by Judith Graham

By all accounts, the woman, in her late 60s, appeared to have severe dementia. She was largely incoherent. Her short-term memory was terrible. She couldn’t focus on questions that medical professionals asked her.

But Malaz Boustani, a doctor and professor of aging research at Indiana University School of Medicine, suspected something else might be going on. The patient was taking Benadryl for seasonal allergies, another antihistamine for itching, Seroquel (an antipsychotic medication) for mood fluctuations, as well as medications for urinary incontinence and gastrointestinal upset.

To various degrees, each of these drugs blocks an important chemical messenger in the brain, acetylcholine. Boustani thought the cumulative impact might be causing the woman’s cognitive difficulties.

He was right. Over six months, Boustani and a pharmacist took the patient off those medications and substituted alternative treatments. Miraculously, she appeared to recover completely. Her initial score on the Mini-Mental State Examination had been 11 of 30 — signifying severe dementia — and it shot up to 28, in the normal range.

An estimated 1 in 4 older adults take anticholinergic drugs — a wide-ranging class of medications used to treat allergies, insomnia, leaky bladders, diarrhea, dizziness, motion sickness, asthma, Parkinson’s disease, chronic obstructive pulmonary disease and various psychiatric disorders.

Older adults are highly susceptible to negative responses to these medications. Since 2012, anticholinergics have been featured prominently on the American Geriatrics Society Beers Criteria list of medications that are potentially inappropriate for seniors.

“The drugs that I’m most worried about in my clinic, when I need to think about what might be contributing to older patients’ memory loss or cognitive changes, are the anticholinergics,” said Rosemary Laird, a geriatrician and medical director of the Maturing Minds Clinic at AdventHealth in Winter Park, Fla.

Here’s what older adults should know about these drugs:

The basics

Anticholinergic medications target acetylcholine, an important chemical messenger in the parasympathetic nervous system that dilates blood vessels and regulates muscle contractions, bodily secretions and heart rate, among other functions. In the brain, acetylcholine plays a key role in attention, concentration, and memory formation and consolidation.

Some medications have strong anticholinergic properties, others less so. Among prescription medicines with strong effects are antidepressants such as imipramine (brand name Trofanil), antihistamines such as hydroxyzine (Vistaril and Atarax), antipsychotics such as clozapine (Clozaril and FazaClo), antispasmodics such as dicyclomine (Bentyl) and drugs for urinary incontinence such as tolterodine (Detrol).

In addition to prescription medications, many common over-the-counter drugs have anticholinergic properties, including antihistamines such as Benadryl and Chlor-Trimeton and sleep aids such as Tylenol PM, Aleve PM and Nytol.

Common side effects include dizziness, confusion, drowsiness, disorientation, agitation, blurry vision, dry mouth, constipation, difficulty urinating and delirium, a sudden and acute change in consciousness.

Unfortunately, “physicians often attribute anticholinergic symptoms in elderly people to aging or age-related illness rather than the effects of drugs,” according to a research review by physicians at the Medical University of South Carolina and in Britain.

Seniors are more susceptible to adverse effects from these medications for several reasons: Their brains process acetylcholine less efficiently. The medications are more likely to cross the blood-brain barrier. And their bodies take longer to break down these drugs.

This column is produced by Kaiser Health News, an independent news service that is not affiliated with Kaiser Permanente.

by in Health

Bouts of dizziness are common for seniors, with 30 percent of people over age 60 and 50 percent of people over age 85 experiencing dizziness. But while this issue is common, that does not mean it can be shrugged off as a natural part of aging.

With the right care, dizziness can often be treated. Here are five things that can cause dizziness and what can be done to treat it.

Vertigo

You may think vertigo and dizziness are the same thing, but vertigo is a specific kind of dizziness in which individuals feel like their world is spinning. The most common kind of dizziness for seniors is benign paroxysmal positional vertigo (BPPV), which is caused by crystals in the inner ear becoming dislodged. If BPPV is the cause of your dizziness, it can be treated with some simple maneuvers that help the crystals move back into place.

“Vertigo can not only be frustrating for seniors, but it can also be deadly,” says Clay Gardner, executive director at Vista Knoll Specialized Care Facility. “Untreated, dizziness can lead to falls, which can cause broken bones and even death. Getting appropriate treatment can help cure vertigo and avoid dangerous complications.”

Infections

Sudden vertigo that lasts up to a week could be the result of a prior infection. Vestibular neuritis is often caused by a viral respiratory illness like the flu that causes the nerve cells in the inner ear to become inflamed. Vertigo caused by infections can be treated with anti-nausea medication or physical therapy. Steroids for inflammation can also help bring down the swelling in the inner ear.

Medications

Some medications can cause dizziness, especially among elderly patients. For people with high blood pressure, hypertension medication could be to blame for dizziness that happens when they get up too quickly. Other medications like salicylates and some cancer drugs can cause permanent damage to the inner ear, affecting a person’s hearing and balance. Unfortunately, people who are taking medicine for dizziness could actually end up with more dizziness, as some sedatives can worsen the symptoms.

Meniere’s Syndrome

If you have dizziness along with ringing in your ear, distorted hearing, and nausea, you may have Meniere’s syndrome. These attacks can last for a few minutes or for several hours. Meniere’s can be treated on several fronts, including diet and medication. Limiting salt and caffeine can help, and anti-nausea medication might provide some relief.

Stroke or TIA

Strokes, or transient ischemic attacks (TIA), aren’t the most common reasons for dizziness in seniors, but they are one of the most serious. Because time is of the essence when treating a stroke, it is important to rule stroke out when sudden dizziness occurs. Symptoms of a stroke can be similar to vestibular neuritis, so you should seek medical attention the first time you experience dizziness to figure out what is causing it. People who are having a stroke often have other symptoms like confusion, numbness, or slurred speech. Even without other symptoms, someone with dizziness could still be having a stroke or TIA, which can lead to a stroke.

Dizziness is a common complaint among seniors, but it does not need to be a fact of life. If you are experiencing dizziness, get medical attention. Your doctor can help determine what is causing your dizziness and figure out the best treatment.

by Dr. Linda Chous, OD, chief eye care officer with UnitedHealthcare

Are my eyes going to keep getting worse as I age? Is there anything I can do to slow the progression of vision decline?

By no means is your eyesight guaranteed to deteriorate with age, but it is perfectly normal to notice changes to your vision as the years pass. Unfortunately, there is nothing that can be done to stop normal vision changes. However, it is important to maintain regular appointments with your eye doctor to help identify pressing concerns.

Although changes are often normal, they can also be signs of conditions like cataracts or even diabetes. If you experience sudden vision loss or any rapid change to your eyesight, contact your eye care provider immediately.

Many people notice tiny specks within their field of vision. These small spots are tiny threads of protein that float across the gel-like substance between your eye’s lens and retina.

Usually there is no need to worry if you only notice these spots occasionally and they disappear after a few minutes, but only a dilated eye examination can determine the cause of the “floaters”.

However, if your vision is overcome by these specks or you are noticing vision loss, contact your eye doctor as soon as possible, as it could be a symptom of a sight-threating condition.

Age-related macular degeneration (AMD)is the leading cause of vision loss in people over the age of 65. AMD causes damage to the macula, the small spot on the retina that enables people to see clearly and to view things straight ahead of them.

Common symptoms of AMD are distortion and blurring of the center of your field of vision. If caught in the early stage, there are potential benefits from taking certain prescription medications and nutritional supplements.

The lens in your eye is like a camera lens – it is clear and allows light to pass through to create an image. A cataract is the clouding of this lens, blocking the flow of light to the back of your eye (retina), which ultimately causes loss of sight.

There are many kinds of cataracts, and most usually form slowly and do not cause pain. If the clouding is small, it is possible you may not even notice it. However, significant clouding can form in some people and, ultimately, negatively impact vision.

The good news is cataracts are treatable via surgery that removes the clouded lens and replaces it with a clear plastic lens. Cataract surgery is generally safe and is one of the most common surgeries done in the United States and recovering after cataract surgery is also pretty easy too! Once a cataract is removed, it cannot grow back

Glaucoma is caused by increased pressure inside the eye, which can cause permanent vision loss and blindness if left untreated. There are several types of glaucoma, but the most common form usually has no noticeable symptoms in the early stages – the only way to detect it is by visiting your eye care provider for routine testing.

What are the best ways to keep my eyes healthy as I age?

Maintaining a healthy lifestyle is as important for your eye health as it is for your overall physical health. Some of the best ways to protect your eyes as you age include:

* Stop smoking. Smokers are up to four times more likely to develop AMD and may contribute to the development of cataracts.

* Maintain a healthy weight. Conditions associated with being overweight, like diabetes and heart disease, increase your risk of developing vision loss from cataracts, glaucoma and retinopathy.

* Wear sunglasses. Help protect your eyes from harmful ultraviolet rays (read on to learn why it is so important).

* Be physically active. A study found people who are physically active experienced less vision loss over 20 years compared to those who didn’t exercise.

* Eat a healthy diet. Colorful fruits and vegetables like leafy greens, tomatoes and blueberries, contain nutrients that can keep your eyes healthy and reduce the risk of AMD.

Staying on top of your eye exams is crucial to helping maintain your eye health as you age. You should aim to see your eye doctor annually even if your vision hasn’t changed.

The purpose of HICAP is to provide free unbiased counseling and community education on Medicare A, B, C, & D. HICAP completes comparisons on all products of C & D, retiree/employer Group vs. Medicare. HICAP resolves billing issues and to help apply for appeals. HICAP’s speaker bureau gives presentations on Medicare 101, Prevention Services, Long Term Care, on all aspects of Medicare products, and on Medicare changes for the new year. HICAP gives advice regarding healthcare insurance options for those contemplating retirement.

Health Insurance Information and Assistance

Agencies offer assistance with filling out forms, submitting bills, and completing other paperwork necessary for reimbursement.

Frequently Asked Questions

What is HICAP-Medicare Program?

HICAP is short for Health Insurance Counseling and Advocacy Program funded through the Older American Act. This service is free. The United States Department of Aging sends funding to the Center of Medicare and Medicaid Services. HICAP is national volunteer Medicare program that gives free and unbiased counseling, and comparisons on all Medicare Health Insurance and Medicare Prescription Drug Plans. The HICAP program also resolves Medicare, HMO, and Prescription Drug complaints for Medicare beneficiaries.

How does it work?

Every year Medicare has its Annual Election Period beginning October 15 through December 7. This is the time all Medicare beneficiaries need to re-evaluate their health plan and prescription drug plan.

Why would a Medicare beneficiary need to reevaluate his or her current plan?

Medicare plans change every year, so it is important to reevaluate your plan every year. If you are a low-income subsidiary for Medicare Part D or a Medicare beneficiary, you will have to reevaluate your plan during the open enrollment period. HICAP can help you complete your choice for a plan that is right for you. You want to make sure that you don’t incur more expenses because your plan changes. Be aware that some plans terminate their contract with Medicare.

How does someone enroll to receive help?

If you will soon be eligible for Medicare or if you are already a Medicare beneficiary, you can call the HICAP program for a personal appointment to go over all your options on Medicare at 805-477-7310. HICAP services are free and unbiased. We do not sell any products.