More on the Value of Exercise in Prevention of Dementia

We last spoke about two recent studies that looked at preventing or slowing down the start of dementia. It is important to recognize that there are a number of types of dementia, not just the dreaded 'Alzheimer's Disease' that we probably all hear the most about. In fact, the second largest number of patients with 'dementia' suffer from 'vascular dementia'. It is probable that people who have vascular dementia (often found in those with heart disease or stroke) will benefit even more than those with Alzheimer's disease, according to an Italian study by Dr Giovanni Ravaglia, at University Hospital S. Orsola Malpighi. The study found that those who exerted the most energy, were 27% less likely to develop vascular dementia. That is a significant enough number to pay attention to and get inspired by- don't you agree??
So, does this mean you can only walk or do aerobic excercise? Not necessarily- some of the day to day activites that we all do can help- such as gardening, housework or climbing steps.
Again- what are you waiting for??
Next up, how about excercise for our brain?

The Value of Exercise in Keeping Mentally sharp

In an article in the Wall St. Journal on 8/12/09 (page D3- by Carrie Porter) two studies in the Journal of the American Medical Association (JAMA) showed that long term lifestyle habits may reduce your chances of cognitive impairment as you age. In one study of 1,880 elderly people in NYC, they concluded that a Mediterranean type of diet combined with physical activity were each linked to a decreased risk for Alzheimer's Disease. The second study focused on diet and mental decline together. The article concluded that while both diet and excercise had a positive impact together, even seperately they provided great benefit.
So what does this mean as we grow older?
Get moving now- make some lifestyle changes as early on as possible to have the greatest impact. The author of the first study, Dr. Nikolaos Scarmeas, said "the relative risk reduction for Alzheimer's is about 60% when you combine the diet and excercise" Wow, that's pretty significant! I'm in, how about you?

In another source, at www.realage.com, Dr. Mehmet Oz talks about the benefit of committing to long term excercise. He writes "it's not clear yet whether the long-term exercise caused favorable changes in the study subjects' brain anatomy or if the people with the healthier brains were simply more likely to excercise" The study he quotes found that the brain imaging tests on adults between the ages of 60 and 80 who were most active, appeared more like those of people much younger.

Ok- so now what? Take some small changes upon yourself- tune in for suggestions of 'palatable' forms of excercise, that you can take upon yourself- slowly.
Meanwhile, get out your sneakers and take a little walk, even if it is around the block, or up and down the hallway outside of your apartment.

Dehydration and the elderly- how to prevent it, how to recognize it and how to treat it

In fact, it is one of the top ten reasons for hospitalization of the elderly.

Dehydration in the elderly is a serious life threatening condition, that is often overlooked.

As the summer continues to heat up, we need to pay extra close attention to older people who are physically frail and/ or have dementia. Some medications add to this problem as they have a diuretic effect- that is they cause the person to pass water- either by sweating or urinating. Many older people’s ‘internal heat sensors’ do not do an adequate job of telling them that it is very dry and warm, and this too can lead them to dehydrate. Often older people with limited mobility might make it difficult for them to get up to get a drink.



I recently had a client, who experienced pain that she believed was due to a urinary tract infection. Without seeing her, her internist called in a prescription for a very powerful anti biotic, (which comes along with a host of side effects ). After a day or two, she decided she felt better, and stopped taking the antibiotic. Several days later, she again complained of similar symptoms. I happened to call her and learned of this. I asked her whether she had been drinking enough water- and she said that she ‘really didn’t care much for water’ and thought she had been getting enough fluid. She agreed to up her intake of fluids, and quickly reported feeling better.



How can you prevent dehydration?

Note that you do not only need to drink water to stay hydrated, and the amount that each person needs varies. It is perfectly fine to offer other types of fluids if the person doesn’t like water, and to remember that soups, fruits and vegetables can also offer fluid- think of juicy watermelon, cucumbers, even leafy green vegetables! Remind the person to drink more when the weather is warm, and if they have a hard time walking to the kitchen, make sure to leave something to drink next to where they usually sit, and at their bedside. Encourage them to drink, even if it is small amount on an ongoing basis.

So, what signs would you observe if the person was dehydrated? Look for sudden confusion, problems with their walking, dizziness, headaches, dry or sticky mouth and tongue, an inability to sweat or tear, a drop in blood pressure when changing from lying to standing, and constipation or decrease in urine output. Another trick that is sometimes used is to pull up the skin on the back of the hand for a few seconds; if it does not return to normal within a few seconds, the person is dehydrated. The urine of people who are dehydrated is often darker in color.

How do you help an elderly person who is dehydrated?



If they became rapidly dehydrated, they need to receive treatment immediately. Call their doctor, as they may need to go to the emergency room. The outcome of dehydration is that their electrolytes may also be off. Therefore the priority is to restore their fluids and their electrolytes. People with severe dehydration may require intravenous fluids and salt. People with mild dehydration can be treated by increasing their fluids, and beverages that help to balance electrolytes are better than plain water for this.



Again, remember that dehydration in the elderly is a very serious matter that can prevented with close oversight of their fluid consumption, and by encouraging them to drink and stay hydrated.

Debra Drelich, President of NY Eldercare Consultants appeared on the Leonard Lopate Show on WNYC 93.9 fm/ 820 am

When the Time Comes

There are currently 45 million Americans caring for family members, and as the 77 million boomers continue to age, this number will only go up. Journalist Paula Span shares the stories of several families who’ve had to deal with older family members to frail to live alone but to healthy for a nursing home. She’s joined by Debbie Drelich, President of the Greater New York Chapter of Professional Geriatric Managers, and Ilze Earner, who has had personal experience caring for an aging parent. In When the Time Comes: Families with Aging Parents Share Their Struggles and Solutions, Span writes about the emotional challenges and practical discoveries about elder care options. Listen to the podcast.

Gifts to Give Your Older Relatives that will be Meaningful and Appreciated

Holidays and birthdays are often celebrated with gift giving for both the young and old. Television, radio and the internet provide gift suggestions from all the latest 'must haves' for the younger set- but little is out there in the world of media to suggest practical and fun, gift giving ideas for older people. Gift giving offers an opportunity to provide loved ones with items that they might possibly be unable to obtain on their own- due to limitations in their mobility or finances.

Here are some suggestions for 'do's and don'ts' that might make your gift planning easier and in the end more meaningful and more appreciated. To begin, think about these questions in relation to your relative:

• Does he or she have a special hobby that they still enjoy- for example knitting, gardening or reading?

• Do they have a preference for a certain type of clothing or item? (For example do they have a penchant for purple clothing- I have a client who does!) Or perhaps they have a favorite perfume?

• Do they enjoy going on outings that are either too tiring to do on their own, or are too expensive on their fixed income?

• Is there a special product that is difficult for them to obtain- because it is not easily available ? (For example, a specific brand of make up or a favorite food item)

• Is there a piece of furniture or equipment for their home that would be useful? (For example, a 'lift chair”- (looks like a recliner chair but has an electric mechanism that easily lifts them to standing) which is available from home care supply companies. Perhaps just a new sitting chair with arms would enable them to more easily get to standing position.

Here are some specific gift ideas that might work for you:

• An electric hot pot/ water heater with an automatic cut off switch might provide a safer and easier way of having that cup of afternoon tea. If the relative suffers from minor memory impairment, this reasonably priced gift can allow them greater independence. Another similar gift that is both useful and safety promoting is a toaster oven with an automatic turn off feature (it shuts off when a certain temperature is reached after a few minutes). Forgetting to shut off kettles or burning food in the oven can be a serious safety concern and it is often recommended that stoves be disconnected when these symptoms occur.

• Give your relative (and yourself) a gift of safety and peace of mind- a Personal Emergency Response system. A “PERS” is an electronic device designed to summon help in an emergency. These wonderful systems are available for a small monthly fee and have saved the lives of many a shut-in.

• A new shirt or blouse might be welcomed by a shut-in who cannot get out to shop any longer. Do however take a peek at what they already have- perhaps your cousins and siblings have had the same idea for a number of holidays! A client once showed me an entire drawer filled with different shades of blue cardigans and multiple ties. (all gifts from loving nieces and nephews!)

• An ongoing once a month delivery of a fruit basket or fresh flowers is sure to be appreciated by all, and will brighten their day upon delivery. This idea is particularly easy as a “one size fits all” suggestion and you do not have to even leave the comfort of your office to arrange it!

• A periodical such as a magazine, or large print newspaper subscription can keep the person connected with their outside world. The New York Times offers a popular large print edition that arrives in the mail weekly.

• A small in-home garden kit would bring a big smile to a serious gardener who suffers from arthritis – which might prevent them from getting out and tilling the soil on their hands and knees.

• Talking books provide people who are visually impaired the opportunity to enjoy books and magazines on tape. Book shops and on line book sellers offer thousands of titles which can be downloaded to an iPod, or played on a CD player. The Library of Congress offers a free lending library of Braille and audio materials to people who are registered. You can register your relative at www.loc.gov. Another option for someone who loves to read and cannot get to the library is an electronic book reader such as the Kindle. The Kindle allows readers to choose books, newspapers or magazines to download with the click of a button, can adjust the font size as needed, and can actually read the text to your loved one.

The last gift idea is the gift of your time. An outing with a family member could be the most enjoyable gift of all to the older person. The outing could be as simple as going out for a cup of coffee or a walk in the park, to something grander such as seeing a remake of a musical. Remember, it is not the amount of money that is spent on the gift, but rather a combination of the thought and that went into it and its usefulness. A 97 year old client once commented to me that the blender with the ‘twenty year guarantee’ was somewhat ironic and frivolous. Choose wisely and your gift will brighten their special day.

• Debra Drelich, is a Geriatric Care Manager who practices in Riverdale, Manhattan and Westchester. She serves as the President of the Greater NY Chapter of Professional Geriatric Care Managers. She can be reached via her website www.nyeldercareconsultants.com

Your Elderly Parent and the Holidays --- Tips on making the holiday enjoyable for all

Holidays can be stressful at the best of times for families, and for an elderly person who is away from their familiar surroundings, even more so.

This is compounded by their missing deceased spouses or other loved ones, especially during holiday gatherings. Fortunately, with some sensitivity and ingenuity, you can enable your loved to have the best possible holiday experience. Do take into account that crowded family celebrations may be over stimulating for them, especially if your relative has become frail, or suffers from memory loss. Perhaps a smaller, more intimate gathering of family and friends may afford greater comfort and participation. Consider the following suggestions:

Before the visit:

• Speak to your loved one prior to the visit- if they are concerned about sleeping out of their own home, perhaps a shorter visit can be arranged.

• Whenever possible, gatherings should begin during hours that your loved one is more awake.

• Try to ensure that foods are served that can meet their special dietary needs (for example- low sodium , low fat and low sugar, not heavily spiced)- after all, the last thing you would want is 90 year old Aunt Sue to become ill while visiting.

• Make sure you have an updated list of their physician’s contact info, and current medications before they arrive.

• Prep your children on ways they can help their older relatives to navigate safely in your home

Prior to their visit, these simple home modifications will make your loved one feel safer and more comfortable in your home:

• Roll up small rugs that may pose a tripping hazard during their visit and look for loose electrical cords that may pose a tripping hazard and tuck them safely away.

• Insert small lights near their bed, along the path from their room to the bathroom and in the bathroom to enable them to safely get around at night.

• Place a non-slip mat both inside and outside the bath tub or shower, and purchase a removable suction grab bar for the bathtub or stall shower they will be using. Purchase a removable raised toilet seat for the primary bathroom they will be using,

During the holiday visit:

• Place your elder in a position where they will be able to see and hear the activities and discussions- it is hard for a person who is hearing impaired to follow the discussion during the meal if there is a lot of noise all around.

• Try to elicit memories of holiday celebrations from the past by pulling out old photo albums and discussing. Many people with memory loss can recall in great detail memories from the distant past. Photographs are also encourage discussion and stories about relatives who the younger family members may not remember or ever have met. Another fun discussion for the younger and older family members would be to compare holiday preparations today with preparation years ago without refrigerators, dishwashers and supermarkets!

• Offer suggestions to both your children and older relatives about activities they can share- for example: cards, Rummy O, Scrabble, reading books and going out together for a stroll.

• To encourage their independence, make sure they are familiar with the kitchen and can easily locate beverages and snacks. Think of small tasks they can assist with for the holiday preparations- this may include setting the table, cutting fruits or vegetables or sharing a special recipe. This may make your relative feel like they are ‘contributing’.

Despite the fact that holiday visits may highlight your loved ones’ deficits, family gatherings should focus upon creating new and wonderful memories for both young and old. Use the visit to observe your elder’s changing needs, and save any serious conversations about their condition for after the holiday celebration. Fortunately, with some sensitivity and ingenuity, you can ensure that your loved one will have the best possible holiday experience.

• Debra Drelich, is a Geriatric Care Manager who practices in Riverdale, Manhattan and Westchester. She serves as the President of the Greater NY Chapter of Professional Geriatric Care Managers. She can be reached via her website www.nyeldercareconsultants.com