Tip #1: Getting Good Sleep
By: Dr. Marcus Lum, MD
Getting good sleep is such an important part of good health. Sleep plays many roles in helping us thrive. Good sleep allows our bodies to restore energy, produce hormones for bodily repair,
enhances our mood and helps us learn and make memories. Cardiovascular disease is improved with quality sleep, as is our digestion, our immune system and our mental capacity and well-being. It’s difficult to say how much one should sleep as the quality of sleep plays an important role. Some people can thrive with less sleep while others do better with more. Nonetheless, the lack of sleep is always detrimental, and one should be aware of the need for good sleep and try to improve their insomnia.
The physiology of sleep can be separated into non-REM and REM sleep. REM is an acronym for Rapid Eye Movement. There are 3 stages in non-REM sleep graded by different grades of wakefulness, stage 1 is typically the drifting stage coming in and out of sleepiness. Stage 2 is light sleep. In stage 1 and 2 people will occasionally jerk and even awaken temporarily falling back to sleep. It is a normal phenomenon. Stage 3 is deep sleep. This is the most beneficial stage for bodily repair and restoration. No jerking is witnessed. Aside from these stages is REM sleep where the brain process information for the day storing items for long-term memory. In this state, the eyes will roam back and forth, and breathing can sometimes be erratic. It is the state where one dreams.
Our bodies also have a natural circadian rhythm. As humans we have evolved to be more awake during daylight and sleepier at night. However, our age does affect this rhythm sometimes causing differences in our natural sleep patterns. As newborns and infants tend to sleep 10-17 hours throughout the day and night their rhythm often shifts gradually to where less sleep is needed in childhood with their patterns more typical during daylight and night times. When people reach adolescence, their internal clocks may shift 1-2 hours later often causing them to sleep in the latter evening hours and be less awake in the early morning. As we age further, the circadian rhythm shifts backwards. Older adults will tend to have a need to sleep earlier in the evening and consequently wake up earlier as well. All this to say, a good understanding of what our natural rhythms is always helpful in understanding our expectations of sleep.
What can we do to improve our sleep naturally? Good habits, a bedtime routine and being mindful of why we sleep are most important. A good start is to remove stimuli that could impair your ability to sleep. Cell phones, television, bright lights, and loud noises create distracting sensory stimuli. A dark quiet and warm environment is helpful. A routine that incorporates the bed as a place of sleep is best. Avoid lying in bed if one is not trying to sleep or has awakened in the morning. Try falling asleep within 20 minutes of laying down. If this is not happening, it’s best to get up and do a mundane task that will tire your eyes. Having a sleep routine and sticking to a schedule is also important as it reinforces sleep behavior. Warm showers and a strategically placed regular exercise routine can help. Lastly, mindfulness either self-learned or taught by a psychologist or therapist can resolve mood issues that cause insomnia. Hopefully these tips can give you some insight on improving your sleep but as always you can make an appointment and ask the doctors.
Tip #2: Fall Prevention in the Elderly
By Dr. Amine Chahbouni
One out of three people over the age of 65 will incur a fall at some point in their lifetime. In the United States, about 7 million injuries and 27,000 deaths occur annually among seniors as a result of falling. Several risk factors contribute to falls among senior patients, these include intrinsic and extrinsic factors. Intrinsic factors include old age, having multiple medical conditions, cardiovascular disease, neurological and/or musculoskeletal function decline, and decreased visual acuity. Extrinsic factors include taking multiple medications, taking sedatives and painkillers, climbing stairs and walking uneven surfaces, improperly using assistive devices or using damaged ones.
There are many serious consequences to falling in the senior population, these include physical, psychological, and economic ramifications. Physical consequences range from minor skin abrasions and lacerations to hematomas, bone fractures, cerebral bleeds, neurovascular damage, and paralysis. Psychological consequences include but are not limited to depression, anxiety, PTSD, fall phobia, and pain medication addiction. Economic consequences include job loss, costly procedures and medications, and necessitating care and assistance from others.
Fall prevention is a multifaceted process that relies on screening, education, and risk modification. Screening takes place at the clinic where the medical provider performs a thorough medical examination and assesses the patient’s risks for falling. A thorough medical examination involves assessing the patient’s cardiovascular health, vision, hearing, and neuromuscular function. Assessing a patient’s risk for falling relies on several tests in the office such as the Timed Up and Go (TUG) test, which assesses the patient’s mobility by measuring the time it takes the patient to get up from a chair, walk three meters, turn around 180 degrees, then walk back to the chair and sit again. A score of 10 seconds or less indicates normal mobility while a score of 30 seconds or more indicates a high risk for falling.
Tip #3: Exercise Plans for Seniors
By Dr. Jose Dalprat
Education and risk modification are also important components of the fall prevention plan. Education involves providing patients with tips and guidance to prevent falls, such as avoiding rapid standing and position change, lighting up the surrounding, and avoiding environmental hazards. Risk modification, on the other hand, involves tailoring a strategic plan for each individual patient to address their specific risk factors.
Ultimately, fall prevention should be a frequent topic of discussion among senior patients and their medical providers. When patients are aware of the risks and consequences of falling, they work more diligently with their medical providers to come up with strategic plans to mitigate falls and prevent mechanical injuries.
Physical activity is one of the best things an individual can do to improve their health. Active people generally live longer and are at less risk for serious health problems such as heart disease, Type 2 diabetes, and obesity. For people with chronic diseases, physical activity can help manage these conditions and complications.
Physical activity is vital for healthy aging. It can help reduce the chances of getting some chronic diseases and prevents early death. Older adults looking to start an exercise program should aim for 150 minutes of moderate endurance activity per week. This can include walking, swimming, and cycling. As little as 20 minutes of exercise each day will improve strength, flexibility, and balance.
Stretching daily will improve your range of motion and decrease muscle stiffness and pain. Different types of exercises will affect different muscles. Fast twitch muscle fibers are used for short bursts of activity and are associated with strength and power, while slow twitch muscle fibers are more endurance-oriented, used for sustained activities, and are resistant to fatigue. Isotonic exercises like walking and lifting weights involve movement and improve muscle strength and endurance. Isometric exercises like wall sits and lunges involve muscle contraction without movement, helping maintain muscle strength and joint stability.
When performing cardiovascular exercise, it is important to do it at a moderate intensity, aiming for 50-70% of your Maximum Predicted Heart Rate (MPHR). The MPHR is an estimate of the highest number of times your heart can beat per minute during intense exercise. It is calculated as 220 minus your age. For example, a 70-year-old would have an MPHR of 150 beats per minute (bpm). For moderate intensity, this patient would aim for a HR of 75 to 105 during cardiovascular exercise.
Here is a sample weekly exercise plan to help maintain overall health, enhance mobility, and improve quality of life for seniors. Start with cardiovascular exercise 3-5 days per week. This can include brisk walking, swimming, or cycling for 20-30 minutes at moderate intensity. Benefits include improved heart health, stamina, and circulation. Add strength training 2-3 days per week, with light weightlifting, resistance bands, and body-weight exercises like squats and lunges. Benefits include enhanced muscle strength, bone density, and functional ability. Remember to warm up and cool down for 5-10 minutes at every session with stretching or light activity.
Consult a healthcare provider before starting a new exercise regimen. Start with low intensity and gradually increase as fitness improves. Stay hydrated and listen to your body, avoiding exercises that cause pain or discomfort.