Wednesday, July 18, 2018

Dementia, Depression and Anxiety Link

In a number of recent posts, this blog has covered how senior citizens can postpone or even eliminate their dementia risk by making lifestyle changes such as following the MIND diet, getting enough exercise, socializing more, and sleeping well.  People who want to protect their cognitive ability also need to understand that untreated depression and anxiety are also linked to a higher dementia risk.

If you are interested in doing everything possible to avoid or postpone different types of dementia, including Alzheimer's Disease, then it is important to take a multi-faceted approach to keeping your brain as healthy as possible.   If you have elderly parents or other relatives, you may want to apply some of this research to their care, too.  They will be happier, healthier and easier to care for if their brain is functioning well, which will make life easier for you, as well.

Symptoms of Depression in Senior Citizens

Younger adults may show signs of depression if they appear to be sad, exhibit a loss of interest in their favorite activities, are agitated easily, or have angry outbursts.  While seniors can have the same symptoms of depression, they may also have symptoms which are not always identified as indicators of depression.  Watch for the symptoms listed below:

Memory difficulties
Slower thinking
Trouble concentrating
Personality changes
Physical aches and pains which are unexplained
Either the loss of appetite or overeating
Sleep problems
Isolation ... a desire to stay home most of the time
Suicidal thoughts, especially in older men
Dwelling on thoughts of death

Medical Treatments for Depression and Anxiety

If you or a family member is experiencing the above symptoms, you should report the symptoms to a doctor right away.  The sooner depression is treated, the less damage it will do.

A doctor can make sure there is not an underlying medical issue causing the symptoms.
A doctor can prescribe an antidepressant or anti-anxiety medication.
A doctor may also recommend a therapist; talk therapy usually does help, especially when combined with medications.

How to Help Yourself with Depression and Anxiety

There are also actions you can take on your own to lessen the depth of your depression and anxiety, but you should do these things in addition to seeking medical help, not instead of it.  Remember, not only do you want to improve your mood, but you also want to reduce your risk of Alzheimer's Disease and other types of dementia.

Learn relaxation techniques such as deep breathing.
Get plenty of exercise and spend time in the sunshine and fresh air, when possible.
Take classes in yoga, Tai Chi or similar relaxing forms of exercise.
Practice mindful meditation.
Try journaling; writing about your problems can reduce depression.

Depression is closely linked to dementia, although it is not the only factor.  Maintaining a generally healthy lifestyle will also reduce your risk.  Check out the articles in this blog explaining all the ways you can lower your dementia risk.  No one wants to lose their memory at the end of their life, if they can avoid it.

If you want to learn more about common medical problems as we age, retirement planning, where to retire, Social Security, Medicare and more, use the tabs or pull-down menu at the top of the page for links to hundreds of additional articles.

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Wednesday, July 11, 2018

Prediabetes and Diabetes Prevention

According to the American Diabetes Association, approximately 30.3 million Americans have diabetes and 84.1 million Americans have prediabetes.  For Baby Boomers, the statistics are even worse.  Roughly one in four adults over the age of 65 have diabetes, and significantly more have prediabetes.  A large percentage of people with these conditions are NOT aware of it.  However, this is not a disease which you want to ignore.  Diabetes is the 7th leading cause of death in the U.S.  As a result, it is important we understand how to avoid it and how to minimize the damage it can cause.

Monitor your A1C Blood Sugar Levels

A1C measures how much sugar has become attached to your red blood cells over the previous 90 days.  Because of this, it is not a test you can "cheat" by being good for a day or two before having your blood tested.  Here is how it is scored:

Normal A1C:  4.8 - 5.6
Prediabetes A1C:  5.7 - 6.4
Diabetes A1C:  6.5 or more

If your A1C is high, your doctor may order more diagnostic tests including a Fasting Blood Sugar Test (FBS), a Random Blood Sugar Test (RBS) or a 2-hour glucose tolerance test.

How Dangerous is High Blood Sugar?

If you become diabetic, it can contribute to heart disease, strokes, kidney disease or cause blindness.  Sometimes your circulation becomes so poor that you need to have a portion of your legs amputated.  As mentioned above, diabetes often leads to death.

Lifestyle Changes to Prevent Diabetes and Prediabetes

If your A1C levels are at the high end of the normal range or in the prediabetes range, it is not too late to avoid developing diabetes.  There are lifestyle changes you can make which may lower your blood sugar numbers before they reach dangerous levels and begin to damage the organs in your body.  Below are a list of changes which are recommended by AARP, the American Diabetes Association, and my healthcare provider, Kaiser Permanente.  The good news is that the tips below are the basis of a healthy lifestyle, whether you are in danger of developing diabetes or not.

For additional help, you may want to order a book from Amazon such as: "The Type 2 Diabetes Cookbook and Action Plan."

1.  Lose Weight - If you are overweight, losing 5 to 10 percent of your current body weight can reduce your risk of developing Type 2 Diabetes.

2.  Exercise - At least 30 minutes of moderate physical activity, 5 days a week, can also reduce your risk.  Include a mixture of aerobic exercises such as brisk walking or swimming, along with strength training to increase muscle strength, and stretching exercises to increase flexibility.  Try not to spend too much of your day sitting.  The longer you spend in a chair each day without getting up and moving around, the greater your risk.

3.  Eat a healthy diet with plenty of colorful vegetables - For a healthy dinner, half your plate should be filled with vegetables such as dark green leafy veggies, broccoli, cauliflower, carrots and similar foods.  One-fourth of your plate can be a protein such as red meat, chicken, turkey, fish, soy or beans. Your serving of protein should be about the size of a deck of card. One-fourth of your plate should be carbohydrates including potatoes, corn, peas or whole grains.  Avoid refined breads and try to get between 25 and 30 grams of fiber a day.

4.  Limit fruit - While fruit can be part of a healthy diet, limit yourself to three small servings a day and avoid juices completely.  It is much healthier to eat whole fruit rather than drink juices.  Even "healthy" vegetable juices often include fruit juice as their base.  These juices can cause a sudden spike in blood sugar levels.

5.  Avoid sweetened beverages - Minimize your consumption of sodas, energy drinks, sweetened coffee drinks, sweet tea, mixed drinks and other high calorie, sweet beverages.

6. Limit unhealthy foods - Cut back on sweets, sugar, honey, desserts, chips, fast food and other high calorie snacks.

7.  Eat three meals spaced out during the day - Space out your meals so you do not go longer than 4 to 5 hours during the day without eating.  This will help you avoid eating too much during one meal, causing your blood sugar levels to spike.

8.  Practice relaxation - Whether you take up meditation, yoga or other spiritual programs, learning to relax has been shown to be an effective way to reduce your risk of diabetes.

What If You Cannot Reduce Your Blood Sugar Levels?

If you try the above suggestions for a few months and find you are unable to lose weight or lower your blood sugar levels on your own, consult your healthcare provider.  They may recommend that you attend classes, try a more intense weight loss program, take medications or even consider weight loss surgery.

Whatever you decide to do, your goal is to prevent your prediabetes from turning into diabetes and, if you already have diabetes, minimize the damage.  This is not a health problem you want to ignore.

For more information, check out the website of the American Diabetes Association.

If you are interested in learning more about common health problems in senior citizens, retirement planning, Social Security, Medicare, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

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Wednesday, July 4, 2018

Living with CKD - Chronic Kidney Disease

Approximately 30 million Americans have Chronic Kidney Disease (CKD) and only about 10 percent of them know it.  This is especially unfortunate because the earlier it is detected, the more time the patient will have to make lifestyle changes which could dramatically postpone dialysis and an early death.  My husband is one of the millions of people in our country who has CKD.  He was diagnosed with Stage 4 kidney disease in 2009.  This diagnosis caused us to spend nearly a decade learning everything we could about the disease.  Because of what we learned, the lifestyle changes we made, and a trial medication, he has managed to avoid dialysis years past the time when he was expected to need it.

 Facts About Chronic Kidney Disease

*  People who are at the highest risk of developing CKD are those with diabetes, hypertension (high blood pressure) or a family history of kidney disease.  However, there are other reasons you may develop it, too.  In fact, one-third of adults are considered at risk for kidney disease.
*  There is a high correlation between kidney disease and heart disease.  Most of the people who die after a kidney disease diagnosis will actually die from heart disease. This makes it essential that you take care of  both your kidneys and your heart.
*  Hispanics, Pacific Islanders, African Americans, American Indians and senior citizens (anyone over the age of 60) have the highest risk.  As a result of this last category, Baby Boomers and older retirees need to have their kidney function tested so they can make appropriate lifestyle changes, if necessary.
*  There are simple tests which can detect CKD:  high blood pressure, urine albumin and serum creatinine.  The last one is often included in your routine blood lab tests, so you do not have to do anything special, other than ask that your doctor use your test result to estimate your kidney function.
*  Your doctor can easily estimate your GFR or glomerular filtration rate, which is a test of your kidney function.  It is calculated from your blood creatinine test, combined with your age, race, gender and other factors. If you know your creatinine, you can even find online sites which will do the calculation for you.  Your doctor may also want to perform an ultrasound or CT scan on the kidneys or do a kidney biopsy.

What to do if You are Diagnosed with Kidney Disease

It can be terrifying to be told that you have CKD and may eventually have to go on dialysis or get a transplant.  If that happens to you, you should immediately do the following:

*  Find out your glomerular filtration rate (GFR) and keep track of it over the years.  It is a good indication of how well you are slowing the progression of the disease ... which you can actually do by making simple changes to your diet. 
*  Know what stage of kidney disease you have.  The five stages are listed below.
*  Get your blood pressure checked frequently.  High blood pressure damages the kidneys.
*  Ask for a referral to a nephrologist (kidney doctor) and a dietician who can help you understand the diet.  The nephrologist will also review all your medications, including over-the-counter ones, and take you off or reduce those which put stress on your kidneys.  Make sure your other doctors are aware of your kidney disease and take it into consideration when they perform any imaging tests or other procedures, because they may have to take special precautions.
*  Find out what you can do to reduce your risk of heart disease, including keeping your blood pressure and cholesterol in check.
*  Stop smoking and get exercise.

Stages of Chronic Kidney Disease

Despite the fact that as many as 10 percent of Americans will develop CKD, most people have no idea whether or not they are at risk or if they are in the early stages of the disease.  The most common way to find out the condition of your kidneys is to ask your doctor to perform a routine blood test and estimate your GFR (referred to as your eGFR). Once you have that information, you can determine whether or not you have kidney disease and how serious it is.

The various stages of CKD are:

Stage 1 - GFR of 90 to 120
Stage 2 - GFR of 60 to 89
Stage 3 - GFR of 30 to 59
Stage 4 - GFR of 16 to 29
Stage 5 - GFR of 15 or less (this is also known as End Stage Renal Disease)

Anyone with a GFR under 60 should talk to their doctor about changing their diet and taking whatever other steps their physician deems important to slow down the progression of the disease.  Your goal is to postpone dialysis as long as possible and many people have been able to go years without dialysis, but only if they make the necessary lifestyle changes.

The Kidney Disease Diet

The CKD diet is restrictive, but it can make a significant difference in your ability to slow down the progression of the disease.  Most people with kidney disease realize they need to reduce their intake of salt.  However, sodium is not the only nutrient which should concern you.  You also want to control your protein, potassium and phosphorous.   The entire diet is quite lengthy, which is why it may benefit you to talk to a dietician, but the information below will help you get started.

Protein - You do not want to eat too much protein, especially from red meat or processed meat.  Avoid sausage and lunch meats.  Limit yourself to only two to four ounces of protein at a meal, primarily from chicken, turkey, and fish.

Salt - Limit your sodium to a maximum of 1800 mg. a day.  This can be difficult to determine, since it is hidden in so many foods.  Do not add salt to your food when cooking and read labels carefully to make sure you are not eating more than about 400 to 500 mg. in a meal.

Potassium - Too much potassium can be very dangerous for someone with kidney disease. Avoid potatoes, tomatoes, avocados, bananas, artichokes, bran, granola, beans, brown rice, spinach (and most other dark green leafy vegetables).  Instead, eat white rice, white bread, tortillas, cauliflower, peppers, lettuce, apples, grapes, pineapples, blueberries and strawberries.

Phosphorus - Avoid whole grain bread, bran, oatmeal, nuts, sunflower seeds, and dark colored soda.  Instead, eat white or sourdough bread, corn or rice cereals, cream of wheat, unsalted popcorn, and lemonade.

You also want to minimize your consumption of milk, cheese, butter and other dairy products. In addition, you should avoid chocolate and limit your consumption of caffeine.  If you regularly take NSAIDs such as aspirin, Tylenol or Motrin, you will want to discuss this with your doctor.  These over-the-counter medications can put additional stress on your kidneys. If you also have diabetes, your diet will be even more complicated, because you will have to monitor your consumption of sugar.

A registered dietician who specializes in kidney disease should be able to give you a complete list of the foods which are good and poor choices.  If you eventually go on dialysis, your dietary restrictions may change to meet your new nutritional needs. You may also want to buy a kidney disease diet book, such as the "Renal Diet Cookbook."

Treatment Options for Renal Failure

Once you are in late Stage 4 or early Stage 5, you will have to decide what type of treatment you would like to receive as you approach end-stage renal failure.  There are advantages and disadvantages to each of your choices, so you need to research them carefully and decide which one seems to be the best choice for you during the remaining years you have left.

Transplant:  In most cases, this involves a long wait, during which time you will probably be on dialysis.  After the transplant, especially if you are an older adult, you will be at an increased risk for problems and possible death from a variety of causes, including heart disease and sepsis.  You will need to take a large number of anti-rejection drugs every day, or the transplant will fail. The anti-rejection drugs can pose health problems of their own. Many people are not aware that transplants do not last forever.  Depending on your age at the time of the transplant and whether the donated kidney came from a living or deceased donor, your transplant may last only a couple of years, or up to a dozen or so years.  In rare cases, they have lasted longer.  The older you are when you get a transplant, the riskier it is.

Dialysis:  You can get dialysis either at home or in a dialysis center.  There are a variety of types available in both locations.  You can do your dialysis while awake or while sleeping, including staying overnight at some dialysis centers.  You will need to have surgery in advance to insert a port or fistula.  The type you will need depends on the type of dialysis you decide to have.  You will want to thoroughly discuss the options with your nephrologist and a dialysis nurse before choosing a type of dialysis.  Ask for a complete explanation of the choices as well as both the advantages and disadvantages of each type of dialysis you are considering.

No treatment:  Some people choose not to go on dialysis or get a transplant.  Others stop dialysis after a few months.  This is a personal decision and it is entirely up to you.

Consider Trying a Trial Medication

My husband and I believe there are two reasons why he has lived as long as he has without needing to go on dialysis.

First, he has followed the dietary restrictions carefully, and used frequent blood tests to make sure he was controlling the levels of protein, potassium and phosphorus in his blood.  He has also followed a very low sodium diet.

Second, within months of his diagnosis he went on a trial medication to counteract the severe anemia which is common with CKD patients.  This medication has helped him maintain a normal hemoglobin level in his blood and, in turn, helped him slow the progression of his disease. 

Sources of More Information:

If you or someone you love has been diagnosed with CKD, you will want to keep up with all the research available, in order to postpone dialysis or a transplant as long as possible.  Two of the best sites are:

National Kidney Foundation (which has a wealth of information on its website)
American Kidney Fund

If you are interested in learning more about common medical problems as you age, financial planning, Medicare, Social Security, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles.

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Tuesday, June 26, 2018

College Scholarship Tips for Grandchildren

At nearly the same time millions of Baby Boomers are reaching retirement age, they may also have grandchildren in elementary or high school who hope to go to college someday.  While they may want to do everything they can to make the college dreams of their grandchildren a reality, the truth is that the vast majority of Baby Boomers will be lucky to finance their own retirement, let alone help pay for the college education of their grandchildren.  Despite the risk to their own financial future, according to AARP, approximately 53 percent of grandparents help their grandchildren with their educational expenses.

The generosity of the grandparents is probably because most of us hate to see our grandchildren assume $50,000 to $100,000 or more in college debt which could take them decades to pay off.  This staggering amount of college debt could also make it difficult for our grandchildren to ever become financially independent and able to buy a home or save for their own retirement.

Because of this dilemma, I have invited the author of "Free College" to give a preview of her book, which has the goal of helping young people pay for college through the use of grants and scholarships.  By sharing this information with your children and grandchildren, you could help your grandchildren afford a college education without the need for you to dip into your retirement funds.   Her guest post is below.

How to Help Your Grandkids Pay for College without Touching Your Retirement Funds

There are no scholarships or grants in the United States to subsidize retirement. That’s zero, none, nada, zilch. There are, however, billions of dollars in both categories to pay for college for your grandchildren. In 2017, there was more than $46 billion in grants and scholarships available. Sadly, more than $2.9 billion in free college federal grant money went unclaimed.  At the same time, grandparents were pilfering their retirement accounts to help their children and grandchildren pay college tuition. This is tragic.

I was a high school German and French teacher for most of my teaching career. When you teach an academic elective, as I did, you need to do something extra to encourage students to sign up for classes they perceive as more difficult. What I did, while helping them become proficient in their chosen language, was teach students what to do in order to be accepted by the college of their choice. I showed them how to stand out from the crowd of applicants. We also discussed scholarships and grants.

One day while I was chatting with some of my high school students about the importance of applying for several college scholarships, a boy spoke up, "I don’t need to do that. My parents will pay.” When I asked if they spent their retirement money on him, would it be okay if they moved into his house when they were old, he paled. Most of the other students who were listening groaned. One girl said she would like her parents to live with her. I asked if she would prefer them to do so broke or with money in their pockets. They all came to understand the importance of applying for lots of scholarships and grants.

We all want our children and grandchildren to do well. We realize 90% of the jobs in the future will require a college education. We don’t want our loved ones to join the more than 40 million Americans who presently owe student loans. I wrote my new book, "Free College," to help families learn from successful graduates who earn the most scholarship and grant money. If their children can earn full-ride scholarships, why can’t your grandchildren?

I am against taking out student loans, whether federal or private. The student loan monster devours the futures of many. Families with such debt aren’t able to take vacations, buy new cars or homes. There has been a decline of over 35% in home ownership because of student loan debt. Many families are even putting off having children. Student loans cannot be discharged in bankruptcy, so they follow people into their senior years. If loans and diverting money from retirement are so bad, and they are, what can you do to help your grandkids?

Grandparents do not need to dip into their retirement accounts to pass on the tips contained in my new book. If you have one child, who has three kids, you only need to buy one copy of "Free College." I designed it to be used by one family for all of their preschool through high school children. If you, the grandparent, have three adult children, and they all have kids in this age range, then you’ll need to buy three copies, one for each family of your adult children. I set the price low enough so it is affordable.

Students who earn massive amounts of scholarship money do not do so simply because they are smart. While that certainly helps, it’s impossible to outsmart lazy. Those who develop good work habits early are more likely to do the right things. Families who encourage college readiness are also encouraging scholarship readiness. Colleges know what they’re looking for when they read applications. So do those who are awarding scholarships. Students need to do more of what colleges want to see, and become more of what colleges want them to become in order to be given a full-ride.

I divided "Free College" into chapters, each devoted to one habit I saw in the most successful scholarship winners. Those who earned the most money were the ones who had acquired all of these behaviors. Those who didn’t quite adopt them all, earned far less when it came time for scholarships. The largest scholarship given to any of my own students was the Bill and Melinda Gates Millennium Scholarship. It covered tuition, books, fees, room, board, and a mentor for the life of the recipient. Several of my students won this scholarship. But they were not the brightest students I ever had. They had, however, practiced all of the strategies that are now in my book.

"Free College" should not be the only book grandparents give their grandchildren. I send mine books on their birthdays and for Christmas. I find series they enjoy, or subjects they’re interested in and buy those books. In the minds of my grandsons, I’m the “book” grandparent. They love my book gifts and after reading them, display them in a place of honor. I autograph each book and write something sweet inside. My daughter told me once when I forgot to include a message, the boys were upset. I haven’t forgotten since.

My book will help your children raise your grandkids in a way that should result in more college scholarships. It does not, however, include the detailed steps high school students should take to apply for scholarships and grants. Those change too often to include in my book. I do, however, tell the reader where they can find this important information. The best place is in the office of a high school’s resident college expert. Most high schools have one. I’ve included other places to find this information if your grandchildren are unlucky and do not go to a high school with a resident expert.

Finally, while reading my book, and following the step-by-step guide it contains, you will find my Twitter handle and blog address. I regularly share information about education as well as college and scholarship readiness in both places. Remember, spend time with your grandchildren, but don’t spend your retirement money on their education. Help them earn enough scholarships and grants to pay their own their way. They’ll be proud, and you’ll be glad they did.

If you are a Baby Boomer or senior citizen who is interested in learning more about financial planning, Social Security, Medicare, where to retire, common medical problems and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles.

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Photo credit:  Photo courtesy of the author of "Free College"