HealthEducationUSA.com | For the Health Educator in All of Us

Bones are living, breathing, always changing, forms of life.  It is our bones that allow us to run, jump and dance for joy.  Without bones, we would all collapse onto the floor like rag dolls made of blood and fleshy tissue.

Unfortunately, bones sometimes break and to an older American a bone breaking can be devastating and traumatizing.  My grandmother was 78 years old when she suffered a “vertebral compression fracture” by lifting a small basket containing roughly two pounds of newspapers.  She thought she had just pulled a muscle, but the pain was so intense, she needed to see a doctor.  The doctor sent her home with pain pills.  No x-ray was taken, just a quick look and a prescription.

I saw her every day at that time and the pain was becoming more and more intense.  After practically picking her up and taking her to the car, we went to the doctor’s office again.  I was fumed that an x-ray was not taken, for I had fortunately heard of “vertebral compression” fractures.  Finally an x-ray was taken and the diagnosis of osteoporosis was made.

When bones become thin and fragile and more likely to break, it is said you have low bone density, or osteoporosis. The word osteoporosis comes from the Latin word for bone, “osteo” and the Greek word for porous, “poros.”  When putting the two words together, the name osteoporosis literally means “porous bones.”  Healthy bones are not porous like a sponge.  Healthy bones are strong and dense like a brick.

A person with osteoporosis has bones so fragile it doesn’t take much to fracture the bone.  Like my grandmother, lifting a small stack of newspapers, opening a can of soup or walking to the mailbox can cause a vertebral, wrist or hip fracture.  The majority of people who have osteoporosis did not know they had osteoporosis until a fracture occurred.

Hip fractures are of primary concern for those with osteoporosis.  They are the most devastating type of bone fracture and account for almost 300,000 hospitalizations each year. Of hip fracture patients, 20 percent die within a year of the fracture; 20 percent end up in a nursing home within a year and many become isolated, depressed, or afraid to leave home because they fear falling (“Epidemiology”).

Few recognize the importance of our bones.  In America, we talk more of breast cancer, heart disease and stroke.  The truth is, osteoporosis is the leading cause of hospitalizations in women over age 45.  This common bone disease in America accounts for more days in the hospital than breast cancer, diabetes and heart attacks alone (Kanis 1997).

Osteoporosis is a major public health threat to Americans. In the United States today, 10 million individuals already have osteoporosis, and 18 million more have low bone mass, placing them at increased risk for this bone disease (“Osteoporosis”).

As the population ages, osteoporosis represents a growing public health concern.  An estimated 8 million women and 2 million men in the United States have bone density levels in the diagnostic range of osteoporosis (Cosman 2005).

Few recognize the importance of our bones.  In American, we talk more of breast cancer, heart disease and strokes.  The truth is, osteoporosis is the leading cause of stays in the hospital in women over age 45.  This common bone disease in America accounts for more days in the hospital than breast cancer, diabetes and heart attacks alone (Kanis 1997).

As well, the bone disease is costly for society and individuals with the disease. Care for bone fractures from osteoporosis costs nearly $18 billion each year.  The cost of a hip fracture for one individual can be more than $81,000 during their lifetime (“Bone”).

Osteoporosis does not discriminate against race or gender; however, Caucasian women are at highest risk for the disease; 80% of all people with the disease are women.

The good news about osteoporosis is that with education, proper nutrition and exercise, it can be prevented.  Some things to take into consideration in avoiding a fate with osteoporosis include (Cosman 2005):

• Getting enough calcium and vitamin D.

• Exercising frequently and stay active.

• Quitting smoking.

• Avoiding over consumption of alcohol.

• Cutting down on foods high in fat and sugar.

• Getting tested frequently for osteoporosis.

• Talking to your doctor about osteoporosis.

Osteoporosis is a very common condition in America and can be very traumatizing and devastating if a hip fracture occurs due to the disease.  Many of us remember the commercial in which the elderly lady falls and shouts, “Help! I’ve fallen and can’t get up!” This scenario is a reality for too many older Americans.  If an elderly person is living alone and breaks his/her hip, leaving them immobile, it is not unusual to lie there for hours before someone discovers their ill-fate.  The majority of these cases can be prevented by a healthy lifestyle, exercise, medication and education.

Bibliography

Bone Health and Osteoporosis: A Report of the Surgeon General. U.S. Department of Health and Human Services, Office of the Surgeon General, 2004.

Cosman, F. (2005). “The Prevention and Treatment of Osteoporosis: A Review.” Retreived January 12, 2007, from http://www.medscape.com/viewprogram/4011.

Crandall, C. (2006). “Osteoporosis.” Retrieved January 13, 2007, from http://www.medicinenet.com/osteoporosis/article.htm

Epidemiology of Osteoporosis.  Retrieved January 13, 2007, from  http://www.medscape.com/viewarticle/502984_5.

Kanis JA, Delmas PD, Burkhardt P, Cooper C, Torgerson P. (1997). Guidelines for diagnosis and management of osteoporosis.  The European Foundation for  Osteoporosis and Bone Disease. Osteoporosis Int; 7:390-406

Osteoporosis Prevention, Diagnosis, and Therapy. NIH Consensus Statement Online 2000 March 27-29; [cited year, month, day]; 17(1): 1-36.

10 Best Sites to Find Survey Results

• Gallup poll, by The Gallup Organization has studied human nature and behavior for more than 75 years http://www.gallup.com

• Harris Interactive “leverage all communication tools to get inside the minds of consumers, to decode what is really being said, and uncover what is really meant”. http://www.harrisinteractive.com/NewsRoom/HarrisPolls.aspx

• Ipsos Social Research Institute “a world leader in understanding the perceptions of citizens, public service users and other stakeholders”. http://www.ipsos.com/public-affairs/SocialResearchInstitute

• National Opinion Research Center aka National Opinion Research Center, on the University of Chicago’s campus, does social science research in the public interest http://www.norc.org/News/Announcements/

• Pew Research Centerstudies public opinion-”valuable information resource for political leaders, journalists, scholars and citizens”. http://www.people-press.org

• Rasmussen Reports studies public opinion http:// www.rasmussenreports.com

• Zogby International polling, market research, information services, and worldwide business solutions worldwide http://www.zogby.com

• YouGov studies public opinion and consumer behaviour http://www.yougov.co.uk

• Angus Reid Strategies studies worldwide public opinion and democratic processes http://www.angus-reid.com/

• Nanos Research (formerly SES Research) strategic research, executive counsel and innovative solutions http://www.nanosresearch.com

Honorable Mentions

• Nielsen ratings “Providing the complete global view of what consumers watch and buy” http://en-us.nielsen.com/content/nielsen/en_us/news/news_releases.html

• Populus, official pollster of The Times, business, culture and politics http://www.populuslimited.com

Dementia is a psychiatric term commonly associated with elderly persons and is defined as a progressive deterioration in intellectual function and other cognitive skills, leading to a decline in the ability to perform activities of daily living, but without impairment of perception or consciousness. The disorder is often characterized by disorientation, impaired memory, judgment, and intellect, as well as personality changes such as uncontrollable mood swings, apathy, and poor judgment (Beers, 2007).

While it’s true that all people who suffer from Alzheimer’s disease (AD) have dementia, all who have dementia do not suffer from AD.  Thus, AD is a major cause of dementia, about 2/3 of all dementia cases are thought to be caused by AD. However, there are numerous other conditions that are known to cause dementia, the majority of the them are due to neurological disorders, such as (NINDS, 2009):

1. Conditions with Lewy bodies (also associated with Parkinson’s disease).

2. Vascular conditions such as having multiple “mini” strokes, such as (called Multi-Infarct Dementia).

3. Binswanger’s disease (also called subcortical vascular dementia).

4. Viral infections such as HIV/AIDS or postencephalitis syndromes.

5. Brain tumors.

6. Cerebral hypoxia/anoxia (lack of oxygen to the brain).

7. Huntington’s disease.

8. Normal-pressure hydrocephalus.

9. Creutzfeldt-Jakob disease and variants of this disease.

10. Pick’s disease (also known as frontotemporal dementia (FTD).

11. Progressive supranuclear palsy (also known as Steele-Richardson-Olszewski Syndrome).

12. Corticobasal (ganglionic) degeneration.

There are also many other health conditions that are known to cause dementia and dementia-like symptoms that are not due to neurological disorders, these include (Beers, 2007)(NINDS, 2009):

1. Metabolic problems and endocrine abnormalities, such as hypothyroidism.

2. Mental depression.

3. Nutritional deficiencies, such as Vitamin B12 deficiency.

4. Fungal infections such as cryptococcosis.

5. Bacterial infections such as syphilis or Lyme disease.

6. Alcohol ingestion and alcoholism.

7. Heavy metal toxicity.

8. Chronic subdural hematomas.

9. Heart and lung problems.

10. Reactions to medications.

By viewing all the causes known of dementia, it may be easy to understand why it’s so common in older adults. Most people think it’s a normal part of aging. In fact, it was thought to be a normal part of aging up until the 1960s when scientific research proved otherwise (NIA, 2008). Today, it is estimated that 10% of persons age 65 and over have dementia and up to 50% of those over 85 have it (McCabe, 2004).

Memory loss, one of the most common symptoms in dementia, and mild cognitive impairment, can be expected as one gets older in age. After all, as the body ages, nerves may conduct signals more slowly, and the number of nerve cells in the brain typically decreases. As well, nerve cells may lose some of their receptors for messages, and blood flow to the brain decreases. Sometimes as one ages, nerves may repair themselves more slowly and may also do so incompletely. However, these are all signs of normal aging and mild slowing of cognitive processes and not signs of dementia (Besdine, 2007).

It’s when these cognitive process impairments and delays and memory problems begin to disrupt normal life that one should be concerned that it may be a form of dementia. For example, impaired ability to identify objects despite intact sensory function (agnosis), impaired ability to comprehend or use language (aphasia), and/or impaired ability to perform previously learned motor activities despite intact motor function (apraxia) are clinical manifestations of dementia that must be addressed with a medical professional. Other clinical manifestations of concern with dementia include: general apathy, difficulty following directions, getting lost on the way to the store, forgetting a regular dinner guest’s name, progressive difficulty with complex activities such as driving, impaired ability to plan and/or organize (executive functions), volatile mood swings, and poor mental judgment, such as giving away a lot of money (Beers, 2007).

Those are all signs and symptoms of mild dementia, whereby the sufferer often doesn’t even recognize he or she has changed or that there is a problem. In moderate dementia, life begins to become more difficult, as the sufferer loses the ability to learn new information, and becomes increasingly lost and disoriented, even unable to find his or her own bedroom in some instances. This disorientation and confusion leads to even more volatile moods and personality changes (Beers, 2007).

It is in this stage of dementia that psychotic symptoms may occur, including paranoia, like persecutory delusions and generalized suspicions. The sufferer will accuse others of stealing, think strangers have entered their home, or think his or her spouse is cheating. It is also at this stage that wandering and behavior disorders develop as a result of the dementia. Physical aggression, agitation, acting sexually inappropriate, and having disorganized sleeping patterns all manifest in the moderate stage of dementia (Beers, 2007).

The severe stage of dementia is the end stage which results in coma and eventually death. Progressive dementia eventually results in losing the ability to do the most basic of functions, thinking, walking, talking, eating, and holding his or her bladder or bowels. Nothing is spared in this stage, the sufferer doesn’t even have control of the simplest of reflex motor functions, thus, has lost the ability to swallow. Death is usually due to infection originating in the respiratory tract, skin, or urinary tract (Beers, 2007).

Nearly all cases of dementia are irreversible, thus, treatment is in the form of slowing the progression. According to the American Academy of Neurology, cholinesterase inhibitors and vitamin E are used to manage dementia. Cholinesterase inhibitors are thought to improve the quality of life and cognitive functions in sufferers of dementia, including memory, thought and reasoning, they have proven effective for people who are mildly to moderately affected by the dementia, and are under evaluation in treating patients with mild cognitive impairment (MCI) and severe dementia. Vitamin E is also considered to slow the progression of dementia in some cases (McCabe, 2004).

Due to the fact that there are many reasons why dementia can and will manifest, there is no simple answer as to how to prevent dementia. For each reason or cause of the dementia, there may be a preventative measure to follow. Such is the case of a vitamin B12 deficiency leading to dementia, whereby taking vitamin B12 would be the preventative measure and the means of treatment. In the case of Lyme disease causing dementia, prevention would come in the form of avoiding tick bites. However, in most aspects of dementia, such as in AD, there is no known cause, thus making prevention an unfamiliar word in the dementia world.

All is not a loss, however, as research has been aggressive in the past few years as to what causes dementia and what can be done to prevent it and treat it. This research has not shown any direct cause and effect links, but has shown a lot of interesting patterns that may lead to direct links in future research. This is good news, the other good news is that the patterns researchers have found are not of high complexity. Actually, studies have shown that what may prevent dementia are the same preventative measures that help prevent other disabilities: physical activity and exercise, a low fat healthy diet, and maintaining a healthy weight. For the lifestyle factors that lead to common disabling health conditions, such as obesity and a sedentary lifestyle can lead to high blood pressure, heart disease, and diabetes, can also cause dementia. For example, Diabetes (type II) seems to double the risk for dementia, pointing to the fact that preventing obesity, eating a healthy diet, and staying physically active will decrease one’s risk of getting dementia (Brayne, 2007).

However, it is important to point out that researchers singled out physical activity as the prevention method they seem most excited about. “This is supported by meta-analysis of the effect of exercise on cognitive impairment and dementia, which reveals consistent evidence that exercise is associated with improved cognition and less likelihood of developing dementia (Brayne, 2007)”.

Dementia is a scary word to many older adults, as it is often associated with senility. The word alone means “mad mind” in Latin and frequently denotes insanity. As people age, this fear of dementia becomes more prevalent with each time something commonly known is forgotten or misplaced. People joke when they are absent minded saying, “It could be the Alzheimer’s”, or “That’s just my dementia”. Many can loosely define dementia, but not know what it really it. No one knows what causes it, including those who study it. Dementia is as mysterious and puzzling as the clinical manifestations that are associated with it. You can’t see it, yet, it acts like a virus or a parasite, or a hungry, cancerous, tumor, as it slowly, almost methodically, but not predictably, eats away at the victim’s mind. It eats away brain tissue leaving nothing behind in it’s place, as it moves along, following an uncertain path. The term for this disorder should’ve been called “Demontia”, for it acts as if controlled by Satan. It seeks to only destroy and kill. And it does, every time, without a doubt, slowly, and surely, as loved ones look on helplessly watching the slow destruction of their loved ones brain, an assault on the human body’s most vital organ.

References

Beers, M.H., Jones, T.V., et al. (2007). Section 5: Delirium and dementia. Chapter 40. Dementia, The Merck Manual of Geriatrics, Third Edition. (Updated online since the last printing of the book in 2000). Retrieved March 8, 2009 fromhttp://www.merck.com/mkgr/mmg/sec5/ch40/ch40a.jsp

Besdine, R.W. (2007). The aging body: changes in the body. The Merck Manual; Online Medical Library Home Edition for Patients and Caregivers. Last full review/revision August 2007. Retrieved March 8, 2009, fromhttp://www.merck.com/mmhe/sec01/ch003/ch003b.html#sec01-ch003-ch003b-186

Brayne, C. (2007). The elephant in the room — healthy brains in later life, epidemiology and public health. Nature Reviews. Neuroscience. March 2007, 8(3). Retrieved March 14, 2009 from http://proquest.umi.com/pqdweb?index=6&did=1219879661&SrchMode=1&sid=2&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1237063783&clientId=29440

McCabe, R. (2004). Detection, diagnosis, and management of dementia. AAN Guideline Summary for Clinicians. Retrieved March 9, 2009 fromhttp://www.aan.com/professionals/practice/pdfs/dementia_guideline.pdf

NINDS. (2009). Disorders A-Z. . Bethesda MD. Office of Communications and Public Liaison. Retrieved March 8, 2009, fromhttp://www.ninds.nih.gov/disorders/disorder_index.htm

For information regarding specific neurologic disorders associated with dementia, fromNational Institute of Neurological Disorders and Stroke, National Institutes of Health website:

• Binswanger’s disease:http://www.ninds.nih.gov/disorders/binswangers/binswangers.htm

• Cerebral hypoxia/anoxia:http://www.ninds.nih.gov/disorders/anoxia/anoxia.htm

• Creutzfeldt-Jakob disease: http://www.ninds.nih.gov/disorders/cjd/cjd.htm

• Corticobasal ganglionic degeneration:http://www.ninds.nih.gov/disorders/corticobasal_degeneration/corticobasal_degeneration.htm

• Dementia with Lewy bodies (DLB):http://www.ninds.nih.gov/disorders/dementiawithlewybodies/dementiawithlewybodies.htm

• Frontotemporal dementia (FTD):http://www.ninds.nih.gov/disorders/picks/picks.htm

• Huntington’s disease:http://www.ninds.nih.gov/disorders/huntington/huntington.htm

• Multi-Infarct Dementia:http://www.ninds.nih.gov/disorders/multi_infarct_dementia/multi_infarct_dementia.htm

• Normal-pressure hydrocephalus:http://www.ninds.nih.gov/disorders/normal_pressure_hydrocephalus/normal_pressure_hydrocephalus.htm

• Progressive supranuclear palsy:http://www.ninds.nih.gov/disorders/psp/psp.htm

• Postencephalitis syndromes:http://www.ninds.nih.gov/disorders/acute_encephalomyelitis/acute_encephalomyelitis.htm

• Viral infections such as HIV/AIDS:http://www.ninds.nih.gov/disorders/aids/aids.htm

1) American Psychiatric Association http://www.psych.org

2) Merck Manual – Psychiatric Disorders http://www.merck.com/mmpe/sec15.html?WT.z_section=Psychiatric%20Disorders

3) Minds on the Edge http://www.mindsontheedge.org/

4) NARSAD (National Alliance for Research on Schizophrenia and Depression) http://www.narsad.org

5) National Institute of Mental Health http://www.nimh.nih.gov

6) National Mental Health Consumers’ Self-Help Clearinghousehttp://www.mhselfhelp.org/

7) SAMHSA – Substance Abuse and Mental Health Services Administration National Mental Health Information Centerhttp://mentalhealth.samhsa.gov/

8 ) World Federation for Mental Health (WFMH) http://www.wfmh.org

9) World Health Organization – Mental Healthhttp://www.who.int/mental_health/en/

10) World Psychiatric Association http://www.wpanet.org/

Honorable Mentions:

• Judge David L. Bazelon Center for Mental Health Law http://www.bazelon.org

• Mental Health Americahttp://www.mentalhealthamerica.net/

Before you invest in a medical or health product or service, do your due diligence and research that product or service! Is it evidence based or a just rip off? Will it make you sick or sicker? Is it a scam? Is is reliable and valid?

• 1. Center for Medical Consumers

Do you know that many medical treatments are based on little or no proof of long-term safety or effectiveness? Their advocacy is about protecting the public from harm and making those who profit from health care accountable for the safety and quality of their products and services.

http://medicalconsumers.org/

• 2. Consumers Union

The nonprofit publisher of Consumer Reports magazine, provides information on a variety of consumer issues, including health care, financial services, food safety, product safety and more.

http://www.consumersunion.org

• 3. Federal Citizen Information Center

http://www.pueblo.gsa.gov/results.tpl?id1=16&startat=1&–woSECTIONSdatarq=16&–SECTIONSword=ww

• 4. Federal Trade Commission’s Health Page

Learn how to spot health scams, like fake cancer cures and bogus weight loss products, or get the facts on different health products and services, like generic drugs, Lasik eye surgery, and dietary supplements.

http://ftc.gov/health

• 5. Junk Science

“Junk science” is faulty scientific data and analysis used to further a special agenda. The junk science “mob” includes: media, personal injury lawyers, social activists, government regulators, businesses, politicians, individual scientists, individuals. Learn what junk science is, how to recognize it, and what you can do about it.

http://junkscience.com

• 6. National Consumer Protection Week (NCPW)

A coordinated consumer education campaign that encourages individuals across the country to take full advantage of their consumer rights. Many health topics.

http://consumer.gov/ncpw

• 7.  National Consumers League

NCL provides government, businesses, and other organizations with the consumer’s perspective on concerns including child labor, privacy, food safety, and medication information. NCL is home to the LifeSmarts program, Child Labor Coalition, NCL’s Fraud Center, and SOS Rx Coalition.

http://www.nclnet.org/health

• 8. National Council Against Health Fraud

NCAHF is a private nonprofit, voluntary health agency that focuses upon health misinformation, fraud, and quackery as public health problems.

http://www.ncahf.org/

• 9. Quackwatch

An international network of people who are concerned about health-related frauds, myths, fads, fallacies, and misconduct. Its primary focus is on quackery-related information that is difficult or impossible to get elsewhere. Also your gateway to: Acupuncture Watch, Autism Watch, Bioethics Watch, Cancer Treatment Watch, Diet Scam Watch, Mental Health Watch, NutriWatch, Device Watch and many more!

http://www.chsourcebook.com

• 10.  The U.S. Consumer Gateway

a one-stop link to a broad range of federal information resources available online. Search for information on food, health, product safety, finances, and transportation.

http://consumer.gov/ncpw/category/health/

Honorable Mentions:

• The Patient’s Guide

Written by true national and international experts, the Patient’s Guide provides the preeminent resource for patients seeking information about skin care and beauty topics. We list more than 250 physician-supervised offices around the US and Canada and are proud to feature some of the most experienced and trusted cosmetic physicians in the world.

http://www.patientsguide.com

• Consumer World®

is a compilation of useful consumer resources on the Internet, including product reviews, discount travel, consumer agency contacts, mortgage rates, wholesale car prices, general finance tips and more.

http://www.consumerworld.org/pages/health.htm

• Consumer Federation of America

Consumer Federation of America (CFA) has provided consumers a well-reasoned and articulate voice in decisions that affect their lives. Day in and out, CFA’s professional staff gathers facts, analyzes issues, and disseminates information to the public, policymakers, and the rest of the consumer movement.

http://www.consumerfed.org/health/default.asp