You may not be able to eradicate all of your individual stroke risk factors, but you likely can mitigate some of them enough to significantly reduce your chance of suffering a stroke. Along with any medications you may be prescribed to lower your blood pressure, cholesterol, and blood sugar, a healthy diet and plenty of exercise are cornerstones of stroke prevention. Eat plenty of fruits, vegetables, and whole grains, and substitute fish and poultry for red meat. Cut back on your salt intake, since too much salt raises blood pressure. Get at least 30 minutes of physical activity each day (you can break this up into smaller segments). If you’ve already had a stroke, eating more healthfully can help prevent another, and exercise can help you regain your cardiovascular fitness and cognitive function, as well as combat the depression that often follows stroke. Stroke rehabilitation programs focus closely on diet and exercise, so ask your doctor to refer you to one of these programs if he or she has not already done so.

Another crucial element of stroke protection is knowing the symptoms that can red-flag a stroke. The American Stroke Association recommends learning the “BE FAST” rubric:

• B for Balance. Do you have a sudden loss of balance or coordination? To check, walk in a straight line or touch your finger to your nose.

• E for Eyes. Are you noticing sudden vision changes, such as double vision, or loss of vision in one eye?

• F for Face drooping. Is there drooping or numbness on one side of your face? Is your smile uneven?

• A for Arm weakness. Look for weakness in one arm (raise both arms and see if one arm drifts downward).

• S for Speech difficulty. Is your speech slurred or otherwise hard to understand?

• T for Time to call 911. If you have any of the above symptoms, call 911.

Keep in mind that women may experience additional stroke symptoms, including confusion and disorientation, nausea and vomiting, and fatigue.

As our article emphasizes, time is brain. Recognizing possible stroke symptoms and seeking medical help immediately can make a huge difference to post-stroke function, since treatment with a clot-busting drug is most effective within 4.5 hours of symptom onset if your stroke is caused by a blood clot.

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It is not unusual for older adults to see depression as normal and dismiss the symptoms as little more than a “low mood.” But persistent depression can have potentially serious repercussions for your physical health—it may impact your desire for social interaction, raise the risk of falls, and decrease your motivation when it comes to eating healthfully, getting sufficient physical activity, and taking necessary medications. Research has suggested that people with cardiovascular disease who are depressed tend to have more severe cardiac symptoms and diminished quality of life compared with people who have similar cardiovascular issues but are not depressed. In one study, older adults who experienced persistently elevated depressive symptoms for four years had double the risk of a firsttime stroke, compared with those who had consistently low depressive symptoms. Late-onset depression also is associated with a greater risk for dementia.

All these facts mean it is important to tell your doctor if you think you may be depressed. As we touch on in our article, depression may present differently in older adults. Profound sadness is the cliché symptom we all think of, but this is less likely in depressed older adults. Instead, they are more likely to lose interest in activities they previously enjoyed, as well as experience fatigue, poor sleep, problems concentrating, lack of appetite, loss of interest in sex, and a sense of hopelessness. The symptoms may be exacerbated by social isolation, bereavement, and events that make you feel you have lost control over your life, such as family members deciding that you should move into an assisted living facility without consulting you.

Our article includes important information on effective treatment approaches for depression. There also are self-help measures that may prevent and/or alleviate symptoms. Exercise has been shown to help: It stimulates the release of moodboosting chemicals called endorphins and will help you sleep better. And although you may not feel like socializing if you are depressed, I recommend you try, since isolation might make you feel worse. Joining a local gym or attending group exercise sessions is a good way to combine socializing with exercise. Above all, take depression seriously because without treatment, the physical and emotional turmoil that accompanies depression can hugely impact your well-being and quality of life.

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Blood pressure is related to two forces: your heart pumping blood through your arteries, and the force of your arteries resisting this blood flow. With each heartbeat, blood pressure rises, and in between beats it falls. This is reflected in your blood pressure measurement: the top figure (systolic) is the pressure when your heart beats, and the lower (diastolic) is the pressure when your heart is at rest between beats. In older adults, lowering systolic blood pressure to 120 appears to decrease mortality. However, most people need to take two or three drugs to achieve this, and they may develop drug-related side effects. As such, most guidelines recommend you aim for a systolic blood pressure that is less than or equal to 140.

Other cardiovascular risk factors— including high cholesterol, triglycerides, and blood sugar—also are associated with potentially serious health outcomes like stroke and diabetes. Your doctor should be keeping tabs on these risk factors at your routine annual health check, but what target measurements should you be aiming for? Here’s a quick rundown:

• Cholesterol Too much LDL (also known as “bad” cholesterol) can cause plaque deposits to build up in your arteries, narrowing the channel through which blood flows. Your cholesterol levels are checked in a routine blood test called a lipid panel. If you do not have cardiovascular disease, your total level should be under 200 milligrams per deciliter (mg/dL), with LDL less than 100 mg/dL, and HDL (“good” cholesterol) 40 mg/dL or greater.

• Triglycerides These are fats that circulate in the blood, and—like LDL—they can contribute to plaque deposits in your arteries. Most experts recommend keeping fasting triglyceride levels (the level after you have fasted overnight) below 200 mg/dL.

• Blood sugar High blood sugar raises your risk for diabetes. If you already have diabetes, you’ll be familiar with the hemoglobin A1C test, which measures your average blood sugar control in the previous three months. While the American Diabetes Association recommends an A1C level of 7 percent for people with diabetes, 7.5 to 8 percent is considered a more reasonable goal for older adults.

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A healthful diet is the best source of vital nutrients. But as we age, the amount and kinds of foods that we eat may change. For example, many vitamins are found in fresh fruits and vegetables, something that may be lacking in the diet of older adults with dental issues that make it difficult to chew food. Our ability to release or absorb vitamins from food also changes as we grow older. This is particularly true for vitamin B12 (for this reason, many doctors recommend that older adults be screened for vitamin B12 deficiency). Vitamin B12 is easily absorbed in supplement form, and there also is evidence that vitamin D is worth supplementing.

There is no evidence that taking a daily multivitamin alone is harmful. But if you’re also taking additional single-nutrient supplements and eating vitamin-fortified foods, you may be ingesting too large a quantity of some vitamins. For example, too much vitamin A may weaken bones, and beta-carotene supplements (beta-carotene is converted into vitamin A by the body) have been linked to an increased risk of lung cancer in smokers. Supplement labels may list vitamin A as micrograms (mcg) or international units (IU). For men ages 51 and older, the recommended daily intake (RDI) is 900 mcg/3,000 IU, and for women in this age group, the RDI is 700 mcg/2,334 IUs). Don’t exceed 3,000 mcg (10,000 IU) daily.

For many years, vitamin E supplements were popular. However, studies have linked doses higher than 400 IU per day with increases in all-cause mortality. Vitamin E also has a blood-thinning effect, so megadoses may raise your risk of bleeding if you take the blood thinner warfarin (Coumadin®). Another nutrient—vitamin K—reverses the effect of warfarin and may put you at risk of developing a blood clot. If you take warfarin, your doctor likely has advised you to avoid taking supplements that contain vitamin K and to limit your dietary intake of vitamin K (which is found in green, leafy vegetables.)

Overall, if you eat a healthy diet rich in fruits, vegetables, whole grains, and lean protein, you should be consuming the right amounts of most vitamins. If you think you may be coming up short, discuss with your doctor whether taking additional vitamins or a multivitamin is advisable before you visit the supplements aisle at your local pharmacy.

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Your personal limits may be influenced by previous injuries or chronic health conditions like arthritis, heart failure, and lung disease. If this is the case, check with your doctor about how much you should be pushing yourself. Also try minor adjustments—for example, golf will be less of an effort if you play nine holes instead of 18. Use clubs with lightweight shafts and perimeter-weighted heads for better shock absorption, and low-compression golf balls (these have a softer core, so you don’t have to swing with as much force to achieve maximum distance from your shot). If tennis is your sport, play doubles, since this means you’ll hit roughly half the shots you would in a singles game, as well as covering only half the court. Play on soft surfaces and avoid overhead shots. If you jog, you’ll benefit just as much from a lower-impact brisk walk.

Warming up properly before engaging in sports can help prevent injuries, so spend at least five minutes doing gentle stretching exercises to loosen your muscles and marching on the spot to increase your circulation. Once you finish your activity session, the same exercises can help you cool down again into a normal resting state. If you experience any worrisome symptoms during sports—including chest pain or pressure, unusual shortness of breath, pain, and/or dizziness—stop what you are doing and contact your doctor.

Studies have shown that sports positively affect a range of conditions, including cardiovascular disease, cancer, arthritis, osteoporosis, lung diseases, and depression. Whatever your age and health status, you still can enjoy the sports you love or find new options that suit you better. Just set realistic limits, pace yourself, follow any precautions recommended by your doctor, and stay hydrated while you are physically active.

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Geriatricians have a saying: If you’ve seen one 80-year-old, you’ve seen one 80-year-old. It reflects the fact that there is no group of people who differ more from each other than older adults—and they also differ from middle-aged and younger adults. That’s because aging modifies the way medical conditions present and how we cope with illness and other health stressors. For example, chest pain is the most well-known symptom of heart attack, but an older adult who is having a heart attack may instead experience breathlessness and/or confusion. Lab test results that are considered normal for younger people might be abnormal in an older adult (and vice versa). Stressors that younger people take in stride (such as extreme temperatures) impact older adults more. To get back to our Newsbrief, drugs that are safe for younger people may potentially cause dangerous side effects in older adults, as well as interact with other meds they take.

Geriatricians have specialized training in untangling these factors and focusing on patient priorities, goals, and quality of life rather than simply treating a condition or symptom. However, many older Americans don’t have access to specialized geriatric care. There currently are about 7,300 geriatricians in the United States: about one for every 10,000 older adults. The U.S. Department of Health and Human Services has projected there will be a shortage of about 27,000 geriatricians by 2025.

You can find a geriatrician at the Health in Aging website (http://tiny.cc/HIADoc). If there isn’t one nearby, there are ways you can assess whether your current doctor is attuned to your unique health needs. Do they regularly ask you about your health-care goals and whether these have changed? Have they explained that common diseases often manifest differently in older adults? Do they encourage you to bring your medications so they can check if any are no longer needed or are unsafe for you? Are they able to explain things to you in a clear way that doesn’t make you feel you are being patronized? If a discussion of your health leads your doctor to make a comment along the lines of, “What do you expect at your age?” it might be time to look for a different provider.

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The study did not ask why people who did not follow up with their PCP opted not to do so. But many older adults find it difficult to accept age-related changes that may impose new limits on what they are safely able to do. They may not want to admit to balance problems because they don’t want to have to use a walker or cane. They may fear losing their independence and being placed in an eldercare facility. Others consider falling a normal part of aging even though there is a lot you can do to prevent falls. Your PCP can play a vital role in fall prevention by carrying out a falls assessment to investigate the underlying reasons why you fell. He or she will ask what you were doing when you fell and whether you’ve fallen before. Your PCP also will ask about any new symptoms, review your medications to see if any of them might have factored into your fall because they make you drowsy or dizzy, and check your strength, balance, and gait (the way you walk). The results can be used to formulate a prevention plan that likely will include fall-proofing your home (see last month’s issue for tips) and building your strength with physical therapy, and may include medication changes, the use of mobility aids, and footwear modification.

The American Geriatrics Society recommends annual fall screening for all adults ages 65 and older. But another alarming takeaway from the study I mentioned is that among people who did follow up with their PCP, 28 percent reported that they did not have a falls assessment and 44 percent did not receive fall prevention interventions. So, if you fall, don’t just follow up with your PCP—be proactive about requesting a thorough falls assessment and getting the interventions that can keep you safe and well.

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Many people find that their appetite and food intake decline as they age. Studies have shown that older adults report less snacking between meals, don’t enjoy their food like they used to, and eat a reduced variety of foods. Appetite declines partly because we begin to lose taste buds from around age 50 on. Those taste buds that remain atrophy so that we are less able to taste sweet and salty foods. Our sense of smell also begins to wane— and being able to smell a delicious meal is a big factor in our food intake.

Other reasons for unintentional weight loss include tooth loss and/or ill-fitting dentures, swallowing difficulties (officially known as dysphagia), Parkinson’s disease, dementia, and nerve damage after a stroke. Medications may play a role, too: Many drugs can affect your appetite or impede the absorption of nutrients. Arthritis might make it difficult to shop for prepare a variety of foods, or perhaps you live alone and don’t see the point in preparing a nutritious meal if there is nobody else with whom to enjoy it.

If you are experiencing unintentional weight loss, raise the alarm with your doctor, in case the root cause is an undiagnosed condition or a problem that can be treated, or a medication adjustment might help. Also mention the problem to your dentist and get oral health problems and/or ill-fitting dentures addressed. If you often don’t eat enough because you live alone and don’t feel motivated to cook, consider batch-cooking meals ahead of time and freezing them in serving portions—that way, when you don’t feel like cooking you can pop something in the microwave and still have a healthy, nutritious meal. If you’re a regular at your local senior center, consider setting up a “freezer swap” club so that you can share your favorite meals with friends and try one of theirs in return. Friends who also live alone may be interested in a weekly “potluck” meal to avoid eating alone every evening.

Also make sure that the food you eat helps keep you healthy and fit—our article contains plenty of advice on what you should focus on.

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As a first step toward helping your mother, it may be worth finding out if she needs to see as many specialists as she does—this is something her primarycare doctor can advise on, in a conversation with both of you if your mother is agreeable. You also mention that she takes several drugs. This is common in older people who see several specialists, and in some cases, the drugs do not need to be taken long-term. If your mother takes all of her medications with her to her next primary-care appointment, her doctor can verify what she is taking and pinpoint drugs that can safely be stopped. Another thing you may want to consider is enlisting the services of a geriatric care manager (also known as an aging life care professional). These usually are licensed social workers or registered nurses who work privately to assist older adults and their families in managing health-care needs and decisions. This option can be costly (most charge by the hour), but may help alleviate your worry. The Aging Life Care Association (www.caremanager.org) has more information.

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

Help settle a friendly argument for me: Are yams and sweet potatoes the same thing?

Yams and sweet potatoes may look similar, but they are different vegetables. Yams can be brown or black, with off -white, red, or purple flesh, depending on the variety. Sweet potatoes have either a lighter orange skin with a yellow, drier flesh (more like a white baking potato) or a darker orange skin (which leads to the yam comparison) with moist, sweeter flesh than the lighter-skinned kind. They provide different health benefits, too. In general, sweet potatoes are more nutritious, with higher amounts of vitamin C, beta-carotene (which converts to vitamin A), fiber, and protein than are found in yams. Yams, however, are higher in carbohydrates. Both vegetables are a good source of potassium, magnesium, and manganese.

Fran Grossman, RD, MS, CDCES, CDN

Nutrition

My cardiologist has recommended I have a left ventricular assist device implanted to relieve my severe heart failure symptoms. How do these devices work?

In a healthy heart, the left ventricle (lower chamber) pumps oxygenated blood out to the body. A failing heart cannot contract strongly enough to do this, but a left ventricular assist device (LVAD) can do it instead. The device is a mechanical pump that is implanted at the bottom of the heart. Blood from the left ventricle flows into the pump and then is sent through a tube connected to the aorta (the main artery leading from the heart to the body). A power cable leads from the LVAD through the skin to connect the pump to a battery pack worn outside the body.

LVADs are associated with improved survival and quality of life in people with heart failure, and after implantation, you’ll be able to perform most of the daily activities that healthy people your age can perform. However, while newer LVADs feature a biocompatible design and materials that reduce the risk of blood clots, infections, and strokes, these complications can still occur. Having one implanted is major surgery that can take from four to six hours. You’ll be in the intensive care unit for about a week, and your overall hospital stay will be about 14 to 21 days. You’ll be carefully monitored during that time, and if all is well, a physical therapist will begin working with you to help your recovery.

Expect to be taking anywhere from five to 10 medications (including a blood thinner) when you leave the hospital—it is vital that you take these as directed, and don’t take any new drugs and/or supplements without informing your cardiologist.

Bruce J. Darrow, MD, PhD

Cardiology

The post Ask the Experts: Coordinating Care Needs; Yams vs. Sweet Potatoes; LVAD for Heart Failure appeared first on University Health News.

People who are living with memory loss tend to do better with structure and familiarity. These often fall by the wayside during the festive season, but do your best to keep your loved one to a normal schedule when it comes to meals and bedtime routines. Accept that you may need to opt out of hosting large family gatherings that could be overwhelming for a person who is living with dementia—instead, arrange for people to make short visits, and don’t schedule too many visitors at once. Also designate a quiet space in your home so that your loved one can retreat to peace and quiet if necessary.

It’s a good idea to warn people if a person living with dementia has experienced a marked decline in cognition since the last time they visited. If he or she often forgets familiar faces, tell visitors that they may need to introduce themselves even if they are family members or close friends. Let them know if your loved one likely will repeat questions multiple times—they will need to be patient and give him or her plenty of time to finish what they are saying. Also update visitors about new behaviors, such as restlessness or agitation.

Even if the festivities aren’t how they used to be, you can still appreciate time spent together. You may not be able to have a conversation with your loved one about the past, but he or she may recognize and be able to hum or sing a song from your shared past. Also spend time with him or her looking back through old photo albums. Tactile activities can be a wonderful way for grandchildren to connect with a family member who is living with dementia—purchase a few inexpensive coloring books and some crayons or pencils, or engage in simple cooking projects (he or she can roll out cookie dough and use a cookie cutter).

It can be difficult to let go of things you’ve always done at this time of the year, but it is important to have realistic expectations about what’s possible under the circumstances. Your life together may be changing, but adapting to your loved one’s unique needs, preferences, and limitations will ensure that you continue to have meaningful times together during the festive season.

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