ParentCare » Vol. 11

Caregiving Now! Research, Trends, and Products

By Erin Hansen

Cataracts

Most of us associate cataracts with simply growing older and anticipate both developing them ourselves and dealing with elders who develop them. But what, really, is a cataract?

Cataracts occur when the natural clear lens inside the eye, located behind the iris, becomes cloudy over time. This lens is important for focusing light on the back of the eye (the retina) so that images appear clear and without distortion, and the clouding of this lens during cataract formation distorts our vision. Cataracts are usually a very gradual process of normal aging but can occasionally develop rapidly. They commonly affect both eyes, but it is not uncommon for a cataract in one eye to advance more rapidly. Cataracts are very common, affecting roughly 60% of people over the age of 60, and over 1.5 million cataract surgeries are performed in the United States each year.

Precisely why cataracts occur is unknown; however, most cataracts appear to be caused by changes in the protein structures within the lens that occur over many years and cause the lens to become cloudy. Rarely, cataracts can present at birth or in early childhood as a result of hereditary enzyme defects. Severe trauma to the eye, eye surgery, or intraocular inflammation can also cause cataracts to develop more rapidly. Other factors that may lead to development of cataracts at an earlier age include excessive ultraviolet light exposure, diabetes, smoking, or the use of certain medications, such as oral, topical, or inhaled steroids. Other medications that are more weakly associated with cataracts include the long-term use of statins and phenothiazines.

Experts have estimated that in the United States, visual disability associated with cataracts accounts for over 8 million physician office visits a year. This number will likely continue to increase as the proportion of people over the age of 60 rises. When people develop cataracts, they begin to have difficulty doing activities they enjoy. Some of the most common complaints include difficulty driving at night, reading, or traveling. These are all activities for which clear vision is essential.

What are the symptoms of cataracts?

Cataract development is often equated to looking through a dirty windshield of a car or smearing grease over the lens of a camera. Cataracts may cause a variety of complaints and visual changes, including blurred vision, difficulty with glare (often with bright sun or automobile headlights while driving at night), dull color vision, increased nearsightedness accompanied by frequent changes in eyeglass prescription, and occasionally double vision in one eye. A change in glasses may help initially once vision begins to change from a cataract; however, as the cataract continues to grow, vision becomes cloudy, and stronger glasses or contact lenses will no longer improve sight.

Cataracts typically develop gradually and are usually not painful or associated with any eye redness or other symptoms unless they become extremely advanced. Rapid and/or painful changes in vision raise suspicion for other eye diseases and should be evaluated by an eye-care professional.

How are cataracts diagnosed?

Cataracts are detected by the finding of lens opacification during a medical eye examination by an eye-care professional. The abnormal lens can be seen using a variety of specialized viewing instruments. Using a variety of tests, your doctor is able to tell how much a cataract may be affecting vision. Usual eye tests include testing visual acuity, glare sensitivity, color vision, contrast sensitivity, and a thorough examination of all other parts of the eye. Your elder’s doctor will make sure vision loss is not due to other common eye problems, including diabetes, glaucoma, or macular degeneration.

Most cataracts associated with aging develop slowly, and many patients may not notice visual loss until it is fairly advanced. Despite being told that your elder has cataracts, it is not imperative to have surgery to remove them until they begin to affect his or her vision. The development of cataracts is unpredictable; some cataracts remain small and never progress to the point where they affect vision and require treatment, while others progress more quickly. Thus, the decision and timing to proceed with cataract surgery is individualized for each patient. The doctor will be able to tell you how much vision loss is due to cataracts and the type of visual recovery that may be expected if surgery is chosen.

Who is a candidate for cataract surgery?

Eye-care professionals may mention during a routine eye exam that your elder has early cataract development even if he or she is not yet experiencing visual symptoms. Although the doctor will be able to tell when cataracts first begin to develop, your elder will generally be the first person to notice changes in his or her vision that may require cataract surgery. Clouding of the lens may start to be seen at any age, but it is uncommon before the age of 40. However, a large majority of people will not begin to have symptoms from their cataracts until many years after they begin to develop. Cataracts can be safely observed without treatment until you notice changes in your elder’s vision (and note that because your elder may not be forthcoming with the information that he or she is starting to have trouble seeing, it is important to be vigilant about his or her sight and check in often by asking whether he or she is noticing any deterioration).

Surgery is recommended for most individuals who have vision loss and are symptomatic from a cataract. If your elder has significant eye disease unrelated to cataracts that limits vision, an ophthalmologist may not recommend surgery. Sometimes after trauma to the eye or previous eye surgery, a cataract may make it difficult for an eye-care professional to see the retina at the back of the eye; in these cases, it may still be appropriate to remove the cataract so that further retinal or optic nerve evaluation and treatment can occur. The mode of surgery can be tailored to individuals based on coexisting medical problems. Cataract surgery is generally performed with minimal sedation and generally takes less than 30 minutes. Therefore the surgery does not put significant strain on the heart or the lungs

The Wright Stuff for Your Elder

As caretakers, we know that while maintaining our parents’ and grandparents’ physical health and safety is paramount, preserving their sense of self and independence is almost as important ~ and inextricably linked to their mental and emotional well-being. With that in mind, Wright Stuff offers products that assist elders in maintaining their daily routines as independently as possible: in the “Getting Ready” section of their website, there are magnetic jewelry clasps, buttoning and zipping aids, no rinse products, long handle shoehorns, elastic shoelaces, and one-handed belt closures, to name just a few. In “On the Move,” you’ll find a great variety of adaptive products that make standing, walking, or transferring easier: scooter, wheelchair, and crutch accessories, bed mobility aids, and car transfer aids amongst other items. Head to the “In the Kitchen” section for eating utensil holders, adaptive plates, plate guards, and bowls, over-bed tables and trays, and the Thomas Steady Arm, which enables users with tremors to write and to feed themselves. For the above items and many, many more, visit http://www.wrightstuff.biz.

Study Finds Elders Improve Health By Volunteering

For elders, “Volunteering with children may be as good for their health as a gym membership,” shares Erwin Tan of the Johns Hopkins University Center on Health and Aging in Baltimore.

Tan was the lead author of a new study showing that older African American women ages 60+ who volunteer in elementary schools are not only more energetic on a daily basis than other elders but also remain more physically active over time.

So how does mentoring grade-school kids improve an elder’s health? “Physical activity is the leading cause of preventable death,” state the researchers, “yet more than half of older Americans get no regular exercise.”

Among the findings was that those who volunteered burned twice as many calories as nonvolunteers in the comparison group. Tan and his research team report in the latest issue of “The Journal of Gerontology: Social Sciences” that they spent three years following the progress of 71 black women (average age 73), who volunteered in elementary schools in Baltimore.

Although the Experience Corps program Tan and his coauthors studied happened to include mainly black elders, they emphasized, that the potential health benefits of community volunteering should also accrue to older adults in any demographic group.

The new study builds on Tan’s 2006 research showing that 15 hours of volunteer work per week at an elementary school nearly doubled a sedentary older adult’s activity level. The current report demonstrates that the increased activity can remain high for at least three years.

Experience Corps participants receive a small stipend to cover transportation and related expenses “making volunteering a more viable option for financially challenged older adults,” the authors explain.

Increased access to national can community service may address “certain health disparities in African American and other disadvantaged older adults,” conclude the researchers, while also helping meet social needs.

Not only did the elders in the study benefit, according to Tan, “for our children, the wisdom that our older adults have is priceless.”

Thanks to New America Media

AT HOME COMMODES

The topic of commodes ~ difficulty using them, the need for assistance in getting to and maneuvering onto them ~ is never an easy one to discuss. And of course it’s also a very difficult issue to deal with for both caregiver and elder. But it is a fact of life, and with more elders remaining at home longer, selecting the right kind of commode ~ from the simple and compact to the highly mechanized ~ is an important choice. Cane & Able (https://www.cane-n-able.com/category) has, along with a full catalogue of products designed for elders and their caretakers, a selection of at home/bedside commode styles for almost every level of mobility and in several price categories. Each commode is listed with price and features for easy ordering.

Diabetes Epidemic Now Poses Challenges for Nursing Homes

Care for aging people with the disease falls short, study finds

Diabetes Research

Diabetes Research

Thanks to medical advances, more and more diabetics are living longer lives. But the long-term facilities that care for aging Americans are potentially not prepared for the additional challenges that come with treating patients with diabetes.

“We need to spend appropriate time to think of a way to successfully provide care for people with diabetes as they enter their elder years, and we’re just beginning to understand how to do that,” said Dr. Paul Strumph, Vice President and Chief Medical Officer for the Juvenile Diabetes Research Foundation.

According to a recent study, although as many as 1 in 4 nursing home residents has diabetes, not all are getting care that meets the American Diabetes Association’s goals for community-dwelling adults. The study, published in Diabetes Care, found that while 98% of nursing home residents with diabetes had their blood glucose levels monitored, only 38% met short-term glucose goals.

The more positive news from the study is that 67% of the nursing home residents with diabetes met their long-term glucose control goals, which meant they scored less than 7% on their A1C tests (A1C is a measure of long-term blood sugar control).

Helaine Resnick, Director of Research at the Institute for the Future of Aging Services for the American Association of Homes and Services for the Aging, points out that “One of the key differences in managing diabetes in a nursing home is that it’s often not the condition of primary importance.”

Resnick’s chief concern with the study’s findings was that no one has yet to come up with specific guidelines for caring for elderly people with diabetes. Glucose control goals for someone who is 40 and living at home may well be different than for someone who is 85, cognitively impaired, and living in a long-term care facility, she said.

“Diabetes medications are designed to lower glucose levels, which can prevent complications from developing in diabetic people. But, when you take medicines to lower blood glucose, it can go too low, which can be extremely dangerous, especially for older adults,” Resnick said, noting that it’s difficult to find “the appropriate balance between keeping sugars low with the risk of keeping it too low.”

Strumph pointed out that the needs of older people with diabetes may be different as well. People with type 1 diabetes and people with type 2 diabetes who need insulin often choose to use an insulin pump when they’re younger, but pumps may not be the best choice for someone who’s older and not as aware, he said.

“Someone in a nursing home could pull out a pump site and not know. In that case, you may want to be on a longer-acting insulin instead. We haven’t yet defined what the ideal insulin [regimen] is for someone in a facility with a fairly predictable schedule,” Strumph said.

Both Strumph and Resnick said it’s important for family members, the nursing home resident, and the staff to come up with a realistic care plan.

“Families need to become more actively involved in working with care teams, and that’s true for diabetes and for other conditions. Ensure that the facility understands the family’s and the resident’s preferences. Is your mother more interested in keeping her blood glucose control tight and risk [low blood sugar]? Or is it better for her to ease up on glucose control and work more on quality-of-life issues? Resnick said.

“Families have to be very involved, and the communication needs to be ongoing, because people’s values can change,” she added.

For tips on selecting a nursing home, visit the AARP Web site.

Thanks to HealthDay News

SOURCES: Paul Strumph, M.D., vice president, chief medical officer, Juvenile Diabetes Research Foundation, New York City; Helaine Resnick, Ph.D., M.P.H., director of research, Institute for the Future of Aging Services, American Association of Homes and Services for the Aging, Washington D.C.; June 2007, Diabetes Care

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