By Jack Huber

A recent study found that the risk of dementia was higher and associated with adults in their 50s and 60s with a sleep duration of less than six hours. This emphasizes the importance for older adults to not only be screened for sleep disorders, but also to maintain and improve their sleep quality.

Between 40 percent and 70 percent of older adults have chronic sleep issues, but up to half go undiagnosed. Sleep disordered breathing, a potentially serious sleep disorder in which breathing repeatedly stops and starts, affects 22 million Americans; and 80 percent of the cases of moderate and severe obstructive sleep apnea, the repeated collapse or partial collapse of the upper airway, go undiagnosed.

Airway stents may be the answer for healthcare providers seeking to not only help optimize sleep for older patients, but also shift away from treating sleep issues with sedatives due to their addictive nature and side-effects, such as impaired memory and focus. 

Aging increases body fat and reduces total body water and plasma proteins, resulting in increased drug elimination half-life and the potential risk of adverse effects. For this reason, older adults should be treated first with non-pharmacological options before using pharmacological options.

Non-pharmacological approaches include relaxation techniques, improving sleep hygiene and cognitive behavioral therapy. These options can be effective even for older adults with cognitive impairment. For proper sleep hygiene, individuals should avoid daytime naps, maintain a regular sleep schedule, limit substances such as caffeinated beverages, nicotine and alcohol, and exercise at least six hours before bedtime.

Common among older people, sleep disorder breathing (SDB) can lead to cognitive impairment, mood changes, compromised quality of life (often attributed to reduced social functioning and vitality), higher risk of stroke and comorbidities, with up to 50 percent of patients with mild symptomatic chronic heart failure having SDB.

One study found that older adults with untreated severe SDB had increased all-cause mortality. Additional outcomes of particular interest in older people may include glaucoma, falls with fractures, impaired quality of life, decreased pain tolerance, frailty, and mortality.

Untreated obstructive sleep apnea (OSA) can lead to high blood pressure, congestive heart failure, atrial fibrillation, stroke, and other cardiovascular problems. This disorder is also associated with Type 2 diabetes and depression, and is a factor in a large number of traffic accidents due to persistent drowsiness.

Treatments

Treatments for breathing issues include weight loss, smoking cessation and increased cardiovascular exercise, enhanced sleep opportunity and environment, optimized medical management of comorbidities, and reduction in caffeine, alcohol and sedatives.

Continuous positive airway pressure (CPAP) therapy is a common treatment for OSA. CPAP pushes air into the airways to keep them open with a pump that controls airflow, a tube carrying air from the machine to the user, and a mask that goes over the mouth, nose or both. Typical problems with CPAP, however, include discomfort, leaky mask, trouble falling asleep, stuffy nose, and a dry mouth. Other treatments include oral appliances, surgery and sleep aid devices.

The most effective sleep-aid devices support natural nasal breathing, which is essential for optimal health because they filter, warm and humidify inhaled air. This protects the lungs, leads to better oxygen supply to the body, stimulates the calming nervous system, and reduces snoring and SDB. All of these factors contribute to a stronger immune system and improve quality of life.

Among the most promising sleep-aid devices, innovative stent-based therapies not only support healthy, natural nasal breathing, but also enhance physical performance, mitigate symptoms of chronic sinusitis and other quality-of-life conditions such as allergies, rhinitis, chronic rhinitis, sinusitis, allergic rhinitis, and many autoimmune diseases.

Stents can be worn comfortably for up to 18 hours at a time for optimal breathing, transform unhealthy sleep patterns, improve nasal breathing to increase oxygen supply, and result in more relaxing sleep.

Healthcare providers should look for airway stents that have been clinically tested for treatment of patients struggling with OSA and snoring and designed to support healthy, natural nasal breathing at night and during the day.

Jack Huber is president of Alaxo Airway Stents.

By Brandy Minks

Exercise for many people is a challenge because of limited mobility. Excess weight can be restraining and joint issues, decreased muscle mass and low endurance can be limiting factors to exercise. Reliance on a cane, walker or wheelchair may also restrict the number or types of activities you can perform.

The goal of exercise is ideally to improve “functional fitness,” or training for the daily activities of life. However, even if you struggle with mobility, there are ways to incorporate functional fitness training into your life.

Focus on these three areas to improve functional fitness:

  • Aerobic capacity refers to how much endurance you have when it comes to activities such as walking, climbing stairs, washing yourself, getting dressed, etc. These activities can increase your heart rate and breathing. When we lack aerobic capacity, daily activities seem harder and make us tire easily. By building up aerobic capacity through regular exercise, activities become easier and we have better quality of life.
  • Muscular strength refers to the strength of your muscles and whether your endurance is adequate enough to complete daily activities without problems. For example, think about whether it is difficult for you to brush your hair or push yourself up from a chair. If these activities are hard for you (or you require assistance), increasing your muscular strength and endurance will help you do these activities with ease.
  • Range of motion/flexibility refers to the ability to move our bodies in ways that allow us to do activities with minimal pain. Ask yourself: Can I reach behind my head to brush my hair? Can I stretch to tie my shoes or put on socks? Having good flexibility allows us to do daily activities effortlessly.

To increase aerobic capacity, start with simple seated exercises. You can do these on your own or in a class. Any movement that causes your heart rate and breathing to increase will work. Take breaks as you need them. Start off slowly and increase the time you exercise by a minute or two every day.

To increase muscular endurance and flexibility, practice the following exercises while seated in a chair 5–10 times. These exercises mimic activities we do every day:

  • Reach for it. Bend slightly forward at your hips and hold your arms straight out in front of you.
  • Pick it up. Pull a backpack or bag from the floor onto your lap. Then pull it up higher and hold it to your chest. You can add items to the bag to make this harder.
  • Push it. Push yourself up from your chair using your arms and legs and sit back down. Make your legs do most of the work.
  • Pull it. Reach your arms straight out in front of you. Pull your elbows back and pinch your shoulder blades together. You can do this with weights to make it harder.
  • Carry it. Carry your bag or backpack from one spot to another.

Brandy Minks, who has masters degrees in nutrition and exercise physiology, works for MultiCare Health System’s Center for Weight Loss and Wellness.

Falls are a leading cause of injury in older adults and carry the risk of permanent disability, high medical costs, and premature death. For people with cardiovascular disease, the risk of falling is even higher, with 60 percent at moderate or high risk for falls. Medications, increased frailty, abnormal heart rhythmslow blood pressure, and fainting are some of the reasons for a fall. 

Even when falls don’t cause significant injury, they can result in increased fear of falling and functional decline in seniors, leading to a diminished quality of life. But despite the frequency of falls among people with cardiovascular disease, the topic is often overshadowed by other medical issues. Many older adults may also be hesitant to mention falls to healthcare professionals or others in their life, thinking they will lose independence in their day-to-day activities and be treated differently. 

Certain medications for cardiovascular conditions, such as high blood pressure, can contribute to falls. The same is true for prescription drugs for non-heart-related conditions. Medications that can increase increase risk of falls include:

  • Arrhythmia medications.
  • Antidepressants.
  • Antipsychotics.
  • Anti-anxiety medications (benzodiazepines) such as lorazepam and nonbenzodiazepine, and sedative hypnotics such as zolpidem.
  • Diabetes medications and diuretics.
  • High blood pressure medicine, including beta-blockers, ACE inhibitors, and angiotensin receptor blockers (ARBs).
  • Opioids.
  • Non-steroidal anti-inflammatory drugs.
  • Selective serotonin reuptake inhibitors.

It’s important to discuss the side-effects of all medications with a healthcare professional and weigh any increased risks of falling. It’s often possible to choose medications with fewer side-effects or that can be taken in lower doses. In some cases, alternative, non-pharmacological options may be available and should also be discussed with your doctor or pharmacist. 

Here’s a rundown of cardiovascular conditions that can lead to falling:

Fainting (syncope).

A person with decreased blood flow to the brain can lose consciousness and fall. The risk increases with age. In addition, people with cardiovascular conditions are more likely to suffer from low blood pressure and experience dizziness and faint.
Heart failure and arrhythmia.

A person’s heart may not pump as efficiently or may beat in an irregular rhythm, causing a decrease in blood flow to the brain. They are also more likely to take multiple prescriptions, which may increase dizziness. People with heart failure are more likely to fall than those with other chronic diseases.and suffer a fracture that requires hospitalization. 
Atrial fibrillation.

Patients with this irregular, rapid heartbeat also face a higher fall risk.
Other non-cardiovascular conditions–arthritis, neurological problems, deafness, blindness, and cognitive impairment such as dementia–can affect mobility and balance, and in turn increase the likelihood of falling. The risk can be reduced by:

  • Addressing hazards at home such as loose rugs, mats, clutter and stairs, and ensuing adequate lighting and ambient temperature.
  • Wearing comfortable footwear.
  • Incorporating physical and occupational therapy into wellness plans.
  • Review medications.

Source: American Heart Association.

Stay active and exercise inside when it’s cold outside

By Meredith Bailey

When the temperature drops, the lure of “hibernation,” snuggling under a blanket and reading a book or watching a favorite TV show is hard to resist. We all need a little rest and relaxation to recharge, yet too much time spent with our feet up isn’t good for the body or the mind — even when it’s cold outside.

“Your health doesn’t take a vacation during the winter months,” said Jenn Ropp, diabetes education and nutrition program coordinator at MultiCare Health System. “Staying active can help you maintain a healthy weight, keep your blood sugar levels within a normal range, and support your mental health and well-being.”

Regular exercise can also help protect your body from injury.

“During the winter months, we see a lot of slips and falls due to icy conditions,” said Allison Blumenthal, a sports orthopedic surgeon at MultiCare Integrated Sports Medicine. “The more you’re able to maintain your core strength, the less likely you are to fall and the less extensive your injuries are likely to be if you do fall.”

While the benefits of maintaining fitness year-round are many, staying active when the chill sets in can be a challenge. Pacific Northwest winters aren’t always amenable to many outdoor activities. Here are tips to keep yourself motivated and your body active.

Come up with a plan. 

Without some forethought, exercise can slip down or completely fall off your to-do list.

“Don’t just say ‘I’m going to work out some time today.’ Decide on a specific time that you’re going to exercise, what you’re going to do and what you need — clothing or equipment, for example,” said Annie Doyle, senior health and well-being director at YMCA of Pierce and Kitsap Counties. “You’re more likely to exercise consistently if you’re prepared and it’s built into your schedule.”

Make it fun. 

Exercise shouldn’t be drudgery. Try new activities until you find ones you like, and switch them up so you don’t get bored.

“You’re more likely to stick to something if you enjoy it and actually look forward to doing it,” said Blumenthal. “Maybe that’s doing Pilates in your living room or simply cranking up the music and dancing — whatever type of movement brings you joy.”

Set goals. 

Fitness goals can help us stay motivated, but not just any goal will do. “Setting short-term, achievable goals that you can measure can be really useful for keeping yourself on track for meeting a more long-term goal,” Blumenthal said. “For example, maybe today your goal is to exercise for five more minutes or do one more bicep curl than you did the day before.”

It helps to have a friend or family member hold you accountable to your workout plan. “This could be someone you’re actually exercising with or just someone that you check in with a couple of times a week about what you accomplished and how a particular activity is going,” said Doyle.

Go virtual. With a little online sleuthing, you can find exercise apps and virtual classes for all ages, skill levels and interests. YMCA 360, for example, “allows you to stream thousands of fitness classes as well as classes on other topics like cooking and meditation,” said Doyle. “We have something for everybody, from very young children to older adults, as well as families. This program is a way to bring our instructors into the comfort of your own home and keep your workout exciting and fresh.”

Transform everyday activities into exercise opportunities. 

You don’t need fancy equipment or a gym membership to remain active when you’re inside. “Exercise can be incorporated into almost anything you do around the house,” said Blumenthal. “For example, do lunges down the hallway instead of walking, or do situps and pushups during commercial breaks when you watch TV. If your job involves sitting at a desk, set a timer for every 30 to 60 minutes to get up and move around.”

Use your spring and summertime interests as inspiration. 

From hiking to softball, many of us have outdoor activities that we love to do when the weather turns warm. Instead of biding your time until the seasons change, work on maintaining or even improving your level of fitness for those activities now.

“Let’s say you’re a gardener. What kinds of exercises could you do in your home to better prepare your body for bending up and down, or some of the other movements associated with yard work?” Ropp said.

Get a step counter (pedometer). 

Step counters use sensors to track your steps. “If there’s a day where you have haven’t been quite as active, then you can take some extra loops around the house to compensate,” Ropp said.

According to a 2021 study in the Journal of the American Medical Association, people who take at least 7,000 steps a day had a 50 to 70 percent lower risk of mortality than those who took fewer steps.

Listen to your body. 

When you are trying a new activity, ease into it and let your body be your guide.

“Exercising can be uncomfortable sometimes and normal soreness is reasonable, but if something you’re doing is causing pain in a specific area, you should stop and possibly seek medical care if it persists,” Blumenthal advised.

One of the goals of exercise is to get your heart pumping, but don’t overdo it. “If someone asked you how you were doing and you couldn’t respond, then your heart rate is too high,” Doyle said. “It’s time to slow down or take a break.”

Source: MultiCare Health System.