Monday, December 11, 2017

Why do seniors not protect themselves from pneumonia?

At a workshop I was doing recently I was asked a question, “is pneumonia contagious” I thought it was but I was not sure, but I had pneumonia a few times in my life and so I am concerned about this infectious disease.
In 2014 the number of visits to emergency departments with pneumonia as the primary hospital discharge diagnosis was 423,000 and 50,622 died of this infection. The deaths per 100,000 population in 2014 was 15.9, which is high. Source:
Despite this, around two-thirds of older adults do not get the recommended pneumococcal pneumonia vaccination to prevent pneumonia.

Pneumonia can be prevented, particularly in people who do not have chronic lung diseases. By avoiding sick people, staying home when ill, washing hands, and adopting basic health measures, such as getting vaccinated, it is possible to prevent this potentially fatal illness.

Back to the question Is pneumonia contagious? Pneumonia refers to an infection in the lungs caused by certain germs, such as bacteria or viruses. When one-person spreads germs that can cause pneumonia to someone else, the recipient can develop a range of respiratory infections, from mild cold symptoms to pneumonia. The problem is that there are a range of factors that determine whether pneumonia is contagious:

Most cases of pneumonia are due to the spread of bacteria and viruses. Bacteria are living organisms that respond to antibiotics. Viruses are tiny strands of protein and genetic material that cannot be treated with antibiotics. Both viruses and bacteria are contagious.

Pneumonia often develops after a person has had a different infection, such as a head cold. This makes a person more vulnerable to other types of infections. An infection that develops in the lungs is called pneumonia.

Some organisms are more likely to cause pneumonia than others. One common example is pneumococcal disease, a bacterial infection that can cause ear infections, sinus infections, infections of the brain and blood, and pneumonia.

Another type of bacteria called Mycoplasma pneumoniae can cause other forms of pneumonia. Mycoplasma bacteria are also contagious.

The influenza virus or the flu is a common cause of viral pneumonia. The virus spreads easily from person to person, causing a range of symptoms and conditions.

Some causes of pneumonia that can be caused by inhaling food particles or contents from the intestinal tract, some fungi are not contagious.

In most cases, infections are contagious for a few days before symptoms appear and for a few days after. The exact length of time a person is contagious depends on the type of microorganism causing the infection.

Some forms of pneumonia, such as pneumonia caused by mycoplasma, remain contagious for several weeks. If a person has pneumonia, they should speak to a doctor about how long the infection will be contagious.

Although anyone can get pneumonia, some people are at greater risk. Pneumonia occurs when an infection develops within the lungs. It can cause complications with breathing and spread to other parts of the body such as the bloodstream.

People who are more likely to get pneumonia include:

very young children and babies whose immune systems are not fully developed
·       older people with weakened immune systems
·       pregnant women
·       people taking medications that suppress the immune system
·       people with diseases that weaken the immune system, such as cancer, HIV, and AIDS
·       people with autoimmune diseases, such as rheumatoid arthritis
·       people with lung and respiratory conditions, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), and asthma
·       People at risk of pneumonia need to be especially cautious around people who have recently had pneumonia or another respiratory infection.

Pneumonia is transmitted when germs from the body of someone with pneumonia spread to another person. This can happen in a variety of ways, including:

Inhaling the infection. This can occur when a person with pneumonia coughs or sneezes and another person inhales the infected particles. This is more likely between people in close contact with each other, such as parents and children, or in poorly ventilated spaces, such as airplanes.
Through the mouth or eyes. This can happen when a person touches a surface that an infected person has coughed or sneezed on. When a person with an infection coughs into their hand and then shakes another person's hand, the second person can become infected if they touch their mouth or eyes without washing their hands.

Food particles and irritants from the intestinal tract can also cause pneumonia. This is called aspiration pneumonia and can occur when a person accidentally inhales these substances.

Aspiration pneumonia usually happens in people who have trouble swallowing, such as someone having a diagnosis of a stroke or other central nervous system conditions, such as Parkinson's disease.

Fungal pneumonia typically develops when people inhale microscopic particles of fungus from the environment. People with weakened immune systems are more likely to develop this type of pneumonia.

Most people recover from pneumonia without any lasting effects. In vulnerable people, pneumonia can be fatal. Worldwide, pneumonia accounts for 16 percent of deaths in children under 5. Older people and those with a weakened immune system are also more likely to experience serious complications.

Older people, people with serious illnesses, parents of newborns, and caregivers to sick people should make sure all visitors wash their hands. It is best that people with symptoms of a respiratory illness or fever do not visit a vulnerable person until their symptoms are gone. Other strategies that can reduce the risk include:

·       washing hands before eating, after touching people, and after going out in public
·       disinfecting all surfaces in the home, particularly if someone has recently been sick
·       keeping up-to-date on all vaccinations, especially any household members around infants who are too young to be vaccinated

·       avoiding locations with inadequate air filtration during cold and flu season

Flu shots work better if you are in a good mood

Another reason to have a good attitude as you age. Flu shots work better for seniors that are in a good mood and have a good attitude. Why is this important. According to the World Health Organization, 2016, between 250,000 and 500,000 deaths are estimated to occur worldwide annually as a result of seasonal influenza epidemics

The current research is clear that the vast majority of these deaths (in excess of 90% in industrialised countries), as well as non-fatal influenza-associated hospitalizations, occur in those aged 65 years or older. Influenza vaccination is comparatively poor at inducing clinical protection in those 65 years of age and older. Clinical efficacy is estimated to be only 17–53% in older adults compared to 70–90% in younger adults  

This means influenza vaccination is least effective amongst those in most need of protection. While pharmacological solutions to this issue have shown some promise, the effectiveness of influenza vaccination in older adults remains relatively poor.

According to a study done at Nottingham University in 2017 influenza vaccination is estimated to only be effective in 17–53% of older adults. Multiple patient behaviors and psychological factors have been shown to act as ‘immune modulators’ sufficient to influence vaccination outcomes.

However, the relative importance of such factors is unknown as they have typically been examined in isolation. The study was to explore the effects of multiple behavioral (physical activity, nutrition, sleep) and psychological influences (stress, positive mood, negative mood) on the effectiveness of the immune response to influenza vaccination in the elderly.

One hundred and thirty-eight community-dwelling older adults (65–85 years) who received the 2014/15 influenza vaccination completed repeated psycho-behavioral measures over the two weeks prior, and four weeks following influenza vaccination.

Positive mood on the day of vaccination was a significant predictor of antibody responses at 16 weeks post-vaccination controlling for age and gender. Positive mood across the 6-week observation period was also significantly associated with post-vaccination antibody response at 16 weeks post-vaccination. No other factors were found to significantly predict antibody responses to vaccination. Greater positive mood in older adults, particularly on the day of vaccination, is associated with enhanced responses to vaccination.

Saturday, December 9, 2017

Workshop on Driving for Seniors

If you are in going to be in Richmond, BC on January 9th or 23rd, I am giving the following two workshops for the Richmond Library. The Library need help in promoting these, so if you are in the Lower mainland will you please help by sharing this information on your social networks. Thank you

These are important workshops for those approaching their 80th birthday and those who have friends who are near 80 and those of us who believe we will live past 80.  First, all jurisdictions are concerned about road safety and one of the issues is that many jurisdictions see seniors who are over 80 as a safety risk. This is a myth, as our society lumps all seniors over 80 into the same category and one that governments act on based on that myth to protect others as part of our safety needs. 

Contrary to widely held opinion seniors under 80 are generally safe drivers (More likely to wear seatbelts; less likely to drink and drive, drive less). However, while they have fewer accidents than other age groups, the number of accidents per kilometre is higher for seniors over 80.  It is true that ageing tends to result in a reduction of strength, coordination, and flexibility, which can have a major impact on our ability to safely control a car.
Many chronic diseases of seniors have symptoms that if not managed properly, can pose significant safety risks while driving, for example, diabetes. The complications of Diabetes can cause visual impairment, disorientation, decreased cognitive functioning. Diabetes is also commonly associated with sensory loss, weakness and damage to limbs due to ulcers (amputation)
Another problem is as dementia progresses, driving skills deteriorate and become more difficult due to loss of memory, decreased abilities in executive functioning (making decisions, i.e. when to stop or change lanes), and spatial disorientation (not processing the speed or distance of an oncoming vehicle).
Because road safety is a big issue, ensuring drivers are medically safe to drive is a high priority among provincial and territorial governments in Canada. Accordingly, certain policies and programs are currently in place in order to achieve this goal. Decisions about licensing people with age-related disorders are based on functional measures rather than on diagnostic labels. 

In the workshop, we point out that older drivers are not a homogeneous group, and there does not appear to be a predictable pattern of risk.  We emphasize that a decision to remove a driver from the road should be based on individual not group characteristics. A person may have diabetes but they also manage it very well, the fact they have this chronic disease should not preclude them from driving.

The purpose of the workshop is to help older adults understand the driver medical fitness evaluation process we have in BC so we can help them prepare for upcoming assessments and their driving future. In BC and I suspect other jurisdictions, there are guiding principles that are used to determine a individuals fitness to drive. We go over the principles with the people in the workshop to make sure they understand the principles. We then go through the process that happens when we turn 80, to ensure they understand the process and finally we go over the medical fitness exam and explain what the doctor will be looking for and how they can prepare for this eventuality.

The second workshop has a different focus. Some senior make the decision to give up on driving, not because of medical issues but just because they don't need to or want to drive anymore. The second workshop focuses on how to prepare for the time when they make a decision (or someone else makes the decision) that they should no longer drive.

In the workshop we explore some of the common circumstances to consider when evaluating driving abilities and decisions. We point out that if a person is having more than three of the following issues they should consider whether it is safe for them to drive. 
  • Difficulty pulling in and out of parking spaces
  • Misjudging distances or intersections 
  • Difficulty driving at night
  • Decline in health status
  • Almost crashing, with frequent "close calls"
  • Finding dents and scrapes on the car, on fences, etc.
  • Getting lost
  • Having trouble seeing or following traffic signals, road signs, and pavement markings
  • Responding more slowly to unexpected situations
  • Misjudging gaps in traffic at intersections on highway entrance and exit ramps
  • Experiencing road rage
  • Easily becoming distracted or having difficulty concentrating while driving
  • Having a hard time turning around to check over your shoulder
  • Receiving traffic tickets or "warnings in the last year
    We encourage participants to Know what they want when they stop driving and the options available to them to help them make this transition. We examine how they can make a plan, research alternative forms of transportation, and explore other possible solutions
    The Library need help in promoting these, so if you are in the Lower mainland will you please help by sharing this information on your social networks. Thank you

    Friday, December 8, 2017

    Retirement in the news from around the world

    Here is a brief sample of some of the stories on retirement that I have been reading and following, for your Saturday reading.

    Traverse City Business News
    Americans are not saving enough for retirementBehavioral finance attempts to answer why there is a lack of retirement savings and, more importantly, makes recommendations as to how to fix the deficit. Saving is not easy. There are competing demands in raising children and purchasing a home...
    Folio Institutional plans more podcasts on topics ranging from “NextGen” advisers, big data, behavioral finance and tax optimization. ... In a policy paper, Morningstar says state-run plans and multiple employer plans in their current form would create a more fragmented U.S. retirement system...
    Many in the sector are concerned regulatory, commercial and behavioural dynamics will combine into a "perfect storm", resulting in a crisis in provision and consumer protection in the retirement income market. The report also points out that the UK's= retirement policy is diverging from many other OECD...

    It dates back to the Pension Protection Act and the rise of behavioral finance. The changes that we have made, the nudges or the automation, those changes have increased participation rates, increased savings rates, improved diversification. That's really only 10 or 12 years old. …

    The Globe and Mail
    "On the plus side, managing your own pension lets you manage that money for your own time horizon, not collectively for the income needs of current retirees." The growth of do-it-yourself retirement planning and management is also leading to more choices in where people can go for advice...

    Pensions Expert
    As more people reach retirement age and live longer, an inadequate state pension, coupled with limited retirement savings, highlight an escalating social crisis. The typical model found across the globe for retirement income involves three sources: a basic state pension; supplemental retirement savings...

    The Punch
    The National Pension Commission has set out modalities for the administration of retirement benefits of professors and public office holders to earn their last salaries as pension under the Contributory Pension Scheme. ...
    But in some parts of the world, the reality is less than rosy. In New Zealand, for example, foreign retirement income is deducted from the local pension that a retiree receives. “If you've lived here [in New Zealand] for at least ten years, you automatically have the right to receive a federal pension,” explains...
    Rises in Italy's retirement age were established by the so-called 'Fornero' law in 2011, named after the then-labor and welfare minister Elsa Fornero. The law dramatically changed state pension provision and limited pension expenditure, but has been heavily criticized since. ...
    Soaring life expectancy is forcing all of us to view retirement differently. Squeezed savings rates have diminished pension returns, putting additional pressures on our years in work, and highlighting the importance of changing careers and retraining.

    The Times
    Auto-enrolment is the system under which moderate and low earners are now automatically placed in pension schemes by their employers. They can then opt out, but nine out of ten have chosen to remain in. More than eight million people have been encouraged to save for their retirement in this way...

    Pensions Expert

    Editorial: Collective defined contribution is getting another close look. And it probably will do until pure DC can prove it allows people to have a decent retirement. The Work and Pensions Committee has launched an inquiry into CDC, which has taken many by surprise...