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When Does Old Age Begin?

pensiveThe boundary between seniors and old people has shifted over the years. Some people are deemed old because they are grandparents—even at forty-five. Others become old when they retire, regardless of age or circumstance. Despite getting a seniors’ discount at age 50, or 60 or 65, some folks don’t fit the definition because of their mindset, Social Security or not. Now that Social Security eligibility in the United States is headed toward 70 and a whole lot of folks are still working, old age might never be attainable. The physical and mental changes can sneak up on us, though. Wrinkles and liver spots, gray hair (if you have hair), reduced lung capacity and voice changes wrought by loss of elasticity are signs of aging. But the mental changes, namely forgetfulness and full-blown dementia, are the more frightening. Depressed mood is common.

Because “out of sight is out of mind” may be truer than we like to think, grandma and grandpa may be among the forgotten, especially if they live more than a few hours distant from the rest of the family. If still a couple, the septuagenarian or octogenarian pair might fare quite well. But if left alone, by death or incapacitation, faring well might be history. Those over age 75 may not be as helpless as they were a decade ago, but their nutrition status is probably the same—miserable. Were it not for assisted living facilities or equivalent communal arrangements, or for home care organizations, or even for dedicated family, many seniors would be categorically undernourished or malnourished. One reason is being alone at the table. The isolated person waits for hunger to drive him to eat, often being satisfied with a bowl of high-carb-low-protein cereal, a can of super-salty soup, or a questionably prepared frozen something. Being alone, regardless of age, has been likened to smoking fifteen cigarettes a day (Cresswell, 2010).

Geriatrics is not the same as gerontology, the latter being the study of the aging process itself, which looks at the psychological and biological aspects. Geriatrics is a sub-specialty of adult medicine that focuses on the aged, which is a time of life determined more by need than by years. An aged body will show a decline in organ systems, some of which can be blamed for choices made earlier in life, including smoking, sedentary lifestyle and poor dietary habits. It’s possible that these can be overcome by quitting, moving and choosing foods wisely.

Nutrient deficiency is common in the elderly because of several factors:  reduced food intake, lack of variety, medications that cause nutrient depletions, financial insecurity, poor oral condition, loss of gustatory sensation, and other dreadful conditions, among which are an uncaring family and a desolate social life. There are some things a single senior can do to help ensure more wholesome intake. Eating away from the kitchen, as on a porch or patio, might excite appetite. Setting the table with a placemat and flowers to brighten things up can make a difference. Inviting neighbors or sharing cooking time helps to encourage mindful eating. The bottom line is that nutrition is a major determinant in aging well because it promotes health and functionality.

Meals have often added a sense of security and meaning to life. That’s hard to get when alone. A single who is sedentary also has a reduced energy need. If a comparable reduction in energy intake is not made, body fat will increase, partly because of choosing foods that are energy-dense instead of nutrient-dense.  This concern requires closer attention than at any other time of life.

Dehydration is a form of malnutrition that is a major problem among those over eighty. Blunted thirst sensation is partly the cause, but so too are medications, cognitive decline and fear of incontinence. Besides constipation, cognitive decline can worsen and death can result from inadequate hydration.

Without enough protein, frailty, lowered immune function and impaired wound healing are issues to face. The RDA of 0.8 grams of protein per kilogram of body weight still holds true in old age. In fact, a little more protein can help to prevent sarcopenia, the wasting of muscle mass attributed to aging. Up to twice as much is still healthy.

The depression that is known to accompany bereavement causes malnutrition and leads to unfavorable outcomes. Loss of appetite in such a situation is common, but the encouragement to eat by a caring family or empathic social network can stave off negative consequences.  Measurement of depressive symptoms using accepted diagnostic tools indicate that as many as forty percent of seniors fit the category, with a considerable number being malnourished, the two states being reciprocal (Ahmadi, 2013) (Mokhber, 2011).

Maintaining nutrition homeostasis is a challenge in the elderly to begin with. Those who are homebound by choice or by chance don’t realize their dietary needs. Some don’t care. But it’s necessary to provide enough protein to maintain tissue integrity, muscle mass and immune function.  We mistakenly think that old age translates to limited kidney function and that protein will unnecessarily tax kidneys. That’s not always the case, especially if hydration is adequate. Someone needs to be there to lead the parade. Loneliness is a complex response to lack of company or to feelings of being disconnected. It can occur even in a household filled with people. As odd as it may sound, loneliness interferes with good health by increasing susceptibility to viral attacks and by intensifying inflammatory responses to stressors (Jaremka, Aug 2013, Jul 2013). The prospect of eating alone reduces appetite, but the opposite is true. Being with family and friends is the best appetite stimulant for the elderly.

References

Ahmadi SM, Mohammadi MR, Mostafavi SA, Keshavarzi S, Kooshesh SM, Joulaei H, Sarikhani Y, Peimani P, Heydari ST, Lankarani KB.
Dependence of the geriatric depression on nutritional status and anthropometric indices in elderly population.
Iran J Psychiatry. 2013 Jun;8(2):92-6.

Adam Cresswell, Health editor
Isolation as harmful as smoking 15 a day
The Australian. July 29, 2010
http://www.theaustralian.com.au/news/health-science/isolation-as-harmful-as-smoking-15-a-day/story-e6frg8y6-1225898190216#sthash.5x6gP5ky.dpuf

Drewnowski A, Warren-Mears VA.
Does aging change nutrition requirements?
J Nutr Health Aging. 2001;5(2):70-4.

Greeley A.
Nutrition and the elderly.
FDA Consum. 1990 Oct;24(8):24-6, 28.

Jaremka LM, Fagundes CP, Peng J, Bennett JM, Glaser R, Malarkey WB, Kiecolt-Glaser JK.
Loneliness promotes inflammation during acute stress.
Psychol Sci. 2013 Jul 1;24(7):1089-97.

Johansson L, Sidenvall B, Malmberg B, Christensson L.
Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home.
J Nutr Health Aging. 2009 Dec;13(10):855-61.

Johansson Y, Bachrach-Lindström M, Carstensen J, Ek AC.
Malnutrition in a home-living older population: prevalence, incidence and risk factors. A prospective study.
J Clin Nurs. 2009 May;18(9):1354-64.

Mokhber N, Majdi M, Ali-Abadi M, Shakeri M, Kimiagar M, Salek R, Moghaddam PA, Sakhdari A, Azimi-Nezhad M, Ghayour-Mobarhan M, Soluti S.
Association between Malnutrition and Depression in Elderly People in Razavi Khorasan: A Population Based-Study in Iran.
Iran J Public Health. 2011;40(2):67-74.

Roe DA.
Geriatric nutrition.
Clin Geriatr Med. 1990 May;6(2):319-34.

Seiler WO, Stähelin HB.
Special aspects of malnutrition in geriatrics.
Schweiz Med Wochenschr. 1995 Feb 4;125(5):149-58.

Wham CA, Teh RO, Robinson M, Kerse NM.
What is associated with nutrition risk in very old age?
J Nutr Health Aging. 2011 Apr;15(4):247-51.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Ultraviolet Light: The Good, The Bad, And The Sun

Summer is officially here, which means more time spent outdoors and soaking up the sun. While all that fresh air and activity is great for your health, it’s important to remember that sun exposure has its limits — and too much of a good thing can cause lasting damage. From the backyard to the beach, here’s what you need to know to keep you and your family happy and healthy all summer long.

The Good: Sunlight is a mood booster.

Exposure to sunlight increases endorphin levels. These are hormones released by the brain and nervous system that relieve stress and pain, and generally make us feel happier. That’s one way the sun “cures” seasonal affective disorder: a mild form of depression that sets in during dark winters, and abates as the days get longer in spring and summer. (Kegel, 2009) (Praschak-Rieder, 2008). Sun worshippers, rejoice!

The Good: It may help you lose weight.

Aside from the fact that we tend to be more active in warmer, sunnier months, a recent studyfrom the University of Alberta Diabetes Institute found that fat cells shrink when exposed to blue light from the sun. At this wavelength, light causes lipid molecules in the cells to reduce in size. This may contribute to the typical weight gain people experience during winter months, when their sun exposure is limited.

The Good: It helps your body produce vitamin D.

Vitamin D is an essential nutrient that helps support your body’s skeletal and immune systems. It increases the body’s ability to absorb of calcium and phosphorous, which in turn strengthens our bones. Whether from the sun, supplements, or fortified foods, Vitamin D can affect more than a thousand different genes that govern virtually every tissue in the body. (Mead, 2008). Studies suggest that vitamin D may also lower your risk of developing chronic conditions, including diabetes, heart disease, and cancer. (John, 2004) (John, 2007).

The Bad: UV rays can cause serious, lasting damage to your skin..

Dry skin and premature aging are the least of your worries when it comes to overexposure to the sun. Cancer is the most serious risk associated with too much ultraviolet (UV) radiation, especially if you leave your skin unprotected.

There are three types of UV rays: UVA, UVB, and UVC.

UVA contains the energy our bodies need daily. These rays are less intense than UVB, but travel deeper into the skin and can still cause skin disease (Haywood, 2003).

UVB causes tanning, burning, and wrinkling of the skin. This is the type of radiation that sunscreen protects against, and even short-term exposure (as little as fifteen minutes) can cause sunburn and lasting damage to cellular DNA (Krutmann, 2012).

UVC is filtered out by the (thinning) ozone layer. High exposure will also cause sunburn and possibly cancer.

Your body’s natural defense against UV rays is melanin: the natural pigment in your skin that causes you to tan. Melanin increases with moderate exposure to the sun, absorbing UV radiation and dissipating its energy as heat to prevent cell damage. But it can only do so much.

The Bad: Too much sunlight can hurt your eyes and affect your vision.

As with skin damage, the effects of radiation on your eyes is cumulative. In the cells and tissues of the eye are molecules called chromophores, which absorb light from different wavelengths at different rates. Over time, too much UV light can result in damage your cornea, lens, and retina. It can also cause cataracts; photokeratitis, a painful condition arising from too much UV exposure; and pterygium, in which tissue grows over the cornea and impairs vision. (Glazer-Hockstein, 2006) (Neale, 2003) (Solomon, 2006

So just how much sun is good for you — and how much is dangerous?

That depends on a variety of factors, including where you live, the altitude, the weather and the time of day. Generally speaking, fifteen or twenty minutes a day of sunlight, without sunscreen, is good for you — especially in the morning or evening, when the angle of the sun is low in the middle latitudes.

But during peak hours when the sun’s rays are strongest, or whenever you’re facing prolonged exposure (like a trip to the beach) there are measures you can take to protect yourself.

  • Reach for a sunscreen lotion (not a spray) that’s at least SPF 30. Be sure to re-apply it every two hours, especially if you’re swimming or exercising.
  • Wear plastic, wrap-around sunglasses, which are the most effective at blocking UV rays from all angles.
  • If you wear contacts, look for brands that are designed to effectively absorb UVB rays.
  • Do not rely on cloud cover. Just because they block the sun, doesn’t mean they are blocking UV radiation.
  • Consider other physical barriers to shield you from direct sunlight, such as clothing, hats, and umbrellas.

Let common sense prevail…

There is no one-size-fits-all approach to sun exposure. Brief contact with the sun is all that’s needed to soak up the benefits; unfortunately, it’s also all that’s needed to inflict lasting damage. Using sunscreen doesn’t automatically imply protection from other damaging effects of UV radiation, including melanoma (Wolf, 1994). But in this case, an ounce of prevention is worth a pound of cure.

Don’t be a statistic. Heed our advice on protecting your eyes and skin, and you’ll have a safer, healthier, happier summer.

Wintertime Depression

concerned-young-manWhen the winter solstice occurs and the sun is above the Tropic of Capricorn, do you turn from Prince or Princess Charming into an ogre? It’s the time of year when people report feeling more depressed—overwhelmed by the impending holidays, bothered by dried out bank accounts, disconcerted by situations at work. Folks get irritated by things that don’t raise a hackle the rest of the year. They get testy, feel low or inferior, and lose energy, concentration and drive. This relationship among body, mind, and environment is called seasonal affective disorder (SAD). Blame it on the sun, or rather its scarcity, and the shortage of what the sun provides…vitamin D, the sunshine vitamin.

Are You Vitamin D Deficient?

Even in the sunniest places on the planet, people are deficient in vitamin D. You’d think that in Oman, at twenty-one degrees north of the equator, just within the tropical zone, the people’s vitamin D stores would be sufficient to prevent signs of deficit. In that part of the world it’s significant that women are covered, and for various reasons avoid sun exposure. This interrupts the complex relationship of sunlight, cholesterol and other factors that cause the body to manufacture vitamin D. (Alshishtawy. 2011) Likewise, in Bangkok, Thailand, whose latitude is even closer to the equator, vitamin D levels are surprisingly low. People living in Thailand’s municipal areas have lower circulating vitamin D than those in the rural areas. (Chailurkit. 2011) Might there be a connection between vitamin D levels and the seasonal blues?

It’s accepted that vitamin D deficiency is rampant, and that for a variety of reasons. People fear skin cancer, so they slather themselves with sun blocker or stay indoors or under cover. Some lack the physiological ability to manufacture vitamin D, perhaps with a cholesterol level insufficient to do the job. If brain development depends on ample vitamin D stores, then brain function seems to follow, especially in the realm of cognition and behavior as they relate to the presence or absence of pro-inflammatory molecules that are modulated by the vitamin. (McCann. 2008) Because seasonal affective disorder is often recurrent and predictable with the change of seasons, internal mechanisms related to circadian rhythms that are directed by vitamin D activity have been evaluated in aspects of SAD related to the major monoamine neurotransmitters, serotonin, norepinephrine, and dopamine. More than one vulnerability factor is suspected, including the environment and genetic susceptibility. (Levitan. 2007)

Vitamin D Deficiency Research

Studies at the University of Texas uncovered an association of high vitamin D levels to low scores on standardized measures of depression. Persons with a history of depressive symptoms were found to have lower levels of vitamin D. (Hoang. 2011) Also in 2011, Dutch scientists found similar relationships between vitamin D deficiency and depression, observing that a poor diet and lack of sun exposure were common elements. (Koater. 2011) The geriatric population is even harder hit with SAD. Their failure or inability to maintain healthy eating habits, and their often self-imposed seclusion prevent them from attaining optimal vitamin D levels through what may be considered normal daily activity by other groups. (Stalpers-Konijnenburg. 2011)

Reports abound that recommend the testing of vitamin D levels for individuals affected by depressive symptoms of any kind, including SAD. The research finds this to be a cost-effective and simple way to effect a therapy that would improve long-term health outcomes and quality of life. (Penckofer. 2010) (Humble. 2010) Additional study has tentatively linked vitamin D deficiency to autism and schizophrenia, the incidence of both hypothetically linked to developmental (prenatal) vitamin D deficiency. (Humble, Gustafsson, et al. 2010)

How To Increase Your Vitamin D Intake

Vitamin D is usually obtained from the skin through the action of ultraviolet-B radiation on a kind of cholesterol, called 7-dehydrocholesterol, after which time it gets metabolized to 25-hydroxyvitamin D (the stuff measured in a blood test). It gets further metabolized to the hormonal form, 1,25-hydroxyvitamin D. Although genetics may play a part in vitamin D blood levels, adequate calcium intake, exercise, and less obesity can help to support them. (Mason. 2011)

Almost everyone decries going to bed in the dark and then waking in the dark. Exposure to bright light in the morning can get you revved up for the day. The problem is that, when you awake in the dark, the eye sends a message to the pineal gland that it’s time to go to sleep, and melatonin is made. That resets the sleep-wake cycle. But this is supposed to happen at night. Light therapy is accepted as an effective treatment for the winter time blues. (Virk. 2009) (Pail. 2011) You can buy lamps that radiate the full spectrum of sunlight. Even your incandescent reading lamp can help. (Szadoczky. 1991) After a couple of weeks of daily use, linked with vitamin D supplementation, you’ll feel better than new.

References

Alshishtawy MM.
To be or not to be exposed to direct sunlight: vitamin d deficiency in oman.
Sultan Qaboos Univ Med J. 2011 May;11(2):196-200.Chailurkit LO, Aekplakorn W, Ongphiphadhanakul B.
Regional variation and determinants of vitamin D status in sunshine-abundant Thailand.
BMC Public Health. 2011 Nov 10;11(1):853.Hoang MT, Defina LF, Willis BL, Leonard DS, Weiner MF, Brown ES.
Association between low serum 25-hydroxyvitamin d and depression in a large sample of healthy adults: the cooper center longitudinal study.Mayo Clin Proc. 2011 Nov;86(11):1050-5.
Hoogendijk WJ, Lips P, Dik MG, Deeg DJ, Beekman AT, Penninx BW.
Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults.
Arch Gen Psychiatry. 2008 May;65(5):508-12.Humble MB, Gustafsson S, Bejerot S.
Low serum levels of 25-hydroxyvitamin D (25-OHD) among psychiatric out-patients in Sweden: relations with season, age, ethnic origin and psychiatric diagnosis.
J Steroid Biochem Mol Biol. 2010 Jul;121(1-2):467-70.
Humble MB.
Vitamin D, light and mental health.
J Photochem Photobiol B. 2010 Nov 3;101(2):142-9.Koster JB, Kühbauch BA.
Vitamin D deficiency and psychiatric patients.
Tijdschr Psychiatr. 2011;53(8):561-5.

Kuningas M, Mooijaart SP, Jolles J, Slagboom PE, Westendorp RG, van Heemst D.
VDR gene variants associate with cognitive function and depressive symptoms in old age.
Neurobiol Aging. 2009 Mar;30(3):466-73.

Lewy AJ, Lefler BJ, Emens JS, Bauer VK.
The circadian basis of winter depression.
Proc Natl Acad Sci U S A. 2006 May 9;103(19):7414-9.

Lewy AJ, Emens JS, Songer JB, Sims N, Laurie AL, Fiala SC, Buti AL.
Winter Depression: Integrating mood, circadian rhythms, and the sleep/wake and light/dark cycles into a bio-psycho-social-environmental model.
Sleep Med Clin. 2009 Jun 1;4(2):285-299.

Levitan RD.
The chronobiology and neurobiology of winter seasonal affective disorder.
Dialogues Clin Neurosci. 2007;9(3):315-24.

Mason RS, Sequeira VB, Gordon-Thomson C.
Vitamin D: the light side of sunshine.
Eur J Clin Nutr. 2011 Sep;65(9):986-93.

McCann JC, Ames BN.
Is there convincing biological or behavioral evidence linking vitamin D deficiency to brain dysfunction?
FASEB J. 2008 Apr;22(4):982-1001. Epub 2007 Dec 4.

Pail G, Huf W, Pjrek E, Winkler D, Willeit M, Praschak-Rieder N, Kasper S.
Bright-light therapy in the treatment of mood disorders.
Neuropsychobiology. 2011;64(3):152-62.

Penckofer S, Kouba J, Byrn M, Estwing Ferrans C.
Vitamin D and depression: where is all the sunshine?
Issues Ment Health Nurs. 2010 Jun;31(6):385-93.

Privitera MR, Moynihan J, Tang W, Khan A.
Light therapy for seasonal affective disorder in a clinical office setting.
J Psychiatr Pract. 2010 Nov;16(6):387-93.

Shipowick CD, Moore CB, Corbett C, Bindler R.
Vitamin D and depressive symptoms in women during the winter: a pilot study.
Appl Nurs Res. 2009 Aug;22(3):221-5.

Stalpers-Konijnenburg SC, Marijnissen RM, Gaasbeek AB, Oude Voshaar RC.
Can I have some sunshine to cheer me up? vitamin D deficiency and depression in the elderly.
Tijdschr Psychiatr. 2011;53(6):365-70.

Szádóczky E, Falus A, Németh A, Teszéri G, Moussong-Kovács E.
Effect of phototherapy on 3H-imipramine binding sites in patients with SAD, non-SAD and in healthy controls.
J Affect Disord. 1991 Aug;22(4):179-84.

Virk G, Reeves G, Rosenthal NE, Sher L, Postolache TT.
Short exposure to light treatment improves depression scores in patients with seasonal affective disorder: A brief report.
Int J Disabil Hum Dev. 2009 Jul;8(3):283-286.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.