Bottom Line Health
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| Although elderly patients often have reduced blood flow as a result of diminishing brain activity, Split says the normal aging process does not account for the striking differences observed in blood flow between the healthy elderly patients and the dementia patients.
FUTURE STUDIES
Ideally, future studies could follow up on this finding by tracking healthy patients over a one-to five-year period, watching to see how blood flow changes correlated to the development of dementia over time, Spilt says.
. . |
Herbert Ross, DC with Keri Brenner, L.Ac.
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 One study compared melatonin levels of elderly subjects who lived independently and were exposed to more bright sunlight to melatonin levels of elderly patients who lived in nursing homes and were less likely to have outdoor activity. The results of this study indicated that a lack of exposure to bright light may lead to reduction of melatonin secretion in old age.23 In another study, researchers concluded that sunlight deprivation is a significant factor in disturbed sleep patterns in institutionalized elderly patients. |
| The study involved 95 elderly patients with insomnia, 25 elderly patients without sleep disorders, and 12 young men without sleep disorders. The melatonin levels in the elderly insomniacs were only half those of either the young men or the elderly people without insomnia. "Melatonin deficiency seems to be a key component in the incidence of sleep disorders in elderly subjects and melatonin replacement therapy may be of benefit," the researchers concluded.31 and noninvasive, and tests can easily be performed at any time or place. |
Bottom Line Health
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| Although elderly patients often have reduced blood flow as a result of diminishing brain activity, Split says the normal aging process does not account for the striking differences observed in blood flow between the healthy elderly patients and the dementia patients.
FUTURE STUDIES
Ideally, future studies could follow up on this finding by tracking healthy patients over a one-to five-year period, watching to see how blood flow changes correlated to the development of dementia over time, Spilt says.
. . |
Herbert Ross, DC with Keri Brenner, L.Ac.
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| The study involved 95 elderly patients with insomnia, 25 elderly patients without sleep disorders, and 12 young men without sleep disorders. The melatonin levels in the elderly insomniacs were only half those of either the young men or the elderly people without insomnia. "Melatonin deficiency seems to be a key component in the incidence of sleep disorders in elderly subjects and melatonin replacement therapy may be of benefit," the researchers concluded.31 and noninvasive, and tests can easily be performed at any time or place. |
J. Douglas Bremner
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 The increased risk of stroke in elderly patients with dementia who take olanzepine prompted the Canadian Drug Regulatory authorities to send a letter to doctors in Canada warning them of this potential danger. The FDA, however, has sent no such letter to American doctors, many of whom are unaware of the risks and the recommendation to cease using atypical antipsychotics for behavioral symptoms in demented elderly patients. I recommend that patients with Alzheimer's or other forms of dementia should not be given antipsychotic drugs unless they have clear forms of psychosis (e.g. |
| This practice seems to be particularly common in elderly patients. Trazodone (Desyrel) and ami-triptyline (Elavil) are two examples that are commonly used for such patients. However, their efficacy has not yet been established, and they can have negative side effects. Elavil has the most anticholinergic side effects of any of the antidepressants (confusion, dry mouth, trouble urinating). Desyrel can cause priapism (a painful and sustained erection that may require a trip to the emergency room). |
Lester A. Mitscher and Victoria Toews
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 In a study of four elderly patients with iron-deficiency anemia and eleven healthy older adults, supplements of iron increased blood levels of iron equally well in both anemic and non-anemic people, whether they drank green tea or did not.3 Another study, this one involving anemic pregnant women taking iron, reports that the anemia was actually cured in slightly more of the green tea drinkers than in the green-tea abstainers. It would seem that not only does green tea not interfere with iron absorption, but that the opposite may be true: green tea may help resolve iron-deficiency states. |
Shannon Brownlee
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 Before Medicare, many physicians had sliding fee scales, depending on their elderly patients' ability to pay. Others simply kept their charges low in areas where most of their patients were poor and paying out of pocket. This was partly out of a sense of duty, but also because doctors were well aware of how they were perceived by their communities, and this awareness had generally disciplined the prices they charged the poor and elderly. Writer Phillip Longman tells the story of his grandfather, a physician in the Midwest, agonizing over what sort of car to buy. |
J. Douglas Bremner
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| The FDA, however, has sent no such letter to American doctors, many of whom are unaware of the risks and the recommendation to cease using atypical antipsychotics for behavioral symptoms in demented elderly patients. I recommend that patients with Alzheimer's or other forms of dementia should not be given antipsychotic drugs unless they have clear forms of psychosis (e.g., seeing or hearing things that are not there or having frank delusions or incorrect beliefs) as outlined in the Diagnostic and Statistical Manual of Mental Disorders. |
| The Evaluation of Losartan In The Elderly (ELITE II) study randomized 3,152 elderly patients over age sixty with heart failure and left ventricular dysfunction to the ARB losartan or the ACE inhibitor captopril.27 There were no differences in mortality (11.7% vs. 10.4%), although fewer patients stopped medication in the ARB group (9.7% vs. 14.7%), primarily because of dry cough with the ACE inhibitors. These drugs do not help African Americans with left ventricular dysfunction, however.
A recent study in the U.K. followed patients prospectively using a database of 1.18 million patients. |
Shannon Brownlee
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| Did people who came to the hospital with a broken hip receive heparin to prevent a stroke or heart attack? Did elderly patients get a pneumonia vaccine when they were admitted to the hospital? Did diabetics receive counseling to improve their diets and get more exercise?
McGlynn's results were so arresting that the article has been cited in the medical literature hundreds of times by other researchers since it was published. Her team reported that on average, patients were given recommended care a little less than cc percent of the time. |
| Same university hospital system, but wildly inconsistent treatment of elderly patients.
What's the difference between the two hospitals? Well, for one thing, more than fifty ICU beds per thousand Medicare beneficiaries at UCLA, versus twelve at UCSF. In a recent study, the Dartmouth group found wide variations in the way two hundred hospitals in California treated dying patients. At Garfield Medical Center, for example, a hospital in Los Angeles, the average Medicare recipient cost taxpayers more than $ 104,000 over the last two years of life. |
Thomson Healthcare, Inc.
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 Constipation
Studies involving elderly patients suggest that cascara treatment, compared with placebo, leads to relief of constipation and increased bowel movements. Many authors recommend cascara for the relief of narcotic-related constipation (Ham-mack & Loprinzi, 1994; Cameron, 1992; Levy, 1991; Ma-guire et al, 1981). indications and usage
Approved by Commission E: ¦ Constipation
Cascara Segrada is used for constipation, relief of defecation with anal fissures, hemorrhoids, and as a recto-anal postoperative treatment. |
J. Douglas Bremner
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| The antipsychotic drugs developed for schizophrenia are actually used just as much or more in elderly patients with dementia. One study of all the studies of antipsychotics for the treatment of behavioral problems in demented patients found data on 3,353 patients randomized to an antipsychotic and 1,757 randomized to placebo that revealed a 1.2% absolute increase in the death of those patients on antipsychotics. The authors concluded that treatment of demented patients with antipsychotics may be associated with an increased risk of death. |
Ray D. Strand
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 The British Lancet recently reported a study in which elderly patients received either optimal levels of nutritional supplements or a placebo. Those patients who received the nutritional supplements had significant improvements of their overall immune response and enjoyed fewer and less severe infections compared to those who received the placebo. |
J. Douglas Bremner
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| In other words, the majority of those antipsychotic prescriptions currently being written are inappropriate for elderly patients without an indication for treatment with an antipsychotic, namely hallucinations or delusion. In addition, the risk of side effects like diabetes and lipid elevations is greater for older patients using these powerful drugs. The FDA recently warned that the use of atypical antipsychotic medication doubles the risk of death in the elderly. |
Shannon Brownlee
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| With the disembodied government now footing the bill, the doctor was no longer charging his elderly patients directly, and it no longer mattered as much whether he drove a Cadillac or a Chevy.
Medicare also made it possible for physicians to discover how much their competitors were charging. Physicians were barred by law from fixing fees, but they could now find out what prevailing rates were simply by going to their local medical societies, which had the Medicare data on what usual, customary, and reasonable rates were in their region. |
Bottom Line Health
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| David Yousem, MD
When looking solely at the elderly patients, however, those who had dementia had significantly more structural brain damage and significantly less brain blood flow than the patients who did not have dementia.
As measured in milliliters (mL), the dementia patients had an average cerebral blood flow of 443 mL per minute—108 mL per minute less than the healthy elderly group. |
Tori Hudson, N.D.
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 In one study, vitamins C and E reduced coronary death and death due to all causes in elderly patients.158 In another, an antioxidant supplement significantly lowered risk for myocardial infarction (heart attack) in men and women over 55.159 A Finnish study showed no significant effect of an antioxidant supplement on death due to coronary artery events;161 however, only 3 percent of the people actually used an antioxidant supplement. In the very large U.S. |
Mark Sircus
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 Entrez Pubmed
36 Electrolyte balance is a critical issue in managing comorbid conditions in both diseased and elderly patients. Patients with hypertension and diabetes need careful regulation of their calcium and magnesium levels, whereas in patients with congestive heart failure, sodium and potassium levels also are critical Potassium, magnesium, and electrolyte imbalance and complications in disease management. Weglicki W, Quamme G, Tucker K, Haigney M, Resnick L. Clin Exp Hypertens. 2005 Jan;27(l):95-l 12. |
Abram Hoffer, PhD, MD, FRCP(C) and Dr. Jonathan Prousjy, DPHE, DSC, ND, FRSH
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 We usually start with 500 mg each dose and often will start with 1 g per dose, especially for cases of arthritis, for schizophrenics, for alcoholics, and for a few elderly patients. However, with elderly patients it is better to start small and work it up slowly.
Very few can take more than 6 g per day of the nicotinamide. With nicotinic acid it is possible to go much higher. Many schizophrenics have taken up to 30 g per day with no difficulty. The dose will alter over time, and if on a dose where there were no problems, they may develop in time. |
Greg Critser
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 All through the 1990s, even as the Beers List grew in length, and in esteem, the number of elderly patients receiving Beers List drugs grew. In a 2004 study of 765,000 patients, researchers found that 21 percent of elderly patients had filled prescriptions for drugs that "are known to cause harm or induce harmful side effects in those over 65 years of age." Even more dramatic was the increase in drug-drug interactions and the elderly. |
Jonny Bowden, Ph.D., C.N.S.
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 Don't Forget B12 for Memory
Research shows tremendous potential for B12 to reverse mental decline in elderly patients. In one study, 61 percent of patients with mental impairment had complete recovery with supplementation; investigators speculate that those who did not recover had suffered from a deficiency for so long that damage to the nervous system had become irreversible.
Then there's Alzheimer's, a terrible condition for which we currently have no cure. |
Thomson Healthcare, Inc.
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| Elderly: elderly patients should initially take half of the normal prescribing dose. drug interactions
MAJOR RISK
Licorice: Concurrent use may result in increased risk of hypokalemia. Clinical management: Avoid concomitant use of licorice and laxatives. moderate risk
Digoxin: Concurrent use may result in increased risk of digoxin toxicity. Clinical management: Patients who are taking digoxin should be advised to avoid concomitant use with Senna. If digoxin toxicity occurs, potassium should be monitored and supplemented if necessary while discontinuing Senna. |
Andreas Moritz
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 For the very elderly patients, though, it might take as long as a week or two for full recovery.
Olive leaf extract is one of the natural alternatives to pharmaceutical antibiotics. It has long been known for its antimicrobial properties, and has been officially tested as an antimicrobial agent, with sufficient power to achieve a published status in peer-review journals.
Astragalus
Astragalus membranaceus (Dong Quai in Chinese Medicine) is mostly used to strengthen immunity and assist the body with preventing colds, the flu and other illnesses. |
Thomson Healthcare, Inc.
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| Hepatic Effects: Monitoring of elderly patients with drug or alcohol-induced chronic hepatotoxicity receiving a Ginseng extract showed an increased bromosulphthalein excretion and improved serum-zinc concentrations, suggesting liver detoxification (Zuin et al, 1987). The preparation also included multivitamins and trace elements. Hepatoprotective effects have been observed for various ginsenosides. Hepatotoxicity was reduced in cultured rat hepatocytes by administration of ginsenosides (Nakagawa et al, 1985; Hikino et al, 1985). |
Bottom Line Health
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| Philip Wang, a psychiatrist and epidemiologist at Brigham and Women's Hospital and an assistant professor of psychiatry, medicine and health-care policy at Harvard Medical School, and his colleagues set out to define the short-term risk of death among elderly patients taking the older, or conventional, antipsychotic medications. The older medications used in the study included Thorazine and Haldol, while the newer, or second generation, drugs included Abilify and Clozaril. |
| The researchers note that although more than 25% of Medicare beneficiaries in nursing homes have such prescriptions, many of the drugs that are widely used for elderly patients have not been well studied in that population.
"Very often, the information on the benefits and the risks of drugs in the elderly is just taken from trials of younger adults," Wang says. "The elderly are just more vulnerable, and clearly, there's a susceptibility to these medications that was never picked up in trials. |
Jonny Bowden, Ph.D., C.N.S.
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 Dandelion leaf extract works great for the water retention of PMS, and Stengler routinely uses it for edema of the lower legs and ankles that he sees in elderly patients (edema is swelling or bloating caused by fluids in the extremities). Dandelion also contains two hormone-balancing constituents, taraxerol and tarax-asterol. "It's one of the premier herbs recommended for hormone-related conditions like PMS," says Stengler. Because it's a natural diuretic, dandelion leaf is a wonderful aid in reducing high blood pressure. |
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