Ask the Experts - Elder Care & Geriatric Medicine
Each day, questions come to HealthLeader from readers who are now responsible—literally or emotionally—for their elder parents. No surprise when you look at the statistics:
- Persons 65 years and older now represent over 12 percent of the population, about one in every eight of us.
- The number of Americans 45-64 who will reach 65 over the next 20 years increased almost 40 percent in this decade.
- The 85+ group is estimated to increase by 40 percent in the next two years.
Our parents (and ourselves) are living longer, not necessarily better. We adult children may have 20 years ahead of us of elder care, even as we’re raising our own children (or grandchildren.) You have questions; we have answers.
This week’s questions have been answered by Dr. Nasiya Ahmed, assistant professor of internal medicine, Division of Geriatric and Palliative Medicine at The University of Texas Medical School at Houston.
The following Q&A is not intended to take the place of the care and attention of your personal physician or other professional medical services. Questions about individual health concerns or specific treatment options should be evaluated and discussed with your physician.
Q. My 77-year-old mother, who is bed-bound, has swung from being constipated, which actually required hospitalization because she was impacted, to having very loose stools, almost diarrhea. We increased her fiber to combat the constipation and that solved the problem. When she started having loose stools, we backed off the fiber a little and have been giving her bananas, but it's not helping. Is this part of aging? Do you have any suggestions on how to treat the diarrhea without the risk of her becoming impacted again?
A. Constipation becomes a common complaint in the older population. However, it’s not necessary to have a bowel movement every day. Many people assume they are constipated if they don’t have daily bowel movements, which is just not the case. Constipation is best differentiated by a feeling of straining, a sense that they’re “not through” (incomplete bowel movements), or hard stools.
People who complain of constipation should have adequate fluid intake and regular exercise. A simple over-the-counter stool softener and motility agent should cure most constipation. Fiber is helpful, but can worsen constipation if the person isn’t taking in enough fluid. Prunes or prune juice may help. However, medications and other illnesses also can cause constipation and treatment should be discussed with your physician.
You were correct in treating her constipation with fiber, though fiber rarely causes diarrhea. Other causes of diarrhea can include infection, cancer, and even bowel obstruction. I would recommend that you have this evaluated by her physician.
Q. My 85-year-old mother has been told that she has a moderate herniation in her back (lower lumbar) that surgery would improve. The neurosurgeon says she's in no danger of severe nerve damage if she doesn't do the surgery; it's for quality of life—living without pain. What are the risks at her age if her only health issue is high blood pressure (for which she takes medication).
A. While surgery is definitely an option, good pain management combined with stretching and exercise, or prescribed physical therapy with a licensed physical therapist can often maintain one’s quality of life and should be tried before surgery.
Q. Why does pain raise blood pressure?
A. A very good question with a good answer: Any stressful situation (and pain qualifies as a major stressor!) stimulates the sympathetic nervous system in the body. The sympathetic nervous system is the “adrenaline rush” that occurs when we are nervous or panicked. The sympathetic nervous system then releases chemicals that cause an increase in blood pressure. These automatic responses by our bodies are built in to serve us when we need more blood pressure to escape danger or react quickly. Unfortunately, the body doesn’t always differentiate between internal (physical pain, emotional pain) stressors and external (car careening toward you) stressors.
Q. My dad, 79 has recently begun having episodes of gout, even with reasonable uric acid levels. His diet is perfect and he drinks only socially. What does one do for “mystery” gout?
A. Gout can be caused both by overproduction and decreased secretion of uric acid. An elevated uric acid level is not necessary to diagnose gout. It also can be a consequence of other health conditions, such as renal failure, polycythemia (an increase in red blood cells or a decrease in blood plasma), some anemias (low hemoglobin, a protein in our red blood cells), and as a side effect of chemotherapeutic agents.
Maintaining a low-protein and low-alcohol diet may help prevent attacks. Also, maintaining adequate hydration and discontinuing diuretics also helps. A non-steroidal anti-inflammatory agent, such as ibuprofen, will help treat the pain and swelling of gout. However, if the attacks become frequent enough, there are preventative medications available, if your father is a candidate for them.
Q. My mom is 86 and has become an insomniac. She's up and down all night. Just can't sleep. Is it safe for her to take a sleep aid?
A. As people age, their sleep cycles change. Older adults sometimes just don’t require as many hours of sleep as younger adults. There are both pharmacologic and non-pharmacologic methods to help improve sleep.
- Make sure that your mother is not taking naps during the day.
- She should limit her caffeine intake during the day.
- Make sure she is relaxed before going to bed; often times a warm glass of milk and reading will help.
- The room should be dark at night to help signal the body that it is time for sleep.
- The bed should be reserved for sleeping, not hobbies such as TV viewing.
- If she is unable to sleep after 30 minutes, she should not continue to stay in bed.
Often, there are other conditions that cause insomnia such as sleep apnea (moments during the night where a person ceases to breathe), restless leg syndrome, and night terrors (different from nightmares). Over-the-counter sleep aids usually contain diphenhydramine (an anti-histamine such as Benadryl) and are not recommended. There are mild prescription sleep agents that can be used to help with sleeping, if her physician agrees and can rule out other causes.
Q. How do you tell your very stubborn mother that she's losing her hearing? Or is she simply unable to track a fast conversation at her age? She feels left out of active dinner conversation and then gets her feelings hurt. She refuses to consider a hearing aid and says her hearing is just fine.
A. As we age, not only do we experience a decrease in high-frequency hearing, but also a reduced ability to understand speech. So, even though a hearing test may demonstrate that an older person has intact hearing, he/she still may not be able to understand a conversation, particularly a fast-paced one with multiple participants.
When talking to a person with decreased hearing, remember to talk in a lower frequency (not necessarily a louder voice). The quieter the setting, the easier it is for a person to hear. Always face the person and enunciate. Turning to the person also allows them to take advantage of the full range of body language we give off—those subtle cues with hands and facial expressions that supplement the spoken word. (We also are reading lips more than we realize!)
One ear may be better than the other; take advantage of this. There are television and telephone amplifying devices as well as pocket microphones that can be used to amplify sound and make daily life easier for a person with hearing loss.
Wearing a hearing aid can be an embarrassing part of aging and your mother may not be ready to accept this yet. I recommend that you share the above information with her, be patient and understanding, and take time out to repeat dinner table conversation for her.
Q. Both my parents are terrified of the MRI test because of claustrophobia. Is it safe for people in their late 80s to take a tranquilizer before they have these tests? Both of them are scheduled for another one soon.
A. It is preferred that sedatives not be used prior to having an MRI (although they can be prescribed or given on-site if necessary). Consider discussing the option of an “open” MRI with your physician, since this is less likely to cause claustrophobia. Ask the ordering physician if there’s another imaging method, such as a CT scan, ultrasound, x-ray or PET scan that can provide the same information as well and can be covered by their insurance as easily as an MRI.