Sunday, January 31, 2010

Dream America: But who will talk to aging immigrants now?

CALIFORNIA: They gather five days a week at a mall called the Hub, sitting on concrete planters and sipping thermoses of chai. These elderly immigrants from India are members of an all-male group called The 100 Years Living Club. They talk about crime in nearby Oakland, the cheapest flights to Delhi and how to deal with recalcitrant daughters-in-law.

Together, they fend off the well of loneliness and isolation that so often accompany the move to this country late in life from distant places, some culturally light years away.“If I don’t come here, I have sealed lips, nobody to talk to,” said Devendra Singh, a 79 year old widower. Meeting beside the parking lot, the men were oblivious to their fellow mall rats, backpack-carrying teenagers swigging energy drinks.

In this country of twittering youth, Singh and his friends form a gathering force: the elderly, who now make up America’s fastest-growing immigrant group. Since 1990, the number of foreign-born people over 65 has grown from 2.7million to 4.3million –or about 11 per cent of the country’s recently arrived immigrants. Their ranks are expected to swell to 16 million by 2050. In California, one in nearly three seniors is now foreign born, according to a 2007 census survey.

Many are aging parents of naturalized American citizens, reuniting with their families. Yet experts say that America’s ethnic elderly are among the most isolated people in America. Seventy per cent of recent older immigrants speak little or no English. Most do not drive. Some studies suggest depression and psychological problems are widespread, the result of language barriers, a lack of social connections and values that sometimes conflict with the dominant American culture, including those of their assimilated children.

The lives of transplanted elders are largely untracked, unknown outside their ethnic or religious communities. “They never win spelling bees,” said Judith Treas, a sociology professor and demographer at the University of California, Irvine, “They do not join criminal gangs. And nobody worries about Americans losing jobs to Korean grandmothers.”

Singh, the widower, grew up in a boisterous Indian household with 14 family members. In Fremont, he moved in with this son’s family and devoted himself to his grandchildren, picking them up from school and ferrying them to soccer practice. Then his son and daughter-in-law decided, “they wanted their privacy,” said Singh and undertone of sadness in his voice. He reluctantly concluded he should move out.
“In India there is a favorable bias toward the elders,” Singh said, sitting amid Hindu religious posters and a photograph of his late wife. “Here people think about what is convenient and inconvenient for them.”

Sociologists call Singh and his cohort the “5 generation,” distinct from the “1.5 generation”-younger transplants who became bicultural through school and work. Immigrant elders leave a familiar home, some without electricity or running water: for a multigenerational home in communities like Fremont that demographers call ethnoburbs.

For the men in the 100 Years Living Club, the road leads to the Hub, where they have been meeting for 14 years, since the Target store was a Montgomery Ward. Patel, who was an herbal doctor in India, started the group after he noticed his friends were in “house prisons,” as he put it, without even the confidence to use a bus. The men keep their spirits alive by sharing homemade chaat snacks. They are the lucky ones.

Courtesy: Patricia Leigh Brown

Friday, January 29, 2010

Asthma and older people

Asthma is a chronic inflammatory disease of the airways, characterized by airway obstruction and increased airway responsiveness to different stimuli. The obstruction is reversible, either spontaneously or in response to treatment. The increase in airway responsiveness may be evident with specific stimuli like cat antigens, ragweed, or dust mites, or with non-specific stimuli like irritants, smoke, odors, infections, methacholine and histamine.

Prevalence of asthma among the elderly resembles the prevalence in the general population, at 5-7 percent. Many of them develop asthma symptoms for the first time at the age of 60 or 70 years, while there are others who age with asthma.

Under-diagnosis of asthma a problem with older people

Asthma is not just a childhood disease; it can occur at any age. The classic symptoms of asthma — coughing, wheezing, breathlessness and tightness of chest — can easily be misinterpreted as part of normal ageing or be misdiagnosed as other health problems in older adults. Older people may not report their symptoms; may attribute their symptoms to another illness or disease or normal ageing; or may simply ignore their symptoms. Here are some of the most common reasons for unrecognized asthma in older people.

·Heart or lung diseases with similar symptoms to asthma, such as wheezing, can mask the presence of asthma.

·The actual symptoms of asthma might be dismissed as other conditions. For example, a chronic cough might be mistaken for bronchitis, or the inability to sleep during the night may be dismissed as insomnia.

Conditions which have symptoms in common with asthma in the elderly include:

§ Chronic obstructive pulmonary disease (COPD);

§ Chronic bronchitis, emphysema, or acute respiratory illness;

§ Rhinosinusitis with postnasal drip;

§ Tuberculosis;

§ Gastro-oesophageal reflux; and

§ Cardiac diseases such as congestive heart failure, acute myocardial infarction (heart attack) or cardiac arrhythmia (abnormal heart rhythm).

Different triggers in older adults

Triggers for asthma attacks can differ in older adults with asthma from those most commonly affecting children with asthma. In older adults, viral respiratory illnesses (for example, colds and ‘flu), and airborne allergens are the most common triggers. This is why it’s important that older adults have an influenza vaccination every year. Pneumococcal vaccine is also recommended for all people who are over 65.

Some medications used frequently in older adults are also known to trigger asthma or make symptoms worse. Examples include: aspirin and other anti-inflammatory medications used to treat arthritis and other pain; beta-blockers used to treat hypertension (high blood pressure) and heart disease; and beta-blocking eye drops used to treat glaucoma. For this reason, it is important to keep a list of all the medications you currently use and show it to your doctor at each visit.

Complications of asthma in the elderly

In addition to the issues above, changes in lung structure and function brought about by normal ageing may make the problems associated with asthma worse in the elderly.

Also, normal, age-related changes in the body mean that older people with asthma are more susceptible to adverse effects from the very medications they are taking to control their asthma. They may also be at risk of adverse interactions between different medications they are taking.

Remembering to take medications for chronic conditions, such as asthma, may be more of a challenge for older people than younger ones. Also, problems with co-ordination or arthritis of the hands may make using puffers and other asthma medication delivery devices difficult, and problems with eyesight may affect ability to read labels. If you have problems coordinating drug release and inhalation, you may find it easier using the puffer in conjunction with a spacer. Alternatively, you may be better off using a breath-activated device such as an Accuhaler, Autohaler or Turbuhaler.

Questions for older adults who suspect they may have asthma

· Have you experienced an attack or recurrent attacks of wheezing?

· Have you had a troublesome cough or wheeze on waking up in the morning?

· Do you have a tendency to cough or wheeze after exercising?

· Do you experience a cough, wheeze or chest tightness after exposure to airborne allergens or pollutants?

· Do colds go to your chest or take more than 10 days to clear up?

What to do

If asthma is suspected, see your doctor who will make a diagnosis and prescribe the appropriate treatment. Making the diagnosis will probably involve doing some basic lung function tests, performed before and after using an asthma reliever medicine. Many doctors have such testing equipment in their surgeries and it can be done by them or their practice nurses. They may also order a chest X-ray to rule out other disorders or to diagnose co-existing conditions.

You should also follow the same recommended general rules for the control of asthma that all people with asthma are encouraged to follow;these will be incorporated in the written asthma action plan that you develop with your doctor.


Thursday, January 28, 2010


1) WHO estimates show that 300 million people currently suffer from asthma. As many as 255, 000 people died of asthma in 2005.

2) Asthma deaths will increase in the next 10 years if urgent action is not taken. Asthma cannot be cured, but proper diagnosis, treatment and patient education can result in good asthma control and management.

3) Asthma occurs in all countries regardless of level of development. Over 80% of asthma deaths occur in low and lower-middle income countries. For effective control, it is essential to make medications affordable and available, especially for low-income families.

4) Asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person.

5) Symptoms may occur several times in a day or week in affected individuals. For some people the symptoms become worse during physical activity or at night. Failure to recognize and avoid triggers that lead to a tightened airway can be life threatening and may result in an asthma attack, respiratory distress and even death.

6) Through appropriate treatment such as using inhaled corticosteroids to ease bronchial inflammation, the number of asthma-related deaths can be reduced.

7) Asthma is the most common chronic disease among children. But it can be controlled through different prevention and treatment plans according to individual symptoms.

8) The strongest risk factors for developing asthma are exposure to indoor allergens such as house dust mites in bedding, carpets and stuffed furniture; pollution and pet dander; outdoor allergens such as pollens and moulds; tobacco smoke and chemical irritants in the workplace.

9) Asthma triggers can include cold air, extreme emotional arousal such as anger or fear, and physical exercise.

10) Asthma is often under-diagnosed and under-treated, creating a substantial burden to individuals and families and possibly restricting individuals’ activities for a lifetime.


Friday, January 22, 2010

UTI May be Cause of Sudden Confusion in Elderly

A Urinary Tract Infection May Cause an Older Person to be Confused

If an older person becomes suddenly confused, some people may think that the elder must be developing Alzheimer’s disease. Others may mistakenly assume that confusion is normal for all older people. If seeking advice from a healthcare provider regarding a quick onset of confusion, you might be surprised if the doctor orders a urine specimen. Actually, a urine specimen is not a bad idea since urinary tract infections (UTIs) are a common cause of delirium in the elderly.

Prevalence of UTI in the Elderly

Urinary tract infections, with or without symptoms, are quite common in the elderly.

  • According to a 2005 article in Drugs Aging by Florian M.E. Wagenlehner et. al. entitled Asymptomatic Bacteriuria in Elderly Patients, 20-25% of women and 10% of men over the age of 65 experience asymptomatic bacturiuria.
  • People over 80 years are even more likely to develop asymptomatic bacteriuria: over half of women and over a third of men.
  • According to The Merck Manual of Geriatrics, as many as 10% of all elders have symptomatic UTIs.

Asymptomatic (without symptom) UTIs in the elderly are usually not treated unless the benefits outweigh the risks, but recognizing and properly treating a symptomatic UTI in an elderly person may help prevent more serious infections and complications.

Common Symptoms of UTI in Elders

  • Painful urination
  • Frequency or more frequent urination
  • Incontinence or incontinence that is unusual for that person
  • Flank pain
  • Fever
  • Confusion or delirium

Common Risk Factors for UTI in the Elderly

  • Use of urinary catheters
  • Living in a long-term care facility or nursing home
  • Hormonal factors such as estrogen deficiency in women
  • Anatomical factors such as an enlarged prostrate in men or a cystocele in women
  • Functional factors such as Parkinson’s disease or dementia
  • Metabolic factors such as diabetes
  • Factors related to immunity such as increased cytokines and acute phase proteins

Measures to Prevent UTI

Prevention is the best and safest approach.

  • Limit the use of chronic indwelling catheters
  • If a catheter is necessary, perform appropriate catheter care and consistently use appropriate infection control guidelines while maintaining a closed drainage system.
  • Recognize and replace an obstructed catheter.
  • Prevent catheter trauma, such as pulling on tubing with a transfer from bed to chair.
  • Employ generally accepted hygienic measures, such as keeping the perineal area clean and dry and wiping from front to back.
  • Oral lactulose showed promising results in a study published in the 1989 Journal of Hospital Infections entitled Lowered prevalence of infection with lactulose therapy in patients in long-term hospital care.
  • Intravaginal estriol is often recommended for postmenopausal women with recurrent UTIs due to studies showing significantly lower rates of UTI with the use of estriol.
  • Certain vaccinations may be recommended for special populations.
  • Future studies are focusing on developing materials in urinary catheters that resist biofilm formation, according to a 2005 article in Drugs and Aging entitled Catheter-related urinary tract infections by Lindsay Nicolle.

Confusion May be Reversed

Is sudden confusion permanent? The answer to that may depend on whether or not and how quickly a cause is determined. Caregivers of the elderly should be particularly watchful for changes in an elder’s mental status and should contact a healthcare provider of any acute confusion or sudden worsening of existing confusion. Ruling out a UTI would be an appropriate early step if an elder suddenly became confused or had worsening confusion. Early treatment of a symptomatic UTI may prevent more serious symptoms and complications and can quite possibly result in a return to the elder’s normal mental status.