Why Does Alzheimer’s Disease Affect More Women Than Men?

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Women are disproportionately affected by Alzheimer’s disease (AD). Nearly two-thirds of the more than 5 million Americans living with Alzheimer’s are women and two-thirds of the more than 15 million Americans providing care and support for someone with Alzheimer’s disease are women. This devastating disease places an unbalanced burden on women at work and at home, forcing them to make difficult choices about their careers, their relationships and  their futures.

As real a concern as breast cancer is to women’s health, women in their 60s are about twice as likely to develop AD over the rest of their lives as they are to develop breast cancer.

So why does this disease seem to affect more women than men? At first glance, the answer may be that women generally live longer than men, making them more likely to reach the ages of greater risk. However, there is emerging evidence that suggests there may be unique biological reasons for these differences beyond longevity alone. These biological underpinnings may contribute to the underlying brain changes, progression and symptom manifestation in Alzheimer’s disease.

There is evidence that biological sex differences may affect mortality in men differently than women, but how that affects Alzheimer’s disease and related dementia incidence is not clear. Do hormones play a role? What about our genes? Do lifestyle components such as sleep patterns, stress and depression influence sex differences in Alzheimer’s disease?

To tackle many of these questions head on, the Alzheimer’s Association convened top experts in the field of biological sex and Alzheimer’s disease to explore these issues in depth. The “Gender Vulnerability Related to Alzheimer’s Disease” think tank identified gaps in our knowledge and next steps in research needed to advance our understanding. During the think tank, three main topics were discussed: underlying biological mechanisms, the role of hormonal factors and the impact of lifestyle factors.

As a direct result of this think tank, the Alzheimer’s Association announced the new Sex and Gender in Alzheimer’s (SAGA) grant funding program, aimed at supporting scientific investigation that addresses the gaps in our understanding of the role biological sex and related genetic, biological, lifestyle and societal factors may play in increasing vulnerability for Alzheimer’s. Additionally, projects funded through SAGA will help meet a need to incorporate learnings from the developing biology fields to merge the expanding field of sex biology research with Alzheimer’s pathophysiological studies.mariacarrillo

As with all of our grants, applications for SAGA funding will undergo the Alzheimer’s Association’s rigorous peer-review process. I look forward to sharing more about these grants when they are awarded later this year.

 

About the Author: Maria Carrillo, Ph.D., is Chief Science Officer, Medical and Scientific Relations, at the Alzheimer’s Association.

SAGA was made possible from the generous support of the Women’s Alzheimer’s Research Initiative (WARI), a campaign that supports research grants specific to sex-biology and gender issues in Alzheimer’s and other dementias. To date, the Alzheimer’s Association has raised $1.6 million for the initiative, including a generous $1 million in support from the Sigma Kappa Foundation.

 

Source: Blog.alz.org, Feb 11, 2016

How Much Do You Know About Heart Health?

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The American Heart Association recently reported that the death rate from cardiovascular disease has fallen more than 30 percent over the last decade, due to better treatment for heart attack, congestive heart failure and other heart disease. But this care comes at a cost: expenditures for the care for heart disease rose to more than $315 billion during the same decade. And heart disease continues to be the number one killer in the U.S. Every 39 seconds, someone dies of cardiovascular disease.

Education is the first step to lowering the risk of heart disease. Start by taking this short quiz to see how much you know about taking care of your heart. (Answers appear below.)

True or False?

  1. The heart is a muscle.
  2. Many diseases and conditions can contribute to the risk of heart disease.
  3. A heart attack always begins with sharp chest pain.
  4. The best thing to do if you experience heart attack symptoms is to call 911 right away.
  5. Women need to worry more about breast cancer than about heart disease.
  6. Quitting smoking is one of the best things you can do for your heart.
  7. If you have a family history of heart disease, you have exactly the same risk yourself.
  8. High blood cholesterol is one of the top risk factors for heart attack.
  9. As we grow older, it’s best to rest as much as possible.
  10. Even a person who has suffered a heart attack should exercise.
  11. It’s possible to eat a “heart smart” diet even if you dine out often.
  12. Emotional stress and anxiety can worsen a heart condition.

Answers to “Test Your Heart Health IQ”:

  1. The heart is a muscle.
    TRUE—The heart is the hardest working muscle in the body, pumping enough blood in your lifetime to fill a supertanker!
  2. Many diseases and conditions can contribute to the risk of heart disease.
    TRUE—A number of conditions—including hypertension (high blood pressure), high cholesterol and diabetes— increase the risk of heart disease.
  3. A heart attack always begins with sharp chest pain.
    FALSE—A heart attack can begin slowly, with subtle signals. Symptoms can include:
    •    a feeling of pressure or discomfort in the chest
    •    discomfort in the arms, neck, back, jaw or stomach
    •    shortness of breath
    •    nausea, dizziness, sweating for no reason
    •    fatigue and lack of energy
  4. The best thing to do if you experience heart attack symptoms is to call 911 right away.
    TRUE—“Better safe than sorry” is very true when it comes to heart attack. Excellent treatments are now available, and the sooner treatment begins, the better the chance of saving the patient’s life and preventing disability. If you experience chest pain, especially if associated with any other of the signs listed above, call 911 right away. Acting quickly can save your life.
  5. Women need to worry more about breast cancer than about heart disease.
    FALSE—Women are far more likely to die of cardiovascular disease than from breast cancer. It is a myth that heart disease is primarily a men’s health problem. Heart disease is the leading cause of death for women—and more women than men die within one year of a heart attack.
  6. Quitting smoking is one of the best things you can do for your heart.
    TRUE—Smoking is one of the top risk factors for heart disease. According to the Centers for Disease Control and Prevention (CDC), cigarette smokers are up to four times more likely to develop heart disease. And even if you don’t smoke, exposure to secondhand smoke may raise your risk by up to 30%.
  7. If you have a family history of heart disease, you have exactly the same risk yourself.
    FALSE—Although your risk increases if a family member was diagnosed with heart disease, it’s not all in the genes! A healthy lifestyle can cut your risk. Obesity and inactivity are greater risk factors than genetic inheritance for most people. Here are the steps to take to lower the risk:
    •    If you smoke, quit.
    •    Take steps to lower blood pressure and cholesterol level.
    •    Increase physical activity.
    •    Maintain a healthy weight.
    •    If you are diabetic, follow your care plan.
  8. High blood cholesterol is one of the top risk factors for heart attack.
    TRUE—Lowering your cholesterol level through diet and lifestyle changes (and in some cases, medication) can cut your risk.
  9. As we grow older, it’s best to rest as much as possible.
    FALSE—The older you are, the more important regular physical exercise is to your well-being. Inactivity can lead to a downward spiral of decline. Ask your healthcare provider about an exercise program that’s right for you.
  10. Even a person who has suffered a heart attack should exercise.
    TRUE—For most patients, preventing another heart attack will include a cardiac rehabilitation program. Be sure you discuss your workout regimen with your healthcare provider and follow his or her instructions.
  11. It’s possible to eat a “heart smart” diet even if you dine out often.
    TRUE—Most menus feature at least a few low-fat, low-cholesterol, low-sodium items. Avoid fried foods, instead selecting baked or broiled. (If you aren’t sure how a dish is prepared, ask your server.) Skip dessert, and order your salad with low-fat dressing served on the side.
  12. Emotional stress and anxiety can worsen a heart condition.
    TRUE—Stressful emotions can raise your blood pressure, causing your heart to work harder. Lifestyle changes and relaxation techniques help lessen the effects of stress.

This article is not intended to replace the advice of your doctor. Speak to your healthcare provider if you have questions about heart health or heart disease.

Source: IlluminAge AgeWise, 2015

 

Could Having a Sense of Purpose Lengthen Our Lives?

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Over the last few years, aging experts have been looking at the role played by a sense of purpose—the feeling that our lives have meaning, and that we have a place in the world, that we make a difference. A number of studies have found that having a sense of purpose motivates us to take care of ourselves, reduces stress, and lowers the risk of a host of ailments that become more common as we age.

In November 2014, an article appearing in The Lancet suggested that having a sense of purpose can even add years to our lives. As reported by University College London (UCL), seniors who experienced a certain type of well-being were 30 percent less likely to die over the course of a study that was conducted by researchers from UCL, Princeton University and Stony Brook University. The researchers explained that “eudemonic well-being” is the positive feeling we get when we feel that what we do is worthwhile and that we have a purpose in life.

Explained study leader Professor Andrew Steptoe, Director of the UCL Institute of Epidemiology, “We cannot be sure that higher well-being necessarily causes lower risk of death, since the relationship may not be causal. But the findings raise the intriguing possibility that increasing well-being could help to improve physical health. There are several biological mechanisms that may link well-being to improved health, for example through hormonal changes or reduced blood pressure. Further research is now needed to see if such changes might contribute to the links between well-being and life expectancy in older people.”

The study appeared in the Nov. 6, 2014 issue of The Lancet. [optional link: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961489-0/fulltext]

Source: AgeWise reporting on news release from University College London.

 

New Census Bureau Report Underscores the Need for Senior Care

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The Baby Boom is now creating a Senior Boom. According to a new report from the U.S. Census Bureau, the number of individuals age 65 and older is projected to reach nearly 84 million by 2050, almost double the size from 2012. Another factor contributing to the boom is the fact that people are living longer. Currently, the average American is living to be almost 79 years old, up from about 71 years in 1970.

 

This raises the question of how we, as a country, plan on taking care of our aging citizenry. According to the Congressional Budget Office, about one-third of people age 65 or older report functional limitations of one kind or another—limitations that require assistance in dressing, bathing, preparing meals, managing medications, etc. Among people age 85 or older, about two-thirds report functional limitations. And experts project that two-thirds of all seniors will need assistance to deal with a loss in functioning at some point during their remaining years of life.

“Changes in the age structure of the U.S. population will have implications for health care services and providers, national and local policymakers, and businesses seeking to anticipate the influence that this population may have on their services, family structure and the American landscape,” says Jennifer Ortman, chief of the Census Bureau’s Population Projections Branch.

The aging population presents numerous challenges and great opportunities for agencies and companies that provide senior care. Home care and home health care services, community care facilities for the older population, and continuing care retirement communities are all expanding. All showed an increase of 20 percent or more in their number of employees between 2007 and 2011. Additionally, age-restricted communities are becoming more and more popular. One such community, The Villages in Sumter County, Florida, was the nation’s fastest growing metro area from 2012 to 2013.

Fortunately, the Senior Boom wasn’t an unforeseen phenomenon. We’ve known for nearly 60 years that Baby Boomers would eventually grow old and need greater care. The associated industries caring for these individuals have, so far, been able to keep pace with demand, although occupancy at senior living communities is on the rise, reaching 89.9% in the second quarter of 2014. Fortunately, construction of new communities is also on the rise. It’s safe to say that senior care will be a growing industry for many years to come.

 

Source: IlluminAgeAgeWise

Leading Physician Group Releases Guidance for Treatment of Urinary Incontinence

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It’s a subject few people openly discuss—yet millions of senior American women are living with urinary incontinence (UI), a troublesome problem that if not managed, can lead to infection, isolation, falls, inactivity and an overall decline in health. Many of these women and their families fail to realize that UI can be treated, often without surgery.

The American College of Physicians (ACP) recently reported that each year, treatment for UI costs upwards of $19.5 billion. In September 2014, the organization released updated, evidence-based recommendations for non-surgical treatment options “to help doctors and patients understand the benefits, harms, and costs of tests and treatment options so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices.”

Treatment recommendations depend on the type of incontinence a woman is experiencing:

Stress incontinence means that urine leaks from the bladder when a woman laughs, coughs, exercises or lifts something heavy. It is caused by physical changes in the muscles of the pelvic floor caused by factors such as childbirth, menopause and obesity. This type is most common in women. For this type, the ACP recommends a specific series of exercises of the pelvic floor called Kegel exercises.

Urgency incontinence, sometimes called “overactive bladder,” happens when the bladder begins to empty itself suddenly, perhaps when the patient thinks about going to the bathroom or hears running water. It can be caused by damage to the nerves or by irritation from infection or certain foods. For urgency incontinence, the ACP is recommending “bladder training, a form of behavioral therapy that involves urinating on a set schedule and gradually increasing the time between urination.” If bladder training is unsuccessful, the ACP recommends medication as recommended by the patient’s physician.

Mixed UI is a combination of stress and urgency incontinence. For this type, the ACP recommends Kegel exercises with bladder training. They also recommend weight loss and exercise for women who are obese.

ACP president Dr. David Fleming states that about half the women who experience this problem don’t even report it to their healthcare provider. He says to doctors, “Urinary incontinence is a common problem for women that is often under-reported and under-diagnosed. Physicians should take an active approach and ask specific questions such as onset, symptoms and frequency of urinary incontinence.”

The information in this article is not meant to replace the advice of your doctor. If you are experiencing incontinence, seek the advice of your healthcare provider.

Source: AgeWise reporting on material from the American College of Physicians. You can read the entire “Nonsurgical Management of Urinary Incontinence in Women” set of guidelines in the Sept. 16, 2014 issue of the Annals of Internal Medicine [link to: http://annals.org/article.aspx?articleid=1905131]

 

Can Seniors Fight Depression By Going on the Internet?

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According to the Geriatric Mental Health Foundation, more than 6 million Americans older than 65 experience feelings of persistent sadness, hopelessness and lack of energy. Two million of these seniors have been diagnosed with a severe depressive illness.

Depression is caused by a chemical imbalance in the brain, resulting from illness, a loss or accumulated losses, chronic pain, the side effects of medication and other causes. You might be surprised to know that retirement can be the trigger event for depression. Even though most of us look forward to having our days to ourselves, with more time to do the things we want to do, retirement may create a “vocation gap” that leaves some retirees without a feeling of purpose and a place in the world. Retirement may also mean the loss of an important social context.

It’s important to seek treatment for depression. Treatment might include medications and therapy. But often, lifestyle changes provide a powerful mood boost. These include everything from exercise to volunteering to watching humorous TV programs. And over the past few years, several studies have shown that internet use can be an effective tool for reducing feelings of boredom and isolation.

This was confirmed recently when a team of researchers headed by Shelia R. Cotton, Ph.D., from Michigan State University examined results from the large Health and Retirement Study, an ongoing survey that provides data on more than 22,000 older Americans. As reported by the Gerontological Society of America, the team asked study subjects: “Do you regularly use the World Wide Web, or the internet, for sending and receiving email or for any other purpose?”

The results showed that the internet users had a 33 percent reduction in the probability of depression. Said the study authors, “This provides some evidence that the mechanism linking internet use to depression is the remediation of social isolation and loneliness. Encouraging older adults to use the internet may help decrease isolation, loneliness, and depression.”

Online socialization is a great way to supplement and increase “real life” friendships. Surfing the Web provides mental stimulation and helps seniors feel informed and connected. Something as small as watching a few cat videos—and sharing them on Facebook—can raise the spirits. And today, many young people who were raised with the internet are providing their older relatives with a little intergenerational tech support. If you or an older loved one is experiencing depression and isolation, check out the resources in your community to help seniors learn to use computers and connect with others online.

Read more about the study here.

Copyright © IlluminAge AgeWise, 2014; with excerpts from news release from the Gerontological Society of America.

 

Do Working Caregivers Provide Less Care for Loved Ones?

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There’s a common assumption that when a loved one needs care, family members who do not work outside the home will be first to step up and provide support. Of course, in reality this is not the case. Many other factors come into play as a family’s caregiving arrangement takes shape.

In a series of studies over the past year, the United Hospital Fund and the AARP have been looking at the facts about family caregiving in the U.S. One thing they’ve discovered is that family caregivers today are performing more and more medical and nursing tasks for their elderly relatives. Family members are providing medication management, performing wound care, monitoring their loved ones’ health conditions and operating specialized medical equipment. The researchers also looked at the level of care and number of care hours provided by family members who were also employed outside the home, compared with those who were not. Said Susan Reinhard of the AARP Public Policy Institute, “We expected that caregivers who didn’t have to manage the demands of a job would have more time to take on these challenging tasks—tasks that would make a nursing student tremble—but our data shows that there’s little difference between the two groups.”

Though working caregivers were only one percentage point less likely to be providing this kind of care (45 percent of them, versus 46 percent of non-working caregivers), the percentages diverged dramatically in another category. Said Carol Levine of the United Hospital Fund, “Where we did find a difference was in the stress associated with juggling the demands of caregiving with other responsibilities.” Levine reports that while 49 percent of family caregivers who are not employed report feeling stressed, fully 61 percent of the working caregivers reported such stress.

This study is yet another reminder of how important it is for our nation to support family caregivers, whose unpaid work is worth billions of dollars each year, and many of whom are also productive members of the workforce.

Read the entire study [link to: http://www.uhfnyc.org/assets/1157] on the United Hospital Fund website.

Source: AgeWise reporting on research from the United Hospital Fund and AARP.

 

Geriatrician Looks at Sensitive Issue of Senior Gun Ownership

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In the United States the debate around gun ownership often focuses on teenagers; however, research shows that elderly Americans are the most likely to own a gun and that presents both medical and legal problems for physicians and carers.

Writing in an issue of the Journal of the American Geriatrics Society, Dr. Ellen Pinholt explored these issues and proposed a series of “red flag” questions which caregivers must ask.

While there is no upper age limit on owning a firearm, Americans aged over 65 have the highest prevalence of dementia, depression and suicide. Federal law prohibits mentally incompetent persons from possessing a gun; however, this only applies to a formal finding by a court and not necessarily to a physician’s diagnosis of dementia.

Using a series of case studies to explore the medical and legal dimensions of the issue, Dr. Pinholt suggested “5 Ls,” questions about gun ownership which should be asked as routinely as questions about driving.

  1. If there is a gun present, is it LOCKED?
  2. Is it LOADED?
  3. Are LITTLE children present?
  4. Does the gun owner feel LOW?
  5. Is the gun owner LEARNED about how to safely use the gun?

Source: Wiley Online Library News Release; Journal of the American Geriatrics Society, 4 June 2014

Learn More

The U.S. Department of Veterans Affairs offers a free online brochure, “Firearms and Dementia.”

Choosing a Quality Hospice

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When a loved one is diagnosed with a serious or life-limiting illness, the questions facing an individual or a family can be overwhelming. The National Hospice and Palliative Care Organization (NHPCO) recommends that people learn more about hospice as an important option before they are faced with a medical crisis.
Hospice is not a place but a kind of care for people who have a life-limiting illness and are making the choice to focus on quality and comfort if more conventional treatments have become burdensome.
Hospices provide high-quality care specially tailored to your needs and valuable support to family caregivers.
With multiple hospices serving some communities, it can seem challenging to select one. NHPCO suggests the best way to begin is by reaching out to the hospice providers in your community to find the one best equipped to meet your specific needs.
“Choosing a hospice to care for yourself or a loved one in the final months or even days of life is an important and stressful process,” said J. Donald Schumacher NHPCO president and CEO. “Each hospice offers unique services and partners with specific community providers – so it’s important to contact the hospices in your area and ask them questions to find the one with the services and support that are right for you.”
Your physician, other healthcare providers or family friends that have taken advantage of hospice services in the past are other good ways to get a recommendation for a provider in your area.
Some of the questions important in choosing a quality hospice include:
1. Is the hospice Medicare certified?
2. When was the last state or federal survey of the program?
3. Is the hospice accredited by a national organization?
4. What services should I expect from the hospice?
5. How are services provided after hours?
6. How and where does the hospice provide short-term inpatient care?
7. What services do volunteers offer?
8. How long does it typically take the hospice to enroll someone once the request for services is made?
Another question is when to begin hospice care. Every patient and family must decide that based upon their unique needs. However, professionals encourage people to learn about care options long before they think they may need them.
To help families make a decision at a difficult time, the NHPCO has created a free worksheet to help consider and answer some of the important questions to consider when learning about or choosing a hospice. Down load the worksheet (www.momentsoflife.org/sites/default/files/public/moments/Choosing%20a%20Hospice.pdf) from NHPCO’s Moments of Life website.
Source: The National Hospice and Palliative Care Organization (www.nhpco.org).

Can Weight Loss Improve Problems with Incontinence?

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Can weight loss improve problems with urinary incontinence?  It may, according the American Institute for Cancer Research expert Karen Collins.

Urinary incontinence is an involuntary leakage of urine. It can occur as stress incontinence (which comes at a time of some form of exertion or when sneezing or coughing), urge incontinence (which occurs with or immediately following a sense of urgency), or a mixture of both. Excess body fat, especially in the abdominal area, is strongly linked to greater risk of urinary incontinence. Researchers say this could be a physical effect, due to pressure of excess fat pushing down and stressing the pelvic floor.

However, since studies also show that fat tissue is metabolically active and linked to inflammation and hormonal changes, it’s possible that these conditions are involved in the link between overweight and urinary incontinence. A recent review pulling together the results of six studies on this link concluded that modest weight loss may help reduce urinary incontinence. The good news is that a 5 to 10 percent weight loss seemed to make a difference, which could mean losing less than 10 pounds for some people.

However, excess weight is far from the only reason for urinary incontinence. It can be related to medications, hormone changes, surgery, childbirth and other causes. It’s unfortunate that many people who experience urinary incontinence are embarrassed and don’t discuss it with their healthcare provider. That is a shame, because in addition to weight loss, other remedies can also be considered. If you are overweight, modest weight loss also can make a difference in controlling or reducing risk of so many other health problems, including Type 2 diabetes and high blood pressure. Making a few changes in eating habits and activity to support a modest weight loss is a good idea. But don’t leave your doctor or other healthcare provider in the dark as you face this problem.

Source: Karen Collins, MS, RDN, CDN, FAND, of the American Institute for Cancer Research (AICR). The AICR is the cancer charity that fosters research on the relationship of nutrition, physical activity and weight management to cancer risk, interprets the scientific literature and educates the public about the results. Visit the AICR website (www.aicr.org) to find a wide variety of consumer information on healthy diet.