Today Alzheimer’s disease is considered to be one of the most common causes of dementia and is estimated to be impacting around 5.3 million Americans. It is an irreversible, progressive brain disease that destroys brain nerve cells and disrupts the memory and thinking skills of the patient.  Although scientists still do not know what causes it, they believe that a combination of various genetic and environmental factors lead to Alzheimer’s.

Alzheimers disease - type of DementiaThe changes and deterioration in certain areas of the brain, with Alzheimer’s, affect thinking, communication, and behavior. Less than 5 percent of the time, the disease is caused by specific genetic changes that virtually guarantee a person will develop the disease. Some of the deterioration can be due to the loss of chemical messengers (neurotransmitters) in the brain called acetylcholine.

These messengers allow the nerve cells to communicate properly. Although it is not very clear why these changes occur, they are a major focus of Alzheimer’s research. Although most people who have the disease do not have a family history of the condition, those who do have a family member with Alzheimer’s do have increased risk of getting it.

Dr. Alois Alzheimer from Germany was the first to identify Alzheimer’s disease in 1906.  During those days, it was considered a rare disorder as compared to today when it is recognized as the most common cause of dementia. Brains affected by Alzheimer’s often show the presence of fiber tangles within the nerve cells and clusters of degenerating nerve endings.  Since the identification of the disease, scientists have been trying to find out the causes that lead to its inception.  Some of the major factors that contribute to the disease are:

Age – Advancing age is the number one risk factor for developing Alzheimer’s disease. It is estimated that among the people over 65 years of age, one out of eight is likely to have Alzheimer’s and the probability of being diagnosed with the disease nearly doubles every five years after age 65.

Family History – Researchers agree that if you have one or more parent or close family member with Alzheimer’s disease, then you can be at a greater risk to develop the disease.  A genetically inherited gene ApoE4 increases your likelihood of getting Alzheimer’s disease.  The second kind of gene called a deterministic gene is a rare gene and is found only in a few hundred extended families around the world. If this deterministic gene is inherited, the person will undoubtedly develop Alzheimer’s and also will probably do so at a much earlier age in life.

Lifestyle factors – Some of the lifestyles that we follow can be very unfriendly to the brain and can increase the risk of Alzheimer’s disease. People who have sustained concussions or head injury through sports, work, or accidents have a greater risk of getting Alzheimer’s.  Positive lifestyle habits, including exercise, a healthy diet rich in antioxidants, socialization, lifelong learning, and avoidance of tobacco use, may prevent or delay the onset.  The Alzheimer’s Association does suspect links between heart health and brain health. They argue that what is good for the heart is good for the head.

Causes of Alzheimers - dementia

High blood pressure and high cholesterol – Ongoing research on Alzheimer’s shows that cardiovascular disease, specifically related to high cholesterol and high blood pressure, can also be a risk factor for the disease.

Diabetes – High blood sugar is also considered a risk factor for eventually developing Alzheimer’s. Lot of studies are being done to understand the connection and some diabetes drugs do appear to slow down the cognitive decline of Alzheimer’s patients.  It is expected that controlling the blood sugar levels with diet and medication may help.

Plaques and Tangles – Research is going on to find out the causes behind the buildup of plaques and tangles in the brain. Plaques consist of the protein beta amyloid that accumulates in the spaces between the nerve cells while tangles are fibers that accumulate inside the nerve cells.  These proteins can block the ability of the cells to communicate eventually leading to cellular death. This can ravage the brain and cause the progressive symptoms of Alzheimer’s disease.

Aluminum– has become one of the most controversial risk factors for the onset of the disease. Researchers have found traces of the metal in autopsies of patients. Aluminum does turn up in higher amounts than normal in some patients but not in all of them.  However, other studies have found that people who are actually more exposed to higher levels of aluminum did not show any signs of increased risks. Therefore, it is still uncertain if the exposure to aluminum has any decisive role in Alzheimer’s disease.

Education level – Research suggests that a person with more years of formal education is less likely to develop Alzheimer’s.  This is because longer education may help produce a denser network of synapses, the nerve fiber connections that enable neurons to communicate with one another. The synapses create a neural reserve to enable people to compensate longer for the early brain changes associated with Alzheimer’s.

Race and Ethnicity – Studies have shown that older African-Americans and Hispanics are twice as likely to develop Alzheimer’s as compared to their white American counterparts. However, the reason for this could be a higher incidence of high blood pressure and diabetes among African-Americans and Hispanics.

Researchers seem to be hopeful that steps are being laid out and strategies will be developed soon to delay the onset of Alzheimer’s or prevent it altogether.


Knee problems can occur at any age. Seniors in particular, are vulnerable to the knee problems, partly due to the associated physiological changes of aging, and often because they tend to develop some problems with mobility as time goes by.  In fact, knee pain is one of the most common problems affecting millions of people living in the US as well as across the world.  Total Knee Replacement stepsMuscles provide the force and strength to move the body. But as a person ages, there are several changes in the muscles, joints, and bones that affect the posture and walk, and lead to weakness and slowed movement. Technically, the knee replacements are surgical substitutions of a knee joint,  with an artificial joint, or an implant. More and more elderly patients are undergoing knee replacement surgeries so that they can remain independent and active in their later years.

However, the increasing rate of obesity can lead to additional surgeries and more costs in the long run.  It  is more difficult with obese patients, because they have a higher risk of infection, blood clots and wound complications. This number is constantly on the rise.  In 2003 there were 450,000 knee replacement surgeries that jumped up to 700,000 by 2010 and the American Academy of Orthopedic Surgeons estimate that by 2030, the number will go up to nearly 3.5 million. Alternatively, obesity in the older adults also causes serious medical complications and impairs their quality of lives. It can exacerbate the age-related decline in physical function and lead to frailty.

Causes of Knee Pain in the elderly

There are many different factors that could lead to mild, moderate or even severe knee pain. There are several causes of knee pain that a good orthopedic doctor can figure out. One of the leading causes of disability among older men and women is osteoarthritis. It causes the development of symptoms such as pain, swelling, bone spur formation and decreased motion. Some of the most common causes for knee pain are:

  • Injuries:  A person can incur a knee injury while playing sports or engaging in any other form of physical activity, their tendons, ligaments, bursae (fluid filled sacs), bones, muscles and cartilage could all get affected. Some of the most common types of injuries that are known to affect the knee include Anterior Cruciate Ligament (ACL), knee bursitis, torn meniscus and patellar tendinitis.
  • Mechanical Problems: This mainly refers to any type of dislocation in either the bones or cartilage that could lead to a pain and could interfere with the day to day activities. Some of the common mechanical knee problems include dislocated kneecaps, knee locking and pain in the hips. Sometimes a bone or cartilage may get degenerated, break off and float about in the joint space, causing excruciating pain in the knees.
  • Arthritis: There are different types of arthritis that have been known to affect the elderly. This condition leads to a considerable about of pain in the joints, not surprisingly in the knees. Some of the knee pain-causing arthritic conditions include gout, pseudo-gout, rheumatoid arthritis, osteoarthritis and septic arthritis.
  • Obesity:  A senior is at a much higher risk of suffering from knee problems, in case s/he is overweight. Excess weight increases the amount of pressure applied on to knee joints, even if they only engage in normal day to day activities such as walking, climbing a flight of stairs, descending and so on.
  • Heredity : There is some evidence that genetic mutations may make an individual more likely to have knee issues.
  • Gender : Women who are older than 50 are more likely to have knee issues as compared to the men at 50.
  • Other Health Conditions : There are many other health problems that can make a person more prone to severe knee pain. Some of the most common conditions include Osteochondritis dissecans, chondromalacia patellae and Osgood-Schlatter disease, to name a few. Also, the repeated episodes of gout or septic arthritis and metabolic disorders can also lead to knee problems.

While the knee implants give many recipients a second chance of walking and living a more normal life, complications can occur. Most problematic are the infections, blood clots in the leg vein or lungs, heart attack, stroke, nerve damage, drainage from the surgical site, increased redness, tenderness, swelling and pain in the knee.  Artificial knees can wear out, especially for people with rheumatoid arthritis or diabetes, when there is a higher chance of infection during the weeks following the procedure.  Complications of knee replacement in elderlySome people suffer a reaction to the metal used in the artificial knee joint, for many others, the problem is a loosening of the implant that can be caused by a defective implant or poor positioning at the time of the surgery. Most of the major arteries and veins are rightly behind the knee, there is a risk that these vessels could be damaged.  Although knee replacements have become a common part of the American healthcare system, but it can be avoided by taking care of the overall health like obesity, injuries, lack of strength and limited flexibility to name a few. A total knee replacement surgery is one of the most successful and life-enhancing  surgical procedures. It has made the life of almost 90 percent people normal by allowing them to return to work and enhancing their quality of life and can therefore be regarded as a most valuable procedure for the elderly group who return to a more functional lifestyle post the surgery.


The second week of September 2015 will be hailed in the history of California with a landmark victory for supporters of assisted suicide, when the State Legislature gave its final approval to a bill that would allow the doctors to help terminally ill people end their lives.

Death with dignity - physician assisted suicide in CaliforniaThe similar right-to-die bill had earlier failed to pass in the State legislative assembly in 2007 and was vehemently opposed by many religious and medical groups. Even in 1992, the voters of the state had rejected the proposition to allow the physicians to prescribe lethal injections to the terminally ill patients. These groups had raised concerns that the ill and disabled could be coerced into choosing death over care, that can be expensive and burdensome.

“California will become the fifth state to allow doctors to prescribe life-ending drugs to terminally ill patients, after Gov. Jerry Brown signed the measure into law on Monday, ending his months of silence on one of the most emotional issues in the state this year.”

Even though similar bills have failed in the state in the past, the case of Brittany Maynard(2014) who moved to Oregon to have a physician-assisted suicide, made headlines that helped the bill gain enough support to pass. 

After more than 25 years of efforts, the state had been on the verge of granting the terminally ill patients the right to end their own lives with the help of a physician and finally it was passed as a law after the governor, Jerry Brown gave his approval on the 5th of October 2015. The law will eventually take effect 90 days after the Legislature adjourns its special session on healthcare, which may not be until next year — January at the earliest, November at the latest.

The Death with Dignity bill requires the patients to submit two oral requests for a lethal prescription, a minimum of 15 days apart, as well as a written request. After the attending physicians receive all the three requests, they grant these patients the so-called “right to die”. The state assembly finally passed a bill that would allow the physicians to prescribe life-ending drugs and would legalize euthanasia or assisted suicide that is essential for anyone who hopes to defeat the evil of imposed death. The bill is called SB 128 and it was the 8th attempt by doctor-prescribed suicide activists in California. It is supposedly modeled after the Oregon’s “Death with Dignity Act.”

The debate regarding this bill had long been evaluated with several groups putting forth their pros and cons of Death  with Dignity.  The opponents described it as against God’s wishes to propel someone’s death while those who favor the law say that it is a humane and a compassionate thing to allow someone die in peace and without enduring too much pain. They propounded the pros of this kind of death to someone as:

  • A freedom to the patient to select the way to die when s/he is already suffering too much from an incurable pain.
  • It helps in alleviating the patient’s suffering if they are terminally ill.
  • To aid the dying patient painlessly.
  • It follows the theory of coping with suffering in such a way that it assists the patient to die peacefully.
  • Death with Dignity must be a normal extension of the rights of the patient enabling him to make a decision about the value of death and life.

But the people against the practice of Death and Dignity choose morality and ethics. They are against the practice and term it as :

  • Mercy killing is ethically incorrect and must be prohibited by law and they consider this practice to be a homicide.
  • Every human life deserves exceptional protection and security.  The medical technology should improve the quality of life and increase the life span.
  • Family members can take undue advantage of the condition of the dying patient.
  • There is no way to guarantee if the assisted suicide is voluntary or is insisted by others.
  • It is an act of murder and killing among all religious beliefs.
  • The right to die is a moral principle based on the belief that a human being is entitled to commit suicide or to undergo voluntary euthanasia.

Possession of this right is often understood to mean that a person with a terminal illness should be allowed to commit suicide or volunteer to ask for assisted suicide or to decline life-prolonging treatment, where a disease would otherwise prolong their suffering to an identical result. The question of who, if anyone, should be empowered to make these decisions is often central to debate.

In 2014, five states of Montana, Oregon, Vermont, New Mexico and Washington considered bills to allow physicians to help terminally ill patients end their lives; this year, that number increased to 6 when California also joined plus the District of Columbia, according to Compassion and Choices, a group that supported the law.


Elderly adults who live in the nursing homes often lash out at each other and have to deal with aggressive or inappropriate behavior from fellow residents. Most of these facilities house elderly, who are uninhibited, typically have dementia, share close quarters with strangers, suffer pain or lose their ability to communicate. Dementia is  also marked by cognitive disorientation, memory loss and aggression in the elderlychanges in intellectual functioning.

It is very challenging and upsetting for both, the elderly as well as their caregivers. A person’s behavior is likely to change when he is overcome with dementia and other old-age frailties like the Alzheimer’s, Parkinson’s disease, etc. Certain physical discomforts viz. hunger, constipation and sleep deprivation also influence their behavior. Not only do they cause dementia, but also other aggressive behaviors like verbal abuse, verbal threats, hitting out at caregivers or anyone around them. According to the data published by the New York state study, it was found that in about 10 centers, there were at least 20%+ residents who would hurl some kind of physical or verbal abuse at anyone around.

Researcher Karl Pillemer, a gerontology professor at Weill Cornell Medical College in New York City believes that agitation and aggression in the elderly are much more prevalent problems than are realized in the medical world. Psychological issues, such as mood disorders or depression are associated with aggression. They are actions that seem tactless, rude or even offensive to some extent. They occur when people don’t follow the usual social rules about what or where to say or do something. As such, for people who spend time in these nursing homes- whether work, or live, or volunteer or visit family members can witness more when the residents lash out at each other.  This can be particularly distressing when the individual behaves in an uninhibited way.

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social life of the elderlyAlthough seniors and the elderly are the largest growing population in the US, they are also one of the most isolated lot. They may be aware of their medical issues like blood pressure, diabetes, Alzheimer’s, but are hardly concerned about the social issues of their lives and rarely do they give any significance to socialization that is probably one of the most important parts of all stages of life. However, seniors experience less social interaction when compared to the younger individuals. Many elderly reside in a hospital or a nursing home rather than in the community. As such, they live far away from friends and families and feel isolated. By maintaining a high level of activity and interacting with people regularly, they can continue to enjoy and improve their lives. The Pew Internet Research revealed that the social media use amongst seniors has doubled in recent years and they are the fastest growing demographics.

Having someone to talk to, share a meal with and having various interests help seniors lead happier and healthier lives. They feel loved, supported and needed. The more socially active the elderly are, the less likely are they to be depressed. The connections to people and activities give them a purpose to look forward to and stay mentally sharp. It keeps them from feeling isolated and alone. Activities including games, walking, volunteering, reading and even talking with others are necessary for everyone and more so for the seniors. As we grow older, the importance of being socially active grows by leaps and bounds.  In fact, social isolation among older adults is an increasingly problematic issue considering they will be almost 20% of the entire US population.

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The Epidemiolody of a Heart Failure in the Elderly

Heart failure develops over time when the pumping capacity of heart diminishes and it is not able to supply enough blood and oxygen to support other organs in the body. It is usually called a geriatric syndrome as most of the heart failure patients are the older adults. It is also a serious cardiac syndrome that can […]

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Dialysis – When do the Octogenarians need it?

Kidneys are our body’s tireless waste removers. Healthy human kidneys purify the body by removing waste, toxins and excess fluid from the blood. They aid in controlling the blood pressure, strengthening the bones, maintaining the electrolysis balance, producing red blood cells in the body and keeping body chemicals in balance. A properly functioning kidney helps […]

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Why are Seniors prone to Vitamin D Deficiency?

Human beings require calcium for signal and muscle contradiction and to build and maintain skeletons. Aging, even in the healthy elderly, reduces muscle mass and muscle strength leading to a functional impairment. It is important in a number of physiologic processes, including calcium absorption, innate and adaptive immunity and homeostasis of a number of organs. The […]

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Pathophysiology of COPD in the Older Adults

Chronic obstructive pulmonary disease (COPD) is a slowly progressive chronic obstruction of airflow into or out of lungs.  It is a term referring to two lung diseases namely, chronic bronchitis and emphysema that often exist together.  Although these are more familiar terms they are not used individually but are often included within the COPD diagnosis. […]

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The Risk of High Blood Cholesterol in the elderly

Cholesterol is one of the most common types of steroids found in the human body. It is an innate body constituent that is present in every cell membrane and is a major component of the brain. It is our carelessness as regards the food that we eat without being mindful of exercises that we associate […]

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Holiday celebrations in the Retirement Communities

Whenever and under whatever circumstances, people move from their own home to an assisted living facility or to a nursing home, they feel homeless and often strive to go back. This feeling becomes more prominent during the holiday season and festivals. Even when we know we cannot do much to make this feeling go away, we […]

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