other health complications. Because it can be overlooked for some time before it’s discovered, sometimes these complications are already happening when type 2 diabetes is diagnosed.

These complications are linked to type 2 diabetes: 4

  • Blindness
  • Kidney failure
  • Non-traumatic amputation of toes, feet, or legs
  • Heart disease
  • Stroke
  • Nerve damage
  • Decreased blood flow
  • Risk of death due to extremely high blood sugar (hyperglycemia) or extremely low blood sugar (hypoglycemia)

Older adults especially are at higher risk of these common complications. They have the highest rates of lower extremity amputation, heart attack, end-stage kidney disease, visual impairment, and death of any age group with diabetes. 5

Overall, diabetes is a leading cause of death in the United States, ranked number 7 in 2019. 6

Treating and controlling type 2 diabetes

Controlling type 2 diabetes involves a combination of lifestyle changes and medical care. These steps aren’t always easy to take, but the result of sticking with them is worth it. There are three key areas to focus on to control your diabetes: physical activity, diet, and following your doctor’s recommendations.

Increase your physical activity

The American Diabetes Association (ADA) states that regular physical activity is critical for blood glucose control and overall health for people with diabetes, and reduces A1C (a measure of blood glucose control), cholesterol, blood pressure, and insulin resistance. 7 Their exercise recommendations for type 2 diabetes include:

  • Daily exercise, or at least not skipping more than 2 days of exercise
  • A combination of aerobic and resistance training is best
  • At least 150 minutes per week of physical activity

You can work with your doctor on the best exercise options for you. Walking, yoga, swimming, water aerobics, and other similar activities can be a regular part of your routine. If you have physical limitations, these activities can be modified for you, such as using chair yoga.

Along with improving diabetes, there are other benefits to exercise, too: the ADA found that group exercises like resistance and balance training, and tai chi classes, can reduce falls by 28%−29%. 8

Practice balanced eating

The ADA recommends following the Diabetes Plate method to help control your diabetes: ½ of your plate should be non-starchy (high fiber) vegetables, ¼ should be a protein choice, and ¼ carbohydrates, with water as a drink.9

Fiber, protein, and healthy fats (like poly and monounsaturated fats) all help to keep you full for longer and have less impact on your blood sugar. Some “superstar” foods recommended by the ADA include: 10

  • Beans
  • Dark leafy green vegetables
  • Citrus fruit
  • Berries
  • Tomatoes
  • Fish high in omega-3 fatty acids
  • Nuts
  • Whole grains
  • Milk and yogurt

If you’re overweight, the combination of exercise and healthy eating can help you achieve weight loss, which has been shown to reduce rates of diabetes in people with pre-diabetes, and in some cases can even help people with diabetes achieve remission. 11,12

Follow your doctor’s recommendations

Along with diet and exercise, one of the most important parts of controlling type 2 diabetes is working closely with your doctor and following their recommendations. They will check things like your blood pressure, cholesterol, and blood sugar levels and suggest medications like insulin as needed to help control any problems.

Know your hemoglobin A1C

This blood test is crucial to controlling type 2 diabetes. It is a measure of how well blood sugar has been controlled over time. For people who have not been diagnosed with diabetes, it is an important test to screen for undetected diabetes.

A normal A1C is 5.7% or below, and the goal for people with diabetes is less than 7%. The CDC recommends having your A1C checked twice yearly if you have diabetes. 13

Recognizing an emergency due to diabetes

Two basic emergencies can happen due to diabetes: hyperglycemia and hypoglycemia. In these situations, blood sugar either becomes dangerously high or dangerously low. Untreated, they can lead to coma and death.

Signs of hyperglycemia

Hyperglycemia involves blood sugar that is too high. This can happen because someone has not taken enough insulin, has eaten too much sugar, or during illness. Symptoms of hyperglycemia include: 14

  • Warm, dry skin
  • Dry mouth
  • Rapid breathing or heartbeat
  • Fruity, sweet breath
  • Excessive thirst
  • Vomiting
  • Abdominal pain
  • Drowsiness, confusion, or unresponsiveness

If you suspect hyperglycemia, check your blood sugar and follow any instructions your doctor has given you for insulin dosing for high blood sugar. If your blood sugar remains high, or if a person in your care with diabetes is confused or drowsy, seek medical care right away.

Signs of hypoglycemia

Hypoglycemia involves blood sugar that is too low. When blood sugar falls below 70 mg/dl, you must take action. The CDC recommends following the 15/15 rule: 15

  • For blood sugar between 55-69 mg/dl, consume 15 grams of carbs and recheck blood sugar in 15 minutes. Examples of carbs include 3-4 glucose tablets, 4 oz. of juice or regular soda, 1 tablespoon of sugar, honey, or syrup, 1 dose of glucose gel (usually 1 tube), or hard candies or jelly beans (follow the label for the amount that equals 15 grams).
  • For blood sugar below 55 mg/dl, injectable glucagon can help correct the low blood sugar. This comes in a prescription kit, and your medical team will have to give you instructions and training on its use. It’s also important that caregivers know how to use this injection, since you might not be able to treat yourself if your blood sugar falls this low.

When in doubt, call 911. It’s also important to wear a medical ID so that first responders are aware of your diabetes if an emergency happens and you can’t relay important details to them.

Symptoms of hypoglycemia include: 16

  • Fast heartbeat
  • Shaking
  • Nervousness or anxiety
  • Irritability or confusion
  • Sweating
  • Dizziness
  • Hunger

Well-controlled type 2 diabetes is possible

By following the above recommendations, and maintaining an A1C below 7%, your risk of long-term complications due to diabetes will be greatly decreased. One way you can have success with this is to involve your family and caregivers in your lifestyle change goals.

Family and professional caregivers can help you prepare healthy meals, get regular activity, take your medications as directed, and attend regular doctor’s appointments.

If you’ve been considering in-home care as a way to help you manage your diabetes and other health concerns, Caresify can work with you to provide care that meets your needs at home. You can read more here, or call 888-799-5007.

References

  1. https://www.endocrine.org/patient-engagement/endocrine-library/diabetes-and-older-adults
  2. https://diabetesjournals.org/care/article/35/12/2650/38582/Diabetes-in-Older-Adults
  3. https://www.cdc.gov/diabetes/basics/symptoms.html
  4. https://www.endocrine.org/patient-engagement/endocrine-library/diabetes-complications
  5. https://diabetesjournals.org/care/article/35/12/2650/38582/Diabetes-in-Older-Adults
  6. https://diabetes.org/about-us/statistics/about-diabetes
  7. https://diabetesjournals.org/care/article/39/11/2065/37249/Physical-Activity-Exercise-and-Diabetes-A-Position
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6908414/
  9. https://diabetes.org/healthy-living/recipes-nutrition/eating-well
  10. https://diabetes.org/healthy-living/recipes-nutrition/eating-well/diabetes-superstar-foods
  11. https://www.cdc.gov/diabetes/basics/prediabetes.html
  12. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/achieving-type-2-diabetes-remission-through-weight-loss
  13. https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
  14. https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631
  15. https://www.cdc.gov/diabetes/basics/low-blood-sugar-treatment.html
  16. https://www.cdc.gov/diabetes/basics/low-blood-sugar.html

How to Care for Tubes and Drains at Home

Most people don’t expect to become medical experts on equipment used to treat health concerns, but if you’ve been sent home after a procedure with a feeding tube or drain, it can feel more than a little intimidating.

Even after you’ve been shown how to use them, knowing how to care for tubes and drains at home isn’t always second nature. When you start the process you might suddenly feel stuck, or run into a problem you don’t remember discussing with your doctor or nurse at the hospital.

Let’s take a look at the common tubes and drains that can be seen in the home, and then at basic use and how to troubleshoot problems. With this guide as a handy reference, you can feel like a pro in no time.

What are some common tubes and drains?

Older adults who are experiencing complications of a health condition or surgery may require tubes and drains for various reasons. These can be temporary until a wound or surgical site heals or a condition improves or they may be a more permanent device.

Common tubes and drains include:

  • Feeding tubes- these are used to help someone who can’t eat or drink get nutrition and hydration. They can be temporary, like nasogastric (NG) tubes, or permanent, like gastric (G) tubes (also sometimes called PEG tubes) that connect directly to the stomach, or jejunostomy (J) tubes that connect directly to the small intestine.
  • Surgical drains- these are placed under the skin during surgical procedures to allow excess fluid or infection to drain from a wound or surgical repair. They can be connected to a collection bag, bulb (such as with a Jackson-Pratt, or JP drain), or small pump called a wound vacuum (wound vac). They are removed by your doctor as the area heals and they are no longer needed.
  • Urinary catheters- when the bladder can’t drain well on its own, a urinary catheter may be used to help. There are three common types that can be inserted into the body:
    • A straight catheter, which is single-use
    • A foley (or indwelling) catheter, which enters the bladder through the urethra
    • A suprapubic catheter, which is inserted through the skin on the abdomen just above the pubic area and directly into the bladder.
  • Nephrostomy tubes- inserted through the skin and into one or both kidneys, these drain urine in cases where there is damage to the bladder, the bladder has been removed, or urine cannot travel from the kidneys to the bladder. They can be temporary or permanent depending on the situation.
  • Biliary drains- the bile duct empties bile produced by the liver into the small intestine. If it becomes blocked, bile will build up in the liver. To help with this, a biliary drain that connects to a drainage bag outside of the body is sometimes placed in the bile duct.

How do I care for tubes and drains at home?

There are some basics to keep in mind when caring for tubes and drains. Anytime a device enters the body through the skin or another opening, there is a risk for infection, so it’s important to keep these devices clean and dry and to report signs of infection such as redness, heat, swelling, pain, abnormal drainage, or fever to your doctor right away.

Along with knowing the signs and symptoms of infection, here are some tips for each device:

Caring for feeding tubes at home

Things to know include: 1

  • Follow your doctor’s instructions for skin care around the tube
  • Wash your hands before handling the tube or feeding solution
  • Keep formula refrigerated and never use formula that has been at room temperature longer than your doctor’s recommendation
  • Don’t put anything in the tube that your doctor hasn’t instructed you to use
  • Flush the tube with plain water between feedings and medications to keep it from getting clogged
  • For feedings that go into the stomach, keep the person sitting up or their head up during the feedings and for 30-60 minutes afterward
  • If the feeding is causing nausea, cramps, or diarrhea, slow the rate. You can work with your doctor on the best rate to avoid problems.
  • If the tube comes out or is blocked, call your doctor right away. Don’t try to reinsert it yourself.

Caring for surgical drains at home

Things to know include: 2

  • Empty and measure the collection bag or bulb for your drain as instructed by your doctor
  • Report any changes in drainage (amount, color, or smell) to your doctor right away
  • Fever, redness, swelling, pain, heat, or drainage at the insertion site of the drain need immediate attention
  • If you’ve been given instructions on milking the tubing, be sure you follow them- skipping this step can cause the drain to clog
  • Always wash your hands before handling the drain, tubing, or changing any dressings
  • Change dressings as directed and keep the site clean
  • If the tube falls out, stitches become loose, or the drainage bulb loses suction, notify your doctor

Caring for urinary catheters at home

By caring for a urinary catheter correctly, you can help reduce your risk of developing a urinary tract infection. Here are some things to know about urinary catheters: 3

  • Always wash your hands before touching the catheter or the skin around the insertion site
  • Keep the drainage bag below the level of your bladder, so urine does not flow backwards into the bladder
  • Empty the drainage bag regularly, before it becomes overly full
  • Avoid touching the spout of the drainage bag to anything
  • Report the following to your doctor right away:
    • Changes in the color, amount, or smell of your urine
    • Pain in your abdomen, back, or in your urethra
    • Redness, swelling, pain, or drainage at the insertion site
    • Fever
    • You notice the drainage bag is no longer filling with urine
    • The catheter falling out- with suprapubic catheters, the opening can close if the catheter is not replaced quickly

Caring for nephrostomy tubes at home

Follow these basics when caring for your nephrostomy tube(s): 4

  • Always wash your hands before handling the site, tube(s), or a drainage bag
  • Change the dressing and clean around the insertion site as directed by your doctor. This includes when it is soiled. Missing this step can lead to infection!
  • Follow your doctor’s instructions for flushing the tube regularly
  • Report the following to your doctor right away:
    • Fever
    • Urine or drainage leaking from the insertion site
    • Red, irritated, or painful skin at the insertion site
    • Nausea or vomiting
    • Back or flank pain
    • Foul-smelling urine
    • A tube that falls out
    • Difficulty flushing the tube
    • A drainage bag that stops filling with urine

Caring for biliary drains at home

To care for a biliary drain, there are some basic things to know: 5

  • Always wash your hands before handling the drain, bag, or touching the insertion site or dressing
  • Change the dressing as directed by your doctor, and when it is soiled
  • Flush the drain as directed by your doctor
  • Record any output from the drain as directed by your doctor
  • Report the following to your doctor right away:
    • Fever
    • Redness, swelling, pain, or discharge at the insertion site
    • Your skin or the whites or your eyes have a new or worsening yellow tint
    • The color or smell of the drainage from the biliary drain changes
    • The tube starts to come loose or falls out from the insertion site
    • New or worsening belly pain
    • New or worse nausea or vomiting
    • Inability to pass stools or gas

Caring for tubes and drains at home is a team effort

With all of the above devices, it’s important to remember that you are part of a team when it comes to caring for them at home. If you’re not sure if something is a problem, it’s best to contact your doctor as soon as possible.

Avoiding infection is critical to caring for any tube or drain. Washing your hands, keeping the site and the tube or drain clean, and reporting signs of infection to your doctor immediately can help you avoid complications of infection.

It is equally important to follow up with your doctor as directed. Be sure to keep a record of any drain output if they have asked you to, and bring it to your appointments. If the drain is temporary, this can help them decide when it is safe to remove it.

Involving family and caregivers in the care of your tube or drain at home can help make the process easier. They can watch for signs and symptoms of a problem and sometimes see the site more clearly than you can. Always be sure that anyone else touching your skin near the insertion site while helping you with personal care and hygiene has washed their hands.

By following these simple rules, you can more easily manage the care of a tube or drain at home and continue your regular activities as much as possible.

Professional caregivers through Caresify can help you with personal hygiene and transportation to follow-up appointments if you require assistance with these activities. To learn more, you can read about care services here, or call 888-799-5007.

 

References

  1. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.home-tube-feeding-care-instructions.uh4017
  2. https://www.lahey.org/article/caring-for-your-surgical-drains/
  3. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut2057
  4. https://healthcare.utah.edu/radiology/preparing-appointment/interventional-radiology/percutaneous-nephrostomy-tube-care.php
  5. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abq1886

Choosing Long-Term Care: Alternatives to Enhanced Assisted Living

Many older adults will eventually need long-term care. On average, adults age 65 and older can expect to need at least 3 years of this type of care. 1 What level of care will depend on many factors, like ongoing health concerns, availability of family support and help, financial ability to pay for the cost of long-term care, and more.

The process of choosing the best long-term care option for yourself or a loved one can be daunting. There are multiple choices to pick from, each with its own pros and cons. To narrow down the right fit, it is helpful to understand the differences between these options and which ones might best meet your needs.

If you are considering enhanced assisted living as a long-term care solution, you will also want to weigh it against the other choices available before making a final decision. We’ll help by taking a closer look at enhanced assisted living, as well as other common long-term care options available to older adults.

What is enhanced assisted living?

To understand enhanced assisted living, we have to first understand the different levels of care. Older adults will have different care needs depending on their cognitive abilities, memory, and physical challenges. While some older adults can live independently, there is a 70% chance that someone age 65 or older will need long-term care services for a portion of their life. 2

When an older adult needs assistance with activities of daily living (ADLs), there are several care options available to meet those needs. Often, family is relied on for some help with these ADLs. But if the need for help is ongoing, with a person needing regular assistance with personal care needs and daily tasks, more intensive care is needed.

This is where options like assisted living facilities become a consideration. While these facilities can offer intensive help with ADLs, an enhanced assisted living facility adds another layer of care to the services available. This allows an older adult to remain in a private, independent living arrangement while receiving help with ADLs and medical care, without the higher level of care (and reduced independence) of a nursing home.

Nursing homes as an alternative to enhanced assisted living

To understand the difference between enhanced assisted living and a standard assisted living arrangement, let’s look at nursing homes as an alternative.

Also called skilled nursing facilities, nursing homes offer the highest level of long-term care services available. Older adults residing in skilled nursing facilities must qualify for this level of service. The requirements depend both on Medicare and Medicaid regulations and individual state rules.

Nursing homes offer care to residents that include management of cognitive and behavioral problems due to dementia, and treatment of medical conditions.

A person who is admitted to a nursing home for care can receive care for conditions such as:

  • Medicines that can’t be given at home, especially intravenous (IV) medications
  • Medical problems that are difficult to control
  • Medical problems that have required long hospital stays in the past
  • Complex wounds, including surgical wounds
  • Rehab after joint replacement surgery
  • Stroke
  • Renal (kidney) disease (including patients new to hemodialysis)

This care can include nursing care, physical therapy (PT), occupational therapy (OT), and speech therapy.

Because of the level of skilled care offered in nursing homes, they are one of the more expensive options, with a national median monthly cost of nursing home care of $7,908 for a semi-private room and $9,034 for a private room. 3

Enhanced assisted living can offer some of these care services, like medication management, assistance with feeding, and wound care while allowing an older adult to stay in their own private apartment.

Assisted living as an alternative to enhanced assisted living

If you require assistance with ADLs but don’t have an ongoing need for a higher level of medical care, simple assisted living may be the right fit. In assisted living facilities, residents enjoy the privacy and independence of their own living unit but receive daily help with care needs such as:

  • Personal care, like bathing and dressing
  • Housekeeping and laundry
  • Social and recreational activities
  • Transportation to activities like shopping and doctor’s appointments
  • Meals

This type of long-term care is not covered by Medicare, but portions of it may qualify for Medicaid reimbursement. The median monthly cost for assisted living facilities is $4,000. 4

CCRCs as an alternative to enhanced assisted living facilities

Continuing care retirement communities, or CCRCs, are another option for long-term care that can meet the changing needs of an older adult. A CCRC offers a spectrum of long-term care, starting with independent living and moving through 24/7 care.

By offering all of these services in one community, older adults who want to maintain familiarity throughout each transition in their lives can access the same services whether they are in assisted living or skilled nursing care, for example.

Some long-term care options offered in a CCRC include:

  •     Private apartments or homes
  •     Assisted living
  •     Nursing home/skilled nursing care
  •     Home care services for those living independently
  •     Healthcare services

CCRCs often require an entry fee, with the average fee at $402,000, and monthly costs thereafter of $3555 (not including annual increases). 5

Home care as an alternative to enhanced assisted living

Home care is increasingly preferred by older adults as an option for long-term care. As many as 90% of adults age 65 and older prefer to age in place. 6 For these older adults, bringing long-term care services to their homes allows them to meet care needs and the desire to stay in their home environment.

Non-medical, professional in-home care services include:

  • Bathing & dressing
  • Light housekeeping
  • Bathroom assistance
  • Transportation
  • Meal prep
  • Companionship
  • Help with safe ambulation (walking)

In-home care can be used occasionally as respite support for family caregivers, or this service can offer part-time, 24/7, or even live-in caregiver assistance depending on your needs.

If medical care is needed, additional services must be brought into the home to provide this care.

Like assisted living, in-home care is not covered by Medicare. The national median monthly cost for in-home care is $5,148. 7 Some programs do exist to help offset some of these otherwise out-of-pocket expenses: HCBS and PACE.

HCBS

Medicaid offers waivers for in-home care called Home and Community-Based Services (HCBS). These can help to cover some of the long-term care costs associated with home-based care. Eligibility rules vary from state to state, and there are also caps on enrollment.

PACE

Medicaid and Medicare offer a program called the Program of All-Inclusive Care for the Elderly (PACE). This program is not offered in all states. Designed specifically to help you avoid leaving your home to receive long-term care, you must meet these criteria to be eligible: 8

  • Be 55 or older
  • Live in an area serviced by a PACE organization
  • Need a nursing home-level of care (as certified by your state)
  • Be able to live safely in the community with PACE assistance

Other long-term care options as alternatives to enhanced assisted living:

If assisted living, in-home care, skilled nursing, or CCRCs aren’t quite the right fit for your needs, there are also some other options for long-term care:

  • Adult day care centers- these can be used by older adults who have family caregivers the majority of the time, but sometimes need to stay in a safe and supervised environment during the day while their family caregivers work or tend to other responsibilities. In these centers, an older adult can receive help with ADLs and access to social activities during daytime hours and then return home with family.
  • Board and care homes- also called group homes, these facilities offer non-medical care in a small facility that is usually in a large home, with residents sharing bedrooms. This can be a lower-cost alternative to assisted living facilities.

Long-term care can help you live your best life

No matter which long-term care option you choose, these services all offer support to help you improve your quality of life. By considering the level of care you need and comparing it to the available choices, you can make the best decision.

Another resource that can help you finalize your care decision is the National Council on Aging (NCOA) or your local council on aging. Along with offering resources and assistance in figuring out eligibility for care services and Medicare coverage, they can help you find services in your area. The NCOA’s AgeWell Planner is one example of the tools available.

If you’ve decided that in-home care is the best option for your needs, Caresify can help you coordinate these services in your home. You can read more here, or call 888-799-5007.

 

References

  1. https://acl.gov/ltc/basic-needs/how-much-care-will-you-need
  2. https://acl.gov/ltc/basic-needs/how-much-care-will-you-need
  3. https://www.genworth.com/aging-and-you/finances/cost-of-care.html
  4. https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx
  5. https://www.aarp.org/caregiving/basics/info-2017/continuing-care-retirement-communities.html
  6. https://gero.usc.edu/students/current-students/careers-in-aging/the-value-of-aging-in-place/
  7. https://www.genworth.com/aging-and-you/finances/cost-of-care.html
  8. https://www.medicare.gov/sign-up-change-plans/different-types-of-medicare-health-plans/pace

Is it a Heart Attack? Know the Signs

Even though heart attacks are a well-known medical emergency, are you sure you could identify all the signs if you saw them? You may be surprised to know there are at least 10 common signs of heart attack (also called myocardial infarction).

The Centers for Disease Control (CDC) reports that heart disease is the leading cause of death in the U.S., with someone having a heart attack every 40 seconds, and 805,000 people suffering one each year. Of these, 605,000 are first-time heart attacks. 1

As people age, the heart experiences strain and wear over time, just like any part of the body. Also, older adults are more likely to have chronic health conditions that contribute to heart disease, like high blood pressure, high cholesterol, or diabetes.

Along with working with your doctor to take steps to reduce your risk of heart attack, it is important that you know your personal risk level for having one, and how to spot the signs when a heart attack is happening. By being informed, you could save your own life or the life of a loved one.

What exactly is a heart attack?

A heart attack occurs when major blood vessels supplying the heart with blood and oxygen become blocked. This can happen because of narrowing due to a buildup of fat and cholesterol in the vessel (called plaques), or because of a blood clot that develops. When blood flow is blocked to the heart, part of the heart muscle starts to die. Untreated, this can lead to death- it is an emergency.

Risk factors for heart attack

Age by itself is a risk factor for coronary heart disease (the buildup of plaques in blood vessels). The American Heart Association states that adults aged 65 and older are at the highest risk of dying from coronary heart disease. 2 Being male, and certain hereditary traits can increase the risk as well. These risk factors can’t be changed, but there are several that can:

  • Smoking
  • High cholesterol
  • High blood pressure
  • Being overweight or obese
  • Lack of exercise
  • Stress
  • Uncontrolled diabetes
  • Poor diet
  • Alcohol abuse

How to figure out your risk score

If you’ve never had a heart attack, your doctor can use a risk calculator to use your unique factors to calculate your 10-year risk of experiencing a heart attack.

The American College of Cardiology (ACC) has developed a calculator known as the ASCVD (Atherosclerotic Cardiovascular Disease) Risk Calculator. 3 A similar calculator for layperson use was developed by the ACC and the American Heart Association (AHA), called the AHA Cardiovascular Risk Calculator. 4

These calculators use values like cholesterol level, age, smoking status, high blood pressure, and others to determine a risk score.

Preventing heart attacks

It’s easy to see some strategies for reducing your risk of heart attack by looking at the list of risk factors mentioned above. Some specific approaches you can take include:

  • Improve your diet- according to the AHA and ACC, the Mediterranean diet (high in vegetables, fruits, nuts, legumes, whole grains, and fish) is a good choice, as is reducing saturated fats. 5
  • Stop smoking, if you smoke- within just five years of quitting, the risk of cardiovascular disease is decreased by 39%. 6
  • Get regular exercise- the U.S. Surgeon General recommends 2.5 hours of moderate-intensity exercise each week. Talk to your doctor about the best plan for you.
  • Lower your blood pressure and cholesterol- both exercise and diet can improve these measurements, and your doctor may recommend medications as well to help control any problems.
  • Manage diabetes, if you have it- talk to your doctor about your A1C numbers, a blood test that helps show how well your diabetes is controlled over time.
  • Reduce stress- because stress can increase blood pressure and has been found to be tied to cardiovascular disease, taking steps to reduce stress can have a positive effect on your risk of a heart attack. This includes getting a good night’s sleep every night.
  • Avoid alcohol- the AHA recommends that men should limit alcohol consumption to no more than two drinks per day, and women should limit consumption to no more than one drink. 7

Signs and symptoms of heart attack

People can have significant symptoms that a heart attack is happening, or mild symptoms. In some cases, there may not even be any symptoms at all. The most serious symptom of heart attack is sudden cardiac death. Other common symptoms include:

  • Angina- a feeling of squeezing, pressure, burning, tightness, aching, or fullness in the chest
  • Angina pain or pressure can be under the breastbone, in the throat, jaw, back or shoulders, left arm, or upper abdomen. It does not have to be in the chest.
  • Pain or pressure that worsens with physical activity
  • Dizziness or fainting
  • Heartburn
  • Nausea or vomiting
  • Irregular or racing heartbeat
  • Sweating
  • Sudden shortness of breath
  • Restlessness, anxiety, or a “feeling of doom”

Heart attack symptoms in women

It’s important to know that for women, it is more common to have heart attack symptoms that don’t fit the classic description of “chest pain or pressure.” Women may not have any symptoms at all, or they may have abdominal discomfort, nausea or vomiting, back pain, shoulder pain, jaw pain, or shortness of breath.

Time is muscle

The most important thing to remember is that if you have any new symptom that is bothering you, you should call 911 or go to the nearest emergency room. Heart attacks are not always dramatic and intense, and they don’t always mean a person’s chest will hurt.

It is far better to find out it’s not a heart attack than to ignore a heart attack that is happening. This is because time is muscle. The part of the heart that doesn’t get enough oxygen during a heart attack is permanently damaged. If hours go by before the blockage is fixed, that area of heart muscle may never recover. This can lead to dangerous problems with abnormal heart rhythms and long-term heart issues like heart failure.

Treating a heart attack

To determine whether a heart attack is happening, medical personnel will use a combination of tests. The first test done in the emergency room (or in the ambulance) is called an electrocardiogram or ECG. Using sensors attached to wires, your heart’s electrical activity is recorded. In a heart attack, this electrical activity is disrupted and can be seen on the test.

Along with an ECG, blood tests can be checked to look for certain markers of heart damage that may be happening.

If a heart attack is detected, emergency treatment is provided to remove the blockage causing the attack. Clot-dissolving medications may be used, and a procedure called cardiac catheterization can be performed. In this procedure, also called percutaneous coronary intervention (PCI), stenting of the blood vessels can be done to relieve the blockage.

In other cases, a surgical procedure called coronary artery bypass graft (CABG) may be done to fix the blockage. With a CABG, blood vessels are taken from another part of the body and grafted to the blocked blood vessel in the heart, allowing blood to bypass the blockage.

After a heart attack

The American Heart Association has found that 1 in 5 people will experience a second heart attack within 5 years of their first. 8 If you’ve had your first heart attack, it’s important to work with your doctor to take steps to prevent another- each heart attack further damages sections of heart muscle.

Your doctor may recommend these treatments:

  • Medication- many people who have a history of heart attack are prescribed aspirin daily, or another blood thinning medication to help reduce the risk of clots. Cholesterol-lowering medication and medication to help with heart function, like beta blockers, may also be prescribed. It’s important to take medications as prescribed.
  • Cardiac rehab- this is a medically supervised exercise program, in an outpatient clinic setting. Patients exercise several times a week, for an average of 3 months, to help strengthen heart muscle. The AHA reports that cardiac rehab reduces the risk of a repeat heart attack by 47%. 9
  • Follow other preventative steps- the measures discussed above, including a healthy diet, quitting smoking, avoiding alcohol, etc. are still important to follow if you’ve had a heart attack.

Knowledge is power when it comes to heart attacks

Knowing the warning signs of a heart attack and acting promptly if you suspect you are having one could save your life. Along with these emergency measures, prevention is an important potentially life-saving strategy as well.

When it comes to preventing or treating coronary heart disease and heart attacks, having family support can be an important part of staying healthy. Both family and professional caregivers can help an older adult get to regular doctor’s appointments, keep track of medications, remember to ask important questions during visits, and participate in activities like cardiac rehab and a healthy lifestyle.

If you need extra support for an older adult to help with these strategies, Caresify’s home care can offer you solutions for maintaining a healthier, happier life. You can read more here, or call 888-799-5007.

 

References

  1. https://www.cdc.gov/heartdisease/facts.htm
  2. https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack
  3. https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/
  4. https://static.heart.org/riskcalc/app/index.html#!/baseline-risk
  5. https://www.ncbi.nlm.nih.gov/books/NBK547760/
  6. https://www.ajmc.com/view/smoking-cessation-found-to-lower-risk-of-cardiovascular-disease
  7. https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack
  8. https://www.heart.org/en/news/2019/04/04/proactive-steps-can-reduce-chances-of-second-heart-attack
  9. https://www.heart.org/en/news/2019/04/04/proactive-steps-can-reduce-chances-of-second-heart-attack

A Complete Guide to Common Health Concerns for Older Adults

The health concerns accompanying aging are an important topic as the population of older adults in the US continues to grow. The number of people 65 and older is projected to double in the next 40 years.1 What common health concerns will play a role as this phenomenon continues?

The saying “knowledge is power,” certainly applies to this topic–understanding common problems you can face with aging allows you to make changes that can help prevent or manage them. Spotting early warning signs can give you an advantage in successfully treating some conditions, or even save your life in some cases.

We’ll explain these common health concerns here, along with symptoms you should know and possible treatment approaches that you can discuss with your doctor.

What are the most common health concerns for older adults?

The National Council on Aging (NCOA) reports that 80% of adults age 65 and older have at least one chronic (ongoing) health condition, and 68% have two or more. 2 Using data from the Centers for Medicare and Medicaid Services, the NCOA lists the 10 most common chronic health conditions older adults face as follows:

  • Hypertension
  • High cholesterol
  • Arthritis
  • Ischemic/coronary heart disease
  • Diabetes
  • Chronic kidney disease
  • Heart failure
  • Depression
  • Alzheimer’s and dementia
  • Chronic obstructive pulmonary disease

The following breakdown of each of these health concerns, along with tips on how to manage them, can help you approach them with confidence and live a healthier life as you age.

Hypertension (high blood pressure)

This is more common for older adults because of changes in blood vessels that happen with age. Untreated high blood pressure can lead to several serious health problems, including some of the other health issues listed above: stroke, kidney disease, heart disease, vascular dementia, and eye problems. 3

People may not always experience symptoms that their blood pressure is chronically high. Regular visits to the doctor can help identify this problem, as well as checking it yourself regularly and reporting high results to your doctor for further advice.

According to the American Heart Association, normal blood pressure is any reading below 120/80. 4

If your blood pressure is too high, your doctor may recommend lifestyle changes along with medication to help control it. Exercising, losing weight, quitting smoking, limiting salt and alcohol intake, eating a heart-healthy diet, getting a good night’s sleep, and reducing stress can all help you to control your blood pressure.

High cholesterol

If the levels of cholesterol in your blood are elevated, it means you have too many lipids (fats) in your bloodstream. These fats can build up on the walls of blood vessels, causing fatty deposits (plaques).

High cholesterol, over time, can cause problems like hypertension, coronary artery disease, heart attack, stroke, and peripheral artery disease.

Along with medications, your doctor may recommend lifestyle changes to help improve your cholesterol levels. Following these healthy habits can help prevent high cholesterol if you don’t already have it, too. These lifestyle changes include: 5

  • Eat a heart-healthy diet low in saturated and trans fats, and high in fiber and omega-3 fatty acids.
  • Exercise regularly
  • Quit smoking
  • Reduce alcohol consumption
  • Lose excess weight

Arthritis

This condition is very common in older adults, with 49.6% of people age 65 and older reporting that their doctor has diagnosed them with arthritis. 6 The discomfort from arthritis is the leading cause of disability in the U.S. 7

Although there are many types of arthritis, osteoarthritis is a common form experienced by older adults. To treat this, doctors often prescribe a combination of anti-inflammatories like NSAIDS (non-steroidal anti-inflammatories) and pain medication. They may also recommend physical therapy or occupational therapy.

In some cases, injections of steroids or other medications into the joint can help relieve symptoms. And transcutaneous electrical nerve stimulation (TENS) can also treat painful joints. In severe cases, joint replacement surgery may be the best option.

Along with these medical interventions, your doctor may make the following recommendations for care at home:

  • Losing weight
  • Low-impact exercise
  • Heat and cold for pain and muscle aches
  • Topical joint pain ointments
  • Yoga
  • Supportive braces
  • Assistive devices like canes

Coronary heart disease

Also called simply “heart disease” and “coronary artery disease,” coronary heart disease affects 18.2 million adults in the United States. 8 Coronary arteries are the large blood vessels that supply oxygen to the heart. Problems with these arteries can lead to a heart attack.

A common cause of coronary heart disease is high cholesterol. Along with age, genetics, and environmental causes, the following lifestyle changes can help you to avoid or improve coronary heart disease: 9

  • Quit smoking
  • Maintain a healthy blood pressure
  • Eat a heart-healthy diet
  • Get regular exercise
  • Aim for a healthy weight
  • Get a good amount of sleep regularly
  • Manage stress

Diabetes

Affecting as many as 33% of adults age 65 and older, diabetes, or chronic high blood sugar, increases your risk for kidney failure and heart disease. 10 If you’ve been diagnosed, it’s vital that you work with your healthcare providers to properly treat your diabetes with insulin, diet, and exercise.

Symptoms of type 2 diabetes (the most common type of diabetes in older adults) include excessive thirst and urination, feeling overly tired, blurry vision, weight loss, and increased hunger.

Along with monitoring your blood sugar levels, if you have diabetes your doctor will periodically perform a blood test called the A1C, which looks at how well your blood sugar levels have been controlled over the past 3 months. This test can also identify pre-diabetes, which means you’re beginning to develop diabetes. An ideal A1C level is less than 7%. 11

To reduce your risk for diabetes and to help control it if you’ve been diagnosed, these lifestyle changes are recommended: 12

  • Lose weight, if you’re overweight
  • Stop smoking
  • Eat healthy foods
  • Get regular exercise

If you have diabetes:

  • Manage your blood pressure and cholesterol
  • Have yearly eye exams to check for eye disease caused by diabetes
  • Check your kidneys: ask your doctor how often they are looking for early problems
  • Protect your skin, and check your feet often. People with diabetes can develop undetected skin injuries and infections

Chronic kidney disease

The National Kidney Foundation recommends annual screening for kidney disease for anyone over 60. More than 50% of adults over the age of 70 have kidney disease. 13 Risk factors include high blood pressure and diabetes, so controlling those health concerns is important.

Symptoms of chronic kidney disease include:

  • Fatigue
  • Decreased appetite
  • Trouble sleeping
  • Swollen feet and/or ankles
  • Dry, itchy skin
  • Increased urination/nighttime urination
  • Muscle cramping at night
  • Trouble concentrating
  • Puffy eyes

The CDC recommends the following strategies to reduce your risk of kidney disease: 14

  • Ask your doctor to regularly screen you for kidney disease
  • Lose weight, if you’re overweight
  • Quit smoking
  • Stay active
  • Control your blood pressure
  • Treat diabetes properly, if diagnosed
  • Eat more fruits and vegetables
  • Reduce your salt intake
  • Maintain a healthy cholesterol level
  • Take any medications recommended by your doctor

Heart failure

Also called congestive heart failure or CHF, heart failure develops when your heart muscle is weak and can’t pump blood effectively. It is more common as people age. Having coronary heart disease, diabetes, high blood pressure, and being overweight can all increase your risk for heart failure.

Symptoms of heart failure include fatigue, trouble breathing (sometimes even with minimal activity), chest discomfort, heart palpitations, cough, chest pressure, swollen feet, ankles, or legs, and inability to lie flat to sleep.

Along with medications, like any chronic health condition, there are lifestyle changes you can make to reduce the risk of heart failure, and manage it if you’ve been diagnosed. These include:

  • Quit smoking if you smoke
  • Maintain a healthy weight
  • Get regular exercise
  • Eat a heart-healthy diet
  • Avoid excess sodium
  • Cut back on alcohol consumption

Depression

This mood disorder is more than just sadness, “the blues,” or grieving a loss. The feelings of hopelessness, helplessness, and sadness that come with depression last for weeks, months, or even years, and interfere with a person’s ability to do everyday things.

For older adults, isolation, illness, and loss of physical abilities can lead to or exacerbate depression. And because they are less likely to seek help for depression, it may be overlooked.

Symptoms of depression to watch for include:

  • Hopelessness
  • Loss of interest in activities or hobbies the person used to enjoy
  • Overeating, or the opposite– decreased appetite
  • Sleeping too much, or sleeping too little
  • Restlessness and irritability
  • Feelings of guilt and worthlessness
  • Difficulty concentrating and making decisions
  • Unexplained aches, pains, and digestive upset
  • Fatigue
  • Suicidal thoughts

Depression is not a normal part of aging. It’s important to talk to your doctor if you are concerned that you’re noticing signs of depression.

For some older adults, medications they take for another chronic health concern can cause the symptoms of depression. Your doctor will need to consider whether this is a possible cause and can suggest treatment options to improve depression symptoms.

Along with talking to your doctor about ways to manage depression, there are steps you can take that can help reduce symptoms. Connecting with others, staying physically active, getting enough sleep, avoiding alcohol, and seeking therapy can all benefit someone with depression.

Alzheimer’s disease and other dementias

The memory and personality changes that accompany Alzheimer’s disease and other forms of dementia are not considered to be a normal part of aging, despite stereotypes. They are part of a degenerative brain disorder.

If you have noticed memory or behavioral changes in yourself or a loved one, it’s important to have a conversation with your doctor. They can assess your cognitive abilities and help you watch for any new or ongoing changes that may signal a problem.

Being proactive in managing Alzheimer’s and dementia is important. Following routines, putting safeguards in place to prevent wandering and falls, and enlisting family and professional caregiver assistance can limit some of the confusion and dangers that memory loss can cause.

It’s also critical that you plan for the future now, by having conversations with your loved ones about your advance directives and end-of-life care.

Chronic obstructive pulmonary disease (COPD)

COPD is an umbrella term covering several chronic lung diseases: emphysema, chronic bronchitis, and chronic obstructive lung disease. Along with chronic cough and shortness of breath, COPD can result in exacerbations, where symptoms become worse, sometimes requiring hospitalization.

The most common cause of COPD is smoking– as many as 90% of cases. 15 Occupational exposure to certain kinds of dust and chemical fumes can also contribute to COPD.

Symptoms of COPD include shortness of breath, wheezing, tightness in the chest, chronic cough, fatigue, and frequent respiratory infections.

The best way to reduce the risk of COPD is to quit smoking if you smoke. If you’ve been diagnosed with COPD, you’re at higher risk for infections like the flu, pneumonia, and COVID-19, so making sure you’re up to date on your vaccinations for these respiratory illnesses is also crucial.

Preventing common health concerns with lifestyle changes

You may have noticed a common theme in this discussion about common health concerns for older adults. Although you cannot control things like your age, gender, and genetic predisposition for developing these problems, lifestyle changes can help prevent many of them.

Exercise, healthy eating, quitting smoking, losing weight, getting restful sleep, and managing stress are all goals to incorporate into your everyday life. It’s also important to be sure you keep up with regular doctor’s visits and screening for these problems so you can catch them early if they happen.

Older adults may find some of these lifestyle changes more challenging, due to problems with mobility, for example. Enlisting the help of a close friend or family member can help remove some barriers to healthier living. They can also be an advocate, such as supporting you in organizing your care and helping with medication reminders and refills.

Older adults who use in-home caregiver services may also find that these caregivers can also be a positive source of support for maintaining healthy lifestyle choices. If you’re interested in learning more about this kind of expert care, Caresify’s team is available to help guide you through the process. You can read more here, or call 888-799-5007.

 

References

  1. https://www.prb.org/resources/fact-sheet-aging-in-the-united-states/
  2. https://www.ncoa.org/article/the-top-10-most-common-chronic-conditions-in-older-adults
  3. https://www.nia.nih.gov/health/high-blood-pressure-and-older-adults
  4. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home
  5. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/reduce-cholesterol/art-20045935
  6. https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm
  7. https://www.arthritis.org/getmedia/e1256607-fa87-4593-aa8a-8db4f291072a/2019-abtn-final-march-2019.pdf
  8. https://www.nhlbi.nih.gov/health/coronary-heart-disease
  9. https://www.nhlbi.nih.gov/health/heart-healthy-living
  10. https://www.endocrine.org/patient-engagement/endocrine-library/diabetes-and-older-adults
  11. https://diabetes.org/diabetes/a1c
  12. https://www.nia.nih.gov/health/diabetes-older-people
  13. https://www.kidney.org/news/monthly/wkd_aging
  14. https://www.cdc.gov/kidneydisease/prevention-risk.html
  15. https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/causes/