Researchers are keen to narrow down the worst offenders so that we can lessen the risk of Alzheimer’s developing. One area of interest is aluminum. There are some scientists that believe that this common metal plays a part in the development of the disease. Others are less convinced and say that the research is flawed or misguided. So how should we really view aluminum in relation to Alzheimer’s? Also, what can we do about this possible link?

Here we want to look at both sides of the argument for and against this relationship. There are some guides and papers that focus too heavily on the potential dangers without questioning the science. Then there are those that are keen to downplay the risks, without giving much information on potential problems. It is important to look at both sides and to try to be more rational and objective. Before we look at the evidence for a link between aluminum and Alzheimer’s, let’s take a closer look at the metal itself.

So, What is Aluminum?

You may wonder what the relation is between aluminum in the body and as a metal, we use on a daily basis. The answer is that they are one and the same. Aluminum, like all metals, can break down into trace elements. These traces are detectable in water, food and in our own bodies through absorption. Most of the time, these levels are so small that they aren’t harmful. But, there are worries about over-exposure and excessive consumption. So, where do these traces of aluminum come from?

First, There is the Aluminum That We Consume:

You may be surprised to learn just how much aluminum is in our drinking water and the food that we eat. Levels are often higher in processed foods. Pharmaceutical companies also add aluminum to drugs. This could be to make them more effective or to lessen a risk of side-effects. This shouldn’t be an issue for many people because of the trace amounts used. As you will see below, there have also been studies on aluminum consumption and tea drinkers.

Then There is the Aluminum in the Environment:

We use aluminum a lot as a metal because it is lightweight and recyclable. This means cans of drinks, cookware and more. There is also aluminum in cosmetics and deodorants, which could be absorbed through the skin. Aluminum particles are also airborne due to pesticides and cigarette smoke. Aluminum in paint can also contaminate the air that we breathe. Once we start to add all these factors together, it is clear that aluminum is a bigger part of our lives than we first imagine.

The good news here is that most people don’t consume or absorb enough for there to be any concern. Most of the aluminum that we obtain is then excreted before there is a chance of it being absorbed into the bloodstream. Healthy kidney function should prevent too much aluminum from entering the brain and causing damage.

Yet, there are cases that show that deposits can occur in the brain. At some point, these patients have absorbed too much. While there have been links to ineffective dialysis machines in the past, this doesn’t explain the levels of aluminum in those with healthy kidneys. This is why there are so many questions about aluminum consumption and the risk of Alzheimer’s

The Argument for the Link Between Aluminum and Alzheimer’s Disease

So, let’s now look at this idea that aluminum is a danger and is responsible – in some way – for the development of dementia and Alzheimer’s. There are researchers that have studied the brains of dementia patients and found increased levels of aluminum and other metals.

This, along with changes to cell structure, suggests a link between excessive mineral deposits and the disease. Researchers have since tested this theory and some of the potential causes. For example, studies on drinking water have highlighted a possible connection.

Increased Mineral Deposits in the Brains of Dementia Patients:

There have been studies that highlight increased amounts of trace aluminum within the brains of dementia patients. Scientists have continued to share this idea since research began in 1911. While these studies exhibited experimental evidence, there were repeated results showing that chronic aluminum levels intoxication could produce protein transformations that were the hallmarks of Alzheimer’s. Research has also shown that aluminum tends to accumulate in areas of the brain that are most susceptible to damage from Alzheimer’s disease

Aluminum in Drinking Water:

Researchers here turn to the PAQUID study in France. This study took 4000 subjects in southwest France and studied the impact of drinking water on the development of Alzheimer’s. The water here had an excessive amount of aluminum of 0.1mg/day. This lead to findings of a doubling of the dementia risk as well as a three-fold increase in Alzheimer’s. Over in the US, the 2016 NYC Drinking Water Quality Report (PDF) looked at the water with a much lower concentration of 0.006-0.057 mg/liter (average, 0.02 mg/liter) and saw lower risks. This is supported by other studies that show a higher risk in areas with a higher aluminum concentration.

Treating Alzheimer’s by Targetting the Aluminum

Chelation is a strategy for targetting Alzheimer’s that it is especially helpful when using an aluminum chelator. Therefore, there are researchers that feel that this strengthens the arguments that there is a strong relationship between aluminum and Alzheimer’s.

What this all shows is that there are some clear links to be made between this metal and the development of Alzheimer’s. It is easy to look at the drinking water studies and be concerned about levels of aluminium in our own water supply. However, before we start looking into better water filtration, we need to look at the other side of this argument.

The Argument Against the Link Between Aluminium and Alzheimer’s Disease

Then there are other factors to consider that suggest the risk might not be so high. It is easy to focus on these brain scans and drinking water studies and concentrate on that correlation between dementia and aluminium. However, this could mean that we overlook other potential causes. In addition to this, there are further studies on environmental contact and consumption that suggest that the risk isn’t all that high. In addition to this, there are also flaws with some older research methods.

Debunking the Myth About Tea, Aluminium and Alzheimer’s

There have been some questions about increased risks of Alzheimer’s in tea drinkers. That is because tea leaves can accumulate a larger quantity of those trace elements of aluminium. The idea was that these would seep into the drink and be consumed on a regular basis – therefore increasing the Alzheimer’s risk.

However, studies have provided no evidence that dementia is more common in tea drinking cultures than anywhere else. It seems that these higher traces still aren’t high enough to cause damage. The aluminium is ingested in the tea but quickly excreted in the renal system before it can be absorbed.

Debunking the Myth About Excessive Use of Antacids

Then there are fears that medication in the form of antacids and anti-ulceratives could also be a risk factor. Some of these substances can contain high levels of aluminum at around 35-208 mg per dose for antacids and 35-1450 mg for dose for anti-ulceratives. The good news here is that studies don’t show increased risk. A study of more than 6,000 people showed no clear link between regular antacid use and the development of Alzheimer’s disease. This was still true for those that used antacids regularly for over 6 months.

Questionable Studies on Animal Subjects

Finally, there is the issue that some of the tests carried out on animals were on a bad subject choice. In 1965, researchers injected rabbits with an extremely high dose of aluminum and created those same abnormalities in their brains. Unfortunately, some of the early researchers didn’t seem to appreciate the fact that their test subject was particularly susceptible to aluminium poisoning. This means that any results on ill effects and brain chemistry may be invalid. The extreme nature of the results led to an unjust panic about the threat of the water supply, cookware and drinks cans. Others would argue that any animals subject is a poor choice because of the differences between their brain make-up and ours.

Could Other Metals Be to Blame for These Changes Within the Brain?

Before we look at a final verdict on the risk of aluminium in the development of Alzheimer’s, we also need to consider the potential threat of other metals. The studies above tend to focus on aluminum consumption because of the clear deposits in the brain, as well as its known effect on key proteins. However, there are other metals that can create a similar effect. So, can we be sure that aluminum is the true culprit here and not one of these other metals?

One of the issues here is that there are metals that create deposits in the brain and can lead to the reshaping of important proteins. Yet, this isn’t exclusive to aluminum. Iron, copper, and zinc all have the potential to do this. Studies carried out in 1953 were the first to indicate high levels of iron in the brains of Alzheimer’s patients. These minerals, in addition to fluoride, are found in drinking water too.

So, are these elements affecting the reactions in the brain and the impact of the water in those areas? Zinc is one element that has been ruled out – to a degree – because studies have shown that it can help to manipulate cells in a more positive way. But, that still leaves some question marks over the iron and copper.

Is Aluminum a Risk or Not?

When we place these factors side by side like this, it is easy to see why so many people get confused about the risk factors. The inconclusive nature of the studies means that most journals and Alzheimer’s organizations are hesitant to give a clear answer. We can’t say that there is a strong, direct link between contact with aluminum and Alzheimer’s because there are so many studies where this wasn’t the case. We also can’t focus on this one metal if it wasn’t the only mineral present.

However, we can’t underplay that clear link between aluminum and dementia that is clear in those brain scans. Essentially, aluminum may not be a big risk that some researcher would have us believe, but it might not be harmless either. The biggest risks come when the body absorbs too much of the metal and it reaches the brain. This is unlikely except for in cases of extreme consumption or problems with the renal system.

What should you do if you want to lessen your own risk of developing Alzheimer’s?

This inconclusive finding isn’t going to be of much comfort to those that want a clear yes or no answer. We can’t say that you are completely safe to handle and consume the same amount of aluminum. Nor can we say that you definitely need to make any changes. However, those that are worried can make some small changes. You can avoid using aluminum cookware and eating processed foods if you want to reduce your intake. You can also look out for aluminum-free antacids and be more careful with your deodorant.

The Debate Continues

There is clearly a lot more research to carry out to determine the true nature of aluminum in the development of Alzheimer’s. The same is true for the other metals that are present, such as copper and iron. For now, we just need to remain aware of a potential link with excessive consumption or absorption of the metal. If you have any further concerns, talk to a doctor or contact a local Alzheimer’s organization for advice.

The post Fact or Fiction- Exploring The Link Between Aluminum And Alzheimer’s appeared first on GeriatricNursing.org.

Regardless of the type of dementia you have, there are several features that are similar across all of the different types and there are specific early warning signs that help to determine if you have early dementia versus simply having some of the normal signs of the aging process.

Dementia affects three major areas of the sufferer’s life.  The first is language, with difficulties in finding words, expressing thoughts, and understanding new things.  The second is memory, with difficulty remembering simple things, such as where an object is located, the names of people you know, and basic facts about your past life. The third is decision-making, meaning that judgment and personality can be so impaired that decisions about how to do a complex task or even what to do next become difficult. Ultimately, these things ultimately block the ability to perform the basic activities of daily living.

Many older people wonder if what they’re experiencing as they age is normal or if it represents a sign of dementia and this can be worrying or frightening.  Fortunately, just because you forgot a phone number or forgot where you left your keys, it doesn’t mean you have dementia.  In fact, there are 10 major early warning signs of dementia that can help you decide if you or a loved one might be suffering from some type of dementia.

Here are the 10 signs you need to think about before you begin to worry about having one of these worrisome diseases. We will also talk about how the normal aging process differs from dementia:

1. Memory loss

Memory loss can be one of the first signs of dementia and can be the most frustrating for some. The memory loss seen most commonly is of those things that have been recently learned. This means not remembering the names of people you meet, not being able to memorize phone numbers, and forgetting where you leave things. You may forget an appointment to visit the doctor or even the birthdates of your grandchildren.  You may find yourself writing down more things you would otherwise be able to memorize or rely on others to remember things for you.

The memories you have of your past life tends to be preserved in early dementia so you will remember your childhood memories without difficulty. You will also remember the names and faces of people you love and care about. You will not have too much difficulty finding your way around familiar places under familiar circumstances unless the dementia is more advanced.

The type of memory changes you can expect with aging will be different if you do not have dementia.  Everyone forgets where they left their cell phone or keys and everyone forgets people’s names and certain appointments.  When it comes to forgetting appointments, if this is just a part of the aging process, you will remember later that you forgot the time or will remember that you forgot something you should not have forgotten.

2. Problem-solving and planning difficulties

Another early sign of dementia is difficulty in following a prescribed plan. If you cook, you might find yourself hopelessly mired in the recipe, forgetting ingredients or forgetting where you were in the making of the recipe.  Tasks that have more than a few steps will be harder to accomplish and you will have more difficulty planning which things you need to do in the task and even where to start solving a complex problem.

Driving may be difficult because you will have difficulty planning how to get from point A to point B. Paying bills can be hard because it can involve balancing a checkbook or planning what to pay and when. Concentrating on a challenging task can be even more difficult than it used to be.

This isn’t to say that some of the problems in planning cannot be a common part of the aging process. For example, everyone makes mistakes balancing their checkbook and anyone can forget an ingredient in a recipe. It’s when this becomes a recurrent thing interfering with your life that you should be more concerned.

3. Difficulty with task completion

Individuals with dementia will have a more difficult time getting everyday tasks completed. With dementia, you will be much slower in completing tasks and may drop them altogether. Things, like remembering the rules to a game you know how to play under normal circumstances or starting a project only to drop it halfway through, are more common occurrences in people who have dementia. Even driving to places you know how to get to under typical circumstances becomes a challenge because you might forget where you are on the road, even if you’ve done it many times before.

So, how does this differ from the normal aging process? People of any age might forget how to set the clock in their car when they only do it twice a year and may forget how to operate a complex piece of machinery.  Tasks that are particularly complex are easier to abandon so just because you decide to give up, it doesn’t mean you have dementia. In addition, everyone can get lost in their thoughts and miss a turn on the highway, even if the route is otherwise familiar.

4. Confusing the place and time

People who have dementia will gradually lose their sense of time. Dates become meaningless and they can even forget what season or month it is.  Because there is a loss of sense of time, there is more of an emphasis on the here and now and less of an emphasis on future planning.

This can extend to becoming lost and forgetting where they are, especially if they are in a place that is not familiar to them.  If you go to a relative’s or friend’s house and find yourself confused about where you are, how you got there, or how long you’ve been there, this could be an early warning sign of dementia. 

A person who is just dealing with the signs of aging can also get confused by what day of the week it is and what they have to do on any given day. This is normal and it usually involves being able to recognize that they have forgotten what day it is and figuring out what day it really is. There is not a true loss of the sense of time—just a matter of being occasionally forgetful and distracted enough to forget the time.

5. Difficulty with spatial relationships

 This involves difficulty understanding the relationship between two things seen visually. One of the tests for early dementia is to ask the person to draw a clockface. This sounds simple but is hard to do for the person with dementia. When you have problems with spatial relationships, it can be harder to read and harder to drive because judging distances and contrasts between colors is more difficult to do.

Some spatial relationship changes are normal and are a part of the aging process. If you have cataracts, for example, you might have difficulty reading in low light, have problems with glare when driving at night, and will have more trouble with telling the difference between colors that are similar to one another. This does not represent dementia and is only a vision problem.

6. Difficulty with speech and writing

 People who have dementia have difficulty expressing themselves when writing and speaking. They may have problems carrying on a normal conversation and may forget what they were saying in the middle of a sentence. Because of this, they don’t engage in conversation as much as they used to. Word-finding difficulties become more common so they shy away from saying as much as they would like. Naming simple objects becomes harder so they often call things by the wrong name. 

On the other hand, everyone—even young people—sometimes have difficulty finding the right word to say.  Usually this is occasional and doesn’t interrupt the flow of conversation. Writing is not typically impaired as one gets older, except that your handwriting can get worse. You will usually be able to express yourself in writing, especially when you have the time to think of the right word to say.

7. Losing the ability to trace one’s steps

This is part of the problem the dementia patient has with losing things. Not only can they not remember where they placed something, but they have also lost the ability to remember where they’ve recently been so they cannot retrace their steps so as to recover what has been lost. This can lead to confusion and to the mistaken belief that someone has taken their belongings.

If you are simply dealing with aging—and even if you’re not getting old—losing things is a normal part of life. Usually though, you can remember where you’ve been recently and can retrace your steps in order to find a lost object.  Again, it is a matter of not losing track of the passage of time so you can remember what you’ve recently been doing.

8. Problems with poor judgment

Because the person with dementia does not think ahead about the implications of doing something, they are particularly prone to doing things they would otherwise have thought twice about. They may be more impulsive and might give away large sums of money to a stranger or may make other bad decisions because they do not think about what will happen in the future regarding their decision and they cannot identify when an idea is a bad one.

If you are having normal signs of aging, you may make a bad decision every once in a while, especially when pressured by another person who doesn’t have your best interests at heart. You will generally later recognize that the decision was a bad one and will see the error you made. It is not a pattern of behavior that affects large portions of your life.

9. Social or interpersonal withdrawal

 The person with dementia tends to withdraw from many types of social interaction, even in the early stages of their disease. They may feel overwhelmed by larger social situations, such as parties or family gatherings, and may not want to talk socially with others on an interpersonal level. They may seem withdrawn and can start losing interest in favorite activities and hobbies.

Things that used to interest them no longer seem interesting and lively discussions with others become a thing of the past. Some of this might be due to the normal social withdrawal that happens when the person with dementia no longer gets anything from social interactions and feels embarrassed by their inability to be easily conversant with others.

If you are getting older and dealing with the normal aging process, on the other hand, you can simply be tired of certain social situations and large gatherings. Work and even leisure activities can become wearisome so you might not want to engage in them to the degree that you used to. This is not evidence of dementia.

10. Personality changes and mood disturbances

 Dementia doesn’t just affect the person’s thinking; it affects their personality and mood as well. Some types of dementia have mood changes as more obvious early signs of the disease process. The person with dementia may appear more depressed than is normal for them and the memory problems can lead to a sense of increased suspicion of others. The combination of poor memory and confusion can lead to being more upset over little things that can otherwise be explained.

The person who is simply dealing with aging may have periods of depression or depressed mood that comes from normal grieving and the changes that come with being older. In addition, the older person might be relatively set in their ways so that deviations from regular daily activities become more irritating. Again, these types of things do not represent evidence of dementia.

What is the Difference between Alzheimer’s Disease and Dementia?

When people think of dementia, many think of Alzheimer’s disease and think that these are one and the same. The truth is that Alzheimer’s disease or “Alzheimer’s dementia” is the most common type of dementia in the United States. It is not, however, the only kind of dementia and is not even the most common type of dementia in some parts of the world. There are many other kinds of dementia a person can have.

Alzheimer’s disease represents more than 60 percent of all dementia cases in the US.  It often starts with simple memory loss and personality changes; it gradually progresses over a period of several years so that the person with Alzheimer’s disease loses the ability to care for themselves and the ability to remember people (even those close to them).

They lose the nuances and vibrance in their personality. It is caused by damage to the “communicating abilities” between brain cells and ultimately leads to permanent injury and death to the cells of the brain.  Because brain cells do not regenerate, this is an irreversible and inevitably fatal disease.

The second most commonly seen type of dementia (and the most common type of dementia in parts of Asia) is vascular dementia.  This involves damage to the blood flow that normally nourishes brain cells.  Many people refer to this type of dementia as resulting from “mini-strokes”. The end result is a stepwise loss of brain function when each of these small strokes occurs, damaging smaller areas of the brain at a time.

The symptoms can otherwise be similar to Alzheimer’s disease, with prominent symptoms of confusion and lack of memory.  Concentration becomes difficult and there can be physical impairment as well, because the parts of the brain responsible for movement and other crucial functions are also affected.

There is a type of dementia called Lewy body dementia, which is caused by deposits of protein called “Lewy bodies” that build up within nervous system tissue. This results in a disruption in the chemical messaging system of the brain, leading to loss of memory, confusion, and disorientation. Lewy body dementia accounts for 20 to 25 percent of all dementia cases.

A common feature with this type of dementia is insomnia and daytime sleepiness, as well as visual hallucinations and disorientation.  Because some people with Alzheimer’s disease and some with Parkinson’s disease also have Lewy bodies in their brain, these diseases are often confused with one another and can coexist.

Individuals who have Parkinson’s disease normally have problems walking and commonly have a tremor. Later on in the disease process, however, they can develop dementia. Typical signs that dementia has set in as part of Parkinson’s disease include judgment difficulties and problems with reasoning. Visual hallucinations can be seen in this type of dementia, which can be both terrifying and confusing. Speech becomes more challenging and the other common signs of dementia, such as irritability, suspicion, and depression are seen as well.

Frontotemporal dementia or “Pick’s disease” is a type of dementia that affects the part of the brain that controls behavior and language abilities. It is seen in older individuals but can affect people who are as young as aged 45 years. One of the key features of this disorder is the loss of inhibition and a lack of motivation.  Personality changes are common as are language difficulties, leading to an inability to remember what certain words actually mean.

Creutzfeldt-Jakob disease or CJD is relatively rare but receives a great deal of attention because it is so rapidly progressive.  It is believed to be caused by a type of infectious agent that infects primarily the brain. Many of the symptoms are the same as other types of dementia; however, there are also physical symptoms, such as muscle stiffness and twitching. This type of dementia is so serious because most people who have the disease die within a year after it first presents itself.

Wernicke-Korsakoff disease or “Wernicke’s encephalopathy” is one of the few reversible types of dementia.  It is primarily caused by vitamin B1 or thiamine deficiency. It is more commonly seen in people who are alcoholics, in part because they do not eat a healthy diet.

Common early findings are double vision and poor coordination of the muscles. When it leads to dementia, things like memory, the acquisition of new skills, and information processing can be impaired. Confabulation or “making things up” is a typical feature of this disease as the person will have memory lapses that they try to make up for.

Normal pressure hydrocephalus is another potentially reversible type of dementia.  People with this disease have a buildup of fluid in the internal chambers of the brain that are supposed to cushion both the brain and the spinal cord.  The fluid collects and pushes on the normal brain structures, leading to brain injury and possible brain cell death.

The causes of this problem are several and include having had a fall, bleeding in the brain, a previous brain infection, brain tumors, or prior brain surgery. Besides the typical memory and behavior symptoms seen in other types of dementia, people with normal pressure hydrocephalus will have balance difficulties, a history of falling, and both bowel and bladder control problems.

Huntington’s disease is a genetic type of dementia that can occur in people as young as their teens, although it most commonly develops around 35 to 45 years of age. It used to be called “Huntington’s chorea” because it involves movement disturbances that doctors call “chorea”. People with this disease begin with tremor and walking problems that progress to having difficulty speaking and thinking problems, which are more typical signs and symptoms of dementia.

As many as 45 percent of individuals who have dementia will have a combination of problems in the brain that are causing their memory and thought problems.  These people have what can only be called “mixed dementia”.  It makes sense that this type of dementia is common because older individuals who have vascular dementia because of circulation difficulties will also have a risk of developing Alzheimer’s disease and vice versa. The features of memory loss, behavior difficulties, mood changes, and physical symptoms common to all types of dementia can be seen in mixed dementia.

How Early Can Dementia Start?

All types of dementia tend to be more common in individuals older than 65 years of age with the average age of onset being about 80 years of age. People can, however, develop dementia earlier than that—as young as 40 years of age.  Most people who have early-onset dementia have some type of hereditary reason for having the disease so early in life. Certainly, people who have dementia because of head injuries or infection can be younger than is normally seen in dementia.

If dementia—especially Alzheimer’s dementia—runs in your family from an early age, you need to consider being tested for early-onset Alzheimer’s disease.  Knowing if you have the genetic predisposition for this disease can lead to the treatment of symptoms with medication that can slow the progression of Alzheimer’s disease. In addition, there are many people with reversible dementia seen at an early age so getting a diagnosis, even when you are younger than 65 years of age, doesn’t mean you will have an irreversible progression of dementia symptoms.

How Quickly does Dementia Progress?

The natural course of nearly all types of dementia is that it will worsen over time.  Exactly how fast it worsens depends on the type of dementia a person has.  People with Creutzfeldt-Jakob disease have a rapid progression of their symptoms, with death occurring within a few months to a year after being diagnosed with the disease.  This is perhaps the worst-case scenario when it comes to having dementia.

Older people who have Alzheimer’s disease have a shortened survival rate compared to older people who do not have dementia. The survival rate can be as short as three years or as long as twenty years, depending on the person.  People who get on medication for Alzheimer’s disease early in their disease process will have a longer lifespan and a longer period of time with mild disease than those who do not have the opportunity to take medication.

Even so, there is no medication yet that will actually cure Alzheimer’s dementia. In addition, people who start their dementia healthier from the beginning will have better physical reserves and will live longer than people who are frail when they get the diagnosis.

People who have vascular dementia do not survive as long as people with Alzheimer’s dementia, with a survival rate of between 3 and 5 years.  Part of the problem is that the disease involves the same risk factors as having heart disease so the person with vascular dementia has a greater chance of having a heart attack or possibly a more severe stroke than the average person.

Is Dementia Inherited?

While it is impossible to say that a person will “get” Alzheimer’s disease from their mother or father, there does appear to be a genetic basis for having this disease, particularly in those who start having symptoms in their 40s and 50s.  There are two kinds of genes that seem to be prevalent in people who have Alzheimer’s disease:

• Risk-related genes. These are genes that increase the chance of developing dementia but do not guarantee that the person with the gene will get the disease. There are several of these genes that are directly related to Alzheimer’s disease.  These are the APOE-e4 gene, the APOE-e2 gene, and the APOE-e3 gene. The APOE genes are inherited from either one’s mother or one’s father.  If you get one copy of the APOE-e4 gene (the one most commonly linked to early-onset Alzheimer’s disease) from a parent, you will have an increased risk of having the disease yourself. If you have two copies of this gene, your chances of having Alzheimer’s disease are even greater.  It never represents a certainty, however, that you will get the disease.
• Deterministic genes. These are genes that, if inherited, guarantee that you will get the disease. There are several deterministic genes linked to Alzheimer’s disease but these are fortunately very rare.  Only a few hundred families in the world carry the risk of developing Alzheimer’s disease because of these types of genes.  People in these families have a very high risk of developing Alzheimer’s disease, usually between 45 and 55 years of age.

While the risk of having a genetic form of Alzheimer’s disease is extremely rare, knowledge of these genes has helped pave the way for researchers who are studying the disease and its underlying causes. Each of these genes has been found to be related to one of the steps in the biological development of Alzheimer’s disease.  If you know that Alzheimer’s disease is prevalent in your family, you might be a candidate for one of the ongoing research projects on how the disease develops and how it can be treated.

Besides the APOE-e4 gene, there are three other genes that seem to increase the risk of developing Alzheimer’s disease. These are the APP gene, which stands for “amyloid precursor protein”, first discovered in 1987, the presenilin-1 (PS-1) gene, first identified in 1992, and the presenilin-2 (PS-2) gene, first discovered in 1993. All of these are referred to as genetic mutations because they change the way the gene functions and all can be found in certain types of inherited Alzheimer’s disease.

So, should you be tested for Alzheimer’s disease? There are genetic tests out there, particularly for the APOE-e4 gene, and you can even be tested for the gene in some mass screening tests that are used to test large populations for certain genetic diseases. Testing for the different Alzheimer’s risk-related genes is also available in some kinds of research studies.  Most doctors, however, do not recommend being tested unless the disease is particularly prevalent in your family. The reason behind this is because none of these more common genes is “deterministic” and will not necessarily say for sure that you will develop this type of dementia.

The post 10 Early Warning Signs of Dementia & How to Spot Them appeared first on GeriatricNursing.org.

The problem is that seniors on low incomes don’t always have this peace of mind. They don’t always have the savings and future income in place to let them remain in the home they once had.

So What Can Seniors and Their Relatives Do To Solve This Issue?

There are schemes in place that can help seniors transition into new low-income housing. Those with a low income are means-tested and assessed to see what support is on offer. There are rental schemes across the US that are suitable doer seniors that need a helping hand – both with their rental payments and other care needs. In this guide, we will look at some of the different options that are available to low-income seniors in need of retirement accommodation.

First of all, we will look at the HUD and some of the programs that can help seniors across the states. We will then look at some of the important considerations for choosing one of these rental properties. We will also consider some of the alternatives to these typical schemes, such as shared housing initiatives. Before that, let’s take a closer look at what it means to be eligible for low-income rental accommodation and why there is such a high need for apartments.

Why Do So Many Seniors Require Help?

There is a surprisingly high demand for low-income and low-cost housing solutions for seniors facing retirement. There is an idealized notion that we will all work hard, earn our social security, save money and have enough to enjoy a golden retirement at home. The truth is that this isn’t the case for many Americans. Workers in low-income situations and low-level employment may not have the means to secure their future in this way.

In fact, a study by the Insured Retirement Institute found that as many as 70% of baby boomers in a middle-income bracket don’t feel confident about being financially secure in retirement. A related survey by the Associated Press showed that those just 35% of those earning below $50,000 felt the same way. Many within this generation need a helping hand to find a rental property they can afford.

Let’s look at some of the basics about low-income housing and seniors.

What is Considered Low Income for Senior Citizens?

What is low-income and what are the income limits? The basic criteria for a low-income household in 2018 was any family whose income did not exceed 80% of the median income for the area. Therefore, values are highly dependent on localities, rather than national averages. For example, eligibility in upstate New York could have entirely different parameters than it does in a rural part of Idaho. There is also some additional adjustment in areas that have an especially high or low income-to-housing cost ratio. Also, remember that the income limits could change again come April 1st.

What Age Does Qualify for Senior Housing?

Eligibility for public housing doesn’t just depend on the income of the household and not all seniors will be eligible for senior housing under Section 202 (more about this below). The minimum age that qualifies for senior housing is 62 and the person must be of very-low income.

There are other factors to keep in mind. The department will also look at an applicant’s status as a senior, a family in need or an individual with disabilities. Some seniors may, therefore, qualify under two grounds. There is support available to seniors regardless of marital status.

Finally, they will also consider an application based on the citizenship and immigration status of the applicant. Those that pass all three criteria can look at finding low-cost solutions with federal assistance.

On the subject of rental prices and affordability, it is important to remember that rental prices can vary wildly depending on the area that you choose. In some cases, suburb prices will be cheaper than those in the neighboring city. The extent of this could be significant and may mean savings that can go towards other care needs. It pays to browse different districts to see if the change in price is worth the move to a new area. Rental costs also vary from city to city. There is no average for the state and it may all depend on the availability and current trends for city apartments.

What is HUD Housing for Seniors?

HUD or U.S. Department of Housing and Urban Development is responsible for overseeing the government aid to HAs or local housing agencies that do the actual management of low-income housing. This is what has become to be known as HUD housing.

Who is Eligible for a HUD Public Housing Scheme?

The best course of action for those uncertain about their eligibility is to talk to an agent from the HUD. They make the rules about the parameters of low-income. They also have a number of schemes in place to help seniors that fall below that 80% target. The HUD offers public housing to those that qualify under the rules stated above. This means access to all kinds of homes, apartment and communal living blocks for those with low incomes, disabilities or those of retirement age.

There are around 3,300 individual housing associations across the states, which means local, tailored support wherever you are. These housing associations receive federal aid to create low-income housing solutions for vulnerable citizens in need of assistance.

Housing association agents are obliged to find appropriate housing for seniors and to support them as much as possible. This means helping them to find suitable housing in the required area. But, the support shouldn’t end there. The HA should remain a reliable figure of support for new tenants. They can provide help with the lease, handle security deposits and generally act as a landlord. Some seniors may also find that their HA will provide them with services and support in retirement. This may include residential support such as transportation service, housekeeping and other needs.

HUD Support and Services for Seniors

What is Section 202 Housing for the Elderly?

This is the most important clause to understand when dealing with seniors in low-income housing. This clause was established by HUD in 1959 in order to provide housing that was exclusive for seniors. This section then allowed the HUD to offer loans to help finance the construction of housing projects that would meet the demand of these low-income seniors. These properties are generally one-bedroom apartments with a kitchen and bathroom. Further aid for those eligible can include housekeeping, transportation and home-delivered meals.

Congregate Housing Services Program (CHSP):

This option is basically an addition to the scheme above, which came into place in 1978. The idea was to provide additional funds to those living on the terms of Section 202. More specifically, the services were created to “help frail and persons with disabilities avoid premature or unnecessary institutionalization”. In other words, the CHSP was designed to allow seniors to live an independent life in the home of their choice, delaying any need for residential care.

Further support is on offer for those in greater need. There is an attempt to provide residents with one communal hot meal per day while applicable. There are also the same non-medical services of housekeeping, personal assistance, transportation, and social services.

Housing choice voucher program:

In addition to this, there is a housing choice voucher program. Here applicants are able to choose housing that best suits their needs with the help of this HUD-approved voucher. This puts greater control into the hands of the senior and their families.

In turn, this may allow for a better choice or something a little less conventional. Housing chosen must meet appropriate standards in order for seniors to receive a lease. The potential downside is that more responsibility then falls on the applicant to find suitable accommodation, rather than the HA agent.

Multifamily Rental Housing for Moderate-Income Families:

Then there are the seniors that may benefit from the multifamily scheme. It is important to note that this is for moderate-income families rather than low-income families. However, this could be a helpful back-up solution following the application process.

Some seniors that consider themselves as low-income earners may earn too much in the eyes of their HA. The alternative is this multifamily housing, which does include some senior-friendly properties. The rental costs may be a little higher here, but there are still some perks for those with care needs and disabilities.

Supportive Housing for Persons with Disabilities Program:

When you start to look around, there are actually a number of different programs out there that can help people in different circumstances. However, it is clear that some programs are more suitable than others. For example, the idea of this supportive housing scheme sounds great. It works to provide independent living options to people with disabilities – which could include many low-income seniors.

However, there is a focus here on group homes, rather than apartments for singles. These units combine multiple bedrooms that connect to a kitchen and shared living area. The promise is that there will be at least one bathroom for every four residents. This is great for people with learning difficulties and other disabilities that need that social support. It isn’t so beneficial for seniors.

How Do I Apply for Low-Income Senior Housing?

How can seniors and their families apply for HUD help with low-income housing and other support? The application process can be quite long-winded and detailed. The department will need to obtain as much information as possible to process the claim and move forward with the application. Some of this information is fairly formal. Applicants will need to provide personal data, contact information, banking details and references of previous landlords.

They will also ask for an estimate of the expected family income for the next 12 months. This will help them to calculate financial eligibility. There will also be some aspects of a more personal nature. The HA representative will ask about possible reasons for seeking specific accommodation, the make-up the family and everyone’s relationships.

The later won’t be so applicable for seniors unless they plan to live with a relative as a carer. After filling out the application with you, the agent will also inspect the applicant’s current property for a better understanding of their situation. It can be long and stressful in some cases. But, preparation and cooperation go a long way.

Important Considerations When Finding the Right Apartment

These services are a great starting point for seniors that need a little help finding something more affordable in retirement. Agents and representatives can point applicants in the right direction. But, there is more to the process than simply finding a home that is affordable. It is important to find a property that not only has an affordable rental price, but that also meets other important criteria. Seniors and family members should take the time to sit down and go over everything that is important.

This can include features of the property itself, but also important aspects of the neighborhood and local services. It is essential that as family and caregivers, we actually listen to the preferences and desires of our elderly parents. It is too easy to focus on what we think is best for them as a demographic, rather than as individuals.

Location:

The location is important when choosing a new retirement property for seniors. There are financial benefits to choosing different areas. As we mentioned above, some suburbs are a little cheaper than inner city areas. But, different districts can vary from each other too. Once you have an idea of what you can afford, you can start to favor certain locations that are more suitable.

Areas out of town can be quieter and more pleasing than some inner-city areas. Many will have a good community feel to them. Applicants may already have friends and family in the area that that can call upon for support and companionship. This could make a big difference when moving to a new home. Other seniors may want to hold onto a city location as long as possible. Maybe they thrive on the vibrancy and activities in the local area. Maybe there is a city park they like to walk in to keep active.

Amenities:

The benefits of a local area also mean accessibility to local amenities and transport links. Moving away from a city can be a good way to enjoy a calmer pace of life. But, does this then place seniors too far away from their social clubs, doctors, friends and other facilities they rely on? Is there a good bus link in place to help to get around, or will they find themselves a little isolated? If there are doctors and specialists in the area that they can use instead, are they actually able to take on new patients at this time? Can seniors walk to a grocery store and get everything they would normally buy?

Property features:

Then there are the extra details and services regarding the property itself. Many of the low-income housing options for seniors have some of the same basic facilities. They have those senior-friendly floors, grab rails and a good, accessible layout. But, some apartments will be better fitted out than others. Some landlords will scrape by with the bare minimum requirements while others will make a point of attracting seniors with other features and services. For example, there may be housekeeping, transportation and other social services that can lend a helping hand.

One way to learn more about the properties and services is to talk to other residents in a block. How many seniors live there and how long have they been there? Are they happy with the facilities and services provided, or have they experienced problems? It may also help to ask about the policies on pets. Many seniors have beloved animals that have been companions for many years. In some cases, such as with widows/widowers, they may be the only companion they have at home. Make sure that a new landlord allows these pets before signing up for a new apartment.

Waiting Lists for Low-Income Housing for Seniors

Another important consideration for anyone that is looking to move into a new low-income housing rental is that there are waiting lists. There are only so many places available, especially with some of the HUD schemes. This availability can depend on the number of properties that there are in your chosen area and the number of seniors looking to rent. Some seniors will get lucky. They may opt for a place in a less popular area that has accommodation that is more readily available.

Others that insist on moving to a more popular area may have to wait a little longer. There is also the fact that the elderly population is growing fast. The baby boomer generation has reached retirement age and we are all living a little longer. That means a lot of seniors in need of appropriate housing – and not necessarily enough properties to house them all.

Shared Housing is a Popular Alternative for Low-Income Retirement Home

With so many seniors in need of help, and such strain on the system, some seniors are turning to alternatives means to help them with their situation. Sharing housing is a great way to solve a number of problems in one go. It can take some time to adjust, as some of these schemes are a little unconventional, but many seniors actually thrive in these situations. Shared housing lets seniors open their home to other tenants, or to share a home with someone they know. This can be highly beneficial for the right people. So why is shared housing such a popular alternative for seniors on low incomes?

First of all, shared housing can offer seniors the chance to stay in their own home. One of the biggest issues for retirees is the idea of no longer being able to afford to live in the home they have created and loved for so long. In fact, it is said that as many as 87% of seniors want to continue to live in their own home – even if it is now a little emptier than it used to be.

Rather than move to an affordable property elsewhere, they can instead make their current home more affordable with a little financial help. A second tenant in the property can take some of the financial strain. This new occupant can also provide valuable social care and support where needed. They may provide companionship for those that live alone. They could be able to help with household chore or transportation as part of their rental agreement. There are some interesting schemes out there that can help.

Sharing with people your own age:

One option is to find a tenant that is around the same age as your relative. This is a good way for two people in need of a better living arrangement to find the support that they need. A second tenant of a similar ages offers someone that seniors can relate to. They can help and support each other with different issues and start a great new relationship. Some seniors may have someone in mind for this. There could be someone at a local social club, church or another meeting place in a similar situation.

Others may find a stranger that ends up being an ideal fit. The Golden Girls Network is designed to do just that. This is a great service that brings together seniors that are ready to create a form of houseshare experience. They can match people together and ensure that two lives are transformed for the better.

Sharing with younger people:

The alternative is to share a home with younger occupants. This has its pros and cons. On the one hand, it may be harder for seniors to relate to their new tenant. There isn’t the same shared experience of life as there is with others their own age. The younger tenant also has to be a good fit and able to respect the home and schedule of the senior. Therefore, nobody that’s going to work unsociable hours, live like a slob and bring questionable friends round.

On the other hand, a younger tenant could have a good source of income to pay their share of the rent and utilities. They may also have the time and energy to help with chores and shopping, or transportation to offer a ride to appointments. It all depends on the tenant. Some single people in their twenties or thirties may prefer this approach to a more traditional house share.

Sharing with college students:

One new way to bring younger tenants and seniors together is via a house sharing scheme with college students. This is a win-win situation for everyone involved – as long as the two parties can get along with each other. Seniors get the same benefits as they would with other young tenants. There is someone there that can support them and provide a steady income to supplement the rent.

In return, students get a secure place to sleep and study with great facilities. They also get a roommate that may be a better cook, a better listener and perhaps even someone knowledge about their chosen major. This is a great scheme for students that either can’t afford the high rental prices of college accommodation or simply don’t like the idea of crowded dorms and the stereotypical freshman scene.

This approach has proved to be a hit in other countries and is now on the rise in the US. Dutch students have transformed the Humanitas retirement community in recent years. Here college student can become active, respectable members of the community. They receive rent-free accommodation in exchange for offering services to elderly residents. This means 30 hours a month where students talk with seniors, run errands and help with chores. This isn’t the best financial model for those on low incomes, but it does help those determined to stay in their own homes.

An alternative approach is underway at New York University. Accommodation for students isn’t cheap, with a typical year’s rent ranging from $10,000 to $18,000. Some now choose to move out into Greenwich Village. This trendy area has a senior population struggling with rising costs. So, these students rent the spare rooms for half the price of a university dorm and help seniors stay in their own home. This scheme only began in 2017. But, the success means that other universities are sure to follow suit.

Other Helpful Services for Seniors Looking for Low-Cost Rental Accommodation

It is important to look into every avenue possible when trying to get the best low-income rental accommodation for seniors. Those that are on waiting lists may benefit from these shared schemes – if only on a short term basis. At the same time, it also helps to understand the rights of seniors in this situation. Discrimination still exists in this area of the housing sector – even with some of the nationwide government schemes. It is vital that seniors feel confident to apply for help and recognize discrimination. There are agencies and acts that can help.

SAGE:

SAGE (Services & Advocacy for GLBT Elders) is an important network that seniors need to be aware of. There are many older tenants that identify as gay, bisexual or have another sexual orientation. For a long time, many will have felt the need to hide this information on rental agreements. Attitudes and questioning for low-income rental applicants still have a way to go. Questions are still asked in blatant acts of discrimination. SAGE works to improve the experience of the senior LGBT community in the housing sector. Anyone worried about their application, or that have experienced discrimination themselves, should talk to SAGE for support and advice.

The Fair Housing Act:

Finally, it is important to remember that there is such a thing as the Fair Housing Act. This basic human rights act works to eliminate any form of discrimination based on an applicant’s race, gender, sexuality, religion and/or disability status. Therefore, the same type of housing opportunities and rental options should be available to all seniors in a community. There should be no favoritism towards all-white neighborhoods or and questioning about religious practices or sexual orientation.

Find the solution that is right for you.

As you can see, there are lots of different options available to seniors that need a low-cost housing solution in their retirement years. Many seniors with low incomes will, understandably, turn to the HUD and its related schemes. Those that are eligible can find a great senior-friendly apparent with an affordable rental price. They will also have the help and support to live an independent life, while still having their needs met.

However, waiting lists, costs, and availability issues can mean that this path isn’t right for everyone. That is where is it important to consider the alternatives, such as shared housing. These schemes can prove to be a great support for seniors that want to stay in their own home, get help with the rent and gain a little more support.

If you have a relative reaching retirement age, and you are both unsure of how to afford housing, take your time researching the options available. Look into local housing schemes for low-cost rentals and see if any properties are a good fit. Listen to there concerns and needs about their new home and neighborhood. This is the only way to ensure that they will be truly happy with the move.

If the idea of a new home in a new neighborhood is scary, talk about shared housing options. Look into local schemes and consider the prospect of bringing in a paid tenant. The more that you discuss with your relatives, the easier it is to find the ideal solution. There isn’t a one-size-fits-all solution here – nor should there be. Take your time, do the research and weigh up the pros and cons. Talk to the right services and they will steer you in the right direction.

The post How to Find Low Income Housing For Seniors appeared first on GeriatricNursing.org.

While the majority of individuals with Alzheimer’s dementia are aged 65 years and older, it is not considered a normal part of the aging process. Only about 10 percent of individuals aged 65 years or older have the diagnosis of Alzheimer’s disease, with nearly two-thirds of sufferers being female. In addition, while there are about 5.5 million people aged 65 years or older in the US who have the disease, there are still about 200,000 people with Alzheimer’s disease who are under the age of 65 years. These individuals are said to have early-onset Alzheimer’s disease.

The natural course of the disease is that it gets progressively worse over time with an average time from diagnosis to death being four to eight years, although it can last up to twenty years until the individual dies from the disease. Even without another disease or illness in the affected person, Alzheimer’s disease is uniformly fatal by itself, being the sixth most common cause of death in the United States.

Alzheimer’s disease is a microscopic nerve cell disease of the brain. There is a fundamental failure of communication between brain cells that are themselves not operating at full capacity. While there are a lot of theories about what the underlying cause of the disease is, it is known to be partly genetic and to result in irreversible changes in the biochemistry of the brain cells so that they no longer communicate and will no longer function as a whole unit. Evidence of the disease can be seen in the brain even before the clinical signs and symptoms appear.

A Progressive Disease

While each person with Alzheimer’s disease has a unique experience from the beginning to the end of their life, the disease is known to have a similar pathway from mild or no symptoms to extremely severe and life-threatening symptomatology in all sufferers. There are several stages of the disease that are somewhat arbitrary but that can be helpful to know about when trying to understand what happens as the disease progresses. Knowing the different stages can help families and loved ones track the trajectory of the disease in their family member and be able to anticipate the future.

While the disease can be divided into “mild, moderate, and severe” stages, there is a seven-stage model developed by New York University’s Dr. Barry Reisberg, known simply as the Reisberg system. It is the most common system used by the Alzheimer’s Association as well as many healthcare practitioners who help manage Alzheimer’s patients.

In understanding the stages, it is important to recognize that this is a disease that has a one-way progression and that, while an individual can be at a certain stage for a long period of time, they will follow a course that will naturally lead to the next most severe stage over time. This is because, while there are effective treatments that can slow the progression of Alzheimer’s disease, these treatments will only slow the disease progression but will not cure this terminal illness.

Stage 1 Alzheimer’s Disease: No Clinical Impairment

This is the stage of the disease in which there are no clinical findings and no diagnosable memory impairment. In short, there is no detectable disease evident in these patients. This is referred to as “preclinical Alzheimer’s disease”. It is not clinically significant because the individual would not know they have the disease unless they happen to be in a research setting where the disease can be diagnosed using sensitive imaging technology.

The imaging technology can identify protein accumulations in the brain called beta-amyloid deposits, which are not as important to know about practically (yet) because there is no way to intervene on the progressive nature of the disease. For now, this stage is important in clinical trials of drugs and other treatments that might in the future become helpful in stopping the disease before there is clinical evidence of it.

There are also biomarkers for Alzheimer’s disease that identify those who might be at a higher risk of developing it. These biomarkers can be shown to be present in the bloodstream during preclinical disease and there are also genetic tests available for individuals who believe they are at risk for early-onset Alzheimer’s disease. Again, while these will be positive in preclinical disease, they don’t guarantee that a person will develop dementia nor are they seen in every person with known disease.

Stage 2 Alzheimer’s Disease: Very Mild Decline

This involves a minor impairment in memory. Memory loss as well as an inability to remember newly-learned material are the first signs of clinical disease in Alzheimer’s dementia. In this stage, the individual may have difficulty that is beyond that which is seen in age-related memory loss, although the distinction isn’t always obvious. The individual may lose things in the home or forget a phone number, but will pass simple in-office memory tests; the family members may not notice any real decline.

Memories of things in the past are generally completely preserved during this stage. It is the memory involved in learning new material that becomes difficult first. This is because the initial changes are seen in the hippocampus, where newly learned information becomes solidified and remembered for longer periods of time. It will be difficult to learn a new language, the name of a newly met person, or the intricacies of a complex physical task. Working memory is most noticeably affected, which is the type of memory involved in problem-solving.

Stage 3 Alzheimer’s Dementia: Mild Decline

This is the first stage in which the loved ones and family members will begin to notice a slight cognitive decline in the Alzheimer’s disease patient. There will be a further decline in working memory so that things like organization and planning will be affected. There may be a lack of judgement about the time it takes to do a specific task and delays in getting tasks completed. Word-finding difficulties are more common and the memorization of names and dates may be impaired.

This is a stage that can also be referred to as mild cognitive impairment. Work and relationships are not generally affected but there will be some loss of memory around things like the content of recent conversations, remembering appointment times, and the knowledge of recent events. The person’s performance on tasks might be impaired by the inability to remember the sequence of steps necessary to complete them. Decision-making might be compromised.

Outside of memory impairment, there are personality changes that become evident for the first time in this stage. The affected individual may appear to be depressed or withdrawn—not engaging in conversations to the same degree as they normally would have before getting the disease. They may also express increased irritability or may seem angrier than is characteristic for them. There is often a newly-expressed lack of motivation in the area of task completion. Their range of ideas becomes limited during this stage of dementia.

The loss or misplacement of things is increasingly a problem in this stage. Both common and valuable belongings can get lost more frequently. This problem also extends to getting lost while driving, even when traveling in relatively familiar surroundings. The pathways in the brain responsible for simple navigation are increasingly diminished in capacity, making it even more obvious that the impairment is far greater than is seen in the normal aging process.

Stage 4 Alzheimer’s Disease: Moderate Decline

Most people in this stage have an obvious reduction in their cognitive capacities. Things like basic arithmetic problems become difficult to do and there is a greater reduction in the ability to remember activities done even earlier in the same day. Finances usually need to be handled by another family member as basic bill-paying becomes impossible to keep up with.

This is the first time that the individual may forget some things that happened in their early lifetime. They may confabulate in order to cover up their loss of memory. Judgement is impaired and things like the day of the week or even the time of year may be lost to the affected person. This leads to a deeper level of confusion and wandering behavior, particularly as their circle of what is familiar to them closes in.

Because of the confusion seen in this stage, it may be unsafe to let this person live independently or even be left alone for more than a brief period of time. Outside of what’s familiar to them, the individual will be markedly impaired in their ability to function, needing increasing reminders regarding activities of daily living and personal cares. Important details regarding the taking of medications and remembering to eat on a regular basis need to be managed by a consistent person in the patient’s life.

Stage 5 Alzheimer’s Disease: Moderately Severe Decline

Most of the activities of daily living involving the affected person will need ongoing assistance during this phase. Simple things like dressing in an appropriate way will need to be supported. Basic life details, such as the person’s address and phone number, are simply forgotten and the person will need near-total assistance with daily life.

While there is significant confusion outside of what is familiar to them, the patient will still be able to toilet themselves and will need variable degrees of assistance with bathing and grooming. There is the possibility of occasional loss of bowel or bladder function but it is not a consistent problem.

Behavior and personality are significantly affected during this stage. Suspicious thinking is extremely common as the individual will lose trust in those around them. They may hoard food with the belief that someone is stealing from them. Hallucinations, either visible or auditory, can be found in the person in this stage of Alzheimer’s disease. Behavior tends to worsen in the evening, with restlessness, agitation, and verbal or physical outbursts seen at night—a phenomenon called “sundowning”.

Stage 6 Alzheimer’s Disease: Severe Decline

This is the stage in which the Alzheimer sufferer requires ongoing professional care. Constant supervision by a nursing assistant or close family member is usually necessary as the person cannot function on their own in nearly all areas of daily living. Awareness of their surroundings is diminished and there is a decreased ability to recognize the faces of most people, except for close relatives or their spouse. All or nearly all details of the individual’s past are lost to most of these individuals.

Assistance is necessary for all activities of daily living, such as toileting, eating, dressing, grooming, and bathing. There is often complete loss of bowel and bladder function. Wandering behavior is profound if the individual still has the ability to ambulate independently. The recognizable features of the patient’s personality fade away and are replaced by ongoing behavioral issues.

There is a significant impairment of communication during this stage. Carrying on a coherent conversation with others becomes impossible, although they may retain the ability to say a few words or phrases. Physical abilities become affected, with abnormalities in gait being extremely common so that walking without assistance is limited.

Stage 7 Alzheimer’s Disease: Very Severe Decline

This is the final stage of this disease process and is the stage that ends with the death of the individual. There is minimal awareness of the environment and an inability to respond with any type of coherent communication outside of being able to say a couple of words or phrases. This person will require total care with all activities requiring movement, including sitting up independently. The sufferer will have essentially no ability to recognize or respond to loved ones. Almost all aspects of personality are lost in this stage.

The physical impairment now becomes the major threat to the patient’s life. The ability to swallow will be affected so that malnutrition and dehydration become commonplace. This inability to swallow properly can lead to aspiration of swallowed solids and liquids into the lungs. This makes choking experiences increasingly dangerous and the threat of aspiration pneumonia is always high. Bladder infections are also common because of dehydration and poor personal cares. Malnutrition and inactivity lead to skin breakdown and an increased risk of skin infections and decubitus ulcers.

The most common cause of death in this stage is an infection of some kind, although others will ultimately die of dehydration, malnutrition, or even falls. Some patients become so vegetative that eating and drinking become impossible and death comes quickly. Because this stage is always terminal, most of these individuals are not good candidates for tube feeding or other parenteral forms of nutrition.

Final Thoughts

The treatments available to slow the progression of this disease tend to be most effective in the earlier stages and least effective in those individuals who already have significant impairment in memory and functioning. Research is however continuing in search of medications or other interventions that can be curative of Alzheimer’s disease or that can reverse the disease process during each of these seven stages. Of course, research in preventing this disorder altogether is also ongoing.

The post The Truth About Seven Stages of Alzheimer’s Disease appeared first on GeriatricNursing.org.

Many of the gifts that we have compiled here are sure to be well-received by older relatives this holiday season. In this guide, we want to provide some inspiration to friends and family stuck for Christmas gift ideas for seniors. We have divided the guide into four categories to help you with your choice.

First, there are some great health and beauty items. These gadgets will either provide practical help to elderly relatives or offer a little pampering.

Then there are gifts for the home. These products should help older relatives maintain their independence in a fun way.

Then there are the products for the garden, for those that are still green-fingered and want to get active outside.

Finally, there are the toys and games that are just a bit of fun. Hopefully, this helps to steer you in the right direction.

Health and Beauty Gifts for Seniors

1. Zyllion Shiatsu Massage Pillow

Massagers and other related products will always go down a treat with seniors that suffer from a few more aches and pain than they used to. This model is ideal for a Christmas gift because it is smaller and more affordable than the more high-tech options. This system uses a deep kneading messager in three dimensions to help with muscles in the neck, back or legs. It is comfortable, easy to use and will prove to be very helpful. This multi-functional element means that relatives can use it as they feel necessary depending on their personal ailments.

2. TheraFlow Dual Foot Massager

This next massager is one for those that don’t like anything too full-on or high-tech, such as the model above. Here there is a simple wooden roller that relatives can use to ease tension and pain in their feet. It looks pretty basic at first, but there is a nice motion and an ergonomic shape that can prove to be very helpful. It is proven for arch issues and conditions like plantar fasciitis. The lightweight and portability mean that it can be used pretty much anywhere. There are also helpful instructions for the best motions and results.

3. Sunbeam Microplush Heated Throw

Many seniors will also find great comfort in this heated blanket over the Christmas period. This blanket has a soft, microplush material that is wonderful to snuggle into on a cold evening. The Thermofine warming system within adjusts to the temperature and the body to provide a great heated blanket. Remarkably, this is also machine-washable with no risk of damaging those layers. This is much safer than traditional electric blankets. There is no fire risk that comes from overheating elements or blankets left on accidentally. This means greater peace of mind for all concerned.

4. Philips Wake-Up Light Alarm Clock

Light therapy devices are a great help for seniors that struggle with darker mornings, or perhaps even exhibit signs of SAD. Philips is one of the most popular brands when it comes to these devices. This SAD light doubles up as an alarm clock by providing a soft sunrise simulation. The round orb gradually changes color to offer a more natural wake-up. This programmable device also has natural sounds to replace the normal buzzing. This can be a great help to seniors that want to make the most of every winter morning.

5. Winonly White Noise Machine

It can also be difficult for some seniors to get to sleep at night. Sleep disorders and insomnia are more common at this time of life. A white noise machine such as this can provide comforting background noise to help them drift off at the same time each night. There is a choice of noises with ocean waves and rainforest noises alongside the typical white noise stream. The bedside device also has timers to help users plan their nightly regime. With regular use, this could prove to be a great help for many conditions.

6. Vaunn Medical Folding Pedal Exerciser

Some seniors may also appreciate the opportunity to use some exercise equipment to stay fit and strong. There is no reason for them to give up on their physical strength and fitness as they retire, but they may need some specialist equipment to do so. This pedal exerciser brings the best elements of an exercise bike to the living room floor. There is a smooth rotation on the pedals, a strong base and a small monitor for data. Users can set this up in front of the TV and enjoy a great exercise session.

7. Fit Simplify Resistance Bands Set

Next, we have something a little bit different. This doesn’t look like much at first. There are 5 exercise bands in a carry bag and an accompanying workout video that users can fit online. These tough latex bands come in different resistance levels and can be used for different exercises. Some people will find that they are great as an additional tool for Pilates and Yoga sessions. This should appeal to many seniors that take up either of these hobbies and wish to push their limits a little further. The portable nature means that they are great for classes in community centers too.

8. LegActivator 

Then there is this LegActivator. This product sounds a little more gimmicky because of the name. It is designed as a passive exercise machine that helps to keep the legs moving and improve the circulation. Regular sessions on this device could help with varicose veins and general conditioning. This compact system is surprisingly quiet and gentle and should provide a great session with no effort at all. In fact, it is more simple to use that the pedal machine above.

9. Healthy Seniors Mini Exercise Ball

Some of these exercise machines and bands are great for those with a current level of fitness and mobility. They help to keep active seniors active. Then there are those relatives that are a little older and frailer. They may have osteoporosis or other mobility issues that limit exercise options. These Healthy Seniors guides provide a simple booklet and piece of apparatus to get people started. The ball is soft and easy to inflate with either the pump or straw. Users can follow the instructions from the comfort of a chair and improve their flexibility and strength.

10. PuTwo Pill Box

Pillboxes never seem like the most exciting gift that you can give to a senior relative at Christmas. Still, this might be something that they really need and didn’t think to ask for. Some pill organization systems are a little more stylish than others. Here there are seven colored containers – a different color of the rainbow for each day of the week. They have clear sections for the time of day and all fit neatly into a portable leather wallet. This means that seniors can take them away on holiday and not have to worry about confusing their medication.

Home Gadget Gifts for Seniors

11. Hamilton CapTel Captioned Telephone

As our elderly members of the family get older, they can struggle with some of the more basic tasks they face. Gadgets and senior-friendly tech can help improve the situation with some special aids. This telephone is a great example. This product has a traditional dialing pad and a large-print touchscreen above. The captions provide an easy-to-read transcription of the calls. It also transcribes answer phone messages. This is great for those that are hard of hearing and need a little help understanding what callers say.

12. SmartShopper SS-301 Voice-Recognition Grocery-List Organizer

Creating a shopping list can also be a bit of a problem for some elderly relatives. It can be difficult to write down everything on a list, perhaps because their handwriting wasn’t what it used to be. Memory problems may mean that going without a list at all is impossible. This voice recognition device prints out a clear list and organizes the items by department. The display is easy to read and users scroll through up to 2500 pre-loaded items.

13. KitchenGadgets Jar Opener for Weak Hands

Another task that can be quite difficult for older family members is opening cans and jars. To be honest, we can all struggle with this from time to time. A tough jam jar or bottle of water is rough on weaker, arthritic hands. This gadget takes the strain with a series of attachments. It is designed as a 5-in-1 mode, so should be able to handle most jars and bottles around the house. Simply place the device on the lid and twist.

14. LED Lytes Flameless Candles

Scented candles are always nice in any home. However, there is a bit of a safety risk with older residents, especially those with complex care needs. A flameless, LED model like this offers the same scent and comfort without the risks of naked flames. This set of multicoloured candles has a remote control and the real wax smells like vanilla. The hand-carved top gives it a more realistic look too.

15. Hog Wild Peeramid Bookrest

Reading is a favoured pastime among many seniors. It is fun to curl up with a good book on a rainy afternoon, or with a little breakfast in bed. In addition to buying a relative a book this year, why not consider a bookrest to lean upon. These sturdy products offer a great angle for the book and take the weight from tired, sore hands. They come in lots of different colours and patterns and even have a soft tassel bookmark to help users mark their place.

16. Nix XO8G Digital Photo Frame

Photo albums are a great way to help preserve memories from events and holidays gone by. A digital version is a great gift for seniors that want to brighten up their living room with photos. This device cycles through images on an 8-inch widescreen display, with high-resolution images. Users can scroll through the display and adjust them via the remote control. Images are uploaded via a USB port or SD card. It is a simple way for grandparents to bring memories to life and show them off to friends.

17. American Lifetime Day Clock

A bold, clear photo album isn’t the only digital screen that can help seniors make the most of their days. This digital clock offers a different type of display that is designed to help seniors that may have some comprehension problems. There are no short-forms or abbreviations on the time, day or date. The months, dates and times are clear to read with the high contrast display. It even reassures users that it is the morning or evening. There is a battery back up as well in case there is a power cut.

18. Nest T3017US Learning Thermostat

The last of these home gadgets for seniors are a pair that is best suited to those that aren’t worried about the cost. There are some impressive pieces of helpful tech that can prove to be a worthwhile investment for a long time to come. A Nest thermostat is a great way of making sure that your parent’s home is the right temperature and comfortable in these colder winters. It is easy to control and you can install it for them yourself.

19. iRobot Roomba 690

There are quite a few different robot vacuum cleaners out on the market right now. Many of them come from iRobot. The Roomba 690 isn’t the most cutting-edge model in the range – which makes it a little more affordable as a Christmas gift. Still, it has a lot of helpful features. Users can program this bot to run on a schedule and rely upon into smart sensors to detect the dirt and the furniture. This model is also compatible with Amazon and Google assistants.

20. Ageless Innovation Companion Pets

Finally, we would like to mention a robot with a difference. This company creates “life-like” creatures that act like pets. They are designed to offer comfort and companionship where a real pet is out of the question. These creatures are great in a residential home or for those with dementia. These cats have brushable fur, can purr and have movements in their limbs. The sensors also provide appropriate responses to interactions with seniors. Dogs are also available if preferred.

Best Gifts for Seniors Who Garden

21. Step2 Garden Hopper

Many seniors want to be as mobile and active out in the garden as possible in their retirement. The problem is that this isn’t always as easy as it used to be. There are lots of fun tools out there that can help make things a little easier. This hopper has a large storage bin for tools and other items, as well as a sturdy seat/lid on the top. The four strong wheels also mean that users can move this around the garden between jobs. If that wasn’t enough, there is also a beverage holder.

22. Single Source Direct Tool Set and Seat

A multi-functional seat is a great idea for senior gardeners this Christmas. There needs to be enough of a balance between time spent planting the roses and time spent smelling them. That is why this well-equipped seat is such a great purchase. The folding seat is comfortable and lightweight. It comes with a detachable tote ba and has a series of pockets for different tools. In fact, 5 tools come with this chair, adding to the value for money. They are a hand rake, trowel, weeder, transplanter and cultivator.

23. EasyGO Wand Weed Puller

It can be hard work getting down on your hands and knees pulling up weeds. Weeding can be a thankless, tough task. But, this weed pulling tool means that users no longer need to get down on the ground. There is a clever mechanism that grabs the weeds and pulls them and users stand on a claw and pull the handle. This time saver could prove to be very popular with many relatives.

24. Gonicc Professional Pruning Shears

On first impressions, you might look at this pair of shears and wonder why they are ideal for seniors. They are a tough, sharp tool that makes short work of dead-heading and pruning jobs. The major difference here is that they require less effort. The mechanism doesn’t need much force and there is a secure grip on the handle. This is much better for all those seniors struggling with strength issues or arthritis.

25. Garden Genie Gloves

This next tool might be a little bit startling for some seniors, or it might be the source of a lot of amusement. It all depends on the recipient really. These gardening gloves have claws attached to the fingers that makes them look a little like a werewolf is out gardening. These claws help users dig at the ground while planting, reducing the need for tools. They are also pretty tough with waterproofing and puncture resistance.

26. Squirrel Buster Bird Feeder

Another reason that many seniors love their gardens is because of the wildlife that lives there. Feeding the birds is another outdoor pastime that can really help to relax people and bring joy. There are lots of different bird feeders out there, but this one is great for those that want to put the birds first. This bird feeder has a weight-driven shroud that activates when squirrels jump on the feeder. This deterrent, along with the 4 feeding ports and 2.4lb capacity, means that the birds should be well-fed.

27. Nature Gear Window Bird Feeder

An alternative option when feeding the birds is to give the gift of a window bird feeder. These products are transparent and stick to the window with suction cups. Users just fill the tray with seed and wait for the birds to arrive. It can take some time to tempt the birds in, but users can get some brilliant views from a living room window. This model is weatherproof, strong and easy to refill. It should provide some close-up avian encounters across the year.

28. Vivohome Antique Outdoor Garden Birdbath

The birds will also want a place to bathe and get some water. An ornate birdbath does, therefore, have a dual purpose as a Christmas gift for seniors. There is the practical side of providing this bathing area. Then there is the decorative, ornamental side to brighten up a garden. There are lots of designs in all shapes, sizes and materials. This one is poly-resin, so not expensive, and should be durable. It also has a nice weathered, antique look.

29. Gardirect Wild Bird Classic Nesting Box

Perhaps your senior relatives might also like to provide a better home for all these feathered friends that come to visit. It can be very rewarding to know that you have made a home for nature. Many seniors will love the chance to open up their garden to wildlife in this way and watch their daily lives. A bird box is a great gift here. These houses aren’t too expensive and are easy to install. This cedar model has the perfect living space for little garden birds and can be secured to keep predators out.

30. The Age-Proof Garden: 101 practical ideas and projects

Finally, some senior gardeners may need a little inspiration to try new projects now that they are a little older. Some may want to get back into the garden but feel unsure about their capabilities. This book shows that anyone can enjoy the garden at any age. It offers a range of tips on creating a beautiful garden in a more manageable way – whether that means working with flowers, vegetables or herbs. There are also helpful photographs.

Fun Games and Toys for Seniors

31. Active Minds Animal Bingo

A great place to start when talking about toys and games for seniors is with the Active Minds brand. This award-winning team create fun activities designed specifically for those with Dementia or Alzheimer’s. There is no reason why grandma can’t join in the fun at Christmas with an appropriate game. This audio game use sounds and images of different animals. Players tick them off their cards just like “normal” bingo. It is so family friendly that everyone can have a go.

32. Active Minds Seaside Jigsaw Puzzle

Jigsaw puzzles are a great gift for seniors that like to train their brains and entertain themselves on a dull, wintry afternoon. Some jigsaws, such as those from Active Minds, are specially designed for people with Dementia. The 35 large pieces are easy to handle and come together to create a great seaside scene designed to spark memories of past holidays and youthful adventures. There are also prompts in the box to help guide the conversation. This is a great way to share some memories over the holiday season.

33. Active Mind Natural World Aquapaint

Art therapy can be very rewarding for seniors – especially those with dementia. Some may have enjoyed artistic pursuits in the past, but don’t have the skill or dexterity they used to. Others may find joy in using paint that lets them handle some of their stress or helps them forget about medical concerns. These Reusable water paint products are a great way to bring some creativity to the day in a controlled manner. The magic pictures transform with water, giving the illusion of a painting. This image may then spark memories and conversations.

34. Colouring Books For Seniors: Relaxing Designs

Colouring books came back into fashion not too long ago. Adults remembered why they loved to colour in images as a child and began to enjoy the therapeutic benefits of the process. The same applies for seniors that may be dealing with stress or anxiety of their own. This Relaxing Designs book has lots of pretty patterns and designs that seniors will love, with plenty of flowers and butterflies. It doesn’t matter if they colour outside the lines. Just let them enjoy the process.

35. UGEARS Roadster VM-01 3D Brain Teaser

Of course, it isn’t just seniors with more complex needs that will benefit from puzzles and games over Christmas. There are plenty of grandfathers and uncles that will love the challenge of creating a 3D model. These wooden kits are fun to build and look stylish when complete. This mechanized version has a rubber band motor and a winding key. This old-fashioned Roadster is sure to be a hit with many relatives. They may even enjoy the chance to share the project with a grandchild.

36. Cardinal Giant Uno Game

Giant sized games are another brilliant way to bring seniors into the fun and games of Christmas this year. Some older family members may get a little frustrated with normal games when they can’t use the tokens or see what is written on the cards. The Giant Uno game takes an old family classic and enlarges it so that it can be enjoyed by players of all ages. The cards are 10.1 by 7.4 inches, so there should be no dispute about who has which card. The only problem comes with shuffling them. They are so big that even the next product on our list won’t be able to help.

37. Casino 6-Deck Automatic Card Shuffler

Grandparents with sharper minds may also enjoy the chance to play a few games of cards in their free time. Grandma may still be a legend when it comes to the local bridge club and Grandpa may still have a few tricks up his sleeve for poker games. An automatic card shuffler makes things even easier on their hands. This device can shuffle up to six decks in seconds. It is also battery operated, which means that seniors can take it with them to other houses and clubs with ease. You may want to add in a pack of cards to finish off the gift.

38. John N. Hansen Mega Screen 7 in 1 Poker

Also, if your grandparent is really into poker, you might want to give them this little handheld game as a bit of a stocking filler. This 7-in-1 poker game is perfectly suited for older players. There is a large screen that clearly shows the cards and the status of the game. All of the buttons on the device are large and clearly labeled. There is a volume control, just in case, Grandma gets fed up with the noise. There is also a power-saving function if the system is left idle. There are plenty of different forms of poker to try out, so plenty of entertainment.

39. Yellow Mountain Imports American Mahjong Set

This next option is a little more expensive. But, this is a great gift for those that love Mahjong and want a gift that they will treasure. You could probably find a handheld game that offers a decent version of Majong. But, this is a beautiful set with true craftsmanship. There is something appealing about playing with real tile. The 166 tiles, racks, and other tools all come in a leatherette case. This means it is portable for trips away or for games at social clubs. This isn’t the cheapest game here, but it is one that players will cherish. The product also comes in different colors and designs.

40. Kavi Black Inlaid Wood Chess Board

Alternatively, you might think about giving them a chess set. A chess set provides a different type of game. Here they can play against friends at their residential home or local club. They may even have the chance to teach their grandchildren how to play. This set has a classic look to the pieces and board, so has that timeless quality. The board is made with maple and ebony inlay and the pieces are weighted with felt bottoms. The attention to detail means that family members will love this set and want to play time and time again.

The post 40 Best Gift Ideas for Seniors: The Ultimate List (2019) appeared first on GeriatricNursing.org.

What you should do is to focus on grandparents hobbies, activities, experiences, and individual tastes to guide you in picking the perfect gift.

Buy a Gift That Entertains

How does Grandpa entertain himself? Does Grandma like watch TV and movies? Do they read books?

If Grandpa is a book lover, get him some of the latest books published in the genre he favors. Amazon has a huge list of bestsellers that you can look into.

If he is interested in technology, consider buying him Kindle. The reader will enable him to get a large selection of books without having to go anywhere and cluttering the shelves, that are filled anyway. The Kindle is also lightweight, making it easy to transport his favorite titles wherever he goes.

If your grandparent is a movie lover, get him a subscription to Netflix, Hulu or Amazon Prime. Streaming services are perfect for movie lovers with mobility issues as you don’t have to go anywhere and can simply do it from home.

Nowadays, grandparents are quite tech-savvy. Although they may not aware of what’s new on the market, they can be persuaded to embrace the technology. Still, grandchildren who buy their grandparent’s new high-tech gadgets need to be careful in their selection.

Make sure the keys and buttons are large enough and user-friendly. Make sure you don’t deliver the gift and run. Have them open the package and be sure they are comfortable using the new gift.

But if you grandparents have sense of humor, why not get them something that is both practical and fun- Rainbow motion sensor toilet light that fits on any toilet bowl and can actually prevent falls in the bathroom. There are estimated 30.000 injuries every year in US alone from toilet related injuries.

Walking Sticks Can Make Unique Christmas Gifts

Walking sticks are produced in all lengths and designs. They make a perfect Christmas gift for seniors because they portray a sporty look, rather than fragility. A great one we found online is this adjustable walking stick that comes even with a LED light!

A person walking with a cane receives polite smiles. A person walking with a hiking stick is either passed by or asked, “Where did you buy that?” These sticks are fashionable, useful and beautiful.

Of course, you can also go down a more traditional route and get a handcrafted stick made by Brazos. They are made from different types of wood and decorated with leather or carvings and come in beautiful shapes. Just watch this video to see how they are made. Simply awesome!

Just as for hikers, walking sticks improve balance, and spare the back and knees. For the elderly who are somewhat unsteady, but too proud to use a cane, a walking stick may be the perfect solution.

Comfort & Safety Come First!

As people age, comfort becomes ever more important. Does your Granny or Grandpa play solitaire on his computer all day? Perhaps he needs a more comfortable or ergonomic office chair. Do they live in a cold house? Perhaps he could use some slippers lined with shearling, a pair of wool socks, or a throw adorned with the logo of his favorite football team.

Talk to your parents for clues about what kinds of items could enhance their lives on a daily basis or see if they complain about something constantly- a great gift idea may reveal itself just like that!

Another fantastic idea that is helpful for anyone who is a bit absent minded (and this does not only include seniors) is this key finder with LED light. This innovative gadget includes 4 receivers and can find all your keys , or other items you tend to lose within 130 feet range.

Personal Christmas Gifts Are the Best

Of course, any gift that your grandparent receives that is personal will be especially meaningful. Even here, though, focus on how he can use it to ensure that it doesn’t become a dust collector.

Many older people live in small homes or apartments and have limited space for framed photos and large albums. A smaller condensed photo album is easy to make, inexpensive, and will provide hours of pleasure.

The family album can be organized by year, child, etc, depending on family size and composition. Grandparents will also enjoy an album with early photos of themselves that have been copied from old family pictures.

Descriptions and digital photos can be printed together on the paper or regular photos can be arranged with handwritten or printed descriptions and attached to the page.

You could also consider making Grandpa or Grandma a calendar with family pictures that will make him smile as he remembers past holidays and family events.

Other great ideas include personalized mugs, mouse pads, magnets, or pot holders adorned with pictures of the grandchildren or their artwork.

It may be cliche, however, it really is “the thought that counts.” One of the most treasured gifts you can give to proud grandparents is homemade Christmas ornaments.

Grandkids could get together for a trip to the local pick and paint pottery studio and make a ‘matching’ set of ornaments hand-painted and dated in each of their different styles. Or, check out craft stores for ornament making kits, or simply purchase inexpensive wooden ornaments in Christmas shapes that can be embellished with glitter and sequins.

Personal gifts may or may not cost a great deal of money, but most require some time and planning. That is exactly why parents appreciate personal gifts. The addition of a handmade gift card with a personal message of love and appreciation is the perfect way to top off a personal gift.

Indulge…

People with a wealth of life experiences can be difficult to buy for because it seems like they have everything they need. If this is the case with your grandparents, a gift of consumption could be a good choice.

If Grandparent has a favorite drink, indulge his/her love for it. You could get a bottle of scotch, a great bottle of Cabernet, or even a fine vodka. Subscribe to a Fruit of the Month club for him. Check out Harry & David or Williams Sonoma for some decadent flourless chocolate cakes that he/she can pop in the oven on special occasions, or buy him/her his favorite, Grade B maple syrup.

Gift baskets can be expensive and often contain a few items that the recipient might not love. Customizing a gift basket to suit the family member or friend saves money and assures that all items will be appreciated, or you can simply get them this super popular nut and dried fruit basket by Oh!Nuts.

Try choosing a container that becomes part of the gift. A watering can for a gardener’s gift, a tote bag for knitting or crocheting supplies, and a reusable grocery bag for spices and kitchen towels add value to the gift and save wrapping paper.

…or Get Busy?

For grandparents who tend to buy themselves all the latest gadgets, try giving them a day to remember. After all, your time will be the most valuable gift you can give. If you need help organizing something,  there are companies which can arrange for an experience voucher for a wide variety of experiences from a helicopter flight to a day with a professional photographer at the Zoo.

Alternatively, grandchildren can plan a special experience themselves and it does not need to be expensive or elaborate. Sometimes even a picnic in the park or a day out is all you need to bring a smile to your grandma’s grandpa’s face.

If your elderly relatives are active and enjoy learning new skills, you could help them with this.

Local community classes offer a variety of learning opportunities, from painting to creative writing to target lessons. Classes are typically in the $50-$150 range for two to four sessions. Keep grandparents’ mind sharp and support your community at the same time this Christmas with the gift of learning!

Be Christmas Savy!

People on a fixed income will appreciate a gift that has more than one use. An example is a Christmas plant or flower that can be used as a Christmas decoration or table centerpiece and can be kept as a houseplant or planted outdoors when the weather warms.

Amaryllis bulbs are perfect for Christmas giving and are available online and in many discount stores and garden centers in the months leading up to Christmas. When the amaryllis bulb blooms, the display is spectacular.

Buy the bulb and plant according to directions in the provided container about four to six weeks before Christmas. When gifting time arrives, place the plant in an inexpensive small basket or wrap with felt, foil or tissue paper and tie with a bright bow.

The gift can be given early so the recipient can use it as part of the family Christmas decorations. Instructions for caring for the amaryllis to make it bloom again should be included in a Christmas card given with the plant.

Offer a Helping Hand

A gift of a cleaning or handyman service might well be appreciated by a person who finds it hard to do these things for themselves. Or perhaps someone in the family could offer to do some gardening, giving a handmade card outlining the service they will be offering.

The same technique could be used for offering other services, such as decorating. It would be worth visiting the elderly person in advance and finding out what they are likely to need. Such personal and useful gifts are always appreciated.

And finally, remember that a gift that comes from your heart is the one they will remember!

The post Christmas Gifts for Elderly Parents and Grandparents appeared first on GeriatricNursing.org.

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<img src=”https://geriatricnursing.org/wp-content/uploads/2018/05/CR1-1.png” width=”540″></p><br /> <p>Cataract – An infographic by <a href=”https://geriatricnursing.org/cataract/”>GeriatricNursing.org</a></p><br /> <p>

If you or a loved one has cataracts, you’ll want to know what these are all about. Cataracts represent are basically areas of opaqueness or cloudiness of the lens of the eye. Normally, the lens is clear and allows for a full amount of light and clear images to pass through to the retina of the eye. Cataracts can be small areas of opacity or can involve the entire lens and can affect normal vision. The majority of cataracts develop in individuals 55 years of age or older; however, certain kinds are congenital (occurring at birth) or can happen after a traumatic injury. Cataracts generally affect both eyes roughly the same but one eye is often more involved that the other with vision loss.

The healthy lens is located behind the iris or colored part of the eye. It focuses light (similar to a camera lens) on the retina, which sends the image to the brain through the optic nerve. The brain then interprets the image. The lens is usually completely transparent so clear images are sent to the retina. If the lens becomes opaque from a cataract, it cannot send a clear image to the retina, and your vision will be blurry.

Signs and Symptoms of Cataracts

In general, cataracts don’t develop overnight and instead develop very slowly. As it develops, the typical symptoms you’ll notice include the onset of hazy or blurry vision, an increased amount of glare from headlights and other lights at night, a deceased vibrancy of colors, changes in refraction (nearsightedness or farsightedness), and difficulty seeing things in a darkened environment. Once these symptoms begin, they progressively get worse. There are no medications or eyedrops that can slow the progression of the disease. Ultimately, when the vision worsens, surgery is the only option.

Risk Factors for Cataracts

There are several risk factors for cataracts. The greatest risk factor is advanced age. By the age of 80, almost everyone will have some degree of cataracts or will have already had cataract surgery. People who are obese or who have diabetes have a greater chance of having cataracts. Excessive sunlight exposure increases the risk of cataracts so sunglasses can make a difference between getting cataracts and not getting cataracts. Smokers have a greater risk of cataracts. Hypertension will increase the risk. Individuals who have had an eye injury or inflammatory disease of the eye will carry a higher risk for cataracts. Past eye surgery will increase the risk of developing cataracts.

Cataracts are so common that it is the most common cause of blindness throughout the world. Most of the affected patients live in developing countries where surgical options are limited. The treatment of cataracts involves detecting the cataracts early, monitoring them regularly, and performing surgery when the vision is significantly impaired, which is something not available in developing countries. If these things can be accomplished, the vision loss is very reversible, even in its advanced stages.

Causes of Cataracts

The underlying cause and pathology behind most cataracts are not completely known. It appears to have nutritional, genetic, and environmental factors. As an individual gets older, the thickness and weight of the lens increases, while its ability to accommodate to visual demands worsens. The central nucleus (inner portion) of the lens gets pressed by new layers added to the lens, decreasing its lucency.

There are age-related changes in the epithelium of the lens so that the epithelium (lining of the lens) decreases in thickness, leading to fibrosis or scar tissue on the lens surface, decreasing the transparency of the lens. The older lens takes on water more slowly and takes up metabolites with less efficiency. This includes having a decrease in the numbers of antioxidants that can get into the cells. The cells develop damage from oxidative stress, leading to cataract damage. Damaging free radicals in the cells (like iodized glutathione) have been found in cells that are affected by cataracts.

The other factor that might lead to cataracts is the precipitation of smaller proteins into larger aggregates of proteins that light cannot pass through. These large protein matrixes are not soluble in water and serve to scatter light rays in the lens, reducing the lens’ ability to have a clear image pass through it.

There are three different types of senile (old-age) cataracts: 1) cortical cataracts; 2) nuclear cataracts; and 3) posterior subcapsular cataracts. Cortical cataracts come from changes in the salt content of the cortex (outer layers) of the lens that produce fibers that can’t let light through. Nuclear cataracts come from excessive amounts of scar tissue that causes a yellow to brown-colored nucleus (the central part of the cataract). Posterior subcapsular cataracts come from granular deposits and plaques in the posterior subcapsular cortex (in the back of the lens) so that light cannot pass through the lens. The treatment of all three types of cataracts is the same.

Age-related cataracts have multifactorial causes, including environmental factors, UV light exposure, dietary factors, and advanced age. Causes of cortical and posterior subcapsular cataracts are more related to having diabetes, taking certain drugs, and being exposed to UV light when compared to nuclear cataracts. Nuclear cataracts, on the other hand, are most related to being a smoker. Alcohol abuse seems to cause all types of cataracts.

As for drugs causing cataracts, being under general anesthesia and taking sedatives are linked to cortical cataracts, while steroid use and high sugar levels are associated with posterior subcortical cataracts. Nuclear cataracts are linked to drinking milk and taking calcitonin. Mixed cataracts seem to be associated with having had general anesthesia in the past.

There are several systemic diseases that are linked to cataracts, such as having gallstones, having high blood pressure, being mentally retarded, and having diabetes. Hypertension is especially linked to having posterior subcortical cataracts. Having high triglycerides, high sugar levels, and diabetes are connected to having this type of cataract at an early age in life.

It is believed that UV light caused thermal (heat-related) injuries to the lenses. Exposure to the sun raises the body temperature and the temperature of the eye so that proteins that aren’t supposed to coagulate become bound together. It has been found that people who live in areas of the world with a lot of UV light exposure have a higher incidence of age-related cataracts than people who have lesser exposure to UV light.

Epidemiology of Age-Related Cataracts

The rates of the different types of cataracts are different but they all increase in frequency with age. In people older than 75 years of age, the incidence of nuclear cataracts is 65 percent; the incidence of cortical cataracts is 28 percent; and the incidence of posterior subcapsular cataracts is 20 percent. About 17 percent of people older than aged forty years have at least some degree of cataract formation in at least one eye. About 3 million people in the US have cataract surgery. The success rate of this type of surgery is about 95 percent (which means the vision was at least 20/20-20/40).

In other parts of the world, cataracts are a leading cause of blindness. The highest rate of visual impairment in the world from cataracts is in India. About 1 percent of all Africans are blind with more than a third of them having cataracts as a cause of their blindness. The research in rural India shows a cataract incidence of 67 percent in those aged 70 years or more.

Failure surgically remove a cataract and replace it with an implant can cause swelling of the lens, secondary glaucoma, and ultimately to blindness. There is no risk of death from cataract extraction as the surgery is done with local anesthesia. There is a higher percentage of cataracts in blacks but this is not felt to be hereditary. It is more related to an increased lifetime incidence of diabetes and possible occupational exposure to UV radiation. There is a slightly higher incidence of cataracts in females versus males. (17 percent versus 13 percent).

Age is the main factor that leads to senile cataracts. As the person ages, there is an increased chance of developing a senile cataract. The total number of cataracts in people aged 45-64 years is 23 cases out of 100,000 individuals. The total number of cataracts in people aged 83 years and greater is about 490 cases out of 100,000 persons.

Traumatic Cataracts

A traumatic cataract usually forms in one eye after a blunt or penetrating injury to the eye. Less common causes include exposure to infrared energy, ionizing radiation exposure, and electric shocks—each of which is largely an occupational exposure.

Blunt trauma to the eye forms a rosette-shaped or stellate-shaped (star-shaped) area of opacity in the lens, obscuring the vision. The opacity may stay the same or may progress to involve more of the lens. Penetrating trauma usually disrupts the capsule of the lens, causing changes that may stay the same over time or, like blunt trauma, may progress to cause cortical opacification of the entire lens.

Besides the actual traumatic lesion on the lens, there is a high risk of lens dislocation (displacement of the lens) associated with having a traumatic cataract. Glaucoma can be a side effect as well as a hyphema (bleeding in front of the lens) and other hemorrhaging in the eye. The entire globe of the eye can rupture. Each of these can contribute to becoming blind after a traumatic injury.

The cause of a traumatic cataract involves what’s called a coup and contracoup eye injury. The coup part of the injury is the direct blow to the eye. It’s caused by whatever injured the eye and is in the front of the lens. A contracoup injury stems from shock waves that damage other parts of the lens through the traveling of these shockwaves throughout the lens.

There can be stretching of the lens capsule from the blow that disrupts the capsule and other parts of the lens so that there are cataract changes in the eye that weren’t directly involved in the traumatic injury in the beginning. In penetrating injuries to the lens, the entire lens becomes damaged if the hole in the lens is big enough. Fortunately, small holes can seal themselves up and there will just be localized damage to the capsule of the lens.

Epidemiology of Traumatic Cataracts

There are about 2.5 million eye injuries in the US per year, accounting for 5 percent of ophthalmology visits. Traumatic cataracts can be acute injuries, subacute findings, or late sequelae of an eye injury. It depends on the nature of the injury and how the original opacification spreads. Trauma is the leading cause of blindness in one eye in people under the age of 45 years. Having a posterior segment injury (a deeper injury) leads to a greater chance of blindness when compared to more superficial (anterior segment) injuries. The male-to-female incidence of eye trauma such as a traumatic cataract injury is about 4: 1. Most injuries are work-related or sports-related injuries.

Congenital Cataracts

These involve lens opacifications that happen prior to birth and that show up at the time of birth. They need urgent treatment because, if they aren’t detected and treated early in life, there will be permanent loss of vision. Not all congenital cataracts are deemed significant visually. They occur in the periphery of the lens and don’t necessarily need treatment. Only those that affect the visual line of sight need treatment. Small cataracts in the periphery or in the anterior capsule of the eye may be tolerated without actual loss of vision.

There are several causes of congenital cataracts. Unilateral cataracts (in just one eye) are sporadic and associated with several development problems in the eye or with things like rubella contracted in utero. As for bilateral cataracts, these are often hereditary and linked to other disorders. A full infectious disease, genetic, metabolic, and systemic workup is necessary as there are a number of disorders associated with bilateral cataracts. These include the various trisomy syndromes (like Edward syndrome and Down syndrome), congenital hypoglycemia, myotonic dystrophy and the various TORCH diseases (such as toxoplasmosis, rubella, herpes simplex, and cytomegalovirus). Premature babies have a higher risk of congenital cataracts.

Causes of Congenital Cataracts

The lens develops from an embryonic nucleus at about the sixth week of gestation. Around this nucleus is the fetal nucleus; together these make up the lens by the time of the child’s birth. After birth, there are changes in the cortex of the lens so that the anterior part of the lens becomes the cortex of the lens. Anytime there is an insult to the nuclear fibers of the lens before birth, there will be an opacification or cataract of the lens that comes out of the insult. Any insult prior to the full development of the lens can trigger the formation of a cataract.

There can be an infectious, metabolic, or traumatic insult to the nuclear fibers of the lens that results in opacification (cataract formation) of the medium of the lens. The type of opacification and its pattern can help identify when the insult was to the lens and the possible cause of the insult.

Epidemiology of Congenital Cataracts

Congenital cataracts occur in up to six infants out of 10,000 live births in the US. Because of a greater incidence of infections in pregnancy and other insults, the rate of congenital cataracts in developing countries is believed to be much higher, although the actual rate is unknown.

There is a lot of morbidity (illnesses) associated with having congenital cataracts. Babies can have abnormalities like being cross-eyed, getting glaucoma, and having retinal detachment. In bilateral disease, some type of systemic or metabolic problem is often found in these babies. Things like deafness, mental retardation, heart disease, kidney disease, and other systemic diseases can be part of having a congenital cataract.

Identifying Cataracts

There are several things to look out for when determining if you or someone you know has a cataract. The most common type of cataract is the age-related or senile cataract so you can expect to find this type of cataract in someone older than 55 years of age. The most common complaint is worsened vision. A cataract is considered clinically important if it affects the person’s vision.

The types of cataracts a person has affects the patient’s visual experience. Slight degrees of cataract formation on the posterior capsular area will cause great disturbances in the vision. Near vision is more affected than far vision because of problems with near vision accommodation. On the other hand, the person with nuclear cataracts have poor distance vision and fairly good near vision. People with cortical cataracts don’t have significant vision loss unless the cataract is very advanced.

Another common problem in the vision of people with cataracts is the phenomenon of glare. There may be glare seen in bright light environment or severe glare from oncoming headlights when trying to drive at night. Glare is mainly seen with posterior subcapsular cataracts and somewhat with cortical cataracts. It isn’t seen to a great degree in patients with nuclear cataracts. Glare alone is not a serious problem and, by itself, isn’t usually serious enough to require surgery.

Cataracts lead to some degree of myopia (near-sightedness). Patients who normally need reading glasses find that they no longer need them (at least for a little while). After a period of time, however, this visual improvement goes away and vision is poor again. Some patients can develop outer cataracts with an inner area of clearing that leads to double vision. The double vision occurs in just one eye and cannot be corrected with contact lenses or other devices.

In looking at a person with glaucoma, they will have deficits in near and far vision. They will test positive for the presence of glare and will have a cataract seen by an ophthalmoscope (eye microscope). A high-grade microscope of the eye should be able to tell the difference between nuclear cataracts, posterior subcapsular cataracts, and cortical cataracts. The eye should be dilated to better see the whole lens.

Treatment of Cataracts

The only treatment for cataracts is surgical removal of the cataract with intraocular lens (IOL) implantation. Before the surgery, the ophthalmologist will determine the focusing power necessary for your intraocular lens. Eye drops can prevent infection and will reduce swelling during the surgery and afterward so these will be started before the surgical procedure. On the day of surgery, you’ll be asked to fast for 6-8 hours prior to the procedure. The surgery will be done in a hospital or outpatient surgery center.

While the surgery itself lasts only about fifteen minutes, you can expect to be at the surgery center for at least an hour and a half. This is because it takes time for the eyedrops to numb the eye and to give you sedating medications. You will need only a brief period of observation after surgery and will receive postoperative instructions. Someone needs to drive you home after surgery and you will not be able to drive until the surgeon clears you for driving.

The eye is numbed with an injection around the eye or with certain anesthetic eyedrops. Medication to help you feel calmer will be provided as you will be fully awake during the procedure. The surgeon will make small incisions in the front of the eye in order to remove the lens. Many surgeries are done with phacoemulsification. This involves putting an ultrasound device into the middle of the clouded lens so the lens breaks up into tiny pieces. These pieces are gently sucked out of the incisions. A new lens will be placed where the damaged lens once was. No sutures are required as the eye will heal itself. After resting for a half an hour in recovery with the eye patched, you will go home with the patch in place until you see the ophthalmologist again.

After surgery, you will use drops to prevent inflammation of the eye. These may need to be used for several weeks after the procedure. You cannot press on the eye or rub it too hard. Sunglasses might need to be worn to protect the eye from injury. Even if there are cataracts in both eyes, only one eye will be done at a time. No soap or even water can get into the affected eye. A shield will be worn at night to protect the eye in your sleep. Gradually, you can return to normal activities.

One side effect that many people get weeks to years after surgery is called “posterior capsular opacification”. It involves an increase in blurry vision caused by scar tissue in the posterior capsule. The posterior capsule is what holds the new lens in place. This usually means you have to have a laser procedure to create a hole in the capsule so you can see better. This is called a “posterior capsulotomy”.

There are risks to having cataract surgery, but they don’t happen very often. They include getting an eye infection or bleeding, swelling of the front part of the eye, swelling of the retina, ongoing pain, detached retina, loss of vision, or dislocation of the IOL.

If you are covered by Medicare if you are eligible for this type of surgery. Most private insurances cover for cataract surgery as well. Special kinds of IOLs may cost you some out of pocket. It will also cost you out of pocket if you decide to have surgery before your vision actually deteriorates too much. If you don’t have insurance, ask the doctor about a payment plan.

Eye Surgery Recovery

Eye drops are necessary for a few weeks and need to be applied several times per day. You will need to wear a shield when sleeping for a week after the procedure. Sunglasses should be worn when outside. There will be some redness of the eye and blurry vision in the first days after cataract surgery. You’ll have to avoid lifting anything over twenty-five pounds, as well as bending or exercising to excess in the first week postoperatively. Don’t splash water in your eyes as this can cause infection. This means showering and bathing with your eyes closed for a week after surgery. There should be no hot tubs or swimming for two weeks after the procedure and you can’t expose your eye to contaminants like dust or dirt.

The doctor will wait at least 1-3 weeks before attempting to do the second eye. Once the first eye has recovered and sufficiently healed, it should be okay to go ahead and do the other eye. After the second eye heals, you should have reasonably good vision.

Unless you select IOLs that correct presbyopia, you will still need reading glasses after cataract surgery. Even with a premium IOL, it is possible that you won’t be able to see well enough to read newsprint or other fine writing and will still need eyeglasses. Because you might also have some nearsightedness after surgery, you might want to wear progressive lens eyeglasses that allow for far and near vision. Glasses will also protect the eye from injury and some people just feel better with glasses.

The trick is to choose glasses that have an anti-reflective coating and those that are photochromic (get darker in bright lighting like in the sun). Talk to your ophthalmologist or optometrist about these features and about how much these features cost. Because you’ll need some sun protection forever, these types of lenses save you from having to buy prescription sunglasses as well.

Laser Cataract Surgery

Lasers that have traditionally been used in LASIK eye surgery have been approved by the US Food and Drug Administration for cataract surgery. Lasers are used in several steps in the cataract removal procedure. It creates the incisions in the cornea so that the surgeon doesn’t have to make any cuts himself. It removes the anterior capsule of the lens and breaks up the cataract with less phacoemulsification energy is necessary to break up the lens prior to its removal. It will also create peripheral corneal incisions at the time of cataract surgery in order to reduce astigmatism (if necessary).

The downside of laser cataract surgery is that it is a fairly new and untested form of surgery that markedly increases the cost of the cataract surgery because just buying the laser device can cost the ophthalmologist up to $500,000 USD. The machine is expensive to use and maintain and this is what adds to the cost of surgery. As it becomes cheaper, it should be done more often because it is safer than regular surgery and provides better visual outcomes with decreased recovery time.

Selecting an IOL

IOLs have been approved by the FDA since the early part of the 1980s. Before they were available, people with cataract surgery need to wear glasses or contact lenses in order to have some sort of normal vision. With IOL, the lens that gives you normal vision is implanted directly into the eye.

Today, there is more than one IOL to choose from. There are basic IOLs and “premium” or special IOLs. The special IOLs have advanced features beyond the basic ones and aren’t always covered under your health insurance plan.

Here are some premium IOLs you can choose from:

• Aspheric IOLs—the usual basic IOLs are spherical in nature, which is easy to produce but isn’t the exact shape of the lens it replaces. Aspheric lenses more naturally mimic the actual shape of the human lens. This gives better vision in low-light conditions than a regular basic IOL. For people with larger pupils or who have to work in low-light conditions, this is a better lens to select.
• Toric IOLs—these are lenses that correct astigmatism, nearsightedness, or far-sightedness. Like soft contact lenses of the same name that have different powers at different parts of the lens, toric IOLs are specially aligned to correct astigmatism.   The surgeon marks the cornea so that the IOL can be rotated into place. This takes the place of having to do an extra procedure later to correct astigmatism. If astigmatism persists, LASIK corrective surgery can be done to fix this problem.
• Accommodating IOLs—most conventional IOLs correct nearsightedness so you can see far distances. You will still need to wear glasses or contacts in order to see things up close. This is not the case with accommodating IOLs. They allow for clear vision for both near and far vision. There are flexible “legs” on these lenses that allow for movement of the lens when you need to see near objects clearly. You will have a decreased need for reading glasses after cataract surgery.
• Multifocal IOLs—these are another type of IOL that corrects presbyopia (the inability to see things up close with increasing age). These have extra magnification for near vision along with the regular far-vision capabilities. It reduces the need for glasses or contact lenses after surgery. These tend do the same thing as accommodating IOLs but work a little bit better. They aren’t as good, however, when it comes to far vision.

Monovision cataract surgery attempts to correct near vision and far vision at the same time. It fixes one eye primarily for nearsightedness and the other eye for farsightedness. This allows one eye to see things at a distance and the other eye to see things up close. You gradually adjust your vision to use one eye for far distance and the other for things like reading and working on the computer.

Preventing Cataracts

Are there things you can do to prevent cataracts from occurring in the first place? Remember that it is believed that oxidative stress in the lens contributes to getting cataracts. Oxidative stress happens when there are too many damaging oxygen free radicals in the tissues and too few of the neutralizing antioxidants. Free radicals involve a molecule that is desperate for a hydrogen atom and that will take one from a healthy molecule. Antioxidants will provide that hydrogen atom, sparing healthy molecules.

It is possible that, by eating foods high in antioxidants will slow the progression of cataracts. Foods high in antioxidants will provide ways to get rid of oxygen free radicals, preventing free radical damage to the lens of the eye. It is believed that the free radicals that damage the lenses of the eye come from pollution, exposure to chemicals, smoking, eating an unhealthy diet, and UV radiation.

Foods high in colorful vegetables, fruits, and whole grains seem to decrease the risk of cataracts. Phytochemicals and antioxidants found in vegetables and fruits may decrease the risk of cataracts and include zeaxanthin, lutein, and vitamins A, C, and E. Eating fish high in omega-3 fatty acids has been linked to decreased cataracts or the progression of existing cataracts.

While there are “eye vitamins” and vision-related supplements, it is believed that it is better to get your antioxidants and other vitamins from foods rather that from supplements. If you absolutely can’t get it out of your diet, it’s probably better than nothing to use one of the supplements dedicated to eye health. Ask your eye doctor about which supplements they recommend. Certain vitamins are toxic at high levels so taking more of the vitamin or supplement than recommended is not a good idea.

A diet that can help improve your vision includes consuming 5-9 servings of fruits and vegetables every day. It is preferable to eat fruits and vegetables with a lot of innate color as these are high in antioxidants. You should also eat three servings of whole grains daily and two servings of fish per week. It is a good idea to keep up a healthy weight as obesity is linked to having cataracts. Avoid sugar, processed foods, soft drinks, and fried foods—all linked to obesity and cataracts. A low sodium diet is better than a high sodium diet.

It is also a good idea to keep your eyes from being exposed to UV radiation. Dietary modifications will do nothing if you don’t protect your eyes from the sun. Some things you can do include wearing a wide-brimmed hat or wearing polarized sunglasses that provide 100 percent of the UV protection you need for eye health. UV-protecting contact lenses can also be worn but you should know that it doesn’t protect the entire eye and can damage non-lens parts of the eye.

Cataracts Websites

1. Facts About Cataract– This site is put out by the National Eye Institute and provides a thorough discussion of cataracts for lay people. It talks about the anatomy of the eye, the causes and risk factors for cataracts, the different types of cataracts, and the treatment of cataracts.
2. The American Optometric Association puts out this website, which gives a nice overview of what cataracts are, the types of cataracts, the symptoms you can expect from cataracts, and how they are treated.
3. Cataract surgery– If what you’re interested in are the basics of cataract surgery, this is the website to read. It talks specifically about surgical options for cataract surgery, including laser surgery and traditional options.
4. The American Academy of Ophthalmology produces this site about cataract surgery and how it’s done. It is a good site for individuals who have committed to surgery and who want to know what to expect out of this type of surgery.
5. Age-related cataracts- This is a good website for health professionals and informed lay people that discusses specifically age-related cataracts versus other cataract types. The causes and epidemiology of cataracts are covered along with presentation, diagnosis, and treatment of cataracts.
6. Congenital cataracts– For those who have a newborn who was diagnosed with cataracts, this site is good for an overall review of the topic. Congenital cataracts are unique in that they start at birth so it pays to look at a website specifically on this topic if this applies to you.
7. Traumatic Cataract– If you or someone you know suffered from a traumatic cataract, this is different from an age-related cataract and you need this site to help you understand how this happened and what you can expect with this type of cataract.
8. 5 Tips for Living with Cataracts– When cataracts are affecting your life and you need to learn how to manage life with cataracts, this site can help. Living with cataracts before surgery can be challenging and you will need the help of sites like this one to get through it.
9. This is a great review site on cataracts, including the basics of cataracts, symptoms you can expect, risk factors, causes, and treatment of cataracts. Everything you wanted to know about cataracts is on this site.
10. Tips for Coping with Vision Loss– Living with vision loss from cataracts can be confusing and difficult. This site provides practical information on how to cope with vision loss on a day-to-day basis. These simple tips can make living with cataracts a lot less frightening.

The post Cataract- The Blinding Menace appeared first on GeriatricNursing.org.

One major bad habit, brought on by the constant commercially driven brainwashing, is to spend money and more money, no matter what. Houses are filled with tons of needless knick-knacks, closets are filled with clothing that hasn’t been worn in eons, garages are filled with “someone else’s treasures,” and kitchens are overloaded with superfluous appliances. It doesn’t help that most appliances, electronic equipment, and technology is designed to be useless every five years or less, nor does anyone seem to care.

Moms over 50 or 60 aren’t brain dead and aren’t all alike. They don’t all live in the past, wear granny glasses or want store-bought cards or long distance flowers sent. They don’t just want framed headlines of some long past last century event that’s supposed to be memory invoking to hang over their bed.

They don’t need aprons or more photos of the grandkids (at least not on Mother’s Day). They may not knit or even care to learn to crochet. They don’t want magnifying glasses or reach extenders for mothers’ day. Saved that for a normal weekday gift. Please, no walkers or department store perfume.

I’ll bet that there isn’t one mother out there who doesn’t have a room or closet, if not more, full of stuff that is never used or really wanted, but she hates to get rid of “good stuff” because it cost someone good money. Also, ask most any mother what kinds of gifts have the most meaning to her, and nine times out of ten she will mention something about the gift of time… quality time spent with her loved ones. Yet, how many loved ones skimp on that “quality time,” or merely substitute attention with a purchased commodity?

It is time to take another look at who our mothers are, what they represent, and why each one deserves more than one day a year of special consideration. And, by the way, I am not referring to birth mothers as the only women to hold the title of a mother; anyone who holds a special place in our hearts as a nurturer can be considered a mother. There are some mothers, who give birth, and who do not nurture, but in general, most mothers are preservers and nurturers of young lives.

Besides providing environments where children can grow in love and secure comfort, a mother is most responsible for building strong physical and emotional bodies with proper nutrition and unconditional love. A mother is most responsible for instilling a sense of values and identity by being the keeper of traditions and maintaining the social fabric of the family. A mother is a person who sacrifices most of her time and personal preferences for others, and rarely expects or asks for anything in return. A mother is always there, in the background, being supportive, encouraging, understanding, and comforting whenever the need arises. Mothers are tireless workers; they are the last ones to bed at night and the first ones to rise each morning.

Given that children are our ultimate investment in the future, it is an almost unfair task, with overwhelming responsibilities that we ask of mothers, yet each woman accepts her place in the world, as part of the ongoing cycle of life. It is this silent resiliency and strength in mothers that is most called upon during these times of stress and strife. In spite of events that are outside of one’s control or own doing, it is a mother who must maintain calmness and adherence to the business at hand. Sustenance must be provided, clothing must be laundered, and routines are kept on schedule. Life continues on to the best of her ability.

All of these words can be said also of the mother of us all, Mother Earth, who is also much taken for granted, and gets very little respect or attention. Like most spoiled, sloven children, we continue to use and take all her resources, giving very little concern as to her general health and well being. It’s time before it’s too late, it’s time we change our attitudes and our way of being negligent to those who matter to us the most. To those who nurture and preserve life, we must all devote more time and attention to helping to support their efforts and wellbeing.

In recognition of efforts of our mothers, it is important that we make mother’s day very special for our dear moms. Remember, Mother’s day is a special day for every mom. keep in mind the one thing all moms have in common; the wish for more time with their grown children. The memories that remain after a personal Mother’s Day visit will last longer than any other gift.

Showing Up in Person on Mothers Day

For a mother, her adult child standing on her doorstep telling her she is beautiful is “priceless.” Mom doesn’t need the card or nicely wrapped gift. She needs the company of her grown-up child.

• Take her to dinner or bring dinner to her.
• Tell her a wonderful childhood memory of something she did that stayed forever in mind.
• Laugh in person with her.
• Plant a tree or rose bush with her or for her.
• Walk her dog or walk along with her and the dogs.
• Bring the kids and act happy to be there. Stay for over an hour, at least.
• Play a board game together.
• Use those frequent flier miles to visit her by surprise.
• Fix something in her house for her.
• Clean up the viruses on her computer for her.
• Show her how to use the remote (again).
• Go to a yoga class together.
• Just sit and share gossip and coffee, tea, wine or beer.
• Take her for lunch or dinner at her favorite restaurant
• Take her to a special Mother’s Day event at the local arboretum
• Go to a concert featuring her favorite musicians or type of music
• Take her to visit friends or relatives if she no longer drives
• Visit museums or art galleries
• Take her to a sporting event if she is a sports fan
• Take a city dwelling mom for a drive in the country
• Take a country dwelling mom for a day in the nearest big city
• Go to a quilt show together. Even if she doesn’t quilt she will likely enjoy it
• Bake a special Mother’s Day cake for her and enjoy sharing it with her
• The best gift will be putting the whole day aside for her, doing together anything she enjoys.

If Seeing Mom in Person is Really Impossible

• Tell her truthfully why being there is impossible and schedule an alternate day. This is important. Make it very close to Mother’s Day.
• Tell her if there is no money – Accept a gift if she wants to give it to you.
• Teach her to skype and spend time on mother’s day skyping with her.
• Talk to her on the phone for an hour. Hang up and then call an hour later with new things to share and speak together another hour.
• Call her upon awakening to say good morning and right before going to sleep that night to say good night.
• Watch a talk show or favorite movie long distance while both on the phone and chat about it, as if together.
• Plan ahead and both read a book that can be discussed that day by phone. Read the newspaper on the phone together. Share opinions.
• Chat online for an hour.
• Text her, if really lame.
• Make sure the flowers and card arrive exactly on time. Don’t leave a message on her phone. Keep trying to reach her.

Best Gifts for Older Mothers

If your mother is competent with technology, consider some high tech gifts. The high tech devices on the market can help an elderly Mom pass the time, stay connected to the family, or encourage a new set of skills in Mom’s life.

Wireless Reading Device

If the budget can handle it, invest in a wireless reading device for Mom; e-books can be downloaded and stored on a Kindle, iPad or a Sony Reader. In addition, Mom can read newspapers, subscribe to magazines and more. The reader can be one gift, perhaps for Mother’s Day, followed by money on a birthday or Christmas to purchase more e-books.

These new readers allow Mom to always have access to a book whenever she leaves the house. They also let Mom adjust the font size, as large as necessary, for “older eyes.”

Digital Photo Frame

The digital picture frame allows Mom to enjoy up to thousands of photographs without lifting a finger; the gift giver does all the work. Download family photos, vacation photos, or scan old photos from Mom’s past and set up the slideshow for Mom. Put the frame on a table close to her favorite chair.

Some of the frames also have audio, video, Wi-Fi, and Bluetooth compatibility; it depends on how much technology Mom can handle.

Mobile Phones for Older Moms

A cell phone for Mom can be a great gift with the giver purchasing the phone and paying for monthly service on a contract basis, or just purchasing minutes. The decision depends on the type of phone purchased; some are designed for elderly people to use straight out of the box.

Most older adults want large buttons that are easy to see on the keypad, clear sound from the speaker, loud and vibrating ring tones and services that are easy to set up and retrieve. Some phones marketed for elderly use have live 24-hour operators to help callers.

Apps for Moms?

If Mom has a mobile device that can download applications, consider buying some. While many are free, some are worth spending 99 cents to $9.99 for the added benefit. Read the reviews in the app store to determine which ones are worth the additional money. Not all are specific to age or gender, but popular app categories for Mom might include nutrition, exercise programs, the weather or gas prices in the area.

Best Gifts for Grandmothers on Mother’s Day

Just as our mothers do, Grandmothers also play a big role in children’s lives. Sometimes, they relieve mums by babysitting the kids. Some even care for their grandchildren full-time. So we shouldn’t forget Grandmas in Mother’s Day. We should also give her a thoughtful and practical gift that she will always cherish. There are many ways to honor grandmothers on Mother’s Day. Thoughtful gifts for Grandma include a special family album, genuine old newspapers, grandparenting books, pillbox products and more time with Grandma.

Special Family Album

Grandmothers are very sentimental and will appreciate gifts that remind them of the strong bond within the family. Go through family albums featuring a few generations of the family. Choose special moments such as weddings, birthdays, christenings and graduations and categorize them accordingly.

Some old photos may need to be restored. Restore old photos by checking out shops that specialize in restoring and touching up photos. Once all the photos are selected, put them in a beautifully decorated album. The special family album will remain a treasure for Grandma for a long time.

Genuine Old Newspapers

If Grandma came from the United Kingdom when she was young, she probably has very strong roots there. There were probably events that she can relate to very well before she migrated. Delight her by presenting her genuine original archive newspapers from the date of your choice. Genuine old newspapers suppliers such as Newspapers Remembered have original newspapers from the United Kingdom that go back over a hundred years. The newspapers even come with a personalized certificate of authenticity. Grandma will certainly cherish this unique and wonderful gift.

Pill Box Products

Many grandmothers are on medication and will need some help to organize their medication. That’s why pill box products such as pill organizers, pill cases, novelty pillboxes, key ring pill box products, alarm or vibrating watchers, pill crushers and pill splitters are very thoughtful and practical gifts. Some of these products come with unique designs and decorative items, making them excellent gifts for someone special.

More Time with Grandma

Nothing delights Grandma more than the opportunity to spend more time with her grandchildren. So make a pledge to visit Grandma more often, not only on special occasions such as Mother’s Day, her birthday, Christmas or Easter. Drop by her house regularly to help out with the gardening, taking her out for a movie or just to have a chat.

If Grandma lives far away, give her a call every now and then. Older ladies still love receiving letters from loved ones. So delight her with regular letters too. If Grandma is tech-savvy, email is the best way to communicate. It’s easy, convenient and cheap!

The post How to Celebrate Mother’s Day? appeared first on GeriatricNursing.org.

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There are several types of arthritis, which can be defined as an inflammation, degeneration, or infection of a joint. Some types of arthritis just affect a few joints and are called oligoarthritis. Others affect many joints in the body and are called polyarthritis. Arthritis can be symmetric, meaning the pain and inflammation is roughly the same on both sides of the body. It can also be asymmetric, affecting just about any joint in the body at any given point in time. This article will talk about several of the major types of arthritis, including osteoarthritis, rheumatoid arthritis, septic (infectious) arthritis, and crystal arthritis (which includes gout).

Osteoarthritis (OA)

Osteoarthritis (OA) is slowly-developing form of arthritis that can affect nearly every joint and that can affect individuals as they age. Joints that take a lot of pressure or that have repetitive motion are at the greatest risk for OA. The disease can be relatively asymptomatic or severely debilitating, affecting the patient’s ability to participate in activities of daily living.

The primary problems with OA are joint pain and stiffness. Symptoms can affect just one joint or several joints. The pain is worse with movement and relieved by rest. There are three stages of pain. The first is stage 1 (predictable, sharp pain with movement). The second is stage 2 (more constant pain that affects daily activities). The third is stage 3 (constant dull/aching pain with unpredictable sharp flares). The pain is usually worse in the late afternoon and evening but can also be worse after awakening. It may interfere with sleep.

OA can be localized or generalized and can affect one single joint or multiple joints at a time. The joints that are particularly a problem for OA include the knees, hips, interphalangeal (hand) joints, facet joints of the neck and back, first great toe joint, and thumb joints. The other joints are less commonly affected, particularly if they are not moveable joints.

Patients with generalized arthritis usually have the distal interphalangeal joints of the fingers involved, the base of the thumbs, the first great toe joint, the spinal facet joints, knees, and hips. Gradually, more joints become involved and the patient becomes more debilitated. The main clinical marker for OA is Heberden’s nodes, which are hard lumps at the distal finger joints.

Diagnosis of OA

Imaging can help diagnose OA. The best test for osteoarthritis is the conventional x-ray. It allows for detection of the usual features of OA (including osteophyte formation, cysts on the bone, and joint space narrowing). An x-ray, however, isn’t very sensitive and doesn’t often correlate with symptoms.

As to specific joints seen on x-ray, the hands are usually bilaterally and symmetrically involved. The distal interphalangeal joints at the tip of the fingers are characteristically affected. Other joints affected are the other finger joints and the base of the thumb. There is a lot of aching and stiffness of the joints. The patient with Heberden’s nodes has nodal OA. Most individuals with nodal OA are female with a family history of the disease.

Erosive osteoarthritis is a rare but aggressive type of hand OA. There is subacute or insidious pain with soft tissue swelling and numbness of multiple finger joints. There is tenderness, redness, and soft-tissue swelling of the hands that is not seen in ordinary OA. Erosive OA is not connected to generalized OA as it affects mostly the finger joints and spares the thumb and metacarpal phalangeal joints.   Erosive OA has a worsened outcome than regular OA and can be seen on x-ray showing joint erosions (wearing down) in up to 8% of patients.

The knee is a common site of OA and the most common cause of lower-limb disability in older adults. It is usually bilateral to some extent. The patellofemoral joint or the medial tibial femoral joint is most affected. Pain from patellofemoral joint OA is made worse by prolonged sitting, standing up from a low chair, and climbing stairs or inclines (coming down often being more painful than going up).

Osteoarthritis of the hip can be seen as increased pain, stiffness, aching sensation, and restricted movement of the hip joint. Pain secondary to hip arthritis is felt in the anterior groin but may involve the upper thigh and buttocks. It commonly radiates down the leg with thigh pain and knee pain common complaints. The pain is made worse by rising from a seated position and during the initial phases of walking.

Facet joint arthritis generally goes along with intervertebral disc degeneration—a term called “spondylosis”. The pain is localized primarily to the lumbar or cervical spine and, in the low back, the pain radiates to the groin, buttock, or thighs, ending at the knees. It is worse in the morning and when active with rotation or bending motions (or with neck rotation and lateral flexion in the neck).

OA can be differentiated from other diseases by clinical history and physical examination. Rarely are things like lab tests and x-ray recommended. The clinical findings are of persistent pain in overused joints, age older than 45 years, and stiffness of less than 30 minutes in the morning. Imaging and lab tests can be done if the person doesn’t meet the obvious clinical features (by history or physical examination). Constitutional symptoms (like weight loss and fatigue) or signs of inflammation of the joint point away from OA and need further evaluation.

Risk Factors for OA

OA has been found to be a complex interaction of many factors, including genetics, mechanical forces, joint integrity, and certain biochemical processes. Genetics is probably the rarest interaction, while things like occupation, aging, trauma, and repetitive movement play a stronger role. These are stronger for the hand and knee and less strong for OA of the hip. Common risk factors include age, being female, being obese, having no osteoporosis, certain occupations, playing certain sports, having an injury, muscle weakness, and proprioceptive deficits. Less common risk factors include genetics, having acromegaly, and having CPPD disease. Advancing age is the strongest risk factor. It occurs in less than 0.1 percent of those under 34 years but is present in more than 80 percent in those older than 55 years.

Previous injury seems to increase the risk of osteoarthritis of the knee and having congenital hip dysplasia enhances the risk of hip arthritis. Long-distance runners have an increased risk of knee injury and knee osteoarthritis. Having an injury during this sport will increase the risk of osteoarthritis of the knee. Knee meniscus injuries are common in OA of the knee. Having an amputation of one leg increases the pressure to the other leg and increases the chances of OA of the unaffected leg. Genetics play a small role in getting osteoarthritis. There is a genetic influence in getting osteoarthritis of the hands and knees.

Treatment of OA

The goals of the treatment of osteoarthritis are to decrease pain, improve function, and modify the process of joint damage. This depends on changing modifiable risk factors as there are no disease-modifying OA drugs. Usually a combination of treatments is recommended. Things like hyaluronic acid injections in the knee are not recommended because they do not work any better than placebo.

The mainstay of treatment for OA is nonpharmacologic interventions. These include weight management, orthotic devices, braces (if necessary). Exercise has been found to be as good as NSAID therapy with strengthening and aerobic exercises good choices. A loss of 10 percent of the body weight will decrease pain by 50 percent with knee arthritis and hip arthritis. Splints and knee braces are good for thumb and knee arthritis, respectively.

Second-line things for osteoarthritis include drugs, such as capsaicin, nonsteroidal anti-inflammatory drugs, duloxetine, and intra-articular corticosteroids. A combination of these can be tried. Duloxetine is also called Cymbalta, which is an SSRI antidepressant that works for arthritic and musculoskeletal pain disorders. If a few joints are affected, a topical NSAID is recommended, with oral NSAIDs used only if topical medications don’t work. Acetaminophen has a risky side effect profile and a negligible effect on OA pain, so it isn’t recommended. Opioids are not recommended as they don’t work well for OA and have a long-term dependence and abuse potential.

Surgery usually means total joint replacement—usually done for advanced hip and knee arthritis. Other surgical options include a partial meniscectomy or debridement of cartilage but these have no clinical benefit over placebo. Hip arthroscopy can be done but may not be beneficial in OA.

Rheumatoid Arthritis (RA)

RA is a symmetric, inflammatory, peripheral arthritis, affecting many joints. The untreated patient will have degeneration of the cartilage and deformities of the joints in a symmetrical way. The prompt recognition and treatment of the condition with DMARDs, which are disease-modifying antirheumatic drugs, will help manage but will not cure the disease. The presentation in the beginning is similar to other arthritis patients but, over time, there will be distinctive evidence of RA, with joint erosions, extraarticular manifestations, and rheumatoid nodules.

Clinical Findings in RA

The synovial joints are what are affected most in RA. The arthritis is usually symmetrical, leading to destruction of joints secondary to bony and cartilaginous erosion. It starts in the hands and feet and moves centrally so locomotion becomes difficult within 10-20 years after onset. The onset is gradual and involves many joints, although some people will have a single joint involved in the beginning. Systemic symptoms occur in about 33 percent of patients and include muscle aches, low-grade fever, depression, weight loss, and fatigue.

In “classic” RA, the patient has morning stiffness, joint pain, and swelling of joints. The MCP (metacarpophalangeal) joint and the PIP (proximal interphalangeal) joints of the hand are the main joints involved initially; however, a few patients can have thumb, wrist, or metatarsophalangeal (MTP) joint involvement. Eventually other synovial joints of both the upper and lower limbs eventually become affected. Morning stiffness is the most common feature of active RA. It tends to last longer than an hour in RA and less than an hour in people with other inflammatory diseases.

Physical signs and symptoms include joint pain and swelling of the small joints (primarily), plus the typical morning stiffness and decreased grip strength. The spine is usually not involved. There is progressive joint damage and deformities, with loss of physical impairment. Late findings of untreated disease include anemia, rheumatoid nodules, eye inflammation, blood vessel inflammation, neuropathy, and pericarditis.

The hands are typically involved at the MCP and PIP joints. Redness and thickening of the flexor tendons may be seen in the palm; nodules may be seen in these tendon sheaths, causing trigger finger and possible tendon rupture. In established RA, there may be an ulnar deviation of the MCP joints.

The second most common areas of involvement are the wrists. Loss of extension happens early on in the disease process and, later on, there is volar subluxation and radial drift of the wrist. The elbow may become fixed in the flexed position. Olecranon bursitis is very common. Shoulder involvement is a late finding, seen in just half of patients after 15 years.

Lower extremity involvement is usually with the forefoot and ankles. Hip involvement is a late finding. Knee involvement can lead to Baker’s cysts. The MTP joints of the feet are the primary joints in early disease with eventual lateral drift of the toes and plantar subluxation of the metatarsal heads. Heel pain will show itself and the ankle may be swollen. Knee swelling is also common and restriction of flexion can be seen. There will be weakness of the quadriceps muscles.

Lab and Imaging Studies in RA

Lab findings in RA include those things seen in the synovial fluid and blood, indicating that the disease is both local and systemic. Things that are seen include inflammatory joint fluid, anemia of chronic disease, and lab tests that are positive for rheumatoid factor (RF) and ACPA (anti-citrullinated peptide antibodies). About 80 percent of patients will be positive for RA and/or ACPA. About 25 percent will have a positive antinuclear antibody titer.

Plain films can tell a lot about the state or RA. There will be joint space narrowing and bony erosions—especially of the hands and feet. These erosions are cardinal findings in RA. MRI testing is more sensitive in detecting synovial inflammation. It is also more sensitive for bony erosions than plain films. Ultrasound is also sensitive for detecting joint inflammation.   Doppler ultrasound is nearly as good as an MRI and is cheaper than the MRI examination.

Evaluation of Suspected RA

This disease is usually present in adults and the main finding will be inflammatory polyarthritis. The affected person will have joint pain and at least thirty minutes of stiffness in the morning. Peripheral joints tend to be prominently involved. Symptoms lasting less than six weeks might be a viral polyarthritis instead of RA. In such patients, an anti-cyclic citrullinated peptide (CCP) antibody titer, rheumatoid factor, and acute phase reactants can be done. It may take many visits to get a clear diagnosis.

The examination includes a thorough joint evaluation, expecting symmetric polyarthritis, limited ROM of the muscles, and some extraarticular findings, like rheumatoid nodules. The lab tests will often include an RF and anti-CCP antibodies as a positive result that will increase the chances of it being RA. In an initial evaluation, however, these will be positive only in 50 percent of patients with early disease.

Other tests that are done include the ANA titer (which can exclude lupus and other rheumatic diseases). The ANA titer, however, will be positive in a third of RA patients so follow-up testing, like the anti-dsDNA and the anti-Smith antibody test should be done as these are highly specific for lupus. The CBC is done to check for anemia of chronic disease, liver and kidney function tests are done, and a serum uric acid level is drawn.

Baseline plain x-ray will be done of the hands, feet, and wrists in order to document a baseline so as to monitor disease progression. Joint erosions may or may not be seen initially. There are other specific findings seen in other joint diseases that will point to other diagnoses as well. Arthrocentesis is done to exclude crystal disease like gout. Gram-staining, cell counts, crystal search, and cultures are done on the fluid. MRI and ultrasound are not routinely done but they are more sensitive tests and can be done in patients with normal plain x-rays.

Treatment of Rheumatoid Arthritis

The treatment of RA depends on controlling the synovitis in the joint and preventing injury to the joint. Treatment strategies have changed remarkably over the last twenty years with the institution of DMARD therapy earlier in the course of the disease process. The goals include early diagnosis, care by a rheumatologist, early use of DMARDs, and tight control having a goal of remission or significantly reduced activity. Now, NSAIDs and glucocorticoids are adjunctive therapies instead of primary therapies. DMARDs have become the primary therapy.

Making the diagnosis as early as possible is important because DMARD therapy works best if there isn’t any joint damage. Once diagnosed, the patient needs a rheumatology referral and follow-up care performed by a rheumatologist (as the disease outcome is better). These patients need comprehensive care that includes drug therapy, education, psychosocial interventions, physical and occupational therapy, nutrition counseling, screening for osteoporosis, and things like vaccines to prevent disease in their immunosuppressed state.

Therapies include NSAIDs and intraarticular steroid injections, biologic and nonbiologic DMARDs, and an oral janus kinase inhibitor. Conventional, nonbiologic DMARDs include hydroxychloroquine, sulfasalazine, methotrexate, and leflunomide. There are a number of biologic DMARD drugs, including TNF-alpha inhibitors (etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol), anakinra (an IL-1 receptor antagonist drug), and tocilizumab (an IL-6 receptor antagonist drug).

DMARD therapy is started as soon as possible. With active RA, an NSAID and corticosteroid are used along with methotrexate (as a first line agent). Patients who can’t take methotrexate should have hydroxychloroquine, sulfasalazine, or leflunomide. Nonbiologic DMARDs can be taken with biologic DMARDs. NSAIDs and prednisone are used temporarily as adjunctive therapy.

RA will naturally have flareups that need management. DMARD therapy may need adjusting. Flareups of just one or a few joints can be treated with intraarticular glucocorticoid injections. Widespread flareups are treated with an increased glucocorticoid dose (oral or IM). IV methylprednisolone done three times daily can be effective in reducing a flareup. Increased doses of methotrexate can help as will increased doses of infliximab.

Septic Arthritis

Septic arthritis is an infection in the joint, usually caused by a bacterial organism; however, it can be caused by mycobacterial species or fungi. These types of infectious processes can result in severe joint destruction and later arthritis. Among adults presenting with an acutely painful joint, septic arthritis represents 8-27 percent of cases, depending on the location in the world. The average is about 10 percent of cases. Some patients will have gonococcal disease, while others will have prostheses that get infected.

Risk Factors for Septic Arthritis

About ten percent of cases of patients with an acutely painful joint have septic arthritis. Risk factors for the disease include age greater than 80 years, having a diagnosis of diabetes mellitus, having rheumatoid arthritis, having a prosthetic joint, having recent joint surgery, IV drug use, being an alcoholic, having a concurrent skin infection, and having a previous corticosteroid injection. Each of these risk factors is small but together they add up.

If a patient has bacteremia, they are more likely to have the bacteria harbor in an arthritic joint when compared to a normal joint. About 40 percent of septic arthritis patients had preexisting RA or OA in the joint affected by sepsis. RA predisposes the patient to septic arthritis to a greater degree than OA but less common joint problems, like gout, pseudogout, and Charcot joint disease can be predisposing factors. Being on immunosuppressive therapy for RA is a predisposing factor, making RA a slightly higher risk than the other joint diseases.

Most cases of septic arthritis come from a blood infection that spreads to the joint. Trauma, direct inoculation, extension of bone infection, or animal/human bite are other less common causes. Risk factors for bloodborne spread include IV drug use, the presence of indwelling catheters, immunocompromised states (like HIV), being a neonate, and being older.

When the infective organism is Staphylococcus aureus, enterococcus, or streptococcus, endocarditis should be suspected and IV drug use is the most common reason for this infective endocarditis. Most of these patients will have negative cultures of the blood because the bacteremia was transient and self-limited. It is unknown why only a small percentage of patients with bacteremia develop septic arthritis.

Bacterial arthritis can occur along with bacterial meningitis. The most common organism associated with both septic arthritis and bacterial meningitis is meningococcus.   Rare cases of septic arthritis can stem from catheter insertion (such as hip arthritis and sternoclavicular arthritis). A ruptured colonic diverticulum can also cause septic hip arthritis by spreading through the tissues.

While many pathogens can cause nongonococcal bacterial septic arthritis, the most common bacterial species causing this in adults is MRSA (methicillin-resistant S. aureus). Less common organisms include S. pneumoniae, Enterococcus, Escherichia coli, and other gram-negative bacilli. Almost all cases are from a single organism (except for those caused by penetrating trauma to the joint space, polymicrobial bacteremia, or ruptured diverticulum causing a hip infection).

Clinical Signs and Symptoms of Septic Arthritis

These patients tend to present with a single inflamed, painful, and swollen joint. There is usually warmth and restricted movement. Crepitus would not be noticed and there are no nodules. Many patients are feverish but will not have chills or spiking fever. There may be evidence of other infections present that point toward the original source of the infection.

The knee is involved in more than half of all septic arthritis cases, with lesser joints being the hips, ankles, and wrists. Rarely, the pubic symphysis can become infected after pelvic surgery. About 20 percent of the time, the situation is oligoarticular or polyarticular, especially with those individuals having RA or another connective tissue disease (and in severely septic patients).

Diagnosis of Septic Arthritis

The definitive test is to identify the bacteria in the synovial fluid. There should be a joint aspiration before starting antibiotics with synovial fluid sent for Gram stain, culture, leukocyte count (and differential), and crystal analysis. The tap may need to be done under fluoroscopic, ultrasound, or CT guidance. The results of the fluid analysis would be as follows:

• There will be purulence with a WBC count of 50,000-150,000 cells per microliter (mostly neutrophils). The higher the WBC count, the greater is the chance of sepsis.
• The Gram-stain is positive in 30-50 percent of cases.
• The culture should be done and will be positive in most patients who haven’t recently been on antibiotics. Blood cultures are generally positive in 50 percent of cases so they should be done.

Treatment of Septic Arthritis

The two components of acute bacterial arthritis include antibiotics and drainage of the joint. The choice of antibiotic depends on the presentation, Gram stain, and probable organism. Gram-positive cocci deserve vancomycin as an empiric treatment as this might be MRSA. If it is found not to be MRSA but to be methicillin-susceptible S. aureus, then the agents of choice include cefazolin, nafcillin, or oxacillin. Second-line treatments for MRSA include daptomycin, linezolid, or clindamycin.

If the Gram stain shows gram-negative bacilli, the treatment is a third-generation cephalosporin, such as ceftriaxone, cefotaxime, and ceftazidime. IV drug users are at risk for Pseudomonas infections and should have a combination of ceftazidime or ciprofloxacin plus gentamicin (or another aminoglycoside). Immunocompetent patients with negative gram stain should be treated with vancomycin. Ultimately, the culture and sensitivities will help detect the correct antibiotic choice. Intraarticular antibiotics are not recommended.

Gout

Gouty arthritis is a type of arthritic condition that causes extreme pain and swelling in the joints. It stems from having high uric acid levels in the bloodstream that form crystals of monosodium urate (MSU) in the joint space. The crystals are very irritating to the joint and will cause swelling and redness of the affected joint space. About a third of all patients with high uric acid levels will develop gouty arthritis. It isn’t clear why some people get gouty arthritis and why others will not get gouty arthritis.

It should be noted that the joints aren’t the only place where uric acid crystals can develop. They can precipitate in the kidneys (impairing kidney function) or in other parts of the urinary tract, causing pain and possible obstruction of the urinary system.

Gout is completely different from CPPD (calcium pyrophosphate dihydrate) deposition disease or “pseudogout”. The crystals are completely different and the etiologies are different. Some of the symptoms are the same, however, so it pays to have an arthrocentesis and crystal analysis in order to define what type of crystal disease a person has.

Risk Factors for Gout

Gout is an adult disease that usually is first manifest in men between the ages of 30-45 years or in women over the age of 55 years. There is no gender difference above 65 years. The prevalence is about 4 percent of all adults in the US. Risk factors for gout include hypertension, obesity, chronic renal insufficiency, fasting, and consuming alcohol on a regular basis. Overeating, especially those things with high fructose corn syrup, meats, and seafood, will increase the risk of gout. Diuretics will increase the uric acid level.

Flareups of gout in patients already known to have gout can include fasting, recently having surgery or an injury, drinking too much alcohol (especially wine), overeating, and taking certain medications.

Symptoms of Gout

Gouty arthritis flares or gout attacks involve the sudden onset of joint pain that is relatively severe and associated with tenderness, swelling, and redness of the joint. It usually affects one joint but can affect a few. The flareups are worse in the middle of the night and in the early morning hours. The inflammation reaches its peak at 12-24 hours and can improve within a few days or weeks. No one knows how the body resolves a gouty flare. The white blood cells increase in the joint space because of the crystals causing irritation of the lining of the joints.

Gouty Arthritis Phases

There are three basic phases of gout: the gout flare, intercritical gout, and tophaceous gout. In a gout flare, the big toe or knee becomes inflamed to begin with or multiple flareups can occur—accompanied by a fever. Some osteoarthritic patients will have flareups in the fingers instead of the toes. Intercritical gout is the time between flareups, which is generally less than two years, even with treatment.

Tophaceous gout is the type of gout where urate crystals build up around the joints, bursae, skin, bones, and cartilage. The buildups are called “tophi”. They may have bony erosion and joint damage called gouty arthropathy as a result. They usually aren’t painful but can inflame like joints, causing redness and tenderness. Tophaceous gout is rare with current treatment protocols except if a person cannot tolerate the medications, is taking cyclosporine for organ transplant, or is a woman past menopause on diuretic pills.

Diagnosis of Gout

Gout can mimic many other diseases. It is strongly suspected when a joint or few joints become acutely inflamed and then resolve within a few days, leaving behind no symptoms. The best way to confirm gout is to take a quantity of synovial fluid using an arthroscopy. The fluid can be evaluated under specialized light microscopy to see if the characteristic needle-shaped crystals can be seen. There will also be an excess of white blood cells in the synovial fluid. Crystals can be extracted from tophi as well. If arthroscopy cannot be done, the diagnosis is based on acute onset of symptoms, inflammation of one joint (usually the great toe), elevated uric acid levels, and complete resolution of symptoms between flareups.

Treatment of Gouty Flareups

The goal of treating gouty flareups is to decrease pain and inflammation. This is a short-term process that is based on the presence or absence of bleeding disorders, history of stomach ulcers, or history of kidney disease. If these are negative, NSAID drugs are the treatment of choice as well as glucocorticoid drugs. Corticosteroids can be given orally, injected into the joint or by injection. Commonly-used glucocorticoids include prednisolone, prednisone, and methylprednisolone. They can be used when NSAIDs or colchicine aren’t tolerated.

NSAIDs are okay if there are no bleeding problems (no warfarin), no stomach ulcers, and no kidney disease. Aspirin is not recommended because it can affect the uric acid level in the bloodstream. Colchicine is good with decreased kidney function and ulcer risk but can cause abdominal symptoms (like nausea, vomiting, diarrhea, and abdominal cramps). It is only taken orally.

There are preventative drugs that will decrease or reduce the number of gouty flareups. Colchicine is one drug that can do this and can be given in lower doses than is necessary to treat gouty arthritis flareups.

Some patients require long-term uric acid-lowering treatment. Lifestyle changes can help the situation. Medications can increase the uric acid excretion by the kidneys, decrease the production of uric acid, or can convert urate to allantoin (which is more easily excreted). These drugs are used when a flareup has resolved itself. Allopurinol works by preventing uric acid formation and is the most commonly used drug for this problem. Febuxostat does the same thing but cannot be used by people at risk for heart disease.

Probenecid increases uric acid excretion by the kidneys. Losartan is an antihypertensive drug used to decrease uric acid levels. Lesinurad is a second-line drug used with allopurinol or febuxostat. Pegloticase works by turning uric acid into allantoin, which is then excreted. It is given by IV and is used to rapidly lower the uric acid level. Allergic reactions and high cost make this prohibitive in many situations. The goal is a uric acid level of below 6 grams per deciliter. It shouldn’t be done too quickly and the individual requires excess fluid during the treatment time.

Website Sources for Arthritis

1. Understanding Arthritis.  This is the site to start your search for arthritis answers. It’s a site created by the Arthritis Foundation and has a wealth of information on the site.
2. What is Rheumatoid Arthritis? This is a site designed by the Arthritis Foundation specifically about rheumatoid arthritis. It’s a good site for people who know they have RA and want to know the latest in diagnosis and treatment of this joint disease.
3. Let’s Dig Into Everything about RA-This is a site put out by a RA support organization that delves into rheumatoid arthritis and its management. They have resources for experimental RA treatment.
4. Septic Arthritis– This is a comprehensive review of septic arthritis designed for people who are health professionals or learned patients wanting to learn all they can about this condition.
5. Gout and Pseudogout– The patient with crystal arthritis will learn all they want to know on this comprehensive site. It’s designed for the person who wants to know the science and medicine behind these two types of arthritis.
6. The American College of Rheumatology puts out this information site for patients and caregivers who want to know about osteoarthritis and its manifestations.
7. Find a Rheumatologist-It isn’t always easy to find a rheumatologist near you if you have an arthritic condition. This site from the American College of Rheumatology will help you get the help you need from a board-certified rheumatologist.
8. Rheumatoid Arthritis– This is a medical site that shows pictures of patients with rheumatoid arthritis plus a comprehensive review of the pathophysiology, presentation, workup, and treatment of this type of arthritis.
9. Gout-This is a lecture series on gout that gives many slides showing pictures of gout and images that easily explain the disease state.
10. Osteoarthritis– This is a picture-filled slide presentation on osteoarthritis. For individuals wanting a visual image of what this disease looks like plus valuable information on the disorder, this is the site to visit.

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-Margaret Mead

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