JustCare

Tag: Alcohol

  • Free local resources to help older adults

    Free local resources to help older adults

    If you’re looking for free local resources to help older adults, your local Area Agency on Aging is a great place to begin. Area Agencies on Aging (AAAs) develop, coordinate and deliver aging services throughout the country. They serve people over 60 at every income level. In fact, they help more than eight million people a year with long-term care choices, transportation options, benefits information and caregiver issues. You can find them in almost every community.

    Most Area Agencies on Aging are also Aging and Disability Resource Centers (ADRCs). ADRCs provide a hub for information on long-term services and supports to help older adults, their caregivers and families; they work to ensure that older adults are better able to live alone in their homes for as long as possible. They are government agencies that work to meet people’s long-term care needs.

    To contact your local Area Agency on Aging for free local resources for older adults or simply to understand available benefits, call the Eldercare Locator 800.677.1116. The Eldercare Locator is a program of the Administration on Community Living. You can also visit the website at www.eldercare.gov.

    LeadingAge, an association of 6,000 community-based non-profit organizations in the U.S., offers another great resource. It has developed on online tool to help you locate non-profit agencies, agencies that “put people before profits,” that provide services and living facilities for older adults.

    By entering a zip code or city, LeadingAge’s Aging Services Directory will let you know about non-profit resources in the community. You can choose from a list of 18 resources, including nursing, transportation, home-delivered meals and dementia care. You can also learn about retirement communities, assisted living, and subsidized housing.

    And, if you need help navigating Medicare, you should contact your State Health Insurance Assistance Program or SHIP.  For the number of the SHIP in your area, click here. Or, for free help, call the Medicare Rights Center national hotline at 800-333-4114.  For other free and low-cost services for older adults, check out Just Care’s Get Help page.

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  • Top predictor for a longer life: close relationships

    Top predictor for a longer life: close relationships

    Only one in 5,000 people in the U.S. reach the age of 100. But, there are places where five to ten times as many people live to 100. Some researchers say that the top predictor for a longer life is have at least a few close relationships.

    People live longer when they are surrounded by friends and family who care for them, in places where old age is respected. Some analysts say that between 10 and 25 percent of a person’s life span can be explained by the person’s genes; the remaining 75-90 percent of the person’s longevity is determined by lifestyle. Based on his studies, Dan Buettner explains in his TedTalk, that people with a plant-based diet, who are socially engaged and have purpose, live longer.

    Buettner found that Seventh Day Adventists in Loma Linda, California and Okinawans who wake up in the morning with a sense of purpose and little stress, and who connect with their families and friends regularly, are more likely to live longer than others. They surround themselves with people who are “trusting and trustworthy.”

    According to Buettner, both men and women in the highlands of Sardinia live into their 100’s far more often than people in the U.S. There are ten times as many centenarians there than here. These Sardinians are surrounded by multi-generations of family members and friends. Their diets and daily physical activity may help explain their long lives. Mostly, it’s their social networks, their personal interactions with family, friends and neighbors.

    Psychologist Susan Pinker also studied Sardinians to understand why they live longer than people in the U.S. She notes in her TedTalk that women typically live six to eight years longer than men in the US. Women are more likely than men to spend time with their friends and family, talking to them, dining with them and bonding with them.

    For a longer, healthier life, Pinker argues that it’s important to have at least three stable relationships. These relationships can lower your stress level and rates of dementia. They can make it more likely for you to survive a disease. She says that “social isolation is the public health risk of our time.”

    You don’t have to be positive or upbeat to enjoy a long life. You need to be socially engaged, surrounded by people who love you and care about you. To promote a longer life with fewer chronic conditions, we benefit from buddies  on whom we can rely to spend time with us. Casual contacts with the postman and the grocery store clerk also are valuable. So are dogs and other pets.

    Of course, diet, exercise, maintaining a healthy weight, and not smoking or drinking too much alcohol all contribute to a healthy, longer life. But, the most likely way to improve your odds of living a long life is to have buddies, people with whom you are socially interacting regularly, people you can count on to take care of you, people you can share stories with.

    And, to be clear, we thrive with face-to-face contact–eye contact, physical contact. This contact releases oxytocin, lowers stress, generates dopamine–gives us a little high. It’s far different from online activity.

    A version of this post was published on August 20, 2017.

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  • Is alcohol naughty or nice?

    Is alcohol naughty or nice?

    With the Holiday Season upon us, there are many opportunities to drink alcohol. Some are undoubtedly tempted to over-indulge, and people who struggle with alcohol may find this time of year particularly challenging and stressful. But what are the benefits and risks of alcohol? Many people can enjoy alcohol without any immediate problems, and may find that it helps them to relax and socialize. In some cultures, it is important for observing traditions or celebrating religious feasts. But does an apparent lack of alcohol-related problems make it safe?

    The science on the possible benefits and safety of alcohol use resembles a mudslide more than a crystal-clear glass of chardonnay. Certainly, heavy alcohol use is associated with myriad health problems, from mental illness and dementia, to heart disease and stroke, to cancer and liver disease, to earlier death. But what about light-to-moderate alcohol consumption? Some studies have actually linked moderate alcohol use with health benefits, including decreased risk of ischemic heart disease, ischemic stroke, diabetes, dementia, and mortality.

    However, since we can’t randomly assign people to take alcohol or placebo, these studies have numerous limitations. For one, there is the “sick abstainer effect,” whereby a subset of people reporting no alcohol may actually have quit drinking due to a history of problems from past heavy alcohol use, which would put them at elevated long-term risk of certain health problems. Another problem is confounding. For instance, people who moderately consume alcohol have been shown to have higher average socioeconomic status, which is associated with better health and a longer life. Researchers have tried to control for potential confounders, but it isn’t possible to account for all of them; only randomization can do that. Finally, almost all studies are based on self-reports of drinking behavior, which is fraught with potential error and bias. We know that people tend to under-report “undesirable” behaviors like heavy drinking, and studies have attempted to correct for this, but no adjustment strategy is perfect.

    Recently, an extremely large, international study tried to get a definitive answer to the question about the safety of alcohol use. Using data from 195 locations across the globe, including 694 data sources about alcohol consumption, 592 studies on the health effects of alcohol use, and a combined study population of 28 million people, the researchers sought to determine the total burden of disease and disability caused by alcohol use between 1990 and 2016. Importantly, they did not solely rely on self-reported drinking, but adjusted alcohol consumption estimates using alcohol sales data, which were further corrected for tourism-related and unrecorded consumption.

    The findings were sobering. In 2016, alcohol was the seventh overall cause of death and disability globally, accounting for 2.2% of deaths among females and 6.8% among males. Among people aged 15 to 49 years old, alcohol was the leading risk factor for death and disability, with 3.8% of female deaths and 12.2% of male deaths attributable to alcohol use. And the study was unable to identify any safe level of alcohol consumption (or in other words, the safest amount of drinking was zero).

    But don’t pour your eggnog and brandy down the drain just yet. Even though this was a massive study with key methodological innovations, there were still limits. Like all previous studies, it wasn’t randomized, so confounding remains a possible explanation for some of the links between alcohol and health problems. Further, the findings have more obvious implications for public health than for individual risk. That means that while the study revealed important harms of alcohol use within the population at large, the danger to any individual person remains quite small. For instance, the top three causes of alcohol-related death for younger people were tuberculosis, road injuries, and self-harm. If you don’t live in the developing world, the first basically doesn’t apply to you. And if you never mix your moderate drinking with driving and have never had a problem with suicidal thinking, the next two aren’t relevant either (though someone else’s drinking and driving could still hurt you).

    For the older group, cancers were the main causes of alcohol-related deaths. This risk technically applies to everyone who drinks any amount, but the actual increase in cancer risk that an individual would experience from moderate drinking is small. For example, if a man in the United States drinks 3-4 drinks per day (moderate-to-heavy drinking), his risk of developing colorectal cancer would increase from about 4.6% to around 5.7%. Assuming this 1.1% absolute risk increase is entirely due to alcohol (and not confounders), this would mean that alcohol is causing a lot of cancer cases in the overall population, but that it arguably does not present a very significant danger for an individual person.

    Finally, especially in wealthier countries, light-to-moderate alcohol consumption was associated with a protective effect against ischemic heart disease for men and against ischemic heart disease and diabetes among women. So you might kick yourself for drinking if you develop a possible alcohol-related cancer at 70 years old, but you’d have no way of knowing whether or not this same alcohol use prevented you from dying of a heart attack at 68.

    So, by now you’re likely asking whether you should drink. Unfortunately, I can’t make a strong recommendation. Yes, there are real risks associated with alcohol, but many also find benefits in light-to-moderate drinking, and every decision we make requires some amount of weighing the risks and benefits (e.g., driving a car is fairly risky but also confers many social and economic benefits). Each person’s calculation will be personal and different. But what we do clearly know is that heavy and/or problematic drinking is very unhealthy. Heavy drinking is defined as more than 3 standard drinks a day or more than eight a week for a woman, and more than 4 a day or 14 a week for a man; and a standard drink is much less than you might think (that martini is likely 2-3 standard drinks). If associated with social, occupational, or health problems, any amount of alcohol can be considered problematic. If your drinking habit matches these definitions, you should consider cutting back and speak with your doctor if you need help. But if you enjoy light-to-moderate drinking without any problems, you may decide that enjoying a little Holiday cheer is worth the risks.

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  • With alcohol, less is generally more

    With alcohol, less is generally more

    It’s hard to know who to believe any more. When it comes to health care research, industry is almost always in the pocket of the researchers. Roni Caryn Rabin reports for the New York Times on an alcohol study that was pulled because the researchers were working with industry and not looking at the health risks.

    Before explaining, if you’re interested in good, seemingly untainted, alcohol research, click here. We write about a study showing that more than five drinks a week can affect longevity.  And, for the record, alcohol is classified as a carcinogen.

    In the study that was pulled because of conflicts of interest, a Harvard scientist, Kenneth J. Mukamal, and his team, some of them working at the National Institute for Alcohol Abuse and Alcoholism, were working closely with executives in the beer and liquor industry to design a trial that would not capture the negative health effects of alcohol consumption. While Mukamal is unapologetic about the tainted nature of his team’s work, the NIH determined that he was meeting the desires of these executives in order to secure nearly $100 million in support for the 10-year trial from them.

    Mukamal’s team was aiming to show the heart benefits of an alcoholic drink a day and not the negative health effects. It was also not collecting data to show the dangers of heart failure or cancer from  moderate drinking.

    Worse still, Mukamal’s team appeared to be hiding from the NIH its collaboration with alcohol industry executives, including the industry’s likely funding of the trial. The team’s primary goal was to collect the industry money and do the trial to show results at odds with a World Health Organization finding that drinking beer and liquor always raises the risk of cancer.

    Industry influence on the design of clinical trials appears all too common. The pharmaceutical industry has a big hand in drug trials, a likely reason that one in three recently FDA-approved drugs have safety risks.

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  • To live longer, limit your alcohol intake to five drinks a week

    To live longer, limit your alcohol intake to five drinks a week

    A new meta-study of nearly 600,000 people from 19 countries, published in The Lancet may give you pause before you take your next drink. The big takeaway: Less alcohol is better for your health. The study finds that recommended alcohol levels in most countries are too high. To live longer, you should limit your alcohol consumption to no more than five drinks a week.

    Older adults in the US often drink more than the US recommended limit–no more than seven drinks a week for women and 14 drinks a week for men. Indeed, a recent JAMA Psychiatry paper found that one in eight American adults is an alcoholic. According to the CDC, about 88,000 people in the US die every year from alcohol-related causes.

    The Lancet study suggests that the US recommended limit for alcohol consumption–beer, wine and spirits–is too high. The study finds that the risk of early death and heart disease increases once people drink as little as one drink a day. (If you are someone you love is drinking excessively and would like alcohol counseling, Medicare covers alcohol screenings and counseling.)

    The researchers looked at 83 studies of people in wealthy countries to determine how much weekly alcohol consumption was associated with the lowest risk for all-cause mortality and cardiovascular disease. They studied data from current drinkers who had no cardiovascular disease. They noted slightly more than 40,000 deaths and just over 39,000 incidents of cardiovascular disease in the 5.4 million person years of follow up.

    The researchers found that people who drank more than five alcoholic drinks a week had a higher risk of stroke, coronary disease, heart failure and death than people who drank five or fewer alcoholic drinks. People who drank between 0 and 100 grams of alcohol a week–about five drinks–had an estimated six months higher life expectancy at age 40 than those who reported drinking double that amount. And people who drank triple that amount, more than 350 grams a week, had a life expectancy four to five years less than people who drank under 100 grams of alcohol a week.

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  • Get the preventive care you need: Medicare pays for it

    Get the preventive care you need: Medicare pays for it

    Preventive care is very important, especially as you age.  As you get older, vision, hearing and balance should be checked annually. And, you should get a flu shot every year as well.  Fortunately, Medicare now pays for many of these services in full, as well as an annual wellness visit.  Medicare covers some tests annually and others every few years.

    Cost:  Medicare covers the full cost of many, but not all, preventive services.  If you have traditional Medicare, for full coverage, you will need to see a doctor who takes assignment, a “participating provider,” who accepts Medicare’s approved rate as payment in full.  Fortunately, the vast majority of doctors accept assignment.  If the doctor finds a problem and needs to do more tests, you may have to pay a deductible or coinsurance for those services.  If you are in a Medicare Advantage plan, for full coverage, you will need to see an in-network doctor.

    Medicare covers 100 percent of the cost of the following services:

    Medicare covers 80 percent of the cost of the following services:

    • glaucoma, trainings for diabetes self-management,
    • barium enemas to detect colon cancer, and
    • digital rectal exams to detect prostate cancer.

    Keep in mind that health care screenings can have risks. Screenings may turn up issues that warrant addressing; they also may turn up issues that would be best left alone. If the screening results turn up something out of the ordinary, doctors often do not know whether there is a problem that should lead to more tests or a surgery. For example, a breast screening may reveal a possible tumor, but the tumor may be best left untouched because it will never grow large or present a health risk. It should not be removed. The risk to you can come from removing a tumor that does not present a health risk. Surgery involves its own set of risks, including bacterial infections. The US Preventive Services Task Force, an independent panel of experts in primary care and prevention, recommends certain preventive care services, and it does not recommend others, based on the evidence of effectiveness.

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  • If you’re often tired during the day, you could have sleep apnea

    If you’re often tired during the day, you could have sleep apnea

    Many people suffer from sleep apnea, particularly older adults.  Sleep apnea is a pausing of breath or shallow breathing while you sleep.  But, because it occurs during sleep, it often goes undiagnosed and untreated. Indeed, it is estimated that up to 80 percent of people with sleep apnea have not been diagnosed for it.

    Most people with sleep apnea have obstructive sleep apnea. During sleep the airway collapses or is blocked. When air squeezes through the blockage it can cause you to snore loudly. People who are overweight are more likely to have it. A small number of people have central sleep apnea. With this condition, the part of your brain that controls your breathing will not send the proper signals and you will not breathe for short periods.

    The National Institutes of Health explains that sleep apnea has one of two causes: a person’s physical structure or medical conditions.  A wide variety of medical conditions  could cause sleep apnea, including obesity, large tonsils, endocrine disorders, neuromuscular disorders, heart or kidney failure, certain genetic syndromes, and premature birth.

    Sleep apnea symptoms include snoring, stopping breathing, or gasping during your sleep. If sleep apnea is severe, you might experience 30 or more long interruptions in breathing an hour. Or, interruptions can be few and only last for a few seconds. But, these interruptions in your breathing can pull you out of your deep sleep into a light sleep. You then end up with a bad night’s sleep and may feel tired during the day. You might also wake up with a headache.

    Healthy changes in your lifestyle could decrease your risk of developing sleep apnea. Smoking, drinking alcohol and unhealthy eating patterns that lead to obesity all could increase your risk of sleep apnea.

    Sleep apnea, when untreated, is associated with heart disease and heart deaths, as well as high blood pressure or hypertension. It can increase your risk of asthma, atrial fibrillation and pancreatic, renal and skin cancers. Sleep apnea is more prevalent among people with diabetes, coronary artery disease and congestive heart failure.

    Your doctor cannot diagnose sleep apnea through a blood test. It is typically diagnosed through a polysomnogram. Once diagnosed, you can usually treat sleep apnea through changes to diet and lifestyle, devices that help you breathe, mouthpieces and surgery.

    The NIH has a short video to help you better understand what happens to people with sleep apnea.  And, here are seven tips from the National Institutes of Health for getting a good night’s sleep.

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  • Clearing the air on marijuana use

    Clearing the air on marijuana use

    United States Attorney General Jeff Sessions just announced that he would reverse the Obama-era decision to not prosecute federal marijuana-related crimes in states where the drug has been legalized. And so again, marijuana is in the headlines. But amidst all the buzz, what do we actually know about the health effects of marijuana? This controversial topic could use an injection of calm, rational, fact-based discussion. As a psychiatrist specializing in the treatment of serious mental illness and co-occurring substance use disorders, I can provide a little clarity.

    First, although nowhere near as damaging to public health as other drugs including tobacco, alcohol, and opioids, we can’t let cannabis completely off the hook. Many people can use pot safely in moderation, but there are several highly vulnerable groups who should avoid it. Despite numerous claims and even some state medical marijuana laws, there is little-to-no scientific evidence that weed helps any mental illness, and it can be addictive. In fact, there are studies showing that cannabis can make depression, anxiety, and post-traumatic stress disorder worse. So, people with psychiatric problems should probably steer clear of that joint. When the brain is forming in the womb, even the slightest external disruption can cause major problems for the child later on, so pregnant women should not use cannabis. Adolescence is another period of rapid and critical brain development, so it’s little surprise that cannabis use – especially frequent or heavy use – can disrupt academic achievement and lower IQ. Parents and teachers need to help young people make healthy choices about marijuana.

    Second, speaking of adolescents, cannabis use raises the risk of developing a psychotic disorder, like schizophrenia, and lowers the age at which psychosis begins. This risk is higher with heavier use as well as use that begins at a younger age. There are also risk factors that make people much more likely to become psychotic after smoking weed, including a family history of schizophrenia, experiencing abuse or trauma in childhood, and growing up in an urban environment. Since psychotic disorders like schizophrenia cause massive disability worldwide, this is an important public health concern.

    For older adults without a history of psychiatric problems, moderate marijuana use may be relatively safe for their mental health. However, cannabis smoke has many toxins including carbon monoxide and particulate matter that could cause and exacerbate medical problems. For instance, marijuana has recently been linked to increased risks of stroke and heart failure. Vaporizing or eating pot may be safer options, though we aren’t completely sure.

    But aren’t there benefits to cannabis use? Maybe. There is some evidence that marijuana can provide relief for certain, specific medical conditions, such as severe pain from neurological problems, anorexia from HIV/AIDS, or maybe even seizures. And certain compounds in the marijuana plant – like cannabidiol – may help with some psychiatric symptoms.

    So what to do? Avoid marijuana entirely? Support Jeff Sessions in his quest to start locking people up again for marijuana possession? On an individual level, the decision whether to use cannabis for medical or recreational purposes is highly personal, but people should at least be informed by scientific evidence rather than media hype, anecdotes, and strong opinions. On a societal level, my opinion is that the War on Drugs has been a complete failure for all drugs, but especially marijuana, causing many more problems than it has purported to solve. Rather than prosecute marijuana users, we should take a public health approach to help people who have a pot problem and work to prevent cannabis use in vulnerable populations like adolescents. And we should pursue rigorous scientific research to find effective ways to prevent harm from marijuana, and search for new medical treatments that could be hiding in this multi-faceted and fascinating plant.

    Here’s more from Just Care:

  • Medicare covers alcohol screenings and counseling

    Medicare covers alcohol screenings and counseling

    Older adults are too often binge drinkers, which can lead to memory loss, difficulty balancing and unstable moods. If you or someone you love is drinking too much, Medicare can help. Medicare covers annual alcohol screenings and counseling to help people over 65 who are drinking more than three drinks at a time or seven drinks each week.

    Medicare covers alcohol screenings once a year, as one of its preventive care benefits, even for people who show no signs or symptoms of alcohol abuse. If the screening indicates alcohol misuse, Medicare covers four alcohol counseling sessions each year.

    To qualify for full coverage of Medicare alcohol counseling, if you are enrolled in traditional Medicare, see a doctor or nurse practitioner who accepts Medicare assignment. If you are enrolled in a private Medicare Advantage Plan, use a network provider. To qualify for coverage, you must also:

    • Be mentally competent
    • Receive counseling  at a doctor’s office or at a clinic

    Medicare does not cover screenings or counseling for alcohol misuse for hospital inpatients or emergency room patients.

    Medicare also covers treatment for alcoholism and other substance abuse in both inpatient and outpatient settings. To qualify, your doctor must certify that the services are medically necessary and prepare a treatment plan.

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  • How to talk to a loved one about alcohol

    How to talk to a loved one about alcohol

    Alcohol use is a growing issue for older adults, who report binge drinking more frequently than any other age group in America. The symptoms of alcohol dependency —memory loss, difficulty balancing, unstable moods, and fragility — often get mistaken for signs of aging, which makes it easy for medical providers and caregivers to overlook. The infographic below, created by Nursing@USC’s online FNP program, based on the original research by the program’s own Dr. Benita Jeanne Walton-Moss, explores the fundamental strategies of addressing alcohol dependency with women over 65.

    How to talk to a loved one about alcohol:

    ● Familiarize yourself with standard drink sizes: Before you can accurately assess drinking habits for yourself or someone else, revisit the standard sizes of different types of alcoholic beverages (like the pictures shown below). Especially for red wine, it’s easy to overestimate a standard pour when the drink itself only takes up a small portion of the glass. People often forget how small a standard drink looks and can get carried away with servings.

    ● Take the time to talk through each question: Even though the questions recommended in the graphic seem simple, the answers can be complicated, daunting, and often hard to admit. Women over the age of 65 grew up in a time when drinking alcohol was deemed a social taboo, so articulating answers can come with difficult nuances. Taking the survey question by question, and allotting time for discussion between each can help keep everyone on the same page.

    ● Maintain a positive, sensitive attitude: Because conversations about alcohol can feel awkward, it’s important for caregivers to stay positive and empathetic when broaching a sensitive subject. Showing a compassionate interest and level of understanding helps people feel comfortable and valued, especially when discussing potential lifestyle changes.

    What’s most important for facilitating a meaningful discussion about alcohol, is to position yourself as an advocate for your loved ones, and let them come to a decision when they’re ready. Consult a doctor or nurse practitioner about strategies that are right for your loved ones, before approaching the situation on your own. If you or someone you know is at risk of alcohol dependency or misuse, visit www.niaaa.nih.gov for more information and click here for information on Medicare coverage of alcohol counseling.

    alcohol-dependency-older-women_infographic