During my travels I meet lots of people with questions about aging. These come in all flavors - people who work with older adults and want to understand what services are available. Lots of questions about Medicare, SCOs and other health insurance. What is the donut hole? What is an "a-sap"? What is a "sniff"? What is PACE? What is the best place to shop for an older adult? To get their hair done? And, of course, people concerned about their own health or that of a spouse or parent.
Fortunately, I've picked up a lot of knowledge during my time and can answer most non-clinical questions in a semi-coherent way. I also have access to some amazing people who practice medicine for a living and are true experts on the aging process.
This month, I wanted to share some of this knowledge by asking three of our geriatricians - what is the one question you get over and over again? Here are their answers:
Is Depression a Normal Part of Aging?
Jason Strauss, MD
Medical Director, CHA Geriatric Psychiatry Specialty Unit
Instructor in Psychiatry, Harvard Medical School
Becoming older can certainly present a number of challenges. As we age, we develop more medical problems. We also become more susceptible to losses - not just the loss of loved ones, but also retirement and changes in family structure. With increased physical and functional vulnerability, other losses may include driving, independence and long-standing living situations.
It is certainly understandable that many people become sad or frustrated around these changes. However, if this sadness and frustration are constant and affect relationships and quality of life, then it's important to discuss this with a medical professional, as this may signal a depressive episode. Other symptoms of depression in older adults include sleep and appetite difficulties, decreased energy and irritability. There are a number of non-pharmacologic and pharmacologic treatments for depression in older adults that we prescribe as appropriate.
The memory of my (father, mother, spouse) is getting worse. He/she can't remember anything anymore. I have to remind them about everything. Can anything be done about this?
George Maxted, MD
Primary Care Physician, CHA Malden Care Center
Associate Clinical Professor, Tufts University School of Medicine
This question is very common and often asked in the context of whether there is a pill I can prescribe. Since we have managed to medicalize virtually all health problems, we have now created the expectation of a pill for everything.
I reassure people early on that the pills available may provide very modest improvement, at best 3 points on the 70 point ADAS-Cog Scale. Donepezil has fewest side effects. I also try to evaluate if depression is a factor ("pseudodementia"). Maybe a pill could help with that.
But overall I try to change the conversation from giving pills to taking pills away. The exceptions might be meds we use for known risk factors for dementia, such as hypertension and diabetes, but we might even be able to back off on targets for those. Attached is a handy list from the journal
Neurology with other drugs to avoid or eliminate.
So what can we do?
There is recent research in a few interesting areas. Modulation of the Renin-Angiotensin System (a hormone system that regulates blood pressure and fluid balance) may actually help (
click here). Also, in some cases
higher blood pressure may get you better MMSE scores, especially if over 75 (
click here). There was also a recent study in the Journal of the American Medical Association about the Mediterranean Diet and olive oil (
click here). But you have to consume a liter of olive oil per week!
So here is the advice I give patients and family members:
- Reduce risk factors like smoking and alcohol consumption
- Try to get appropriate physical and mental exercise. Social interaction may also help.
- Avoid drugs or therapies that may exacerbate symptoms or have no benefit. For example, hormones, statins, NSAIDs, and Vitamin E do not work to lessen or prevent cognitive decline. Diphenhydramine and meclizine seem to be in all medicine cabinets these days. You can also throw these out.
When it's time to move on and leave our home for better living?
Jonathan Burns, MD
Medical Director, CHA Elder Service Plan
Instructor in Population Medicine, Harvard Medical School
In my experience, giving up one's home, often a place lived in for decades, is an extraordinarily difficult and symbolic step, despite the reasons. Yet frailty and setbacks in the aging process can lead to safety concerns. Many older adults need to consider leaving their homes if they are prone to falling. For others, financial and upkeep issues predominate. This is a scary reality to face.
It sounds like a cliché, but each situation is unique. People have different health problems, different support systems and different living arrangements. Some situations are black and white. But there are a lot of gray areas as well.
Before making any decisions, evaluate if there are resources or programs that could help an older adult live safely in their home. The
CHA Elder Service Plan, a PACE program, is a great example. If staying at home is ruled out, there are options available other than living in a nursing home. For example, assisted living, senior housing or group homes.
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You should also feel free to contact Roberta Robinson, our resident expert at CHA for services people may need. She can be reached via email (
rrobinson@challiance.org) or via phone 617-835-1422.
Another good resource is the local Council on Aging. These municipal departments can connect people to services and help people understand what options are available as they evaluate one of the biggest decisions in their later years.
Do you have a question you would like answered in our next newsletter?
Email us and let our expert team be a resource to you.
