…what you should know about palliative care. During her final days, former First Lady Barbara Bush helped start a national conversation about what’s really important during times of significant illness by announcing that she would end her curative treatments to focus on comfort (or palliative) care.
Palliative care provides relief from the symptoms and stress experienced by people living with serious illness. Its goal is to improve quality of life for both the patient and the family—by managing the pain that can accompany chemotherapy, for example. This kind of care can be provided at the same time as measures aimed at curing the patient. It may be appropriate if you have a serious condition such as cancer, congestive heart failure, COPD, end-stage renal disease, ALS, HIV/AIDS or dementia.
You don’t need a terminal diagnosis to receive palliative care; anyone with a serious illness, regardless of diagnosis, is eligible, according to the National Hospice and Palliative Care Organization. A specialized team of physicians, nurses, social workers and others works with your primary care provider or specialist to deliver an additional layer of care. Along with treating pain and other physical problems, palliative care includes psychological, social and spiritual support.
Palliative care can help you and your family better understand the nature of your illness and make timely, informed decisions about your care. Most people who receive this type of care report improved quality of life and are better able to function. They also say they have a better grasp of their options and feel more in control of their lives.
Many people only receive palliative care at the very end of their lives. While end-of-life care, also known as hospice, includes components of palliative care, it’s not the same. You must have a terminal diagnosis or be within six months of death to be eligible for most hospice programs or hospice insurance benefits. Palliative care has no time restrictions and can be received by patients at any time, at any stage of illness.
All the same, palliative care and hospice often go hand-in-hand. Experts advise thinking about the kind of care you might want if a serious or life-threatening illness occurs. They recommend talking with your family and your physicians and writing down your wishes, in case you are unable to communicate while ill. You can fill out a document known as an advanced directive, which identifies and clarifies your choices and personal beliefs for your family and health care providers.
This video from the Center to Advance Palliative Care may help you better understand what this specialty is and how experts provide care.
…whether lack of sleep is linked to dementia. It’s a popular misconception that we need less sleep as we age. In reality, we require as much as younger adults—a good seven to eight hours. Without enough Zzzs, we run the risk of plaque buildup (abnormal clusters of protein fragments between nerve cells) in the brain. There’s mounting evidence that plaque buildup damages areas of the brain linked to cognition, starting well before any outward signs of memory problems appear.
In addition, lack of sleep can worsen high blood pressure, diabetes, heart disease and depression. These are all known dementia risk factors.
As we age, we tend to have a harder time falling asleep, and more trouble staying asleep, than when we were younger, according to the National Sleep Foundation. After age 60, nighttime sleep tends to be shorter, lighter and interrupted by multiple awakenings.
Sleep experts say everyone—regardless of age—needs to recharge their brains through enough restorative slumber.
Insomnia, which is trouble falling and staying asleep, is the most common sleep problem in older adults, according to the National Institutes of Health. It can last for days, months or even years. Researchers have found that those suffering from insomnia were 10 times more likely to suffer heart attacks, three times more likely to be hospitalized and were more likely to die from heart problems than those without insomnia.
Sleep problems may be caused by conditions such as chronic pain, medication side effects, depression, Alzheimer’s disease or other health issues. They may also come from disorders like sleep apnea (the interruption of breathing during sleep) or from breathing problems like emphysema. Older adults may wake in the middle of the night for other reasons, such as needing to use the bathroom, or from alcohol use, anxiety or everyday stress. Some people worry about not sleeping even before they get into bed. This may make it harder to fall asleep and stay asleep.
Fortunately, there are many nonmedication options you can try for insomnia, such as relaxation training and behavioral changes that can help you get more rest.
It’s important to know that poor sleep is not an inevitable part of aging. Developing healthy habits—like not using the bedroom for anything but sleeping, putting away electronic devices at least an hour before bedtime or practicing relaxation techniques—can calm your mind and body. Experts also advise going to bed and waking up at the same time every day, even on weekends.
If you struggle with insomnia for more than two or three weeks, it’s advisable to seek medical help. These tips from Kaiser Permanente Health can help you or a loved one get a better night’s rest.
…how education affects dementia risk. If you have a college degree, your chances of developing dementia may be lower than someone with only a high school diploma. Not only do your chances of developing dementia seem to decrease with more education, according to one recent study, but the odds are that if you do eventually have memory problems, they’ll occur later in your life than they would if you had less education.
An international research team conducted the first study that estimated differences in dementia frequency by age and education levels in the United States. They analyzed data from a large, national survey done between 2000 and 2010, which included information about education and socioeconomic levels of people with and without dementia. Comparing those with more education to those with a high school education (or less), the researchers found that the more educated developed dementia less frequently. If they did develop it, they maintained good cognition longer and did not have dementia for as long a period before death.
Living in good health as we age is important to maintaining good cognition. We already know that people with less education tend to have more chronic diseases—such as heart disease, a known risk for dementia—and die sooner than those with more advanced levels of learning. Researchers concluded that higher educational status appears to provide lifelong cognitive and health benefits but cautioned that education disparities, primarily due to socioeconomics, remain a challenge for the nation to address.
Despite social disparities, the overall frequency of dementia is decreasing among all populations in the United States. Another study looked at health and aging trends between 2011 and 2015 and found that the rate at which people developed dementia dropped by as much as 2.6 percent among those 70 and older. There were noticeable declines among women, non-Hispanic whites and blacks.
Both studies were published in a special issue of the Gerontologist.
…why states need to do a better job of addressing oral health. Twenty-five states received a “fair” or “poor” rating when researchers examined how well they met minimal standards for the oral health of older adults, according to a report by Oral Health America, a nonprofit that supports better overall health through oral health.
The organization rated states on six factors: severe tooth loss (loss of six-plus teeth); dental visits; adult Medicaid dental benefits; community water fluoridation; state oral health plans; and whether the state conducted basic screening surveys about dental care and habits among its residents. The states with the lowest overall scores are Wyoming, Delaware, West Virginia, New Jersey, Arkansas, Texas, Oklahoma, Louisiana and Tennessee; Mississippi ranked number 50. Alabama improved from number 50 in 2016 to 29 in 2018.
Minnesota, Wisconsin, Iowa, Connecticut and Colorado all earned an excellent overall score. Iowa and California made big improvements, jumping in 2016 from 23 and 30, respectively to 3 and 9 in 2018. You can see how your state ranks here.
Sociodemographic factors—such as income, race, gender and education—play a
critical role in oral health, which is often overlooked in the overall health assessment of older adults, according to the Centers for Disease Control. One third of older adults have lost six or more teeth.
Poor oral health can significantly affect a person’s life. In addition to causing pain, dental problems can create difficulty speaking, chewing and swallowing. They can lead to poor nutrition and increased social isolation. Oral problems can be made worse by certain medications for conditions like diabetes or osteoporosis and can worsen some chronic conditions like heart disease.
Medicare doesn’t cover most dental cleanings, fillings or tooth extractions, or dentures or other dental devices. Under Medicaid, states have flexibility to determine what dental benefits are provided to adult enrollees. While most states provide at least emergency dental services for adults, fewer than half currently provide comprehensive dental care.
On the upside, more than 72 percent of Americans are now connected to a community water source with fluoridated water, a national increase of about 2.2 million people. Additionally, Medicaid coverage of oral health benefits has increased, providing more people with these important services.
Freelance journalist Liz Seegert has been writing about health for nearly 30 years. Her work has appeared in Consumer Reports and Kaiser Health News, on the AARP and New America Media websites and on WBAI-FM/Pacifica Radio. She covers aging for the Association of Health Care Journalists. A native of Queens, NY, she loves to walk with her rescue dog, Duke. You can follow Liz on Twitter: @lseegert.