Tag Archives: Aging

Nighttime Toileting and Osteoporosis

1 Jul

Despite the significant effort in public education messages and pharmaceutical advertising, osteoporosis-linked fractures have risen dramatically over the past decade.  According to the Agency for Healthcare Research and Quality (AHRQ) in the Department of Health and Human Services, the hospitalization rate of patients admitted for treatment of hip, pelvis and other fractures associated with osteoporosis increased by 55% between 1995 and 2006.  An estimated 10 million Americans suffer from osteoporosis, which causes bones to become brittle and subject to easy fracture.  Even worse, osteoporosis slows healing following fracture and can contribute to multiple fractures leading to excessive pain, disability and permanently impaired mobility, and eventually death.  Because osteoporosis is involved mostly in older adults, with 90% of hospitalizations for patients 65 and older, the increasing longevity of our country has only increased the likelihood of higher prevalence, all else being equal.

Couple this trend with the heightened risk factor for overactive bladder (OAB) accompanied by aging, and we are facing the perfect storm.  Overactive bladder, including symptoms of nocturia or being awakened more than once nightly to urinate, affects an estimated 33 adult Americans, with prevalence increasing with age.  Impaired mobility coupled with middle of the night toileting in the dark is an equation leading to disaster for millions.  And with increasing numbers of the elderly living along, the problem is only exacerbated.

Our country has to get smarter about the convergence of these risk factors and wiser about how to practice practical, preemptive intervention.  Yes, it’s important to have bone density screening and  for patients to be compliant with osteoporosis-prescribed medication.  However, it’s equally important to take steps to strengthen bone, with strength-building exercises, with supervised instruction and in a safe environment.  If OAB is in the equation, then a full-scale intervention with behavioral therapy including pelvic floor muscle exercises, bladder retraining, and dietary changes and possibly medication is called for.   And watch out for medications prescribed for other problems that can cause you to be unsteady on your feet or easily disoriented, as research shows a link between sedatives/narcotics and falls.  Even chronic pain has been found to increase the risk of falls in older adults.

If nighttime toileting and overactive bladder problems persist, there are other remedies including peripheral nerve stimulation and device implants for sacral nerve modulation.

We’ve got to wise up to the combination of factors and preempt the perfect storm before it comes to shore.

Nancy Muller, Ph.D.
Executive Director,
National Association for Continence

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Tomorrow’s Wellness Professional

22 Feb

A most extraordinary effort is afoot aimed at establishing a whole new category and kind of professional: a “Wellness Professional.” The effort represents an initiative, still very much in the concept creation stage, of the International Council on Active Aging (ICAA), on whose 2020 Visioning Board I serve. The Canadian-based organization is one of the most exciting, “out there” groups on the map. It represents an eclectic, interdisciplinary team of fitness coaches, physiologists, doctors, teachers, public health educators, patient advocacy organizations, community leaders and others, all with the same mission to help give all people the tools they need to age with good health.
On a teleconference call today, we brainstormed how to define the qualifications and role of a Wellness Professional. It is definitely that of a coordinator well-versed in multiple dimensions of aging, including social, spiritual, physical, and other realms. It is viewed as a central player in a hub and spoke system. But over time, it is conceivable that the role may pass from a single individual who works as a resource manager and communicator to that of a process or an electronic algorithm that directs, guides, and even drives intervention to insure an older person’s optimal wellness. It is also viewed as being community-based, as opposed to being institutionally based. In a retirement community, such a player may even be considered the CEO!
Under leadership of the Obama Administration, last year’s healthcare reform legislation clearly spotlighted a role for preventive services. But they were cast in the context of a medical model, namely doing such things as routine blood tests as checks for keeping diabetes under control or regular blood pressure checks for managing hypertension and thus preventing strokes. And they require the services of a medically trained healthcare provider. What ICAA’s Visioning Board is conceptualizing is a professional who interfaces with healthcare providers and links with information in the medical record but who may not necessarily be a trained provider of healthcare services. The thinking is that this individual will know much more about fitness, nutrition, and spiritual healing than the large majority of healthcare providers. The Wellness Professional will also be sensitive to cultural issues and concerns that affect the myths, health-seeking behaviors, and priorities of certain individuals, as well as be knowledgeable about gender differences that affect a person’s wellness, as do their economic status and personal health literacy.
In an era that is focusing increasingly on patient centeredness and moving away from hospital-based healthcare and physician centeredness as our healthcare delivery system has traditionally been structured, it’s time for each of us individuals to own our wellness, especially as we grow older and begin experiencing the effects of the aging process. Rather than waiting for our primary care physician to instruct us in how to control our cholesterol through diet and exercise, it’s time to seize the challenge and step into it, avoiding overreliance on medications whose costs and side effects may sap one’s energy and resources. It’s about exercising smartly as we age and on age-appropriate exercise equipment. It’s about always wearing sun block and a hat and sunglasses, to protect our skin from cancer and our eyes from cataracts.
Taking ownership means taking control. It means discovering that you have choices and claiming access to them. It means maintaining your freedom and your independence. And until there are credentialed Wellness Professionals to assist you, all of this may require you to tackle this on your own. You can start by going to Oregon State University’s extended online campus to master aging well.
The mastery of aging well also means that you don’t just accept your symptoms as a natural consequence of aging, like one third of Americans do. If bladder and bowel control problems are robbing you of your quality of life as you age, look for tips on safe toileting, fall prevention in the night, and related topics among NAFC’s articles. Or just visit http://www.nafc.org and search with the single word “aging” in the search toolbox on the home page. And then seek interventions towards wellness.
Yes, one day there will be Wellness Professionals to inspire and coach us. Until then, take ownership and take heart.

Nancy Muller, PhD