Showing posts with label elderly. Show all posts
Showing posts with label elderly. Show all posts

Wednesday, September 10, 2014

Aging brain affected by environmental exposures

The population of Americans aged 65 and older is expected to double between 2010 and 2050,1 and by mid-century the proportion of the human population made up of people over age 80 is projected to have quadrupled since 2000.
Seniors may be affected by poor IAQ and chemical
exposures earlier in life, researchers say.

So factors that affect this aging population are of increasing importance. Of particular concern are the neurological diseases and disorders typically associated with advanced age, among them Alzheimer’s and Parkinson’s diseases, dementia, and reduced cognitive function.

Investigators are studying the effects of not just present-day exposures and environmental influences such as physical and mental exercise, but also exposures that occurred much earlier in life, whose effects may only become apparent in old age.

It was long assumed that “once the brain received its allotted quota of nerve cells, its destiny was frozen. After that, the passage of time eroded our allotment steadily and irrevocably,” as professor emeritus Bernard Weiss of the University of Rochester School of Medicine and Dentistry wrote in 2007.3

Now, however, there is increasing evidence that the brain is capable of generating new neurons and other functional brain cells even during advanced age. There is also evidence that the older brain can respond quickly and positively to external influences such as physical exercise and intellectual stimulation.

This is prompting considerable interest in developing strategies for protecting and enhancing neurological function in the elderly.

The two most vulnerable periods for the brain, Weiss says, are early in life, when the organ is first developing, and later in life, when the body’s defenses and compensatory mechanisms begin to falter.

There is a large and growing body of evidence indicating these two vulnerable life stages can be linked when damage incurred during early development contributes to health disorders that may not become apparent until later in life.

Weiss also notes that declining defense mechanisms may magnify vulnerability to contemporary environmental exposures.

He says that when older adults experience cognitive problems, diagnoses rarely consider the possibility that environmental chemical exposure may be involved, simply because questions about such exposures are typically not asked as part of clinical intake.

Over the past 30 years, Weiss says, research attention has focused primarily on environmental influences on early developmental stages. Far less extensively researched, but a subject of increasing interest, are environmental chemical exposures that can affect the health of the aging brain.

Neurotoxic agents

In the past 10 years, however, a number of studies have looked at the effects of chronic low-level lead exposure on adult humans’ cognitive abilities. The findings of such studies suggest that lead that has accumulated in bones can be mobilized over time as part of the aging process, resulting in exposures that adversely affect adults’ cognitive skills later in life.

Other metals may adversely affect neurological function in later life by either acting directly on the brain or adversely impacting other organs or hormones that maintain healthy neurological function.

For example, cadmium can cause kidney disease, which is associated with cognitive problems. Like lead, cadmium is stored in the body, primarily in the kidneys and liver but also in joints and other tissues, where it has a biological half-time of decades.

Similarly, lead and mercury have been associated with liver disease, which itself is associated with adverse neurological health effects, including a condition that produces a type of neuronal plaque associated with Alzheimer’s disease.

Chemical exposures that adversely affect kidney and liver function can also hamper the body’s ability to detoxify and excrete environmental toxicants, thus letting them remain in the body—an effect that may be particularly problematic in advanced age when a body’s defense mechanisms are in decline.

There is evidence connecting certain metals (e.g., lead, manganese), pesticides (e.g., paraquat, maneb), and solvents (e.g., toluene, trichloroethylene) with neurological 
symptoms characteristic of Parkinson’s disease. Many of the exposures studied have been occupational, and some were acute, rather than lower-level and chronic. Much more extensive research is needed to determine the precise role environmental exposures to these agents may play in prompting Parkinson’s disease.

More substantial evidence links various solvent exposures to other neurological conditions, including cognitive impairments, neuropathy, and what is sometimes called “pseudodementia,” when temporary neurological dysfunction produces symptoms similar to those of dementia.

Organic solvents, including toluene, have also been found to impair color vision, while other solvent exposures have been linked to hearing loss, particularly when combined with noise exposure.

Such exposures have been primarily studied when they occur occupationally, but some epidemiological studies suggest there is also potential for adverse effects from ambient environmental exposures.

Solvent and pesticide exposures have
been linked to neurological disorders.
These solvent and pesticide exposures can, of course, occur at any age. But because the neurological disorders with which they are linked mirror those associated with motor and sensory-function declines of aging, they can be mistaken in diagnosis for the effects of aging or diseases of old age like Parkinson’s and Alzheimer’s diseases.

It also appears that long-term non-acute exposures to solvents and pesticides can affect verbal memory, attention, and spatial skills, with effects that may not become apparent until later in life, when they, too, might be confused with or compounded by aging-related conditions.

More subtle environmental exposures are also thought to be implicated in neurological health effects that can manifest later in life. These include exposures to chemicals that may disrupt the normal function of hormones involved in regulating neurological health, chief among them thyroid hormones.

Hormones are intimately involved with neurological function; a normal brain can’t develop without healthy thyroid hormone function, and the fetal brain is extremely receptive to thyroid hormone.

When environmental factors affect thyroid and other hormones, the result can be health effects associated with conditions that impair neurological function.

For example, there is evidence that exposure to persistent organic pollutants including dioxins and certain polychlorinated biphenyls, halogenated flame retardants, and pesticides can produce hormonally mediated effects that promote obesity and diabetes, which increase risk for vascular health problems.

There is also evidence that exposures to some of these same compounds may directly increase risk for hypertension and cardiovascular disease.

These cardiovascular conditions can, in turn, cause less dramatic neurovascular effects that sometimes result in memory loss, or what’s called “vascular dementia,” when reduced blood flow to the brain deprives brain cells of oxygen and causes the equivalent of small strokes.

Evidence of similar effects has been reported for exposure to chemicals that are pervasive due to widespread use but are not environmentally persistent.

Among these is bisphenol A (BPA).

Laura Vandenberg, an assistant professor of environmental health studies at the University of Massachusetts Amherst, explains that numerous animal studies indicate early-life exposure to BPA can produce health effects characteristic of metabolic syndrome.

Individuals with metabolic syndrome are at increased risk for hypertension, with its risk for adverse neurological effects. It is also often hard to exercise for those who are overweight or obese or who have cardiovascular disease or diabetes. Yet aerobic exercise in later life appears to be an essential component of maintaining, if not also enhancing, brain function in older age.

Protective Factors

There is now substantial research investigating how physical activity and exercise affect brain function. This is also the area of research where it is perhaps the easiest to make direct comparisons between animal experiments and human studies.

One focus is to understand the mechanisms by which exercise protects and restores the brain.

Of particular interest is learning how physical exercise increases the production of new neurons, and how that may enhance performance of certain memory functions. Functions of interest include what’s called “relational binding”—for example, remembering the name of a person you recently met and where you met that person.

Physical exercise also appears to enhance “visual pattern separation,” which enables you to distinguish and remember different patterns—a process that increases memory accuracy.

Concerned about chemical exposure at work or at home? Electrocorp has designed industrial-strength air cleaners with activated carbon and HEPA filters that can help remove dangerous airborne pollutants, including chemicals, VOCs, solvent fumes, vapors, odors, bacteria, viruses, mold, particles and many more. Contact Electrocorp for more information and a free consultation.

Friday, February 28, 2014

Nursing homes benefit from telemedicine

Telemedicine can reduce hospitalizations

Telemedicine used at nursing homes during hours when doctors are not typically present is a viable way to reduce avoidable hospitalizations, according to research published in February's issue of Health Affairs.

Commitment to telemedicine can save
a lot of money at nursing homes.
Hospitalizations of nursing home residents are occurring more frequently, and result in complications, morbidity and expensive Medicare costs.

When a medical issue arises on nights and weekends that cannot be addressed by the on-call physician not present at the facility, the doctor can either travel to the nursing home or recommend that the resident be sent to the hospital emergency room.

Very often, the physician recommends the hospital emergency room.

Researchers David C. Grabowski of Harvard Medical School and A. James O'Malley of The Dartmouth Institute for Health Policy & Clinical Practice at the Geisel School of Medicine designed a study to determine whether nursing home residents who receive off-hour physician coverage by telemedicine experience a lower rate of hospitalizations, thereby generating savings to Medicare in excess of the costs of the telemedicine program.

They studied a Massachusetts for-profit nursing home chain, which had signed a contract with a telemedicine provider to introduce service in 11 nursing homes to cover urgent or emergent calls on weeknights and weekends.

The telemedicine service consisted of two-way video conferencing with a high-resolution camera, allowing nursing home residents to be examined remotely by a physician. For the period of October 2009 through September 2011, the nursing home chain staggered its telemedicine introduction. Six of the 11 nursing homes in the chain were randomized to initiate the telemedicine service while the five remaining nursing homes served as the control group.

The researchers found that four of the six treatment facilities were responsible for most of the telemedicine calls. Across all calls, the rate of hospitalizations declined 5.3 percent for the control group and 9.7 percent for the treatment group. This effect was largely concentrated in the four "more engaged" nursing homes, whose rate of hospitalization declined 11.3 percent.

"We did not observe a statistically significant effect of the telemedicine intervention on hospitalizations," the researchers wrote.

However, when they compared the four more-engaged nursing homes with the two less-engaged ones, they found a significant decline in the hospitalization rate at the more engaged facilities. A secondary finding of the analysis is that the hospitalization rate for non-engaged intervention facilities was very close to that of the control facilities.

"According to these estimates, a nursing home that typically had 180 hospitalizations per year and that was more engaged with telemedicine could expect to see a statistically significant reduction of about 15.1 hospitalizations per year" than a facility that was less engaged, the researchers said. The average Medicare savings would be roughly $150,000 per nursing home per year.

The annual cost of the telemedicine service in this study was $30,000 per nursing home, implying a net savings of roughly $120,000 per nursing home per year in the more engaged facilities, the researchers said.

The researchers say engagement is the key to the use of telemedicine preventing hospitalizations. Simply making it available does not guarantee its use by nursing home staff. Telemedicine providers and nursing home leaders will have to take additional steps to encourage buy-in among nursing home administrators, front-line staff members, and physicians.

Additional research will be needed to test models that encourage stronger engagement on the part of providers, as well as examine the implications of new policies that incentivize increased adoption, they said.

Source: The Dartmouth Institute for Health Policy & Clinical Practice 

Seniors are often affected by poor indoor air quality, which includes toxic chemicals, odors, allergens, asthmagens, bacteria, viruses, mold and other contaminants. Electrocorp offers industrial-strength air cleaners with the right air filters to remove these types of indoor air pollutants. Contact Electrocorp for more information and a free consultation.

Monday, September 23, 2013

Home health care workers get recognition

OT, minimum wage extended to health care workers

New rules for home health care workers
may limit access for some families.
The Obama administration approved rules that extend minimum wage and overtime pay to nearly 2 million home health care workers who help the elderly and disabled with everyday tasks such as bathing, eating or taking medicine, according to an AP report.

Home care aides have been exempt from federal wage laws since 1974, when they were placed in the same category as neighborhood baby sitters. But their ranks have surged with the aging population and the field is now one of the fastest-growing professions.

Labor unions and worker advocacy groups have been seeking the change for years, arguing that nearly half of caregivers live at or below the poverty level or receive public benefits such as food stamps and Medicaid.

But some health care companies claim new overtime requirements will make it tougher for families to afford home care for their aging parents. Lobbyists for the $84 billion industry argue the new requirements could reduce the quality of care and even lower the take-home pay of caregivers if companies decide not to send workers out for shifts longer than eight hours.

The new rules will take effect in January 2015, which will give time for states and industry providers to adjust to the new requirements. New wage and hour rules typically take effect within 60 days after final approval. The rules cover home health aides, personal care aides and certified nursing assistants that provide care to the elderly and people with injuries, illnesses and disabilities.

President Barack Obama first proposed the rules nearly two years ago as part of broader effort to boost the economy and help low-income workers struggling to make ends meet. More than 90 percent of home care aides are women. About 30 percent are black, and 12 percent are Hispanic.

Experts estimated that by 2020, the country would need about 4 million home care aides to meet the needs of its graying population. The number of Americans over 65 is expected to nearly double over the next 20 years.

Fifteen states already extend state minimum wage and overtime protections to home care workers, and another six states and Washington, D.C., mandate state minimum wage protections.

The current median pay for home care workers is about $9.70 per hour, higher than the federal minimum wage of $7.25 an hour, according to Labor Department figures. But overtime pay could help lift wages substantially for those who work more than 40 hours a week.

The new rules will continue to exempt from minimum wage and overtime requirements those workers who mainly visit the elderly to provide company or engage in hobbies and are employed directly by the person or family receiving services.

Source: ABC News

Adjust IAQ in home care situations


Illness and disease can lead to bad odors and poor indoor air quality. Opening windows regularly helps but is not always feasible.

For better indoor air quality and healthier air, home health care aides can use portable and reliable indoor air cleaners with the right types of filters.

The air cleaners need activated carbon, HEPA and UV germicidal filtration to remove airborne contaminants such as bacteria, viruses, odors, chemicals, particles and mold.

Electrocorp has designed a variety of indoor air cleaners for the healthcare system. Contact Electrocorp for more information.