Blood Pressure

Blood pressure (BP) is the measurement of the force exerted by the heart, against resistance created by the arteries—this pressure helps to keep blood flowing through the body.

High Blood Pressure, or hypertension, is when the force of blood against the arterial walls is greater than it should be; eventually, long-term force against the artery walls increases a person’s risk for health problems, including heart attack and stroke. According to the Center for Disease Control (CDC), high blood pressure is a common and potentially dangerous condition. About 75 million people in the U.S.—or 1 of 3 U.S. adults—have high blood pressure. The terrifying fact is that only about half of people with high blood pressure have the condition under control.

Low Blood Pressure, or hypertension, is when the force of blood pushing against the walls of the arteries is lower than it should be. Low blood pressure is only a concern if a person experiences signs or symptoms or is associated with a serious medical condition, such as heart disease.

Difference Between Blood Pressure and Pulse

Many people think blood pressure and pulse—also called heart rate—go hand-in-hand. After all, these two vital signs are often measured at the same time at the doctor’s office. Vital signs are clinical measurements that indicate the state of a person’s bodily functions, specifically, BP, pulse rate, temperature, and respiratory rate.

But each of these vital signs measures distinctly different components of the heart. As mentioned, the blood pressure is the force of flowing blood against the arteries, while the pulse, is the number of times the heart beats per minute (bpm).

The BP and pulse often rise and fall simultaneously; however, if the heart rate increases this doesn’t mean the blood pressure increase or vice versa. For example, when faced with fear the hormone epinephrine, also known as adrenaline, is released into the circulatory system causing the blood pressure and pulse rate to rise.

How Does the Body Maintain Blood Pressure?

The body’s nervous system helps regulate internal processes by using sensors in the walls of arteries that sense blood pressure and send signals to the vessels, the heart, and the kidneys—causing them to raise or lower blood pressure.

The aorta and carotid arteries have important stretch sensors called baroreceptors. These are the most sensitive receptors of the circulatory system, which allows for immediate correction of abnormal arterial pressure.

Understanding Blood Pressure Readings

A BP reading is determined by both the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries. Constricted arteries will cause an increase in resistance to the blood flow; therefore, the more narrow the arteries, the higher a person’s blood pressure.

How is Blood Pressure Measured?

Blood pressure is an easy measurement that is done at a doctor’s office, at home, or at a pharmacy. Often, home readings and measurements at the pharmacy are taken with a mechanical blood pressure monitor.
Some doctors may prefer to take a manual blood pressure (BP) with a sphygmomanometer. This technique is known as the auscultatory method.

Basic steps for taking a manual blood pressure are as follows:

  1. The blood pressure cuff wraps snugly around the arm, on the biceps, just above the antecubital fossa, the shallow depression located on the anterior aspect of the arm.
  2. Correct cuff size is crucial for an accurate reading. Note, the cuff bladder should cover 80 percent of the person’s arm circumference.
  3. Light pressure is used to place the bell of the stethoscope over the brachial artery.
  4. The valve on the sphygmomanometer bulb is closed, as to not let air out of the cuff during inflation.
  5. The cuff is inflated to above the maximal or estimated systolic pressure.
  6. As the cuff pressure is slowly released clear tapping sounds are heard through the stethoscope—the appearance and disappearance of these sounds are noted on the manometer, or the gauge that measures the blood pressure in millimeters of mercury (mmHg).

Two numbers are heard and measured when taking a blood pressure:

  1. Systolic is the first (top number)—it is noted upon the appearance of the thumping or tapping sound, which is the pressure in the arteries when the heart beats. Systolic pressure is clinically more significant than diastolic when it comes to determining the risk of cardiovascular disease.
  2. Diastolic is the second (bottom number)—it is derived from the disappearance of the sound heard as the thumping fades out, which is the silence in between the beats—the heart at rest.
  3. The tapping sounds heard with the stethoscope when taking a blood pressure are universally known as Korotkoff sounds, or K-Sounds. However, the exact physical basis for the mechanism producing these sounds is poorly understood.

Classification of blood pressure sounds are as follows:

  • Phase-1 (K-1): the appearance of clear tapping sounds; the first clear sound is the systolic pressure.
  • Phase-2 (K-2): softening and elongation of the sound; characterized by a swishing sound.
  • Phase-3 (K-3): the sharpening of the sound; crisp and loud, similar to K-1.
  • Phase-4 (K-4): soft muffling sound; as the blood flow become less turbulent with the release of the air in the cuff.
  • Phase-5 (K-5): the sounds disappear completely since the blood flow through the artery has returned to normal; the last audible sound is the diastolic pressure

Over the years K-4 and K-5 have both been used as the diastolic blood pressure. The Journal of the American Society of Hypertension (2015), explains there is some evidence that the muffling in K-4 may be a more accurate end-point than K-5 in children, pregnancy, and exercise.

Some people may not have a distinct fifth sound—the muffling sound of K-4 is heard all the way to 0 mmHg; for these people, K-4 is noted as the diastolic pressure.

Some practitioners often take note of all three numbers 120/86/72 (K-1/K-4/K-5).

Blood pressure guidelines exist, but what is optimal, or healthy, varies from person to person—keep this in mind when reviewing the table 1.

Table 1. Blood Pressure Guidelines.

Blood Pressure Category Systolic (upper #) Diastolic (lower #)
Hypotension <90 <60
Optimal ⥶120 ⥶80
Prehypertension (Normal) 120 – 139 80 – 89
Hypertension (Stage 1) 140 – 159 90 – 99
Hypertension (Stage 2) 160⥸ 100⥸

A person’s age and health condition determine their particular “optimal” blood pressure reading. The Eighth Joint National Committee (JNC 8) released target blood pressure recommendations (Table 2).

Table 2. Target Blood Pressure.

Age and Health Condition Target
30 – 59 140/90
⥸60 150/90
People with diabetes or people with non-diabetic chronic kidney disease 140/90

Blood pressure doesn’t stay the same throughout the day—it decreases during sleep and increases upon awakening. Blood pressure also increases during activity, anxiety, and excitement.

High Blood Pressure

Development and Risk Factors

The exact cause of hypertension is not known; however, several conditions and factors may have a role in the development, including:

  • Smoking
  • Being overweight or obese
  • Lack of physical activity
  • High sodium (salt) in the diet
  • More than 1-2 alcoholic drinks a day
  • Older age
  • Stress
  • Race
  • Genetics and family history
  • Chronic kidney disease
  • Adrenal and thyroid disorders
  • Sleep apnea
  • Low Potassium or vitamin D

Clinical Manifestations

Many people with hypertension have zero signs or symptoms, even when the blood pressure measurement reaches high levels. Often, prolonged hypertension is called the “silent killer.” A few people with high blood pressure may have shortness of breath, headaches, facial flushing, or nosebleeds. These clinical manifestations are not distinctive or inclusive and usually don’t occur until the blood pressure has reached a life-threatening stage.

Types of High Blood Pressure

Primary or Essential Hypertension

High BP that develops over several years as a person ages.

Secondary High Blood Pressure

Type of BP that develops from an abnormality in the arteries that supply blood to the kidneys.

Additional Types of Hypertension

  • Isolated Systolic – systolic rises above 140 and diastolic stays near normal or below 90 mmHg.
  • Malignant (discussed in untreated complications) – occurs in about 1 percent of people and is more common in young adults, women who have toxemia from pregnancy, and black men of African descent.
  • Resistant – diagnosed when the person is prescribed three different types of antihypertensive medications and the blood pressure remains high; it is resistant to treatment. It occurs in 20 to 30 percent of people with hypertension.

Low Blood Pressure

Development and Risk Factors

Development of hypotension most commonly occurs in two different scenarios.

  1. When a person stands up quickly from lying down gravitational force pulls the person’s blood, however briefly, to the lower extremities.
  2. After a person has been standing for a long time.

In a functional or healthy nervous system and circulatory system the body is extremely sensitive and responsive to changes. Therefore, the body rapidly adjusts to ensure enough blood and oxygen are available to the brain and other essential organs. With most forms of hypotension, the body can’t bring the blood pressure back to normal or can’t do it quick enough. Some people have a normally low blood pressure—all the time—and they have no symptoms. In other people, certain conditions cause an abnormally low blood pressure; resulting in less blood and oxygen to the body’s organs.

  • Occurs in all ages (older adults at increased risk)
  • Hardened or sclerotic arteries
  • Medication
  • Dehydration or hypovolemia
  • Prolonged immobility
  • Pregnancy
  • Medical condition(s)
  • Autonomic dysfunction
  • Malfunction of baroreceptor response

Clinical Manifestations

Many of the signs and symptoms are related to the cause of hypotension and not the effects of hypotension.

  • Dizziness
  • Lightheadedness
  • Blurry vision
  • Headache
  • Confusion
  • Fatigue
  • Shortness of breath
  • Irregular heartbeat

Types of Low Blood Pressure

Orthostatic hypotension, neurally mediated hypotension (NMH), postprandial hypotension, and severe hypotension (discussed in untreated complications) are three types of hypotension.

Orthostatic Hypotension

Orthostatic hypotension, often called postural hypotension, is a type of low blood pressure that happens when a person stands up from a sitting or lying position; symptoms usually only last a few seconds or for some people may be a few minutes. Once the blood pressure and blood flow adjust, the symptoms subside.

Neurally Mediated Hypotension

With NMH, blood pressure lowers after a person has been standing for a long time. Also, this type of low blood pressure can occur if a person has an unpleasant, scary, or upsetting experience that raises the individual’s blood pressure. Once high blood pressure is detected, the body’s nervous system is stimulated to lower the blood pressure; in some cases, this response malfunctions and a person will have dilation in the veins of the lower extremity with a rapid drop in blood pressure resulting in syncope, or fainting.

Postprandial Hypotension

Postprandial hypotension is a rare condition that is characterized by a fall in blood pressure occurring 15 to 90 minutes after meals, or postprandial. The digestive system requires a sizable amount of blood for digestion after a meal—the heart rate increases and blood vessels in other parts of the body, such as the extremities, constrict to help sustain blood pressure. In postprandial hypotension, blood flows to the intestine, but the heart rate does not increase sufficiently, and blood vessels do not constrict adequately to retain a stable blood pressure; consequently, blood pressure drops. It happens in a small percentage of older people, but virtually never takes place in younger individuals. A person with high blood pressure or a disorder affecting the autonomic nervous system is at an increased risk for postprandial hypotension.

When to Take Blood Pressure

Blood pressure is customarily taken during a routine doctor’s appointment. The following table is a replication of the 2015 U.S. Preventative Services Task Force (USPSTF) clinical guidelines for blood pressure screening (Table 3).

Table 3. USPSTF Screening for High Blood Pressure in Adults: Clinical Summary.

Factors Suggestions and Advice
Population Adults aged ≥18 y without known hypertension
Recommendation Screen for high blood pressure; obtain measurements outside of the clinical setting for diagnostic confirmation.
Risk Assessment Persons at increased risk for high blood pressure are those who have high-normal blood pressure (130–139/85–89 mmHg), those who are overweight or obese, and African Americans.
Screening Tests Office measurement of blood pressure is done with a manual or automated sphygmomanometer. Proper protocol is to use the mean of 2 measurements taken while the patient is seated, allow for ≥5 min between entry into the office and blood pressure measurement, use an appropriately sized arm cuff, and place the patient’s arm at the level of the right atrium. Multiple measurements over time have better positive predictive value than a single measurement.Ambulatory and home blood pressure monitoring can be used to confirm a diagnosis of hypertension after initial screening.
Screening Interval Adults aged ≥40 y and persons at increased risk for high blood pressure should be screened annually. Adults aged 18 to 39 y with normal blood pressure (<130/85 mmHg) who do not have other risk factors should be rescreened every 3 to 5 y.
Treatment and Interventions For non-black people, initial treatment consists of a calcium-channel blocker, angiotensin-receptor blocker, angiotensin-converting enzyme inhibitor, or a thiazide diuretic. For black people, initial treatment is a calcium-channel blocker or a thiazide diuretic. Initial or add-on treatments for people with chronic kidney disease consists of either an angiotensin-receptor blocker or an angiotensin-converting enzyme inhibitor, but not both.

High blood pressure in children is a growing health concern that is often overlooked. Children 3 years and older will ordinarily have a blood pressure check during their yearly check-up. Normal blood pressure readings for children and adolescents are based on sex, age, and height—prehypertension is defined as a blood pressure in at least the 90th percentile, but less than the 95th percentile, for sex, age, and height, or a measurement of 120/80 mmHg or higher.

The National Institute of Health provides details of blood pressure levels based on age and height percentiles of boys and girls in this table. Under JNC 8, in all cases, target blood pressure levels should be reached within 30 days of starting any treatment.

Lifestyle and Home Remedies

Lifestyle changes are an enormous part of managing proper blood pressure levels, whether the person has hypertension or hypotension.

Healthy Lifestyle Habits

  • Eating Healthy
    • Limiting sodium, or salt
    • Heart-healthy whole-foods—fibrous vegetables, legumes, fruit, and protein
    • Fish high in omega-3 fatty acids are recommended twice aweek
    • Avoiding sugary food and beverages
    • Limiting alcohol intake
  • Being physically active
  • Maintaining a healthy weight
  • Managing stress
  • Taking medications as prescribed

Untreated Blood Pressure Complications

Hypertension is more likely to cause complications than hypotension, both, however, need to be taken seriously.

High Blood Pressure Crisis

Excessive pressure on the arteries, if left uncontrolled, can lead to:

  • Heart attack – blockage of blood flow to the heart muscle.
  • Heart failure – heart doesn’t pump blood as well as it should.
  • Stroke – damage to the brain from interruption of blood supply.
  • Aneurysm – blood vessels that weaken and bulge.
  • Weak and narrow blood vessels in kidneys.
  • Thickened, narrow, or torn blood vessels in eyes.
  • Memory issues and difficulty understanding.

Hypertensive Urgency

A hypertensive urgency is defined as a severe increase in blood pressure marked by systolic greater than 220 mmHg or diastolic greater than 120 with no evidence of organ damage.

Hypertensive Emergency

A hypertensive emergency occurs when hypertension results in organ damage. Systems most affected include the central nervous system, the cardiovascular system, and the renal system.

  • Accelerated hypertension is a recent increase of blood pressure over baseline and is associated with organ damage, but without papilledema, swelling of the optic disc.
  • Malignant hypertension is hypertension with the presence of papilledema.

Low Blood Pressure Crisis

If blood pressure is sufficiently low, syncope and seizures can occur.

Severe Hypotension Linked to Shock

To healthcare providers the word shock implies a collapse of the cardiovascular system from a possibility of several reasons. Shock related to hypotension occurs when not enough oxygenated blood is flowing to the body’s major organs, including the brain. Signs and symptoms of shock vary, depending on the cause. Typical characteristics include:

  • Diaphoretic – skin becomes cold and sweaty
  • Pallor – skin is pale or gray
  • Slowed capillary refill – pressed skin returns to normal color more slowly than usual
  • Weak and rapid pulse
  • Rapid respirations

Vasodilatory Shock

In vasodilatory shock, blood vessels suddenly relax causing an extreme drop in blood pressure. A person will feel warm and have flushed skin at first, then they become diaphoretic and weak. As shock worsens, the person cannot sit up without passing out, and if not treated, the person will lose consciousness. As with any medical emergency, a person needs treatment right away. If a person has signs or symptoms of a hypotensive or hypertensive urgency or emergency, call 911.

Lifestyle and Home Remedies

Lifestyle changes are an enormous part of managing proper blood pressure levels, whether the person has hypertension or hypotension.

Healthy Lifestyle Habits

  • Eating Healthy
    • Limiting sodium, or salt
    • Heart-healthy whole-foods—fibrous vegetables, legumes, fruit, and protein
    • Fish high in omega-3 fatty acids are recommended twice aweek
    • Avoiding sugary food and beverages
    • Limiting alcohol intake
  • Being physically active
  • Maintaining a healthy weight
  • Managing stress
  • Taking medications as prescribed

Untreated Blood Pressure Complications

Hypertension is more likely to cause complications than hypotension, both, however, need to be taken seriously.

High Blood Pressure Crisis

Excessive pressure on the arteries, if left uncontrolled, can lead to: ● Heart attack – blockage of blood flow to the heart muscle. ● Heart failure – heart doesn’t pump blood as well as it should. ● Stroke – damage to the brain from interruption of blood supply. ● Aneurysm – blood vessels that weaken and bulge. ● Weak and narrow blood vessels in kidneys. ● Thickened, narrow, or torn blood vessels in eyes. ● Memory issues and difficulty understanding.

Hypertensive Urgency

A hypertensive urgency is defined as a severe increase in blood pressure marked by systolic greater than 220mmHg or diastolic greater than 120 with no evidence of organ damage.

Hypertensive Emergency

A hypertensive emergency occurs when hypertension results in organ damage. Systems most affected include the central nervous system, the cardiovascular system, and the renal system.

  • Accelerated hypertension is a recent increase of blood pressure over baseline and is associated with organ damage, but without papilledema, swelling of the optic disc.
  • Malignant hypertension is hypertension with the presence of papilledema.

Low Blood Pressure Crisis

If blood pressure is sufficiently low, syncope and seizures can occur.

Severe Hypotension Linked to Shock

To healthcare providers the word shock implies a collapse of the cardiovascular system from a possibility of several reasons. Shock related to hypotension occurs when not enough oxygenated blood is flowing to the body’s major organs, including the brain.

Signs and symptoms of shock vary, depending on the cause. Typical characteristics include:

  • Diaphoretic – skin becomes cold and sweaty
  • Pallor – skin is pale or gray
  • Slowed capillary refill – pressed skin returns to normal color more slowly than usual
  • Weak and rapid pulse
  • Rapid respirations

Vasodilatory Shock

In vasodilatory shock, blood vessels suddenly relax causing an extreme drop in blood pressure. A person will feel warm and have flushed skin at first, then they become diaphoretic and weak. As shock worsens, the person cannot sit up without passing out, and if not treated, the person will lose consciousness. As with any medical emergency, a person needs treatment right away. If a person has signs or symptoms of a hypotensive or hypertensive urgency or emergency, call 911.

You also can read this article here: Pacific Medical Training

Enjoying springtime outdoors for the elderly

Although Midwestern weather is notoriously unpredictable, we can say with confidence that we have seen the last snowfall before next winter. The warm temperatures are inspiring everyone to get outside and enjoy the sunshine, and the same goes for the elderly.

Going outside, even for a short period of time, allows a person to soak up some sunshine, generating vitamin D, which is good for the brain, bones, and muscle function. Some doctors have even start prescribing sunlight as a source of vitamin D to improve cognitive function, among the elderly and younger generations.

Being outside also encourages socialization, something that is often missing from the lives of elderly people. One of the major benefits of living in a nursing home is that it is an environment that has built in socialization opportunities. Elderly people typically lack a strong social network because many friends may be ill or have passed away. It is considered a very isolated stage of life, but it does not have to be.

Having fun outdoors is not out of reach for the elderly, even those who live in nursing homes and are not able to be very active. There are benefits to be had just sitting and talking to other residents and caregivers, and looking at animals.

There are many outdoor things you can do as a family, as well. Each person is different and so are his or her abilities to be outside and be active. Ultimately, you and doctors know the limitations best. Given the green light, there are many low-impact outdoor activities elderly people can enjoy.

Watch a game
Family time is as crucial as time in the sun, and you can get two-in-one. A perfect afternoon outside could include sitting in the shade and watching a grandchild’s soccer or baseball game. If being in an arena is not too arduous, go to a professional sports game and feel like a kid again.

Take a walk
Walking is a wonderful low-impact activity that has a large impact on health. A slow, pleasant stroll is the best way to reduce stress and get blood flowing. Physical activity does not have to be intensive; a nice walk can be incredibly beneficial.

Plays in the park
The classics are timeless, and people across generations can enjoy these works together. Many cities have Shakespeare in the Park events, or other plays in outdoor spaces. Grab some folding chairs and find a shady spot to take in some culture in the sunshine.

Stop feeling guilty about your parent living in a nursing home

Taking a parent to live in a nursing home is difficult. Many people who ask their parents to move to a skilled nursing facility often hear a flat-out “no!” After all, who wants to leave a home that they know to permanently live in a strange place, especially when they are in their senior years? Adult children are often consumed with guilt when asking a parent to move to a nursing home, thinking that they are upsetting or harming their loved one, that somehow it is abandonment.

Most people come to elder care after an event that makes it difficult or unsafe for the person to live on their own; or it highlights reasons why the elderly person should not have been living on their own for a while now. This can mean that the elderly loved one’s physical health has deteriorated, and other times it can mean that behavior and mental issues resulting from old age or illness have rendered an independent life impossible or dangerous.

No matter how our emotions may cloud reality, the truth of the matter is that your parent is in danger if they remain living alone – you understand that, which is why you are reading this and looking for a solution.

When a loved one is in the winter years of life, we are reminded that our time together is limited. This is especially true for people who have lost one parent already. When people lose a parent, it is a sorrow that never leaves, and they are missed every day. Therefore, when a second parent needs care, the children may feel that they must take on total care responsibilities. After all, if you miss one parent, how can you send the other to live away?

There is no way to change how much time we have together, but what you do have control over is the quality of time spent together rather than the quantity. The reality is that most people are not equipped to provide full-service medical and nursing help to their parents. That is, unless they are healthcare professionals, in which case they are likely busy at work all day. Leaving work to provide around the clock care to a loved one is not a luxury most people have, and no one wants to leave an elderly sick person home alone all day. Isn’t that why you are looking for the perfect nursing home for your parent in the first place?

At the end of the day, your parent’s health, safety, and long-term happiness is most important, and a decision made in service of those things cannot be worthy of guilt.

Research shows insulin prices skyrocket since 2002

If you think that insulin prices have sharply increased over recent years, it is not your imagination. A recent analysis of U.S. drugs prices shows that the cost of insulin has more than tripled from 2002 to 2013, increasing from $231 per year per patient to $736. These numbers are also reflected in the rise in cost for a milliliter of insulin, which increased by nearly 200 percent, from $4.34 to $12.92 over the same period.

Researchers combed through 28,000 diabetes records in the Medical Expenditure Panel, which is a US Department of Health and Human Services database on healthcare costs. The records show that approximately 25 percent of diabetics used insulin and roughly 66 percent took a pill. According to the Centers for Disease Control and Prevention, more than 29 million people in the United States have diabetes, which is 9.3 percent of the population.

The rise in cost is upsetting to many, including patients and doctors alike, because the advancement in diabetes medication and technology has been miniscule in comparison with the sharp rise in cost, and insulin is crucial, life-saving medication. Many people with diabetes, especially those with type 1 diabetes, could not live without insulin injections.

The rise in cost, therefore, poses a serious threat to the lives of diabetes patients who cannot keep up with payments for the medication. Keep in mind, insurance coverage, both private and public like Medicaid and Medicare, has not increased or improved a significant amount since 2002; and income has remained flat in the U.S. for several years, if not decades.

Insulin seems to be the only diabetes medicine that has been experiencing ballooning prices. The analysis showed that cost of many common oral diabetes drugs has actually been going down or, in the case of price increase, the change has not been as dramatic as that of insulin.

For example, the price of Metformin, a generic, decreased from $1.24 per pill in 2002 to 31 cents per pill in 2013. The price of DPP-4 inhibitors, a new class of diabetes drugs, did go up since they hit the market in 2006, but only by 34 percent instead of the 200 to 300 percent increases seen in the cost of insulin.

Although efforts to track insulin prices have been made before, this is the first time researchers examined national drug pricing data over an extended period of time.

Orthopedic rehabilitation critical for long-term bone health after incident

There are 206 bones in the adult human body, down from the 270 we are born with, which then fuse to form our final shapes by age 30. These bones have 206 unique purposes, as they carry us through life. Unfortunately, bone health quickly deteriorates among the elderly population, leaving the 35 percent of elderly people who fall every year in a precarious position. It is no wonder the orthopedic rehabilitation is so prominent and necessary in this slice of the American population!

However, the best way to prevent falls among the elderly is exercise, regardless if the person is 65 years old or 90 years old. Lack of physical activity is one of the main causes of falls, along with dizziness or weakness as a side effect of medication, and tripping hazards around the home. Orthopedic rehabilitation specialists and doctors recommend even mild exercise for at least 30 minutes every day in order to reduce elderly falling risk.

Bone problems can affect nearly anyone, not only the elderly. Of the 43 million Americans struggling with joint inflammation, more than half of Americans affected by arthritis are younger than 65 years old, and that number is poised to hit 60 million people in the U.S. by 2020. More than 63 percent of injuries sustained in the United States are to the musculoskeletal system, costing approximately $254 billion each year in this country alone. Still, the elderly population is the target group for musculoskeletal issues and need of orthopedic rehabilitation.

Arthritis can be painful and prohibitive, but the real danger facing the elderly in America is the hip fracture. Each year, approximately 200,000 adults in the U.S. older than 65 years old will fracture a hip, and they are more common among women than men. Hip fractures are seen in 1 percent of women over the age of 75. At first glance, this does not appear to be dire, until you understand that a person who has fractured his or her hip has a 20 to 30 percent chance of dying within a year of the fall.

To protect your elderly loved one from falling, secure all rugs in their home or room, and install night-lights to prevent tripping. If the elderly person lives in his or her own home, install railings close to the shower and toilet, and include some sort of emergency notification, even if it is just a phone nearby. Regardless of the steps taken to mitigate the risk of falling, it is important to remember that it is crucial to undergo orthopedic rehabilitation after a fall or surgery to have the best post-treatment results.

On-site hemodialysis patients can travel, too

On-site hemodialysis offers patients vital kidney failure treatment at the comfort of their home, typically a long-term skilled nursing facility. This saves on cost of transportation, is more convenient, and has been connected with better status of health because the patient is spared the physical and emotional stress of traveling to and from a dialysis center.

This can be crucial for older patients who have difficulty moving around, or are otherwise not healthy enough to be exposed to elements like wind, cold, or bright sun. Bedside hemodialysis provides the next level of care for long-term nursing home residents who have difficulty leaving their beds or rooms.

Kidney disease is very prevalent in the United States, the ninth leading cause of death across the nation. More than 23 million people in this country currently have chronic kidney disease, and 400,000 members of this group require dialysis.

The weather is warming up and families are getting ready for wedding in different cities, and this joyous time is tinged with a sadness that a loved one with kidney failure will not be able to travel to attend. After all, hemodialysis typically takes a few hours and is done several days a week. However, with some planning, you may be able to take your loved one with you on a fun family trip.

Doctor’s Orders
The first step to traveling with a parent or loved one who requires dialysis is to speak to their doctor. There are many reasons why they may not be healthy enough to travel, and only a medical professional would be able to properly assess that.

Gather Intel
Check into the health insurance situation to see what is covered. Some insurance, including Medicare, may not cover dialysis treatment at a location different from their “home” center. Same goes for “home” centers that are long-term care facilities. In that case, you may have to pay for treatment out-of-pocket.

Home Remedy
You may want to think twice about doing home hemodialysis while on vacation. Whether or not your parent has home hemodialysis, a treatment center may be the better option because you will not have to transport dialysis equipment, which can be expensive if flying, but more importantly it can get damaged. Again, this is a conversation to have with the doctor. You should also speak with the hemodialysis team at the long-term care home or dialysis center to gain some insight and get recommendations. Even if your parent prefers home hemodialysis while traveling, contact the nearest hemodialysis center when you arrive at your destination to find out what emergency care they offer and the procedure, just in case.

One Key Step to Reduce Preventable Rehospitalizations

Reducing preventable readmissions in Chicago has a strong ally on its side. Dr. Marilyn Szekendi, PhD, RN, published a report last year in the Journal of Hospital Medicine that claims that hospitals need to make only one key step to reduce preventable rehospitalizations, and it required identifying common traits across all, or most, patients.

Dr. Szekendi is the director of quality research at University Health System Consortium in Chicago, otherwise called UHC. She says that observing that different traits and characteristics that are shared among those that frequently admitted to the hospital can pave the road to finding a solution to unnecessary rehospitalizations in Chicago, and beyond. Frequent hospital admissions are defined as being admitted to the hospital more than five times in a given year.

For the study, UHC worked with an alliance of affiliate hospitals and nonprofit medical centers to conduct the study. The group studied more than 28,000 patients who were admitted from 2011 to 2012 for a combined 180,185 times to academic medical centers, like the ones at the University of Chicago and University of Illinois Chicago (UIC), but this study included similar institutions from across the country. Although the patients in the study made up only 1.6 percent of all patients, they comprised more than 8 percent of all admission and 7 percent of direct costs.

The study provides hope of solving preventable rehospitalizations because the scientists and doctors who wrote this report believe that this type of analysis can easily be conducted in any medical institution.

The study also revealed the common factors that are linked to frequent readmissions. Patients with comorbidities are readmitted an average of 7.1 times versus 2.5 in a control, and 84 percent of those admissions are for medical services. They also found that patients who have Medicaid or are completely uninsured are also more likely to be readmitted to the hospital, 27.6 percent versus 21.6 percent of those who have private insurance.

Dr. Szekendi wants to expand this study to observe other factors that they were previously unable to collect data for, and she believes that that will reveal even more solutions to preventable rehospitalization. These factors include housing status, preexisting access to medical care, and other key lifestyle indicators.

Although there is still a while to go before the collected data can paint a picture clear enough to indicate proper course of action, but we do have the tools to reduce unnecessary readmissions. Extending post-hospitalization treatment and rehabilitation at a short-term nursing facility has been proven to dramatically reduce rehospitalization and set the patient up for successful rehabilitation, to get back to regular life quicker and safer.

Is Alzheimer’s caused by viruses and bacteria?

When developing diagnoses and treatments of complex illnesses, like Alzheimer’s disease, most of the battle lies in finding the root cause. However, that is much more easily said than done. Although science has made considerable progress in figuring what Alzheimer’s disease is, as in what physically happens to the brain with this illness. What is still left up to debate, and research, is what causes Alzheimer’s to begin with.

New research from Manchester University in the UK indicates that Alzheimer’s disease and other forms of dementia could be caused by fairly common viruses like herpes. This may sound shocking, and the findings did indeed surprise the international medical community. However, these findings are brought to us by world renowned dementia experts who are urging scientists to investigate the link between dementia and exposure to certain viruses.

The main viruses in question here are the strain of herpes that causes cold sores, chlamydia, and spirochaete. The scientists – 31 in all from Oxford, Cambridge, Edinburgh, and Manchester Universities, and Imperial College – published their findings in the editorial section of the Journal of Alzheimer’s Disease. Here they indicate that viral or bacterial infections are the culprits that trigger dementia-causing plaque buildup.

In fact, most scientists currently studying dementia and Alzheimer’s disease are looking for treatments that prevent the accumulation of sticky amyloid plaques and misfolded tau proteins, which disrupt or prevent neuron from communicating. This leads to memory loss and a decline in cognition. The team of scientists that are encouraging research into viruses and bacteria say that there is incontrovertible evidence that there is a dormant microbial component in Alzheimer’s disease.

In the UK alone there currently more than 850,000 people suffering from dementia, and that number is due to spike up to one million by 2025, and two million by 2050. Although there are hundreds of drug trials taking place all over the world to help combat dementia, so far nothing has proven helpful in fighting Alzheimer’s disease and dementia.

It is important to pay attention to these viruses and microbes because the brains of elderly people typically contain dormant viruses and bacteria that can “wake up” in periods of stress or if the immune system encounters any issues. More than 65 percent of people in the world will contract the herpes virus (cold sores) over the course of their lives, and many may never know they have it. After all, the herpes virus is already known to damage the central nervous system and the limbic system in the brain. The limbic system is responsible for mood and instinct, and is tied to mental decline and personality changes.

Scientists say that viral infections in the brain cause Alzheimer’s-like symptoms and therefore the link between viruses and dementia has been overlooked for too long.

When is it time for seniors to hang up their keys?

A major national debate regarding the senior generation is whether there should be an age cap to driving a car. As the United States population ages, new fuel is added to the argument. Seniors feel that revoking driving privileges inhibits their freedom and independence, while driving-control proponents say that it is a matter of public safety.

About 66 percent of seniors older than 80-years-old in this country have active driver’s licenses and they are using them. Research shows that octogenarians (and older seniors) are driving more today than people their age in previous generations.

Older drivers tend to self-regulate their driving habits so as not to pose a danger for others. This means not driving in inclement weather, suspending driving after sunset, and avoiding highways or rush hour. Some older drivers even avoid making left-hand turns. However, age-related accidents are still fairly common. It is easy for an older driver to mistake the gas pedal for the brake, or otherwise get disoriented. Also, reaction times are not what they used to be.

In Massachusetts, senior-related car accidents reached 20 percent and in 2010 a new regulation was put in place. Since then, drivers older than 75 years must renew their driver’s licenses in person at an AAA office or the DMV. This test also requires the driver to prove the quality of their eyesight by passing a vision test or providing a vision screening certificate.

This law posed a problem for some elderly residents, as they had difficulty getting themselves to the DMV alone, which the state says can be a good sign. The Massachusetts legislature argued that this “problem” can be a good indicator of who is no longer fit for the road.

Although it is never easy to tell an elderly loved one that they are no longer fit to drive, it may be necessary for their wellbeing, and the wellbeing of others. People tend to overestimate their abilities, regardless of age, which also happens when seniors self-evaluate their driving abilities. The message can be tempered with news that stopping driving does not mean being stranded. Many senior centers and medical offices have van services that are either free or covered by Medicaid and Medicare (when used for medical appointments).

The point at which a person is no longer a safe driver due to age and illness is also a time in which they often stop being able to do a lot of things for themselves. If you need to speak with your loved one about possibly stopping driving, then it may also be a time to have a conversation about the overall next step for care. How much longer will your loved one be able to live on their own? Does not having a driver’s license limit how long they can be on their own? Now is the time to start exploring long-term care options for the next stage of life.

Long-term care insurance can be necessary for (almost) anyone

The marvels of modern medicine have extended the natural lifetime for people all over of the world, including the United States. The gift of more time is weighed down, however, with the prospect of extended time in uncertainty. The only thing that we know for sure is that we will continue to age and our health will deteriorate along the way.

 

The National Bureau of Economic Research estimates that 50-year-olds in the U.S. have a 53 to 59 percent chance of living in a nursing home at some point in their lives. As the study group’s age increases, so do encounters with nursing homes. The Employee Benefit Research Institute found that from 2010 to 2013, 23 percent of people 85 years and older had an overnight stay at a nursing home. This figure may seem pretty low for many people, and indeed it would be impressive, but that 23 percent only includes individuals who survive the two-year study. When fixing this number to include those who passed away during the study, then the new figure becomes 62 percent.

 

So now that we have established that nursing home stays of varying duration are a way of life for the majority of elderly Americans, let’s look at the accessibility of nursing home care. Most people assume that Medicare will pay for long-term nursing home care, but the reality is that Medicare covers only some expenses up to 100 days in the facility, and it must be a skilled nursing facility that follows a qualifying hospital stay that lasts longer than three days. There are a lot of stipulations to Medicare’s payouts, so be vigilant about your plan and know exactly what will and will not be covered.

 

What most people overlook is that Medicare does not cover custodial care, and that is what makes up a large part of long-term care. Custodial care is nonmedical assistance like bathing, eating, dressing, and other daily activities. Medicare can cover custodial care, but the beneficiary and their family would have to liquidate most (or all) of their assets and income, as Medicare is supposed to be a last resort for long-term care coverage.

 

Long-term care coverage is designed to help people from all walks of life, but especially middle class individuals who may not qualify for full Medicare coverage and do not have the assets and income of the more affluent to pay for long-term nursing home care. Long-term coverage costs vary depending on age when the policy is bought, extent of coverage, and a few other factors, but it is offered for people of all ages.