Sleep and Aging

The quality of our sleep often deteriorates as we age. People tend to sleep less and are prone to more waking episodes after initially falling asleep. Sleep latency – the time it takes to fall asleep – may also increase. Some studies suggest that, beginning in middle age, the average person loses 27 minutes of sleep per night for each subsequent decade.

These decreases in sleep quality and duration are tied to the body’s internal timekeeping systems. The body cannot process circadian signals as efficiently, which in turn may cause older people to go to bed and wake up at earlier times.

Our sleep architecture also changes as we age and seniors are more susceptible to waking episodes during the night and also affects how refreshed and alert they feel in the morning.

Epidemiology

Insomnia is a highly prevalent sleep disorder, affecting upto 10% of young adults and increases to about 30% to 48% in those older than 65 yrs. The prevalence of insomnia is higher in older adults, which is likely due to age related reductions in sleep efficiency and the accrual of comorbidities that are associated with insomnia.

Comorbid psychiatric conditions increase the likelihood of developing chronic insomnia. Depression is perhaps the most common and strongly associated mental illness with insomnia. Anxiety is also a risk factor for developing insomnia.

A wide variety of medical problems are associated with insomnia. Epidemiologic evidence shows a greater prevalence of insomnia in hypertension, heart disease, arthritis, lung disease, gastrointestinal reflux, stroke and neurodegenerative disorders, to only name a few. Symptoms of medical illnesses that can disrupt sleep include pain, paresthesias, cough, dyspnea, reflux and nocturia.

Many medications can impair sleep or change sleep architecture. if stimulating medications (eg caffeine, sympathomimetics, bronchodilators, activating psychiatric medications)  are taken too near to bedtime, sleep can be disturbed. Furthermore, sedating medications can lead to daytime sleeping which often decreases the ability to sleep at night.

Late- life insomnia is often a long- lasting problem. One study showed that a third of older patients had persistent severe insomnia symptoms at 4- year follow up. Among women older than 85 yrs, more than 80% reported sleeping difficulties, with many using over-the-counter (OTC) sleeping medications. Lastly being a caregiver for others, which often occurs later in life, is a contributing factor to the development of insomnia.

Causes:

1. Predisposing factors: are a vulnerability to insomnia which may include anxiety, depression, or hyperarousal.
2. Precipitating factors: these are triggers for insomnia such as loss of a spouse, retirement, moving to a new home, or any other sort of stressor.
3. Perpetuating factors: these are maladaptive habits or beliefs that the patient has acquired to deal with the insomnia such as spending long periods in bed or taking naps.

Clinical presentation and evaluation:

Many patients do not talk to their doctors about their sleep complaints. The presence of insomnia may be revealed by eliciting self-medication with over- the- counter therapies or alternative sedatives. A careful sleep history and evaluation is conducted in order to assess whether there are comorbid sleep disorders such as Sleep disordered breathing (SDB), underlying the sleep disturbance  The presence of undiagnosed OSA is common in those with insomnia.

PSG and other sleep studies are obtained if a comorbid sleep condition is suspected. Sleep diaries with daily entries over 1 to 2 weeks, with caffeine, alcohol and medication use noted can be very helpful in determining the severity of insomnia as well as identifying possible perpetuating factors such as irregular bedtimes or late night caffeine.

 Sample Sleep diary

1. Bedtime
2. Time taken to fall asleep (after lights off)
3. Number of nighttime awakenings
4. wake up time
5. Time out of bed (morning)
6. Total sleep time (night only)
7. Total wake time (night only)
8. Nap time (if any)
9. Medication (time/dosage)
10. Caffeine/ Alcohol (time/dosage
11. how was your sleep last night
12. how tired were you in the morning

Management:

Behavioral and other non pharmacologic interventions: Behavioral treatment of insomnia is the recommended first line treatment for insomnia in all adults. Cognitive Behavioral therapy for Insomnia (CBT-I) usually combines sleep hygiene, stimulus control, sleep restriction and cognitive therapy.

Sleep hygiene is education on general practices to maintain a healthy sleep-wake routine.

Sleep hygiene rules for older adults: Check effect of medication on sleep and wakefulness; Avoid caffeine, alcohol and cigarettes after lunch; Limit liquids in the evening; Keep a regular bedtime- waketime schedule; Avoid naps or limit to 1 nap a day, no longer than 30 min; Spend time outdoors (without sunglasses), particularly in the late afterrnoon or early evening; Exercise- but limit exercise immediately before bedtime

Stimulus-control therapy is designed to break the negative associations patients have with their sleep environment.

Instructions for Stimulus-Control therapy for older adults:

• Patient should only go to bed when tired or sleepy
• If unable to fall asleep within 20 min, patient should get out of bed (and bedroom if possible). While out of bed, do something quiet and relaxing
• patient should only return to bed when sleepy
• if unable to fall asleep within 20 min, patient should again get out of bed
• behaviour is repeated until patient can fall asleep within a few minutes
• patient should get up at the same time each morning (even if only a few hours of sleep)
• naps should be avoided.

Sleep restriction therapy was developed from the observation that many patients with insomnia spend a large amount of time in bed unsuccessfully attempting to sleep. It is guided by the patient’s sleep diary.

Instructions for sleep restriction therapy for older adults

• calculate the average amount of time asleep per night reported by patient
• patient is only allowed to stay in bed for this amount of time plus 15 min.
• patient must get up at the same time each day
• daytime napping should be strictly avoided
• when sleep efficiency has reached 80%-85% patient can go to bed 15 min earlier.
• this procedure should be repeated until patient can sleep for 8 h (or period needed for a good night’s sleep)

There are several small studies that have found a beneficial effect of bright light, either from natural sunlight or light boxes on the sleep of older adults.

If these non-pharmacological interventions are not effective, then the doctor may consider sleep medications. Choosing appropriate insomnia medication for elderly patients requires a lot of care and consideration. Some medications, such as benzodiazepines (BZDs) and non-benzodiazepines (Z-drugs), produce hypnotic effects and can increase the risk of falling for older people. These drugs also carry a high tolerance, dependence, and withdrawal risk, and  patient’s other prescriptions are also taken into account in order to prevent negative drug interactions.

Other insomnia medications carry lower risks, but they should still be prescribed with caution. Some medications promote sleepiness by interacting with natural hormones in the body. These include  an agonist for receptors of melatonin, a hormone produced in the pineal gland that induces feelings of sleepiness after the sun goes down; and dual orexin receptor antagonist, which suppresses orexins, neuropeptides that causes feelings of arousal and wakefulness. Over-the-counter antihistamines may also be prescribed.

Dr Murassa Shamshad, Geriatric Specialist, Deptt of Health, J&K

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The Changing Landscape of Aging

The number of people in the world who are over the age of 65 is increasing rapidly. This is due to factors such as increasing life expectancy and declining birth rates. By 2050, nearly 2 billion people worldwide will be over the age of 60. This aging population has a significant impact on society, especially healthcare and quality of life.

Lifestyle Challenges Faced by the Elderly

Older adults face a number of lifestyle challenges, including physical health challenges, mental health challenges, social isolation, and financial security.

Physical health challenges: Older adults are more likely to have chronic conditions such as heart disease, diabetes, arthritis, and hypertension. They may also have reduced mobility, increased frailty, and a decline in sensory perception.

Mental health challenges: Conditions such as depression, anxiety, and cognitive decline are more prevalent in the elderly population. These conditions can lead to social isolation, loss of cognitive function, and reduced overall quality of life.

Social isolation: Many older adults experience social isolation, which can lead to loneliness and depression. This can exacerbate both physical and mental health issues.

Financial security: Many older adults rely on fixed incomes, such as pensions and retirement savings, which may not be sufficient to cover the rising costs of healthcare, housing, and daily living expenses.

The Role of Vaccination in Promoting Elderly Health

Vaccination is one of the most important things older adults can do to stay healthy. Vaccines can help protect older adults from serious diseases, such as influenza, pneumonia, shingles, and COVID-19.

Prevention of infectious diseases: Vaccines can help prevent infectious diseases that can be particularly severe in older adults. For example, the influenza vaccine can help prevent the flu, which can lead to serious respiratory complications in older individuals.

Boosting immune function: As people age, their immune systems may weaken. Vaccines can help boost the immune system and help older adults fight off infections.

Reducing disease burden: Vaccines can help reduce the burden of vaccine-preventable diseases on healthcare systems. This can lead to improved access to healthcare services for the elderly.

Enhancing quality of life: Vaccines can help older adults maintain their independence and remain active in their communities. This can combat social isolation and improve mental health.

Promoting community immunity:

When a significant portion of the population is vaccinated, the spread of infectious diseases is limited, protecting those who cannot be vaccinated due to medical reasons or age. This is particularly important for the elderly who may have compromised immune systems.

Vaccination Programs for the Elderly

Governments and healthcare organisations around the world have developed specific vaccination programs tailored to the needs of older adults. These programs often focus on several key vaccines:

Influenza vaccine: The seasonal influenza vaccine is highly recommended for older adults. The flu can lead to serious respiratory complications in older individuals, making vaccination crucial for preventing hospitalizations and deaths.

Pneumococcal vaccine: The pneumococcal vaccine is recommended for older adults to protect against pneumonia, bacteremia, and meningitis caused by the bacterium Streptococcus pneumoniae. Pneumococcal infections are a leading cause of morbidity and mortality in the elderly.

Shingles (Herpes Zoster) vaccine:

Shingles, caused by the reactivation of the varicella-zoster virus, can be excruciatingly painful and lead to long-lasting complications. A shingles vaccine is recommended for the elderly to reduce the risk of developing this condition.

COVID-19 Vaccination: The COVID-19 pandemic highlighted the importance of vaccination in older adults. The elderly were disproportionately affected by the virus, facing higher mortality rates. COVID-19 vaccines were rapidly developed and administered to older populations to protect them from severe illness and death.

Barriers to Elderly Vaccination

Despite the recognized benefits of vaccination, barriers exist that may limit vaccine uptake among the elderly. These barriers include:

Access to vaccination: Access to vaccination services can be a significant challenge for older adults, particularly those with limited mobility.

Vaccine hesitancy: Vaccine hesitancy, driven by misinformation and misconceptions, can affect individuals of all ages, including the elderly.

Healthcare disparities: Healthcare disparities, such as unequal access to healthcare services and information, can result in lower vaccine coverage among disadvantaged elderly populations.

Comorbidity and Fragility: Certain older adults may have multiple comorbidities and be more frail, making vaccination decisions complex. Healthcare providers must carefully assess the risk-benefit profile of vaccines for such individuals and tailor recommendations accordingly.

Dr Murassa Shamshad is a Geriatric Specialist, DHSK.

The post The Lifestyle of the Elderly and Vaccination appeared first on Greater Kashmir.

One challenge is making your home physically accessible and safe. This may mean installing ramps, widening doorways, or adding grab bars in the bathroom. Another challenge is staying socially connected. Seniors who live alone or have limited mobility may have fewer opportunities to socialize, which can lead to isolation.

There are a number of solutions that can help seniors age in place safely and comfortably. One solution is to make home modifications. This may include installing grab bars, ramps, or stairlifts. Another solution is to use ageing-in-place technologies, such as smart home devices that can monitor your home environment and provide assistance in case of an emergency.

Seniors can also stay socially connected by participating in community-based social programs, senior centers, or virtual communication groups.

If you are a senior who is considering ageing in place, it is important to talk to your doctor and other healthcare providers about your needs and how you can best prepare. There are also a number of resources available to help you age in place, such as government programs and non-profit organizations.

Here are some additional tips for ageing in place:

Make sure your home is well-lit and free of clutter.

Install non-slip flooring in your bathroom and other areas of your home where you may be at risk of falling.

Keep your medications organized and in a safe place.

Get regular exercise and checkups from your doctor.

Stay connected with your family and friends.

Ageing in place can be a rewarding experience for seniors.  By taking steps to prepare your home and yourself, you can make it possible to stay in your home and enjoy your independence for many years to come.

Dr Murassa Shamshad, Geriatric Specialist, DHSK

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The United Nations General Assembly adopted a resolution on December 14, 1990, and designated October 1 as the International Day of Older Persons.

The day is celebrated to spread awareness about the importance of senior citizens in our society and to appreciate their contributions. Senior citizens carry a lot of responsibility on their shoulders as leaders of the society.

They also carry the traditions, culture of the society and pass on the knowledge to the younger generation. However, older people are also highly vulnerable, with many falling into poverty, facing health issues or discrimination.

They also sometimes face abuse, which has a detrimental impact on them. The day is also marked to put focus on the world’s responsibilities towards older people to make their lives happier.

According to the United Nations, the population of persons aged 60 years and above will grow from 962 million to 1.4 billion, a growth of 46% globally, between 2017 and 2030. Currently, their population is 600 million, according to the World Health Organisation (WHO).

It is poised to double by 2025 and touch 2 billion by 2050. Their population will outnumber the youth as well as children under the age of 10.

The growth in the population of the elderly will be most rapid in the developing economies. Population ageing will be the most significant social transformation of the 21st century, according to the UN.

Due to advancement in medicines and other technologies, the life expectancy has risen sharply over the last few years. Improvement in education, economics, sanitation, medical science, and health care has also contributed immensely to the increase in life expectancy.

Elderly in India

According to Census 2011, India has 104 million older people (60+years), constituting 8.6% of total population. Amongst the elderly (60+), females outnumber males.

Increase in longevity and decline of joint family and breakdown in social fabric pushes seniors into loneliness and neglect. A heathy life, with physical activity, good diet, avoiding tobacco, alcohol recommended. Positive attitude and mental wellbeing promotes quality of life in advancing years.

The Government of India runs various schemes and provides preventive, rehabilitative services to the people who are above the age of 60. Government of India’s National Policy on Older Persons 1999, Maintenance and Welfare of Parents and Senior Citizens Act, 2007 and National Policy for Senior Citizens 2011, provide the legal framework for supporting the needs of seniors. The National Programme for Health Care of Elderly and Health and Wellness Centres under the Ayushman Bharat programme provide dedicated healthcare to elderly at primary health care settings.

Geriatric care in Kashmir:

In light of the above, J&K administration introduced several landmark initiatives. Hon’ble LG Manoj Sinha virtually inaugurated the 10-bedded Geriatric Ward for each district hospital. Director Health Services Kashmir, Dr Mushtaq Ahmad Rather constituted a team of Geriatric specialists to promote the healthcare of the elderly. As a part of the initiative, Geriatric OPDs are functional at all the District Hospitals, geriatric health camps and home visits of the bed-bound elderly population have been carried out at far flung areas.

Dr Murassa Shamshad, Geriatric Specialist, DHSK

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

The post To make their lives happier appeared first on Greater Kashmir.

The aim of the month is to raise awareness about the disease dementia, its common symptoms and risk factors attached to it and challenge the stigma that surrounds Alzheimer’s and dementia, and it has been running since 2012, with September 21st celebrated annually as World Alzheimer’s Day. In many countries, World Alzheimer’s Day is observed throughout the month.

The theme for this year’s World Alzheimer’s Month is ‘Know Dementia, Know Alzheimer’s,’ which continues from the 2021 campaign, that focused on diagnosis, the warning signs of dementia, and the continued effect of Covid-19 on the global dementia community, and more.

In 2022, the campaign specialises in post-diagnosis support, following on from recent developments and potential breakthroughs in dementia treatment and support.

On World Alzheimer’s Day, health organisations across the globe focus their efforts on raising awareness about this disease. Alzheimer’s disease is a brain disorder that slowly depletes memory and thinking skills and, eventually, the ability to carry out the simplest tasks.

In most people with the disease — those with the late-onset type symptoms first appear in their mid-60s. It is a degenerative brain condition that affects over 50 million people internationally and is a form of the disease dementia. Early-onset Alzheimer’s occurs between a person’s 30s and mid-60s and is very rare.

Alzheimer’s disease is the most common cause of dementia among older adults, occurring in 50-60 per cent of all dementia cases. German psychiatrist Alois Alzheimer identified the first case of what would later become known as Alzheimer’s disease.

The patient was a 50-year-old German woman. Alzheimer’s is a progressive brain disorder. It slowly destroys memory and thinking skills. Eventually, when someone has Alzheimer’s, they lose the ability to carry out simple tasks.

An estimated 44 million people in the world have Alzheimer’s disease. Of all the places in the world, Alzheimer’s disease is most common in Western Europe. North America is close behind. In the United States, 5.5 million people have the disease. Every 66 seconds, someone in the U.S. receives an Alzheimer’s diagnosis.

As the population ages, a higher percentage will be affected by Alzheimer’s. For example, beyond the age of 65, the prevalence of Alzheimer’s doubles every five years. It’s predicted that by the year 2050, 16 million people in the U.S. will have Alzheimer’s.

Alzheimer’s is the 6th leading cause of death in the country. Around the world, it’s the 7th deadliest. Additionally, the condition causes more disability and poor health than any other disease.

Not only does the person with Alzheimer’s suffer, but their caregivers and family members have a difficult time as well. Caregivers often experience emotional and financial difficulties.

Their physical health also declines. The global cost of Alzheimer’s disease is over $6 billion. By 2050, the disease is expected to cost over $1 trillion in the United States alone.

DHSK takes World Alzheimer’s Month as an opportunity for sufferers, carers, professionals, press and media and communities to work together against dementia as well as raise awareness of the realities of it while combating stigma and misinformation and lobbying the government for better help and care.

Dr Murassa is a Geriatric Specialist, DHSK

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK .

The post World Alzheimer’s Month September 2022 appeared first on Greater Kashmir.