Falls Can Be Fatal For Older Adults
Joanna Hayden, PhD, CHES

A report by the Centers for Disease Control and Prevention released on September 22, 2016 in conjunction with the 9th Annual National Council on Aging Falls Prevention Day, showed that 29 million falls occurred in older adults in 2014 causing 7 million injuries resulting in 27,000 deaths.

For a summary of the report go to: http://www.medicalnewstoday.com/releases/313064.php

For the complete report go to: http://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm?s_cid=mm6537a2_w

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Falling is serious business for older adults.  According to the CDC, it is a leading cause of death from injury in people over 65 and causes more than 95% of the broken hips that occur in this age group every year. The risk of falling increases as we age because of muscle strength decline, changes in balance and gait, inactivity, multiple severe chronic health conditions and more prescription medication use.

So, what can you to decrease the chances of you or a love one falling?

1.       Ask your health care provider to evaluate your risk of

2.       Have your pharmacist review your medications,
          prescription and over-the-counter, for any that cause
          dizziness or sleepiness.

3.      Do exercises that strengthen your leg muscles and improve
         balance. Tai Chi and yoga are two examples.  For others,
         click on this link to the National Institutes of Health Senior
         Health site: https://nihseniorhealth.gov/exerciseandphysicalactivityexercisestotry/balanceexercises/01.html

4.      Have your eyes checked at least once a year.

          If you wear bifocals or progressive lenses, talk to your eye 
          health provider about getting a pair of glasses with only
          your distance prescription.  Sometimes bifocals or 
          progressive lenses make things seems closer than they
          really are, increasing the risk of falling.

5.      Remove things in your home that you can trip over – like
         scatter/throw rugs, loose carpeting -  especially on stairs.

6.      Repair/replace uneven flooring tiles.

7.      Install grab bars inside and outside your tub or shower and
         next to the toilet.

8.      Put railings on both sides of stairs, if possible.

Use brighter light bulbs and avoid walking around in dim 
          light or in the dark.

10.     Install night lights for those middle of the night trips to the

For more information:

National Council on Aging –
Preventing Falls: Tips for Older Adults and Caregivers

National Institutes of Health – Video Library
Falls and Older Adults - https://nihseniorhealth.gov/videolist.html#exercise

American Heart Association –
Strength and Balancing Exercises

Study finds...
many older adults not taking their high blood pressure medication – increasing risk of stroke and heart attack.

Joanna Hayden, PhD, CHES

A study reported in the CDC publication Morbidity and Mortality Weekly Report (MMWR) reveals that 26% of people 65 and over with high blood pressure either don’t take their medication as directed or stop taking it altogether, increasing their risk of stroke  and heart attack.

For the complete report: http://www.cdc.gov/mmwr/volumes/65/wr/mm6536e1.htm?s_cid=mm6536e1_w

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According to the American Hospital Association (2016) about 70% of people 65 and older have high blood pressure (hypertension). High blood pressure is diagnosed when the systolic (top number) reading is above 140 and/or the diastolic (bottom number) is above 90. Blood pressure between 120 –139 systolic and/or 80-89 diastolic is considered pre-hypertensive with normal blood pressure at 120/80 or less.

Blood pressure is the force of the blood pushing against the walls of arteries in the body when the heart beats (top number or systolic) and when it’s at rest in between beats (bottom number or diastolic). 

Keep in mind that high blood pressure does not cause symptoms, which is why it’s called “the silent killer.”  Therefore, keeping blood pressure as close to normal as possible is necessary to  prevent the consequences of high blood pressure, which include:

Getting high blood pressure under control consists of making lifestyle changes and if they don’t work, medications. Although lifestyle changes can bring high blood pressure down,  they don’t work for everyone.

To reduce blood pressure through lifestyle changes the Mayo Clinic suggests the following:

Weight loss – If you are over weight or obese, losing as little as 10 pounds can make a difference especially if you carry extra weight around your waist.

Exercise – Regular physical activity 30 minutes on most days helps to control high blood pressure. Good activities include walking, dancing, jogging, swimming or cycling.

Healthy eating - A diet with lots of whole grains, fruits, vegetables and low-fat dairy products can help with weight loss as well as high blood pressure control.

Sodium reduction: – Not everyone is created equal when it comes to the effect of sodium on blood pressure. Limiting sodium to no more than 2300 mg/day (the amount of sodium in 1 teaspoon of salt) can help lower blood pressure in some people. In people who are “salt sensitive,” limiting sodium to 1500 mg is advisable.

Limited alcohol – A little alcohol (1 drink a day for men and women over 65, or two drinks for men under 65) may actually lower blood pressure slightly. However, more than the 1-2 drinks a day increase blood pressure and can interfere with the effectiveness of blood pressure medications. 

Smoking cessation– The nicotine in tobacco smoke narrows the arteries which increases blood pressure.  The effect of nicotine on blood pressure last for about 20 minutes after each cigarette.

Caffeine reduction – Although caffeine doesn’t seem to affect blood pressure in people who regularly drink it, it can does raise it in those who  rarely drink it.

Stress management

- Identify your stress triggers and avoid those you can.

- Give yourself time to get things done.

- Learn to say no.

- Think about problems under your control and make a plan to solve them.

- Make time to relax and do things you enjoy.

- Breathe - Take 15 to 20 minutes a day to sit quietly and breathe deeply.

- Practice gratitude. Expressing gratitude to others can help reduce stressful thoughts.

When lifestyle changes don’t bring blood pressure down to more normal levels, a number of different types of medications can be used.  Below is an explanation of how the different medications types work from the National Health, Lung and Blood Institute of Health.

  • Diuretics (Water or Fluid Pills): Flush excess sodium from your body, which reduces the amount of fluid in your blood and helps to lower your blood pressure. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill.
  • Beta Blockers: Help your heart beat slower and with less force. As a result, your heart pumps less blood through your blood vessels, which can help to lower your blood pressure.
  • Angiotensin-Converting Enzyme (ACE) Inhibitors: Angiotensin-II is a hormone that narrows blood vessels, increasing blood pressure. ACE converts Angiotensin I to Angiotensin II. ACE inhibitors block this process, which stops the production of Angiotensin II, lowering blood pressure.
  • Angiotensin II Receptor Blockers (ARBs): Block angiotensin II hormone from binding with receptors in the blood vessels. When angiotensin II is blocked, the blood vessels do not constrict or narrow, which can lower your blood pressure.
  • Calcium Channel Blockers: Keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax, which can lower your blood pressure.
  • Alpha Blockers: Reduce nerve impulses that tighten blood vessels. This allows blood to flow more freely, causing blood pressure to go down.
  • Alpha-Beta Blockers: Reduce nerve impulses the same way alpha blockers do. However, like beta blockers, they also slow the heartbeat. As a result, blood pressure goes down.
  • Central Acting Agents: Act in the brain to decrease nerve signals that narrow blood vessels, which can lower blood pressure.
  • Vasodilators: Relax the muscles in blood vessel walls, which can lower blood pressure.
In order for any of the blood pressure medications to work, they have to be taken as prescribed -  which unfortunately, the above study found many people are not doing. If you are one of these people, talk to your health care provider about why you aren’t taking your medication. If it’s because of side effects, a different type of medication might work for you. If it’s because of the medication cost, perhaps a generic version is available. You and your health care provider need to work together to prevent the consequences of uncontrolled high blood pressure.

For more information

National Institute of Health – National Heart, Lung and Blood Institute
How is high blood pressure treated?

Causes of high blood pressure

American Heart Association
Understanding high blood pressure reading

Got Head Lice? OTC products may no longer work.
Joanna Hayden, PhD, CHES

A review of over-the-counter head lice treatments published in the journal Pediatric Dermatology last week found those containing pyrethrins or permethrin  to likely be ineffective probably due to insect resistance that developed over 30 years of indiscriminant use.

Summary/journal article abstract: http://onlinelibrary.wiley.com/doi/10.1111/pde.12982/abstract

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Head lice infestation is pretty common among young children. Although the exact number of cases each year in the U.S. is not known, the CDC estimates it to be between 6 - 12 million among children 3 to 11 years of age.  What is known is that infestation is less common among African-Americans possibly because the shape of the hair shaft makes it more difficult for lice to attach.

Head lice don’t fly, jump or hop, they crawl.  Because of this, they spread from person to person by direct contact, i.e they need to “walk” from one head to another, or from contaminated objects (brushes, combs, hair clips)  or articles of clothing (hats, coats, sweaters, etc.) Lice infestation has nothing to do with personal cleanliness or living conditions. Although crowed living conditions do make it easier for them to spread from person to person.

Lice are usually found on the scalp where they bite and then feed on blood. They  live for
about a month.  Adults are about the size of a sesame seed and take on a lighter or darker coloration depending on the color of the host’s (your) hair.

Nits (louse eggs) are usually found on the hair shaft about ¼ inch above the scalp, most often around the ears and along the hairline at the back of the neck.  They are tiny with a pearl like appearance and are “stuck” securely to the hair shaft. (Picking them off is a tedious process which is where the saying “nit picking” originated.)

Lice cause the following symptoms:

  • Tickling feeling on the head – from them crawling
  • Itching, from a reaction to the bites (It may take 4-6 weeks before this happens)
  • Irritability and difficulty sleeping because they are most active in the dark.
  • Sores on the head from scratching that sometimes become infected.
As the study above found, over-the-counter lice treatments are likely to be ineffective.  Their brand names are: A–200, Pronto, R&C, Rid, Triple X and Nix. As a result, prescription products might have to be used.

Following are the prescription products listed on the CDC website as approved by the FDA for the treatment of lice:

·         Benzyl alcohol lotion, 5%
Brand name product: Ulesfia lotion
Benzyl alcohol lotion, 5% has been approved by the FDA for the treatment of head lice and is considered safe and effective when used as directed. It kills lice but does not kill the nits (eggs). A second treatment is needed 7 days after the first treatment to kill any newly hatched lice before they can produce new eggs.

·            Ivermectin lotion, 0.5%
Brand name product: Sklice
Ivermectin lotion, 0.5% was approved by the FDA in 2012 for treatment of head lice in persons 6 months of age and older. It does kill nits, but does seems to prevent newly hatched lice (nymph) from surviving It should not be used for retreatment without talking to a healthcare provider.

·         Malathion lotion, 0.5%
Brand name product: Ovide
Malathion is an organophosphate, an insecticide. The formulation of malathion approved for the treatment of head lice is a lotion that is safe and effective when used as directed. Malathion kills live lice and some lice eggs. A second treatment is recommended if live lice still are present 7–9 days after treatment. Malathion can be irritating to the skin, but more importantly, it is flammable; do not smoke or use electrical heat sources, including hair dryers, curlers, and curling or flat irons, when applying the lotion and while the hair is wet.

  ·         Spinosad 0.9% topical suspension
Brand name product: Natroba
Spinosad is derived from soil bacteria. It kills live lice and unhatched eggs (nits), so a second treatment is usually not needed unless live (crawling) lice are seen 7 days after the first treatment.

If none of the above work:

·         Lindane shampoo 1%
Brand name products: None available
Lindane is an organochloride. Although lindane shampoo is approved by the FDA for the treatment of head lice, it is not to be used as a first–line treatment and The American Academy of Pediatrics no longer recommends it be used at all. Overuse, misuse, or accidentally swallowing lindane can be toxic to the brain and other parts of the nervous system. Lindane should not be used to treat premature infants, persons with HIV, a seizure disorder, women who are pregnant or breast–feeding, persons who have very irritated skin or sores where the lindane will be applied, infants, children, the elderly, and persons who weigh less than 110 pounds. Retreatment should be avoided.

If you want to avoid exposure to harsh chemicals, nits and lice can be removed manually by combing them out.
Make sure you have bright light or are doing this outside on a sunny day.

1. Coat the hair and scalp with conditioner or another lubricant (avoid using petroleum jelly as it is very  difficult to remove)

2. Use a wide-tooth comb to separate hair into very small sections.

3.      Follow with a thin toothed finely spaced metal nit comb—not plastic. (These can be found at most drug stores, or you can use a flea comb).

4.      Using the nit comb, comb a very small section of hair at a time making sure to get close to the scalp. Remember that nits are on the hair shaft about ¼ inch from the scalp.

5.      After each comb-through:
  • move the section over of hair
  • wipe the comb on a paper towel
  • inspect for lice and nits.
  • seal the paper towels in a resealable plastic bag and dispose if it when done with the whole head.

6.      Clean combs in very hot, soapy water. (Consumer Reports, 2015 http://www.consumerreports.org/cro/news/2014/09/to-get-rid-of-head-lice-comb-them-out-instead-of-using-nix-rid-or-other-chemicals/index.htm)

This process may have to be repeated a few times to remove all nits and lice.

To prevent re-infestation -

Head lice survive less than 1–2 days if they fall off a person and cannot feed. Nits cannot hatch and die within a week if they are not kept at the temperature as that found close to the scalp. Although head lice do not survive long off the human head, the steps below will help avoid re–infestation by lice that recently fell off the hair or crawled onto clothing or furniture. (CDC, 2016)
  1. Machine wash and dry clothing, bed linens, and other items that the infested person wore or used during the 2 days before treatment. Use the hot water (130°F) laundry cycle and the high heat drying cycle.
             Dry clean clothing and items that are not washable or seal              in a plastic bag and stored for 2 weeks.

       2.   Soak combs and brushes in hot water (at least 130°F) for
                5–10 minutes.

        3. Vacuum the floor and furniture, especially where the    
              infested person sat.

  For more information:

Centers for Disease Control and Prevention  - Lice FAQs

Mayo Clinic – Head Lice

Consumer Reports: Comb nits out


FDA Says -  Antibacterial Soaps Coming Off The Market. 
Joanna Hayden, PhD, CHES

On September 2, 2016, the FDA announced that over-the-counter antibacterial soaps containing any of 19 different ingredients will be removed from the marketplace within a year. The reason for this ruling? Manufacturer’s did not provide evidence that these         soaps are safe for long term use or that they are more effective in preventing illness than plain soap and water.

FDA Ruling: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm517478.htm

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For years we used antibacterial soaps because the companies that sold them said they would reduce our chances of getting sick. And for years, the companies that sold them didn’t provide any evidence that they in fact, worked better than plain soap and water. 

In 2013, the FDA asked antibacterial soap manufacturers to provide proof that their products reduced disease risk. What the FDA got was either no information or insufficient information, which is why they ruled last week for the removal of antibacterial soaps containing any of 19 different ingredients.

Two of the most commonly used ingredients, triclosan (which is also used as a pesticide) and trilocarban, can potentially cause health risks by contributing to the development of antibiotic resistant bacteria. (see Health News You Can Use  July 18, 2016 for more information). When bacteria develop resistance to antibiotics, treatment of bacterial infections becomes much more difficult, and in some cases, impossible.

Washing our hands with plain ol’ soap and water is an easy, effective way to decrease the risk of spreading disease causing germs.  To this end, the CDC urges all of us to wash our hands:

Before, during, and after preparing food
Before eating
Before and after caring for someone who is sick
Before and after treating a cut or wound

After using the toilet
After changing diapers or cleaning up a child who has used the toilet
After blowing your nose, coughing, or sneezing
After touching an animal, animal feed, or animal waste
After handling pet food or pet treats
After touching garbage

Following are the CDC’s  five steps to correct hand washing:

1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
     Running water is important because water in a basin may be    
     contaminated from previous handwashing.

    The temperature of the water does not effective how clean you     get your hands, so using cold, cool or warm water is fine, but         water alone does not do remove germs very well.

    It is the soap that makes the difference. The dirt lifting ability     of soap along with the actual action of scrubbing removes the     germs.

2. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.

     Rubbing hands together creates friction which releases dirt         and germs from the skin.

    Although germs are all over our hands, they are in higher             numbers under our nails!  So, make sure to clean under nails         every time you wash your hands.

3. Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.

    The dirtier your hands are, the longer you should wash them.     Globally, recommendation range from 15-30 seconds.

4. Rinse your hands well under clean, running water. Scrubbing your hands loosens dirt and germs, but rinsing sends them down the drain.

    While many use paper towel to then turn off the faucet, there     are no studies showing that this is action improves health.

5. Dry your hands using a clean towel or air dry them.

Wet hands are more likely to pick up or transfer germs, so dry     your hands after washing by using a clean towel, paper towel         or letting them air dry.

If running water is not available, then using a hand sanitizer with 60% alcohol is the next best thing.

  • Alcohol-based hand sanitizers can reduce the number of germs on hands in some situations, but they NOT remove all types of germs.
  • Hand sanitizers may not be as effective on hands that are visibly dirty or greasy.
  • They might not remove harmful chemicals like pesticides and heavy metals from hands.
  • Be careful when using hand sanitizers around children; swallowing alcohol-based hand sanitizers can cause alcohol poisoning if more than a couple mouthfuls are swallowed.
To most effectively use a hand sanitizer:

  • Apply the product to the palm of one hand (read the label to learn the correct amount).
  • Rub your hands together.
  • Rub the product over all surfaces of your hands and fingers until your hands are dry.

For More Information:

Food and Drug Administration (FDA)
              Antibacterial Soap  

Centers for Disease Control and Prevention (CDC)
              How to wash your hands

Science behind how to wash your hands