HEALTH EYE AND SIGHT HEALTH Mom used to be an avid reader. She still likes to handle her books. She reads the opening page over and over again with obvious pleasure. Often she’ll read her favorite paragraph out loud to you, each time with the exact same intonations. Even if she never gets past that first page, it’s still important to her that she can see well enough to read it. You’ll want to take her for regular checkups with an ophthalmologist, at least once a year. She’ll have a thorough eye exam, which will identify problems that are common in the elderly. The following are the conditions the doctor will look for. Glaucoma is a buildup of pressure in the inside of the eye. Usually occurring without any symptoms, it is easily diagnosed during the course of a routine eye examination. Untreated, glaucoma causes damage to the optic nerve, with gradual, painless loss of vision. Eye drops are usually effective at preventing the vision loss. Advanced cases may require laser treatment or other surgery. Age-related macular degeneration affects the macula, the central part of the retina, the lining of the back of the eye. As the macula begins to deteriorate, the central vision becomes blurry, affecting reading and detail. In its advanced form, people are left with large central blind spots, seeing only in the periphery of their field of vision. Recognizing faces, watching TV and reading become impossible. Treatment with vitamins may be helpful in slowing down the progression in some cases. Leakage, associated with wet macular degeneration, can sometimes be treated with laser and photodynamic therapy. Cataract is a term used for a clouding of the lens of the eye. It develops in everyone as they age although does not always require treatment. If the vision becomes blurry as a result of cataract, treatment involves removal of the cloudy lens and replacement with a new, clear lens, called a lens implant. Surgery involves phacoemulsification which uses ultrasound to break up and vacuum out the cloudy lens. Lasers are used to treat films that may develop years after surgery. The surgery is usually quick and easily tolerated by the elderly, typically being done in ten minutes or less under a local anesthetic. Diabetic retinopathy. Diabetes causes leakage from the tiny blood vessels in the back of the eye. The leakage, untreated, causes blurring of the vision. More advanced diabetes causes fragile blood vessels to break and bleed inside the eye. This results in severe vision loss. The treatment involves use of laser to reduce the leakage or more advanced surgical techniques to remove the blood from the back of the eye. For more detailed information on eye health, go to: National Eye Institute or contact them at: National Eye Institute 31 Center Drive MSC 2510 Bethesda, MD 20892-2510 (301) 496-5248 DENTAL HEALTH Toothaches, gum disease and other dental problems can aggravate Alzheimer’s disease. It’s a good idea to take Dad for a cleaning and checkup every three to four months, if he can handle it. His dentist can probably catch cavities before they become a serious problem. A toothache can be serious for Dad. It can cause eating problems and lead to infections of the gums. He may also be experiencing pain that he isn’t able to convey to you. Toothaches, gum disease and other dental problems can aggravate Alzheimer’s disease. Dad doesn’t want to brush his teeth. He may be reluctant because he’s forgotten how to use toothpaste or may even have difficulty with the brushing itself. Try making it a shared experience by brushing your own teeth at the same time. Chat about how he taught you to brush correctly, which will allow you to casually demonstrate for him: “This is how you showed me when I was little. I still brush exactly the same way, see?” Toothpaste is not healthy when consumed. If you think Dad may be swallowing it, you can apply only a small dab to his wet brush, just enough to add a little flavor. Since adult toothpaste tends to be quite strong, it may irritate his gums. You can switch to children's toothpaste, which is safer when swallowed, milder, and comes in a variety of flavors. You may even leave out the paste altogether, because it’s the brushing itself that’s important. You’ll want to get him a soft bristle brush, possibly in a child’s size if that will help him reach back to his molars. It’s a good idea to soak his brush (and your own) overnight in a mixture of half and half water and peroxide to kill germs. When Dad can no longer brush by himself, you’ll have to do it for him. If he hesitates having you do it for him, I have found this to work: Have him sit in a low chair, so you can comfortably stand behind him and cup his chin in one hand while you lean over him brush his teeth with the other. You’ll want to make sure that his gums get massaged well and if he’ll let you, you can floss his teeth as well (Good luck on that one.) It may take a few tries before you’re both comfortable with this new routine. PS: Since he can't see you, you'll want to talk to him, tell him what you're doing - he will feel safer if you talk to him and explain what you’re doing and why. Use a light positive tone and you can even joke about your own awkwardness, since this is new to both of you - and find a way to praise or compliment him. (Example:"You've always taken such good care of your teeth (even if he didn't) and we're so lucky to have our own teeth, aren't we?") If you’re not sure how to go about this, ask his dentist demonstrate for you. Having his dentist involved makes it easier for you to honestly tell him that this is doctor’s orders, even if he doesn’t remember. Dentures Dad wears dentures. Check his gums periodically. Red spots can be from irritation caused by food particles, which have worked their way under the plate, making his gums tender. The spots may also be caused by a bad fit, causing the dentures to be rubbing on his gums. Talk to his dentist for advice on this. For more information, go to: Medline: Dental Health or National Institute of Dental and Cranial Research National Institutes of Health Bethesda, MD 20892-2190 301/496-4261 FOOT CARE In her day Mom never missed her bi-monthly pedicures. You’ve been doing your best to keep them up because they always make her feel good. Lately however she has been making funny little noises when she walks. Because of her dementia she may not be able to tell you what’s bothering her. Her toenails could be rubbing against the front of her shoe making every step uncomfortable or maybe her shoes don’t fit her right anymore. She may also have bunions, corns or calluses that are too subtle for you to detect. Look for reddish areas and feel her skin. Calluses may not be visible but they can be warm to the touch. If untreated, calluses can become ulcerated or infected. You’ll want to start taking her to a podiatrist for a nail clipping and checkup every three months. It may not be as fancy as her pedicurist, but a podiatrist can identify the problems and advise you on regular care, including the best footwear for her. Another common condition is athlete’s foot, which flourishes in the damp environment of socks and shoes. Walking barefoot or in sandals is a good way to minimize this problem. You can make up for the luxury of the pedicure by giving her foot-baths and rubbing her feet with fragrant lotions. If Mom is a diabetic you’ll want to be extra vigilant and talk to her podiatrist about the extra care you need to give her at home. Footwear: You’ll want to make sure that Mom’s shoes are a good comfortable fit. Soft pliable leather shoes or sandals that are securely fastened on the foot. Avoid slip-ins, clogs or flip-flops. For more information, go to: Podiatric Medical Association or call: 800-366-8227 HEARING HEALTH Mom appears to have problems with her hearing lately. You’re wondering if you need to get her a hearing aid. You take her to a hearing center for tests. It turns out that it’s only a serious accumulation of wax in her ears. A quick cleaning takes care of the problem. After this visit you decide to take her back for regular visits every few months. If it turns out that Mom is in fact hard of hearing, you have some tough decisions to make. A person has to learn how to use a hearing aid, which may be virtually impossible for an Alzheimer’s person. Even when an Alzheimer’s person has used a hearing aid before, she may have difficulties with the adjustments. If Mom is hard of hearing, there are a couple of remedies available over the counter. For television viewing you can get a cordless set of headphones and for general use you can get Mom a sound amplifier, which works with a simple earplug. With the latter, just be aware that Mom’s own speech will be amplified as well, likely startling her. National Institutes on Deafness and Other Communication Disorders, go to: National Institues on Deafness and Otehr Communication Disorders or: National Institutes of Health 31 Center Drive, MSC 2320 Bethesda, MD 20892-2320 ©New Harbinger Publications