Increase Your Chances of Avoiding a Heart Attack

Excerpts from December 2013 Senior Spirit Newsletter

Last month, a report by the American Heart Association and American College of Cardiology recommended extending statin drugs to a wider pool of people to prevent heart attacks as well as strokes. Previously, a high cholesterol level was the main criterion, but the new guidelines encourage people with normal cholesterol levels but higher risk factors related to age, gender and race to consider the cholesterol-lowering drugs. 

The guidelines also promote more traditional preventive measures: 40 minutes of moderate to vigorous exercise four times a week and a diet focused on vegetables, fruits and whole grains.

Reinforcing the need for exercise to prevent heart attacks, new research from the Swedish School of Sport and Health Sciences suggests simple activities can reduce the risk of a heart attack (as reported in the online British Journal of Sports Medicine, October 28, 2013). Researchers found that those who were most physically active reduced their risk of heart attack and stroke by 27 percent and decreased their risk of all-cause mortality by 30 percent, when compared with the least active participants in the study.

Aging Factor for Heart Attack Risk

Taking preventive measures becomes more important as we get older, because aging increases our risk factors. In fact, the number one cause of death in adults over the age of 60 is heart disease, including heart attacks. Heart disease can strike anyone, but older adults are hit the hardest for several reasons. For one, people who smoke or have a history of smoking have a much higher risk. Smoking is the leading cause of heart disease. (For help quitting smoking, you can call 1-800-QuitNow.) 

The medical term for a heart attack is myocardial infarction, in which the supply of blood to the heart is suddenly and severely reduced or cut off, causing the muscle to die from lack of oxygen. This often happens as plaque, a fatty material, builds up over the years on the inside walls of the coronary arteries, which supply blood and oxygen to your heart; this build-up is often due to smoking. Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery. If the flow of blood isn't restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.

As we age, changes normally occur in the heart and blood vessels, which can lead to heart disease, including heart attacks. The heart becomes more vulnerable to various injuries, and its “pump” capabilities begin to deteriorate.

The heart’s decrease in elasticity and ability to respond to changes in arterial-system pressure means escalating resistance to its pumping action. This increases the effort needed to drive blood to various organs. In addition, as the arterial wall thickens, the arteries stiffen. Rigid arteries lead to high blood pressure, which is especially dangerous for the elderly. (See the sidebar for other heart disease factors associated with aging.)

Heart Attack Symptoms Vary

People experience the symptoms of an oncoming heart attack differently. Women and those older than 75, especially, are less likely to feel any chest pain and more likely to suffer what is known as a silent heart attack. The problem is that silent heart attacks don’t exhibit the traditional warning signs but are equally deadly. In fact, they are even more common in older adults than heart attacks that immediately come to the attention of doctors and patients, according to a recent study in The Journal of the American Medical Association (as reported in “The Deadly Threat of Silent Heart Attacks,” New Old Age blog, New York Times). Silent heart attacks are hard to diagnose because the symptoms can be vague: prolonged fatigue, confusion, shortness of breath.

In general, common symptoms of a traditional heart attack include:

• Chest pain and pain that originates in the chest and spreads to the back, jaw or arms. People may also feel pain in all of these places and not the chest, or they may feel pain in the stomach area and mistake it for indigestion. The pain is like that of angina but usually more severe and longer lasting, and it does not get better by resting or taking a nitroglycerin pill.
• Faintness
• Sudden sweating
• Nausea
• Heavy pounding of the heart
• Abnormal heart rhythms (arrhythmias), which occur in more than 90 percent of people who have had a heart attack
• Loss of consciousness, which sometimes is the first symptom of a heart attack
• Feelings of restlessness, sweatiness, anxiety and a sense of impending doom
• Bluishness of the lips, hands or feet

Certain symptoms are mostly seen in older adults:

• Shortness of breath
• Progressive fatigue
• Heartbeats that are too fast, too slow or irregular
• Dizziness
• Pain in the left chest, or more commonly, “chest tightness,” especially if brought about by physical or emotional stress
• Symptoms that resemble a stroke, such as feeling disoriented 

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

Susceptible to SAD?

The holiday season is a time that can provide much joy and togetherness - but it can also be a period of great loneliness and even depression for certain people. Seasonal affective disorder (SAD) is a cyclical form of depression that can affect people at specific times during the year, mostly in the fall and winter, and its symptoms can be severe.

In your interactions with the seniors in your care, be careful not to ignore potential SAD symptoms. The individual might even brush off his or her own symptoms, attributing them to temporary "winter blues" or a "seasonal funk." But such temporary down moods can be persistent and quickly resist improvement. Turning your back to such signs can lead to more serious problems, including thoughts of suicide.

Be sure to watch for the following symptoms of SAD:

• anxiety and irritability
• sadness
• lack of energy and increased fatigue
• hopelessness, discouragement and feelings of worthlessness
• changes in appetite/weight gain
• concentration/memory problems
• problems sleeping
• confusion
• suicidal thoughts

SAD Seniors

People of all ages can experience SAD, but seniors represent a particular challenge. It can be difficult to properly diagnose older people who might be exhibiting symptoms of depression that actually result from other serious medical conditions, such as cancer, stroke or heart disease. Seniors are also susceptible to vascular depression, which occurs when blood vessels harden and constrict over time. This loss of flexibility in the vessels can disrupt normal blood flow to the brain. And certain medications can have side effects that resemble depressive symptoms.

Indeed, depressive symptoms can arise from a number of factors closely associated with growing older. A general biological slowdown can lead to decreased energy, increased health risk, fewer opportunities for social interaction and a loss of independence. Because these factors are so common, seniors or their caregivers might be inclined to believe the symptoms of depression are not serious.

However, although depression isn't a normal component of the aging process, it is quite common among seniors. Studies have shown that about 6 million Americans age 65 and older suffer from depression — and a mere 10 percent of those receive proper treatment.

White males age 85 and older have the highest suicide rate of any age group, and the main cause is untreated depression. Many have a depressive illness that their doctors might not detect.

What causes SAD?

The cause of SAD is unclear, but it might result from several factors related to age, genetics and body chemistry. In particular, drops in levels of the natural hormones melatonin and the brain chemical serotonin might lead to SAD symptoms. Both chemicals play a role in mood, but it's the connection of sunlight with serotonin — and the reduced level of sunlight in fall and winter — that provides perhaps the biggest clue. It's well known that these darker seasons can disrupt the body's biological clock or circadian rhythm.

Put simply, SAD might very well be caused by the body's reaction to light deprivation — a lack of sunlight.

Treatment

Typically, older adults suffering from depression show improvement after receiving treatment such as antidepressants and psychotherapy. In fact, psychotherapy alone might be particularly effective in addressing mild forms of depression. But perhaps the most effective way to handle SAD is a combination of psychotherapy, medication and phototherapy (light therapy).

Caregivers should already be encouraging the seniors in their care to bring more sunlight (and Vitamin D) into their lives. During the shorter, colder days of fall and winter, it can be more of a challenge to seek the sun; even something as simple as opening the blinds or taking a walk outside can help.

In the absence of such opportunities, doctors can prescribe phototherapy (or light therapy) to treat SAD. There are two types of light therapy:

• Bright light treatment — The individual sits in front of a special fluorescent lamp (a "light box" or "sunbox") for a specific length of time.
• Dawn or sunshine simulation — In the morning, a light box gradually brightens from dim to brilliant, like a sunrise, while the individual is still asleep.

It's amazing what a little sun can do! Light therapy has a high success rate, typically bringing relief from SAD within days. But the individual needs to keep up with the treatment. Adding other simple, proactive measures — getting regular exercise, keeping a strict sleep schedule and eating a healthy diet — can further enhance the person's mood.

If a depressed person does not respond to lifestyle changes such as increased light and exercise, it's important to seek the help of a health care professional promptly. With proper attention, SAD is a very treatable condition.

Download this handout

 

Blog post provided by Society of Certified Senior Advisors

www.csa.us

 

Conversations with Seniors: a simple guide to making them easier

In 2000, approximately 605 million people were 60 years or older. According to the Administration on Aging, that number is expected to be close to 2 billion by 2050. It will be the adult children who manage the care of these older adults that will need to discuss the many difficult, yet important topics that are critical to the health and wellbeing of these senior adults. Topics of conversation include finances, driving safety, living situations, health and wellbeing, and many more.

There is an ever-growing need today for understanding just how to effectively communciate with aging adults on these important topics and that providing them with meaningful support is imperative for their wellbeing. While it can be a daunting challenge, it is essential for those managing the care of older adults to be patient, respectful and empathetic to the situation. An effective conversation with an older adult should always consist of thoughtful speech, careful listening and an open awareness to their wants and needs.

The Key Ingredients to a safe conversation:

• Acknowledge the difficulty of the conversation.
• Look at all facts - be gentle and sensitive (if there is any resistance, back-up and create a safe space before proceeding.)
• Ask questions - always look for ways to have the senior control the conversation.
• Identify the outcome you're both looking for - the future you want to create. Be open to their thoughts and be thinking outside the box.
• Inquire into what would help the senior create the next stage of their life as the best part of their life.
• Take this as an opportunity for soul searching and valuing your relationship with your senior.

Common Barriers to Good Communication

• Judgments
• Having the answer
• Being argumentative
• Getting angry
• Getting defensive

When utilizing this information, it will help to provide you with the tools to plan and structure your conversations more effectively and it will provide you with the support you need to support the seniors in your life. See Making the Difficult Conversation Easier.  


Sources:

www.csa.us
www.aoa.gov


Blog post provided by the Society of Certified Senior Advisors