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Minority Diabetics High-risk to Cataracts
People of African descent appear to run a higher risk of developing cataracts if they are diabetic, says the American Academy of Ophthalmology (AAO). The study, which appears in the 1/99 AAO journal, suggests that controlling diabetes, especially in those under
the age of sixty, may significantly reduce cataracts in this high-risk group.
A cataract, says AAO, is a cloudy or opaque area in the normally transparent lens of the eye. As the opacity thickens, it prevents light rays from passing through the lens and focusing on the retina, the light sensitive tissue lining the back of the eye. Between the ages of 52 and 64, you have a 50% chance of having a cataract, but you probably won't experience any problems with your vision until about 65. By 75, just about everyone has a cataract; and 50% of the people between 75 and 85 have lost some vision as a result. In the United States, cataract surgery is the number one therapeutic surgical procedure performed on Americans 65 and older. Medicare pays $3.4 billion a year for 1 million of the 1.3 million cataract procedures performed annually
M. Christina Leske, M.D. and colleagues from the University of New York Stony Brook conducted the Barbados Eye Study (BES), the largest study in the world to examine the prevalence, incidence, and risk factors for major eye diseases in a population of African descent In the BES, persons of African heritage were four times more likely to have cortical or spoke-like cataracts than Caucasians. Study authors looked at the relationship between risk factors such as diabetes, high blood pressure, and obesity to explain the increased prevalence of cataracts in people of African ancestry.
The authors of the study found 14 percent of all cataracts studied could be attributed to diabetes. Diabetes was highly associated with cortical cataracts, especially among people under the age of sixty. The study also found cortical cataracts related to central obesity and high blood pressure, which may be due to common underlying link with diabetes. The authors conclude, "Given the increased prevalence of lens opacities in black populations, it is important to identify potentially modifiable factors that may lead to cataract prevention, especially at younger ages." Careful maintenance of diabetes may reduce this risk.
Cataract symptoms including blurred vision, sensitivity to light and glare, increased nearsightedness, or distorted images in either eye, may develop. Older Americans who are at most risk for cataracts will find the National Eye Care Project (NECP) a valuable source of eye care information. A public service project of the American Academy of Ophthalmology and the Knights Templar Eye Foundation, Inc., the NECP provides medical referrals to qualified seniors at no out-of-pocket cost to the patient. The toll-free NECP Helpline may be reached at 1-800-222-EYES, and is available from 7:30 am to 4 pm Pacific time, Mondays through Fridays year-round except holidays.
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Gender Biased Trips Favor Men
All things equal, healthy women older than 65 years of age are more likely to fall following a trip than their male counterparts. Further, the likelihood of falling is larger in the youngest of the older women, according to a study funded by the National Institutes of Health and executed by the Cleveland Clinic Foundation. The study is discussed in the February l999 issue of the Journal of Gerontology.
Older women fell more than four times as frequently as the older men, and women younger than 70 years fell more than three times as frequently as those older than 70. Among men the trip outcome was essentially unaffected by age. The decreased likelihood of falling in the oldest of the women suggests that these women had made some type of adaptation to their gait pattern that reduced their risk of falling following a trip.
In the study, 50 women and 29 men were tripped by a concealed mechanical obstacle as they walked. The researchers are convinced that the trips in this study were similar to those that occur during everyday living. In other words, the rigid obstacle that blocked the path of the toe during the study did not differ from what takes place when elders trip over everyday obstacles such as a curb or sidewalk crack.
The study by researchers Pavol, Owings, Foley and Grabiner is important because falls are a significant source of morbidity and mortality in older adults. This study will go a long way in identifying factors that determine an individual’s risk of tripping and falling.
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Melanoma Rises, Skin Self-Exam Advised
The American Academy of Dermatology (AAD) is concerned about the increasing incidence of melanoma, the deadliest form of skin cancer. It is estimated that 44,200 people in the United States will be diagnosed with melanoma this year, a six percent increase from 1998. The AAD urges everyone to examine their skin regularly. This means looking over your entire body including your back, your scalp, soles of your feet, between your toes, even the palms of your hands. If there are any changes in the size, color, shape, or texture of a mole, the development of a new mole, or any other unusual changes in the skin, see your dermatologist immediately.
Follow the simple ABCD rule which outlines the warning signs of melanoma.
- A is for asymmetry.
One half of the mole does not match the other half.
- B is for border irregularity.
The edges of the mole are ragged, notched, or blurred.
- C is for color.
The pigmentation of the mole is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance.
- D is for diameter.
A diameter of greater than six millimeters (about the size of a pencil eraser), or any growth of a mole should be of concern.
Sun exposure is the most preventable risk factor for melanoma. The AAD recommends that you adopt a comprehensive sun protection program including wearing protective clothing, avoiding the sun at midday when the sun’s ultraviolet rays are the strongest, seeking shade whenever possible, and wearing a broad spectrum sunscreen with a Sun Protection Factor (SPF) of at least 15. Don’t forget the "Shadow Rule" if your shadow is shorter than you are, the damaging rays of the sun are at their strongest and you are likely to sunburn.
If a laboratory test reveals a malignant melanoma, your dermatologist will determine the appropriate treatment depending on the stage and location of the disease as well as your overall health. The primary growth must be removed. Advanced cases of melanoma may be treated with radiation therapy, immunotherapy, or chemotherapy, according to the characteristics of the case.
The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership over 11,000 dermatologists worldwide, the Academy is committed to: advancing the science and art of medicine and surgery related to the skin; advocating high standards in clinical practice, education, and research in dermatology; supporting and enhancing patient care; and promoting a lifetime of healthier skin, hair, and nails.
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Elders With Vision Eat More Spinach
New research indicates that the eye disease that has replaced glaucoma as the most feared among older adults can be diagnosed before it destroys vision and treated successfully with, of all things, spinach. The disease is age-related macular degeneration (ARMD). Unlike glaucoma, which destroys side vision, ARMD destroys central vision. It leaves its victims extremely dependent. They cannot see to drive, read, watch television or, in many cases, to handle daily living chores. ARMD
affects about 10 million older adults now. The National Eye Institute estimates the number could rise to 18 million by 2030.
Stuart Richer, O.D., Ph.D., chief of the Optometry Section at the DVA Medical Center in North Chicago and a noted authority on nutrition and vision, says ARMD can be stopped in its tracks. He explains how in new research published in the January 1999 Journal of the American Optometric Association (JAOA). It's a one-two punch approach. First there's a series of diagnostic tests Dr. Richer has compiled that can uncover the very earliest signs of ARMD before any noticeable symptoms occur. That's followed by doses of spinach and other dark green leafy vegetables, which contain a nutrient
called lutein. Dr. Richer is finding that lutein can actually reverse ARMD in its very early stages.
Dr. Richer says lutein works because it increases the density of macular pigment in most people. In case histories published in the January JAOA, his patients who ate three or four portions of spinach a week experienced positive results in as little as 12 weeks. With his new research funding, Dr. Richer is conducting a controlled clinical trial study to explore this further. But since eating spinach, kale and other dark green leafy vegetables in moderate amounts usually won't hurt anyone, he encourages people to do so. Lutein and other nutrients in spinach are also available in some multivitamin ocular
formulas. Dr. Richer recommends, however, that people seek their optometrist's advice about using these supplements to help prevent ARMD.
The four diagnostic tests Dr. Richer is using have been available for years but this is the first time they have been used together in the United States to diagnose the very early stages of ARMD. They include a:
- Contrast sensitivity test
enables the optometrist to evaluate vision at different spatial frequencies. With this test, the optometrist can diagnose changes in vision long before they would be noticed by the person or be picked up by a visual acuity test.
- Glare recovery test
determines how quickly a person recovers from exposure to glare. It would measure, for example, how long it would take a person blinded by a camera's flash to recover normal vision.
- Low-luminance low-contrast test
determines how well a person can see at various levels of low light. ARMD affects the cells in the retina that are needed for seeing in low-light conditions.
- Questionnaire on night driving and glare disability.
Dr. Richer said that, although the diagnostic equipment for these tests is relatively inexpensive, the tests themselves do take additional time, which would increase the cost of an eye exam. The contrast sensitivity test is not covered by Medicare, he noted. Dr. Richer recommends that these four tests be given to all people who are at risk for ARMD. They include:
- aging blue-eyed Caucasians
- post-menopausal women not using estrogen replacement
- people with a history of cardiac disease
- photosensitizing drug use, cigarette smoking, and decreased physical activity
- people who consume few vegetables.
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Help for Parkinson Patient Cargivers
The American Parkinson Disease Association, Inc. ( APDA) offers helpful hints to ease the daily life of Parkinson’s patients. A person who suffers with Parkinson’s disease needs ways to simplify life’s daily challenges of living with Parkinson’s disease. The purpose of the following hints is to help patients maintain the greatest degree of personal dignity and independence possible.
- Bathing and Grooming Aids
1. Use a tub bench or shower chair to bathe safely.
2. Place a non-slip rubber mat or adhesive anti-slip surface at the bottom of the tub or shower, and install grab bars.
3. "Soap on Rope" keeps soap safely and conveniently within reach while showering or taking a bath.
4. A sponge attached to a long handle will reach the lower legs, feet and back facilitating balance by reducing the need to bend.
5. Use a terry cloth wash mitt instead of a washcloth.
6. Install a night light in a bathroom wall socket.
- Dressing Aids
1. Lower clothes rods in closets, so you don’t have to reach too high for items.
2. Choose clothing that closes in the front, with easy style and uncomplicated fastenings.
3. Put on and take off clothes from your stiffer side first and have a family member lay out the clothing you need.
4. Velcro closures make an excellent substitute for buttons and zippers.
5. Use buttonhook or Button Aid.
6. Large, easily grasped zipper pulls make opening and closing trouser flies, jackets and coats less difficult.
7. Secure shirt cuffs with firm elastic bands. This eliminates buttoning and the result is unnoticeable. Be sure the bands are not tight enough to restrict circulation.
- Kitchen Aids
1. Store food items and food preparation implements near dishwasher and sinks; pots near the stove.
2. Try preparing food while seated.
3. Cook as much food as possible during "on" times and freeze it for times you don’t feel up to cooking.
4. Use a cart with wheels to move items from one place to another and to offer support while walking.
5. Use a rubber pad or a wet dishcloth under bowls and pans to stabilize them while preparing foods.
6. Prevent diced vegetables and small food from falling off the board by using a cutting board with raised sides.
7. Hammer a nail through the cutting board to act as a skewer to keep food from slipping while dicing or cutting.
8. Attach an old broom handle or a long wooden dowel to the kitchen dustpan to collect floor sweeping without bending.
- Mealtime Aids
Attachable plate guards provide a rim on one side of the plate. Food, such as small vegetables, can be pushed against the guard, where it falls onto the fork. "Scoop dishes" contoured with raised edges, plates with suction cups and plate guards all help prevent spills.
1. If eating is slow, use a plate with a hot water container attached to the underside to keep food hot.
2. Silverware with built-in plastic handles is easy to grasp.
3. Use a soupspoon instead of a fork for small pieces of food.
4. Flexible plastic straws will reduce spills for patients with tremors.
5. A lightweight mug with a large handle for easy grasping is useful when tremor is severe.
Patients and caregivers can obtain tips such as these and information about Parkinson’s disease and ways to cope in the "APDA Parkinson’s Disease Handbook" and booklet "Be Independent". These, and other literature is available by calling the American Parkinson Disease Association, Inc. at (800)223-APDA (2732).
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