Tag Archives: Centers for Disease Control and Prevention

Opiate Addiction and Seniors

February 14, 2019 by
Illustration by Derek Joy

Substance use disorders occur when at least one substance or drug leads to distress or impairment that is clinically significant. According to the Centers for Disease Control and Prevention, the number of opioid addicts in the United States is estimated to be in the millions.

Exact numbers may never be known, as many people who are addicted to opioids try to keep it a secret or legitimately do not realize a problem exists. Some may fear the stigma and judgment that come with being an addict.

A recent study by the CDC determined over 200,000 people died in the United States between 1999 and 2016 from causes related to prescription opioids. Nebraska saw 44 deaths in 2016. While less than the national average of 13.3 deaths per 100,000, according to the National Institute on Drug Abuse, Nebraska still saw 2.4 deaths per 100,000 people.

Those over 60 are not immune. The AARP has stated in educational literature that while bipartisan efforts, public awareness of prescription drug issues, and treatment have increased, fewer efforts have been geared to the older population, whose “unique characteristics may demand different or more nuanced solutions to these problems.”

Dr. Allison Dering-Anderson is the community pharmacist in the University of Nebraska Medical Center’s Department of Pharmacy Practice and a lecturer in pharmacy law and ethics. She agrees that older adults have more medical issues that put them at risk for substance use disorders.

“People over 60 have any of a number of things that set them up in a circumstance where they need an opiate to treat pain,” Dering-Anderson says. “They are the ones most likely to have some chronic pain condition from an injury that never healed right, or arthritis that is ridiculously painful, and they need an opiate to control the pain.”

Dering-Anderson is no stranger to pain or opiates. She was prescribed opiates after a painful knee operation. Post surgery, she said she would not have been able to do anything without significant pain control, but was lucky that her body chose to accept pain medication as that and nothing more. Not everyone is so lucky. Problems may occur when the body accepts the medication, but the brain becomes accustomed to, and craves, the euphoria associated with opiates.

The problem is the scientific method, Dering-Anderson says, not one of intentional over-prescription or market pressure to sell more drugs. For example, when Tramadol (a synthetic opioid) was introduced to the American market, it was considered to have no potential for contributing to substance use disorder. But that changed after its release—as with many drugs new to market—when hidden side effects and statistical outliers were discovered.

“There have been some missteps in determining the potential for substance use disorder,” Dering-Anderson says, adding adamantly that deliberate misdirection is not the issue. “The FDA approved the Tramadol label based on studies that did not show this was a problem. Now it’s a problem, and they did all of the correct post-market things to send out new warnings to change their labeling.”

More often the problem is selective participation in treatment. Patients may avoid physical therapy or exercise, preferring the quicker results of opiates.

Jessie Thompson works in the front lines of substance use disorder treatment as a counselor at Lutheran Family Services. Her observation is that older patients may have been prescribed opiates for so long they might not necessarily realize that they are addicted.

“Sometimes I think they have pain and maybe the pain is not as bad as it was, or there are other treatment modalities that haven’t been prescribed because they’ve had chronic pain for so long,” Thompson says.

Stretching, exercise, and rest are often part of any recovery plan, but may fall by the wayside while medication takes front stage.

Thompson and Dering-Anderson agree that the pendulum has swung both ways and that, over the decades, doctors have been alternately leery of prescribing opiates for pain and then encouraged to do more to manage pain.

Dering-Anderson says seniors should know they do not have to be in pain, that not all pain medications lead to substance use disorder, and that following a complete regimen of treatment can reduce a patient’s drug load.

“If the prescriber and the pharmacists recommend ibuprofen [which is not considered addictive], give that a try, but do all of the other things that go along with pain management,” she says. “You need to rest, do your exercises, massage therapy, go to physical therapy, because it is with those professions that we have a chance at reducing your drug load and to keep you safe.”

There are many variables that go into addiction. Life circumstances, relationship status, genetic predisposition, type of substance, and medical conditions can all be factors contributing to substance use disorder. But one factor in avoiding addiction is vigilance.


Visit unmc.edu or lfsneb.org for more information about addiction resources at UNMC and Lutheran Family Services.

This article first appeared in the January/February 2019 edition of 60PLUS in Omaha MagazineTo receive the magazine, click here to subscribe.

ADHD

September 24, 2013 by

One of the most common neurobehavioral disorders found among children is Attention-Deficit/Hyperactivity Disorder (ADHD), according to the Centers for Disease Control and Prevention (CDC). And rates are on the rise.

Dr. Ashley Harlow, psychologist at Children’s Hospital & Medical Center, believes that this spike in diagnoses is due to a combination of factors. “Parents, teachers, and [health care] providers are more aware of the signs and symptoms and, therefore, are investigating this diagnosis as a possibility,” he says.

Because ADHD is so prevalent, there is concern that children are being misdiagnosed.

Misdiagnosis can go many ways, explains Dr. Harlow. “I think misdiagnosis is a problem, although I think it is important to consider misdiagnosis as both diagnosing another condition as ADHD and diagnosing ADHD as another condition.

“I see kids who have been diagnosed with ADHD because they do not like their teacher, they do not listen to their parents, or they do not follow through on what their parents tell them to do,” says Dr. Harlow. “These behaviors do not necessarily indicate ADHD.”

Also complicating the issue are instances where children have ADHD and are instead diagnosed with another disorder, like Autism Spectrum Disorder, or when high-school and college students use ADHD medication to support studying. “In these cases of students seeking study aids, misdiagnosis might occur because of misrepresentation of the symptoms by the patient,” adds Dr. Harlow.

Dr. Harlow says that visible signs of ADHD can include behaviors like “difficulty sitting still in the classroom, disorganization in completing homework or turning it in, making careless mistakes, staring off into space, interacting with peers in immature ways, or starting chores but not finishing them.”

Many children may demonstrate these behaviors, so Dr. Harlow advises careful consideration before jumping to conclusions. “[Health care] providers, in consultation with families, work to determine if enough symptoms are present and impairment is at a level to warrant a clinical diagnosis.”

The CDC states that “children with ADHD do not grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.” Therefore, it is important to treat children who are afflicted with ADHD.

Treatment of ADHD focuses on reducing the impact of the symptoms, not eliminating them. “It is important to remember that ADHD is a neurologically based disorder, and so improving behavior likely means learning to manage symptoms rather than removing the symptoms entirely,” explains Dr. Harlow.

He recommends a combination of medical and behavioral health interventions, including setting up the environment (classroom or home) to be predictable and organized for the child and to make consequences immediate and consistent.

Children’s Hospital & Medical Center offers free parent education sessions related to topics surrounding ADHD. For more information, visit ChildrensOmaha.org/BehavioralHealth.

Shingles

June 20, 2013 by

Most of us weathered childhood chickenpox years ago with no worse than some intense itching and a few missed days of school. But for approximately one out of three people who’ve had chickenpox—99 percent of us, according to the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention—that’s not the end of it. A painful viral infection called shingles can show up years later.

“It’s pretty common. About 30 percent of Americans will get shingles at some time in their lifetime; it turns out to be one million cases a year,” says Dr. Michael Walts, a family medicine physician with Alegent Creighton Health. “Usually shingles only occurs once. In most cases, it’s self-limiting; it goes away, and you don’t have any further problems.”

Shingles is so common because it’s caused by the varicella-zoster virus, the same virus that causes chickenpox, he explains.

“Although the [chickenpox] rash goes away, the virus doesn’t. It crawls into your spinal column, where it goes to sleep, maybe forever,” Walts says. “But maybe, for most reasons we don’t know, the virus wakes up and will crawl down one nerve of the spinal cord and into the skin. Wherever that nerve is going to, that’s where the shingles rash will show up.”

And unlike chickenpox, this rash is more than just annoying.

“The most significant risk factor for the development of shingles is age. The reason we think that’s the case is that the immune system, like everything else as we get older, just doesn’t work as well.” – Michael Walts, M.D., family medicine physician with Alegent Creighton Health

“You’ll have pain first, and then all of a sudden the rash appears…It can be excruciatingly painful,” Walts says. And for some, the pain is long-lasting, even permanent.

“One of the most significant complications of shingles, a small percentage of time, is that even after the rash goes away, the pain doesn’t,” Walts explains. “The condition is called postherpetic neuralgia, or PHN.”

Shingles is more common after age 60, Walts says. “The most significant risk factor for the development of shingles is age. The reason we think that’s the case is that the immune system, like everything else as we get older, just doesn’t work as well. And the older you are when you get shingles—if you do—the more likely you are to get postherpetic neuralgia.”

It’s even possible that people who’ve been immunized against chickenpox can still get shingles later, he says, and it also strikes people who believe they’ve never had the chickenpox.

“People will say ‘I got shingles, but I never had chickenpox as a kid,’ and my response to that is, ‘Yeah, you did. You just didn’t know it,’” Walts says. “Maybe you had a bump or two that nobody ever even noticed, or maybe you had a rash that somebody said was contact dermatitis, because there’s no way you can get shingles unless that virus is living in your spinal cord.”

It’s not all bad news. A single-dose vaccine called Zostavax may prevent shingles altogether or prevent a recurrence. And if a person suspects shingles, especially when a rash appears on only one side of the body, he or she can still see their physician for treatment.

“(Anti-viral) medication does help. It does speed up the resolution of the pain and the rash, so go to your doctor and make sure it’s shingles,” Walts says. “We’re not sure about this, but one of the theories is that maybe treatment will not only decrease the amount of time you’re symptomatic, but it might decrease your risk for that postherpetic neuralgia. That’s all the more reason to get treatment, because, boy, anything you can do to prevent that side effect—even though it’s not common—you ought to try.”

Feeling the Heat

Everyone loves a little fun in the sun, but when people linger in the sun’s rays a little too long, it can have harmful effects on their health, especially for seniors.

Heat-related illnesses, collectively known as hyperthermia, occur when the body overheats and does not have the sufficient means to cool itself down. According to the Centers for Disease Control and Prevention, the elderly are more prone to the sun’s harmful rays because they are more likely to have a chronic medical condition or take medication that inhibits normal body responses to heat.

“People who work in high heat develop a certain degree of tolerance. With the elderly, their ability to adapt to extreme temperatures is limited, and the body’s ability to maintain status quo is much more at risk,” says Kris Stapp, vice president of community and public health at Omaha’s Visiting Nurse Association.

Heat exhaustion is a mild form of heat stress. Continuous exposure to high temperatures, combined with high humidity and physical exertion, can lead to dehydration. If you develop heavy sweating, a pale complexion, muscle cramps, and a sense of tiredness, you may be suffering from heat exhaustion. If not controlled, heat exhaustion can escalate to heat stroke, which can cause permanent brain and organ damage.

Stapp stresses the importance of taking into account the timing of outdoor activities, especially strenuous ones such as gardening or walking. Older folks may need to adapt their outdoor plans in times of extreme heat.

“What is dangerous about any heat-related illness is, it comes on so subtly that people don’t realize it’s happening until the symptoms really set in,” Stapp says. “When people get to the point where they are confused, it can lead to unconsciousness.”

To combat heat stress, the CDC advises drinking plenty of non-alcoholic beverages. Make sure to get plenty of rest and try to stay in air-conditioned environments during the heat of the day. Also, make sure to wear lightweight clothing if venturing outdoors.

“Be smart,” Stapp says. “It’s about turning all this information around, and not only knowing the warning signs, but also how to prevent it from happening.”

Avoiding Falls

February 25, 2013 by

Did you know falls are by far the leading unintentional injury, accounting for more than 8.7 million emergency room visits each year in the United States. One in every three adults age 65 and older falls each year, according to the Centers for Disease Control and Prevention.

Most falls are preventable. Many people attribute falls to being clumsy or not paying attention, but many risk factors exist. Physical hazards in the environment, vision, health conditions, and lack of exercise all increase the risk of a fall. Winter weather introduces an additional risk when ice and snow are on the ground. Reduce your risk and find fall hazards in your workplace and home to prevent injuries to yourself and others.

Tips for a fall-free year:

  • Maintain good lighting on outdoor walkways.
  • Wear sensible footwear. Consider changing from dress shoes to boots when walking outside.
  • Check the condition of outdoor handrails, walkways, and steps and repair as necessary.
  • Remove fallen leaves or snow from outdoor walkways as soon as possible to keep ice from forming.
  • Keep your shovel and de-icing products in the garage or inside the house so you won’t have to walk on a slippery surface to get your supplies.
  • Be aware that alcohol or other drugs, including prescription and over-the-counter medicine, can affect your balance and increase risk of falling.

Older Adult Falls. Older adults are more prone to become the victim of falls and the resulting injuries can diminish the ability to lead active, independent lives. According to the Centers for Disease Control and Prevention, the following tips can greatly help older adults prevent falls, but are beneficial to those of all ages:

  • Stay active. Chances of falling can be reduced by improving strength and balance. Examples of activities include brisk walking, tai chi and yoga.
  • Fall-proof your home—inside and out. This includes taking advantage of the tips above and removing indoor tripping hazards like rugs and clutter.
  • Review your medications. Have your doctor or pharmacist review all the medications you take, both prescription and over-the-counter. Some medications or combination of medicines can make you drowsy or light-headed, which can potentially lead to a fall.
  • Check your vision. It’s best to have your vision checked at least once a year to make sure you have the best prescription for your glasses. Poor vision greatly increases your risk of falling.

Tips adapted from the National Safety Council website. For more information, including local fall prevention resources, visit safenebraska.org.

Not Home Alone

December 25, 2012 by
Photography by Bill Sitzmann

As the largest generation in American history, often referred to as the post-war “Baby Boomers,” begins to reach and pass their 60th birthdays, the sheer size of the population is predicted to overwhelm the current facilities intended to meet the needs for assistive care and skilled care. That fact, along with many seniors’ desire to remain in their familiar, comfortable family home, have prompted many Americans to turn to companies and resources that can help them stay in their homes safely, happily, and productively and at a reduced expense.

The “Aging in Place’ trend has gained steam in recent years, and is expected to continue to grow in popularity in the next decade. The Centers for Disease Control and Prevention (CDC) has defined “Aging in Place” as “the ability to live in one’s own home and community safely, independently, and comfortably regardless of age, income, or ability level.”

Finding quality providers of at-home products and services is one of the most important aspects in preparing a successful plan for aging in place. Omaha has a wide selection of service providers, caregivers, and equipment providers who can work with the individual or the family to make aging at home a viable option.

Matt Nyberg, owner of Home Care Assistance of Omaha, says that while the majority of “Baby Boomers” haven’t yet reached the point of requiring home-care products and services, his company is preparing for the deluge of demand ahead. His firm provides seniors with non-medical, hands-on assistance with activities of daily living, bathing, and transferring, with what he says is an innovation in the business. Each client has an RN (registered nurse) who assesses needs, manages services, and attends doctors’ appointments, if requested. The RN then communicates with the family (with the client’s permission) in order to keep the family up-to-date on the client’s condition.

Laurie Dondelinger, marketing director at Kohll’s Home Care in Omaha, recently took this writer on a tour of their 10,000-square-foot showroom, which contains hundreds, perhaps thousands, of assistive devices from canes to stairway lifts to walk-in tubs to ceiling lift tracks which literally lift a disabled person out of bed and motor them anywhere in the home where the ceiling track has been installed. Kohll’s has in-house contractors who can install assistive devices as well as remodel a home to accommodate such devices.

Dondelinger tells of a satisfied client who installed a stairway lift in his three-story house. He is so thrilled with the ease in moving from floor to floor that he feels as if he now lives in a ranch-style home, and he’s no longer faced with having to sell his beautiful home on the river where he has lived for many years.

Bob Sackett, owner of Complete Access in La Vista, got into the home-accessibility business because of a personal crisis facing a family member 25 years ago. He is now a licensed elevator sales and installation provider specializing in modular ramps, stairway lifts and elevators, for the home serving customers in western Iowa and central and eastern Nebraska. His company sells both new and previously owned products, allowing him to meet the needs of even tight budgets. Like so many in the stay-at-home business, Sackett has a true fervor about his business, which he says is not only cost-effective in keeping people in their own homes, but also improves clients’ quality of life.

However, Sackett says that, in his initial assessment, he looks and listens to learn whether or not the person can survive happily at home. If his accessibility services could result in a person living 24 hours alone with no human interaction, then he isn’t interested in the business opportunity because then he would not be providing a high quality-of-life service.

Spirit Homecare is a newcomer to the Omaha home-assistance market, providing skilled hands-on care such as administering medications and treatments per doctor’s orders, as well as non-medical services via homemakers and companions, including meal preparation, transportation services, and light housekeeping. They also provide supervised hands-on assistance with personal care needs, help with prescribed exercises and medical equipment, and much more. Up to 24-hour care and live-in companion services are available as well.

Spirit Homecare is part of St. Jude Healthcare, a company that provides services in Wisconsin, Nebraska, California, Arizona and Kansas. Although non-medical assistance is not reimbursable by Medicare, sometimes Medicaid and private long-term care insurance does provide reimbursement. Tom Moreland, CEO of St. Jude Healthcare, says that his company is the only one in the Midwest that provides services in a manner consistent with the Ethical and Religious Directives for Catholic Health Services.

The above providers are but a tip of the iceberg of services, providers, and products available to assist with aging in place. It cannot be emphasized too much that if one wants a future at home, one should begin the planning as soon as possible.