Sleep hygiene: Not the practice of keeping clean but the behaviors we do to try to get to, and to stay, asleep. There is a belief that the older we get, the less sleep we need. The evidence is otherwise. The need for sleep remains about eight hours from young adulthood throughout life. It may be harder to get sleep the older we get because of health problems and other factors. The need for the full night’s sleep is evident in studies that show heart, mood and safety risks associated with less than adequate snooze time. Weight control and immune function have recently been linked to adequate sleep.
One truth is the “early bird” factor, the older we get, the more our circadian clock shifts backwards. Early to bed, early to rise was written by a guy who lived into his eighties at a time life expectancy was about 47 years. Teen-age brains don’t really turn on ‘til mid morning- getting up early to study didn’t help in high school.It is easiest to fall asleep when the body temperature is dropping. A hot shower or bath can keep you at fever temperature for hours. A tepid shower will help more with falling asleep. Remember that one of the ingredients in chocolate is caffeine. Even if there’s not a lot, a sensitive person will take a few hours to metabolize the stimulant. Avoid tea, coffee and soda after the sun goes down. Alcohol may make you feel drowsy but the chances of getting stimulated, restless and staying awake are just as good as going to sleep. Unless you drink enough to pass out in which case this column won’t help you one way or the other.
Darken the room, wear something or nothing, whichever is more comfortable. You might fall asleep in front of the TV but turn it off at bedtime. And have a bedtime! Consistency will help over time. Many people sleep better after sex. That would probably be with a long time partner, (no adventures if you want to rest).

I was at the flu shot event at Live Oak Park last Friday, seeing if my encouragement got anymore folks lined up for the jab. Since I last wrote about flu vaccine I saw a study in the New England Journal of Medicine citing a huge difference in death rates for older adults given flu shots. Up to 48% fewer hospitalizations! What I noticed in the long line in the morning, which quickly dropped to only about ten people waiting and a five minute visit over all, was this. Older people weren’t hurrying to get the shot and get out. They were hanging out with their friends, laughing and joking with the volunteers.
It reminded me of the value of laughter in health. It’s been long established that laughter will produce endorphins, circulate cerebro-spinal fluid and improve breathing. Most non-smokers never take a deep breath without a conscious decision to do so. Unless they’re laughing. The fluid around our brain and spinal cord has no pump, no heart to move it. Laughing does that.
“Words are worlds” and it’s no mistake that the opposite of gravity is levity. Laughter keeps you from the pull of the grave. So what if you have nothing to laugh about? What if you can’t remember the punch line of a joke? TV sure won’t do it. What causes a true belly laugh is the unexpected surprise in a conversation with someone else. Getting out with other people and taking an attitude of openness to the environment is the best thing you can do to find a laugh. You had to be there. Go to the movies or try a new restaurant. Find a group to join.
There is a new senior activity going on at Live Oak Park called Healthy Thursdays from 10 AM to Noon. It is free but they do ask for a reservation. The reason I bring it up is the November 29 topic- Laugh off That Turkey! That should levitate any of us. Call Mary @ 579-0461 to reserve.

One of those aging issues that is talked about is Parkinson’s Disease. PD happens to more men than women, more whites than African or Asian descended and increases with age. For those few unacquainted with the condition, a small part of the brain that regulates movement, called the substantia nigra, atrophies in a Parkinson patient’s brain. The usual symptoms are tremors or “pill rolling” sometimes starting on one side. Shuffling gait and stooped posture are a result of changes in balance. Eventually the person stops having control over starting and stopping motion. The face becomes mask like and the voice may soften or hush.
Recent studies link family members with dementia, especially Alzheimer’s type, to PD. They are very different diseases though. Memory changes with AD are different than the cognitive changes that may occur in late PD- attention rather than language tasks are measurably different. About 30% to 60% have memory changes after 70. Depression is also a concern. Swallowing can become an issue. It is easier to swallow something thick, like juice, than something thin, like water.
There is no cure for PD but there are a lot of treatment options. I read the other day that Parkinsonian rats get some relief from nicotine. There is a reduced incidence of PD with high cigarette and caffeine intake. The protection holds after stopping so there is no reason not to quit smoking, now! It is well established that some medications affect the ability to inhibit behavior; brain implants in PD patients have caused impulse disorders as well. This has led to compulsive gambling among other problems for some patients. Sinemet and other medications often give the person with Parkinson’s a cycle of time where their control is “on or “off.” At one hour they may be thrashing about quite a bit, later the control of movement is very good. In Belgium they have a rating scale to estimate driving safety for PD sufferers. There are a number of other conditions that can easily be confused with PD so be sure a qualified physician diagnoses and treats the symptoms. More info can be found at www.michealjfox.org.

I have tried to think of ways to begin talking about this topic without being too heavy handed or too flippant. The topic is suicide. I know that most of the people reading this will stop now and see what Bruce has to say about financial planning or Tamara about cars. Still, it is so essentially an older adult issue that I can’t let too much time pass without addressing it here.
An older adult completes suicide every 100 minutes in the US. Notice I don’t say he is successful. It is not a success. A completed suicide is a failure of the people and the environment around the person to hear and respond to the signals he’s given that he is at risk. A vast majority of older adults who die by their own hand have visited their doctor in the last month. Very few older adults will not tell someone, in some way, that they are thinking about killing themselves. Sometimes they start to give everything away, make arrangements for pets, and cancel services like meals on wheels or cable TV. Nearly all will admit this is their plan if asked directly.
Some groups are at more risk than others. African-American women seem to be protected by an unknown factor, White men, Asian women, and some other older ethnic/gender groups are more often at risk for suicidal behaviors.
There is basic information that everyone who knows older people should have.
If you ask someone about suicide, they won’t be more likely to do it. You can’t talk someone who is not suicidal into being at risk.
If someone talks about suicide they are at risk. It is a myth that people who talk about it never try it.
Alcohol is less often a factor for older adults and suicide than for younger folks.
Multiple changes, especially losses, will often be related to thoughts of suicide.
If someone you know tells you that they are thinking about suicide you or they can call 1(800) 273-8225 to get help. I’ll write something funny next week.

The Medicare Hotline established by the social security administration reports diminished satisfaction ratings with users who call for help with questions about benefits. I wonder how much of that dissatisfaction is from problems with the way you get information and how much is dissatisfaction with the news you get when you call.
I have seen a number of reports and cases from older adults who have reached the “donut” in Part D benefits- the new drug coverage has a surprise for many people who depend on their insurance to cover medication. When you get to a certain level of expense, they stop paying. The coverage resumes when you reach a new threshold. From about $2400 covered at 75% to $3000 you pay all the drug cost. For some users, accustomed to paying one quarter of the cost of their medication, they suddenly have to pay all of it. That part, the donut, lasts until the drug cost reaches $3051.25 then lowers again. So there is this time bomb of six hundred dollars you didn’t budget. The RAND Corporation reported last month that the real cost isn’t the six bills; it’s that about half of seniors don’t pay it. They miss the medication for as long as ninety days. For hypertension, cardiac and diabetes drugs, there is a higher cost at the point where those conditions cause functional impairment. That point is hastened by “drug holidays”. The difference between what the government expected and what was spent adds up to a rebate from the Part D insurers of … $4 billion! That’s a lot of pills folks didn’t get.
Help doesn’t seem to be available from the Medicare folks but there is a group called The Center for Health Care Rights that can coach you through some of this. If you are a Medicare enrollee living in Los Angeles County and have questions about Medicare or need help resolving Medicare or health insurance-related problems, you can call the Health Insurance Counseling and Advocacy Program at 1-800-824-0780. And the Medicare hotline isn’t just giving bad news. Of more than two hundred people trying to get through the automated answering system, only five got the information they needed. Please press 1 now to exit.

“I yam what I yam and that’s all that I yam, Right Olive?” It looks like the very first super-powered comic character in history may have been on the right track. Popeye got his strength from eating spinach. A recent study published in The Archives of Opthamology reports that spinach and other dark leafy vegetables prevent age related macular degeneration. Other eye problems are also reduced but AMD is the leading cause of blindness in folks between 60 and 80.
In an oddly related story, it seems that poor dentition and dementia have an unexplained relationship as well. A study in England noted that cognitive impairment and tooth loss have a high correlation. (They go together but cause and effect aren’t clear.) There could be inflammation or nutrition factors that create both conditions.
Last week I went on kind of a tirade about hand washing but never said this: Flu is probably carried to your upper respiratory tract by your hands, not from breathing in someone’s sneeze or cough. Advice: don’t touch your face unless you wash your hands first. That is tied for the best way to prevent flu with this: get a flu shot. If your Doctor isn’t giving flu shots, pay the pharmacy students at the corner drug store to give you one. It’s worth it.
So, let me review. Wash your hands. Eat your vegetables. Brush your teeth. Get your shots.
Now lest you mistake me for your mother, Eat chocolate, have a beer or glass of wine now and then and get plenty of physical intimacy. That’s advice every senior can put to use.

I enjoy writing about the lighter side of aging and anyone looking for chocolate after last weeks column should find a soccer player who is raising funds this week. However, my good friend Jeanine Yonashiro is a graduate student in gerontology at USC and reminded me recently that I am in a position to advocate against elder abuse in this space.
She reminds me of the recent news that caregivers for Alzheimer’s sufferers that receive counseling are healthier than those who are unsupported. Since the majority of abusers are family members and caregivers, keeping those people healthy is going to directly reduce the number of abuse cases that occur. Caregiver stress is a superhuman burden and I absolutely encourage those of you who care for a family member or client to seek out help, either from a mental health professional or a peer support group like Leeza’s Place in Sherman Oaks or from a church or religious group in your own community. The important factors are having someone to talk to who won’t try to tell you it’s like when their kids act up, but know what you are dealing with, and won’t be shocked when you tell them how very bad you feel sometimes toward the person who has multiple physical, cognitive and behavior problems.
Dr. Tony Kuo of the L.A.County Public Health tells me that the death rate for dementia is increasing and we don’t have the tools to track it and tell us why. A condition that is still poorly understood in many ways, often managed in isolation and silence, and now increasingly dangerous. How can a caregiver not approach burn-out?
My best advice is to use every resource offered. If the Alzheimer’s Association will pay for respite, take it. If the local hospital gives a support group, go! If your church starts an elder day care, use it. Make a selfish choice now and then. Now I think I need a piece of chocolate.