Seniors and chronic pain

It stands to reason that many seniors experience chronic pain because many tend to have disorders or illnesses that can contribute to pain. The issue isn't so much that they have it - it's what we need to do about it.

Did you know that, in Canada, seniors are expected to make up about one-quarter the population by the year 2031? People who are in pain are less able to contribute to society, less able to care for themselves and require more assistance from others.

As the population ages, there will be fewer people in caregiving roles who will have to give more care. The CBC has an article on chronic pain and the elderly. It's a bit of an eye opener if this isn't an issue you've yet thought about:

News for Today:
Chronic pain a big issue for seniors: StatsCan
Improvement in diabetes a positive side effect of obesity surgery
Strokes triple among middle-aged women in U.S.: study
1 in 4 Americans knows heart attack warning signs: CDC
Stroke more prevalent in United States than in Europe
A regular dip could benefit fibromyalgia sufferers

Yup, it was a hot day yesterday

It was hot in Montreal yesterday. Very hot, with a high of 35 degrees Celsius (95 Fahrenheit) and with the humidity factor, a temperature that felt like in the 40s (over 104 F).

Environment Canada has this Humidex chart that gives you an idea of how the temperatures feel according to the humidity in the air.

We don’t have air conditioning in our house. It’s a 45-year-old home that has hot water heating, so to put in central air would be expensive. We’d have to go with the ductless type. Window units drive me crazy with their noise, but we do have one in our bedroom we use on the really hot nights. I’m lucky in that I don’t often feel the heat, but I do feel the humidity. Oddly enough, it shows when it’s humid because I can’t laugh. My asthma is affected by the humidity and if I laugh, I have to take a deep breath and I can’t. So, I end up coughing away for hours all because I laughed. I know, I said it was odd. :-)

We’re young though, we’re healthy, so the heat is really more annoying than anything else. But I worry for those who aren’t young and aren’t healthy. The elderly who live in top floor apartments or flats so not only does the heat rise, but they have the sun beating down on them. Those with limited resources can’t afford to air condition their homes. Our city does declare an emergency when we hit a certain temperature for three days in a row, so that is some consolation. When that happens, they open shelters and air conditioned areas for those who need the help.

We know the drill of how to stay safe in excessively hot weather: drink plenty of fluids, stay inside as much as possible, don’t do anything strenuous if you can avoid it, and so on. But there are still a lot of people who don’t take it seriously enough and do develop heatstroke, or hyperthermia.

How serious is heat stroke? According to the Centers for Disease Control in the United States, during the period between and including 1999 to 2003, there were 3442 deaths related to heat. Of these 3442, 65% (2239) were directly caused by the heat. Heat was considered a contributing factor to the remaining number of deaths. Some of these deaths make the news, like when it’s a student athlete: Heat-related deaths in middle, high school football players spikes in 2006.


The Red Cross has this very informative page about heat-related illnesses. They discuss the prevention, the different stages, and emergency interventions for people who are affected.

Oh, and one more thing – watch out for Fido. Dogs feel the heat too. Don’t let them overexert themselves in the heat. Walks should be kept to a minimum and don’t forget that the pavement is burning hot on those paw pads. And please, please, please, don’t leave your pooch in the car, even with the windows cracked. It’s like leaving him in an oven.


News for Today:

Screening improves detection of major stroke risk factor
Ontario to provide teenage girls with HPV vaccine
Alberta gets first human case of West Nile
Breastfeeding moms quitting too soon, officials say
Many heart attack patients still not getting emergency clot-busting treatment
Heat-related deaths in middle, high school football players spikes in 2006

Broken hips in the elderly can lead to death

Yesterday, I posted a link to a story about hip protectors not reducing the number of broken hips among seniors in nursing homes. According to the National Center for Health Statistics; Centers for Disease Control and Prevention; 2003 National Hospital Discharge Survey, there were about 345,000 hospitalizations of elderly men and women in the US during 2003. Statistics show that only 1 of 4 patients recovers completely and nearly 1 in 4 will die within a year of the fracture because of complications.

Broken hips among the elderly is a serious problem. What makes it such a problem is not the broken hip itself, but all the issues that surround it.

Picture this: a healthy 75-year-old, walks daily, is fully independent at home and is happy with her life. She visits her grandchildren and volunteers in her community. One morning, she slips on the stairs, falls, and breaks her hip. She’s brought to the emergency, where she waits to be seen. The doctors admit her so they can operate and replace the broken part.

While waiting, she can’t move, she can’t go to the bathroom without help. Her pain level is sky-high. So, this previously active woman is now lying in bed, completely dependent on others to help her.

She has her surgery and works on recovery. However, her bedrest has led to pneumonia (How Can You Die from Pneumonia?), or because she couldn’t urinate in a bedpan, she was catheterized and may develop a urinary tract infection.

She has little appetite because she isn’t moving around, has pain, there’s no-one to help her, and/or doesn’t like the food. The lack of appetite makes her lose weight and get weaker.

She could develop confusion from the pain, the different medications she’s given, or an infection. The hip may not heal, causing further problems. And the list goes on.

While these scenarios are all maybes and perhaps, they happen and they happen often. To the point that this once healthy, active person is now dependent on others and may not be able to live alone again. According to the American Geriatrics Society Foundation for Health in Aging, for seniors the risk of death in the year following a hip fracture is as high as 20% to 25%. The rate varies depending on the person’s sex, age, race, physical condition, and previous medical history.

Women are more prone to breaking a hip, 2 to 3 times more often than men. Hip fracture rate doubles every 5 years or so after the age of 50 years. The American Academy of Orthopaedic Surgeons reports that white, post-menopausal women have a 1 in 7 chance of fracturing a hip, and that almost half of women who react the age of 90 years fractured a hip.

What can be done to protect our seniors? Prevention is pretty well the only thing that will help. Wherever an older person lives, the environment has to be as fall-proof as possible.

While falling from dizziness or illness happens, most falls happen as accidents. The American Association of Orthopaedic Surgeons offers this page with many tips for seniors to reduce their risk of falls. Some tips include not getting out of bed as soon as they wake up, but to sit on the side of the bed and wait for a moment to make sure their blood pressure doesn’t drop and don’t leave clothes or newspapers on the floor.

I often add other tips such as, no scatter rugs – they are dangerous for slipping. Make sure all electrical cords are tucked away and not where they can be a cause of a trip. If there are runners on the stairs, make sure they’re fastened down well. And, make sure that slippers or shoes have good tread and grip on the floor to prevent slipping.

Since women with osteoporosis have a higher chance of breaking a hip, getting regular check ups, taking medications if prescribed, doing weight-bearing exercises, all help prevent bone mass loss, reducing the risk of a hip fracture.

As the population ages, more hips are going to break. We need to be vigilant and try to prevent as many of them as possible.

Why don’t older people and some sleeping pills mix?

There’s a new study out that says more than half of elderly patients in hospitals who are prescribed sleeping pills (sedatives) are still using them 6 months later. This is disturbing and I would add the issue of all the other medications with sedative effects that this population tends to take and there’s a huge concern, in my opinion.

While it may not seem such a big deal, people taking sleeping pills to get a good night’s sleep, it’s not the sleeping part that is the problem. When we look at the older population, we see a larger number of people with problems that can affect their mobility, their cognition (thought process), and safety. Since sleeping pills are supposed to make you drowsy, if an older person has to go to the bathroom in the middle of the night, this drowsiness could easily make them lose their balance and fall (and breaking a bone or striking their head, for example), they could become disoriented as sedatives can do, or they can not wake up and be incontinent in bed – something that might not have happened otherwise.

There is also the issue of about daytime sleepiness. Many people, young or old, who take sleeping pills experience a daytime effect of lingering sleepiness. This could end up messing up the person’s body clock because of the temptation and need to sleep during the day, starting a vicious cycle of making it hard for them to sleep at night and requiring yet another sleeping pill. The daytime drowsiness could affect their safety and increase falls or, if the person is still driving, could even cause an accident. Someone who is sleepy from a sleeping pill could have cognitive problems, seeming confused and lost when normally he or she wouldn’t be. This could start a whole round of medical concerns from family and friends that aren’t necessary. Someone who is sleepy from sedatives could end up being housebound, increasing social isolation, and they can become less able to care for themselves, starting a downward spiral in self care.

While some of this may seem way off, sadly, it’s not. Medications often work differently in older people than they do in the younger population. Drug testing isn’t usually done in the older age group so it’s not always understood how drugs can affect them.

In this particular study, the sedatives are benzodiazepines. Benzodiazepines are also given for anxiety. According to the study findings, of almost 12,500 patients who had been prescribed a benzodiazepine while in the hospital, more than 6,100 were still taking them over the next 6 months.

So, how does this affect us? If you’re in the population mentioned in this study, be aware of what you are taking. Ask your pharmacist about the drug’s side effects; ask your doctor if there isn’t another type of medication that might be safer for you. If you are the child of someone who may be in this situation, keep in mind that excessive sleepiness, memory issues, falls, things like that, could be the result of your parent taking sleeping pills. If you’re a nurse or a healthcare worker, keep in mind that this can happen to your patients as they are discharged home, so maybe you can keep this in mind when discussing discharge planning.

Sleeping pills have their place – not much replaces a good night’s sleep. But we need to be careful how we go about getting it.