By Helen L. Sloan, RN, CS, DNS, and Anne White Robinson, RN, DNS | July 28, 2006 12:00 am
An ancient Chinese proverb says, “One disease, long life; no disease, short life.” For many women, diabetes is that one disease that, perhaps ironically, leads to a longer, healthier life. That’s because a big part of the treatment for diabetes is adopting a healthy lifestyle: following a nutritious diet, getting regular exercise, not smoking, drinking only in moderation, finding ways to cope with stress, and simply paying attention to one’s body. Maintaining a healthy lifestyle gets no less important with age. In fact, it may get more important, since diabetes is a progressive disease. Here are our top 10 tips for women over 65 who want to take charge of their health and stay healthy, strong, and independent in the years to come.
If you don’t already follow a meal plan, work with a dietitian to design one that helps you achieve your blood glucose goals, lowers your risk of complications, and includes foods that you like to eat. If you have Medicare Part B, some sessions with a dietitian are covered with a physician’s referral. You may receive up to three hours with a dietitian in your first year of nutrition therapy and two hours each subsequent year.
The American Diabetes Association recommends eating a variety of high-fiber foods such as whole grains, fruits, and vegetables to get the vitamins, minerals, and other nutrients you need to maintain your overall health. A diet that’s low in fat, saturated fat, cholesterol, and sodium will help you keep your cholesterol and blood pressure levels in a healthy range and thus lower your risk of heart disease, stroke, and other complications.
A particular concern for women is preventing osteoporosis. As we get older, we gradually begin to lose bone mass. Estrogen helps to maintain bone mass, so after menopause, women can begin to lose bone very rapidly, and this bone loss can lead to osteoporosis. To slow bone loss, women must get an adequate amount of calcium, a mineral the body uses to build bone. The National Institutes of Health recommend that women get between 1,000 and 1,300 milligrams (mg) of calcium a day, depending on their age and whether they are pregnant or lactating. Some calcium-rich foods include milk, yogurt, cheese, collard greens, fortified orange juice, and fortified soy products. If you don’t get enough calcium from your diet, you may consider taking supplements.
For your body to be able to absorb calcium properly, you also need to get an adequate amount of vitamin D. For many women, the easiest way to get vitamin D is to get some sun — the body produces vitamin D when the skin is exposed to the sun’s ultraviolet rays. However, for people in northern climates, the sun may not be strong enough, and there’s evidence that our bodies don’t produce vitamin D from sunlight as easily when we get older. It’s a good idea to try to get your vitamin D from food sources such as fortified milk. But if you don’t drink milk, vitamin D supplements are available; aim for 600–800 international units (IU) a day. Some calcium supplements have vitamin D in them, but you don’t need to take calcium and vitamin D at the same time to get the benefits.
If your health care is the ship, you are the skipper; your primary-care physician and the rest of your health-care team are there to help out and make recommendations, but ultimately it’s you who decides what course to steer. Take charge of your medical care in the following ways:
A good way to stay healthy is to detect and treat medical problems early — or, better yet, to prevent them altogether. Preventive measures you can take include getting screened for diabetes complications, cancer, and other conditions; getting immunizations; and taking precautions to prevent falls and injuries.
An important concern for women with diabetes is screening for and preventing cardiovascular disease. Having high blood cholesterol and/or high blood pressure raises your risk of heart disease, so you should have your cholesterol checked once a year (or as recommended by your doctor) and your blood pressure checked every time you visit your doctor. You should also get tested once a year for microalbuminuria, or protein in the urine, an early sign of nephropathy and a risk factor for heart attack and stroke. In addition, you should have your HbA1c level checked two to four times each year to get an idea of how well you’re controlling your blood glucose level. Keeping your blood glucose as close to normal as possible helps you reduce your risk for diabetes complications.
According to the National Cancer Institute (NCI), 1 in 8 women will develop breast cancer at some point in her life, and 1 in 18 will develop colorectal cancer. Detecting these types of cancers early makes treating them more likely to be successful. The U.S. Preventive Services Task Force recommends that women age 50 and over get a mammogram (a screening test for breast cancer) every one to two years. Several tests can detect cancer of the colon or rectum, and the American Cancer Society recommends that starting at age 50, all people at average risk of the condition have either a fecal immunochemical blood test once a year and flexible sigmoidoscopy every five years, a colonoscopy once every 10 years, or a double-contrast barium enema or CT colongraphy every five years. In addition, getting regular pelvic exams and Pap smears can help detect cervical, vaginal, and other gynecological cancers.
Another wise precaution to take is getting immunized against pneumonia and influenza. Cases of pneumonia and the flu can be more serious and cause more complications in older people — in fact, pneumonia and influenza are the fifth leading cause of death for people 65 and older. Having diabetes also raises your risk of flu complications, including pneumonia. The Centers for Disease Control and Prevention (CDC) recommends that people over 65 get a flu shot every September or October; it can greatly reduce your chances of contracting the flu. It is possible to get the flu even after getting a flu shot, but your case will be milder than if you had not been immunized. The CDC also recommends the pneumonia vaccine for all people 65 and older. People in this age group should have two doses of the vaccine, at least one year apart. If you haven’t had a pneumonia or flu shot, talk to your doctor about getting them.
Medicare helps pay for many different preventive measures and screening tests. If you have Medicare Part B, you can get one flu shot each year and two pneumonia shots of a different type in your lifetime. You may also receive one pelvic exam, clinical breast exam, and Pap smear every two years (or every year if you’re at high risk for gynecological cancer). One mammogram is covered every year, as is one fecal occult blood test. Other colorectal cancer screening tests are also covered; you can get a flexible sigmoidoscopy or barium enema once every four years or a colonoscopy once every 10 years (unless you have had a sigmoidoscopy in the last four years). If you’re at high risk for colon cancer, you can get a colonoscopy every two years. If you don’t have Medicare, contact your insurance provider to find out what your plan covers.
Another concern for older women, particularly for those who have osteoporosis or are at high risk of developing it, is preventing falls and bone fractures. Hip fractures in particular can be quite serious: According to the American Association of Orthopedic Surgeons, nearly one in four older people die within a year of fracturing a hip, and about 40% are unable to live independently after their hip fracture. Most serious falls occur in the home, so take steps to make your house fall-proof, such as tacking down rugs, cleaning up clutter, and putting nonslip mats in your shower and by your bathroom and kitchen sinks. Doing aerobic, weight-bearing, and stretching exercises can also help prevent falls because they strengthen your muscles, increase your range of motion, and improve your balance.
Having diabetes raises your risk of getting foot infections, so it’s important to pay attention to foot care. A common complication of diabetes is neuropathy, which can lead to a loss of sensation in the feet. If you can’t feel a cut, scrape, or blister on your foot, you may not treat it, and it may develop into an ulcer. An untreated ulcer can become infected, and, if the infection is serious enough, amputation can be necessary.
To help prevent foot ulcers and infections, follow these foot-care steps:
To really stay on top of the condition of your feet, check them at home for loss of sensation. The Lower Extremity Amputation Prevention Program (LEAP) offers a free screening kit to do just that. The kit includes a device called a monofilament that you or someone else touches to the bottom of your foot in several places. If you don’t feel the touch, tell your doctor.
Mental-health problems such as depression and anxiety are not uncommon in older women, but they often go undiagnosed and untreated. Women may dismiss symptoms of depression or anxiety as normal feelings of sadness or worry that they just have to “get over.” Health-care providers similarly may not recognize depression or anxiety for what it is. The fact is, however, that clinical depression and anxiety disorders are not simply passing moods, nor are they a normal part of aging, and they can be treated effectively with medication, counseling, or a combination of both.
Women are twice as likely as men to have depression, and people with diabetes are twice as likely to have it as people who don’t have diabetes. Of course, we all go through periods of sadness or grief now and then, but you should talk to your doctor if your feelings of sadness or emptiness last for more than two weeks and are accompanied by any of the following symptoms:
Many women experience one of several anxiety disorders. The most common type is generalized anxiety disorder, in which a person feels constantly and excessively anxious. Often, people with generalized anxiety disorder don’t know why they are worrying, and sometimes they can’t stop worrying even if they realize that their anxiety is exaggerated. In addition to persistent anxiety, symptoms may include trouble sleeping, muscle tension, headaches, hot flashes, and difficulty concentrating. Many people with generalized anxiety disorder also have depression. If you have any of these symptoms, talk to your doctor. Treatment options include antianxiety medicines, psychotherapy, and relaxation techniques.
Exercise is a beneficial activity for all women, including those who are past menopause. In fact, an individualized exercise program should be part of any treatment plan designed to help control diabetes. Exercise can help lower blood glucose levels and increase insulin sensitivity, or the body’s ability to use insulin efficiently. Some people who exercise regularly are able to take less insulin and/or oral diabetes medicine. Exercise can also help you lose weight and maintain weight loss.
The benefits don’t stop there. Exercise can also help prevent diabetes complications. Having diabetes makes a woman two to four times more likely to develop cardiovascular disease or have a stroke, but regular physical activity can lower these risks by strengthening the heart, reducing cholesterol levels, and lowering blood pressure.
Exercise is also good for your bones. Weight-bearing activities such as brisk walking, stair climbing, and weight lifting can help maintain bone mass and lower your risk of developing osteoporosis, a condition in which bones become porous and fragile. In addition, by strengthening muscles and improving balance and flexibility, regular physical activity can help you reduce your risk for falls and bone fractures.
And there’s more. Getting regular exercise can help you fend off fatigue by giving you more energy during the day and helping you sleep better at night. When you exercise, your body produces chemicals called endorphins, which can act to improve your mood and even relieve the symptoms of anxiety and depression.
According to most recent exercise guidelines from the US Surgeon General, you should aim for at least 150 minutes of moderate-to-intense physical activity each week — 30 minutes of physical activity each day for at least five days a week. Jogging or walking at a brisk pace, bicycling, and swimming all qualify as moderate-intensity physical activity, and so can other activities, such as raking leaves, gardening, and washing your car. You don’t have to do all 30 minutes at once; you can exercise in several shorter bouts throughout the day. For example, you may spend 20 minutes working in the garden in the morning and then take a 10-minute walk after dinner.
If you don’t already exercise regularly and would like to begin or if you would like to increase the amount of exercise you do, pay a visit to your doctor first. It is important to get a thorough physical examination to make sure that exercising will be safe for you. Your doctor will check for complications, including cardiovascular disease, peripheral arterial disease (the hardening of the arteries in the legs and feet), retinopathy (eye disease), nephropathy (kidney disease), and neuropathy (nerve damage). Having one of these complications doesn’t mean you can’t exercise, but it does mean that certain exercises may be safer for you than others. For example, if you have proliferative retinopathy, you should avoid high-impact aerobics, heavy weight lifting, and anything that involves straining or jarring movements. If you have neuropathy with loss of sensation in your feet and legs, you should limit weight-bearing exercise and stick to activities such as swimming, bicycling, rowing, and chair exercises. Repetitive activities that place pressure on the feet, such as using a treadmill, walking long distances, jogging, and doing step exercises, may lead to foot ulcers and fractures. If you have nephropathy, it’s a good idea to avoid high-intensity or strenuous exercises.
In addition to discussing what types of exercise are appropriate for you, ask your doctor how your blood glucose level may be affected during and after exercise and how to handle any changes you experience.
The older you get, the more medicines you’re likely to take. In fact, older people spend an estimated $3 billion annually on medicines, and the average older person takes six or seven prescription and over-the-counter medicines a day. That’s a lot to keep track of. To help you keep them all straight, make a checklist that includes the names of all the medicines and the times at which you should take them. As you take each dose, check it off the list. Keeping the week’s medicines in a pill box that has a separate compartment for each day can also help you remember to take them.
Be sure to follow the directions for taking your medicines. Don’t leave the doctor’s office or the pharmacy without being sure when and how often you should take your doses and whether to take them with food or on an empty stomach. Also be sure to find out what you should do if you ever forget to take a dose. With some medicines, it’s OK to take a missed dose when you remember it — as long as you remember fairly soon after you were supposed to take it. However, if it’s nearly time for the next scheduled dose, you may be better off skipping the forgotten dose altogether. Taking two doses of insulin too close together, for example, could cause serious hypoglycemia. If you miss a dose of your medicine and aren’t sure what to do, call your doctor or pharmacist.
Many drugs can cause side effects. Some side effects, such as intestinal gas or mild nausea, might be annoying but not medically serious. (In addition, such side effects often subside over time.) Others, however, such as light-headedness or hypoglycemia, can have serious consequences, such as, in this case, falling or having a car accident. Make sure to ask about the possible side effects of the medicines you’re taking so you know what to expect and what to do if you experience severe symptoms. Never stop taking a medicine without consulting your doctor first. Stopping some medicines, such as antibiotics and corticosteroids, before you’re supposed to can be quite harmful. However, if you think you’re having an allergic reaction to your medicine (characterized by hives, itching, swelling, or difficulty breathing), contact your doctor immediately.
Some medicines require that you get periodic tests to evaluate whether the drug is working properly. For example, if you take warfarin (brand name Coumadin) to reduce your risk of having a heart attack or stroke, you need to get regular blood tests to make sure you’re getting the right dose. Oral diabetes medicines in the thiazolidinedione class, such as pioglitazone (brand name Actos), also require certain blood tests because they have the potential to cause liver damage. If you take one of these drugs to control your blood glucose, read the package insert and talk to your doctor to make sure you’re getting the tests you should have.
Last but not least, many medicines can interact with other ones. An interaction can increase or decrease the effectiveness of one of the drugs or cause unwanted side effects. To prevent drug interactions, make sure that your doctor and your pharmacist know about everything you’re taking — that means all prescription drugs, over-the-counter drugs, herbs, and supplements. It helps to buy all your prescription drugs at one pharmacy, so the pharmacist has a complete list at his fingertips. In addition, once a year, bring all your drugs and supplements to a doctor’s appointment and ask him to check for possible interactions.
Smoking is the leading preventable cause of death in the United States; the American Lung Association estimates that it’s responsible for one in five deaths each year. Older adults are reported to be less likely to have tried to quit, possibly because many believe that smoking does not harm their health. The fact is that smoking does harm your health — and that quitting smoking has proven health benefits, even for older people. Smoking raises your risk for lung disease and cancer, and, because it narrows your blood vessels, it also increases your chances of developing heart disease or having a stroke. When you stop smoking, your circulation improves immediately, and your lungs begin to repair damage from the tar and toxic substances contained in cigarette smoke. One year after quitting, the added risk of heart disease that comes with smoking is reduced by one half, and over time, the risk of stroke, lung disease, and cancer also decrease.
If you currently smoke and are ready to stop, talk to your doctor. You and he can discuss ways to quit successfully. Quit-smoking programs through organizations such as the American Lung Association or the American Heart Association may be available in your community. You can find the phone numbers of your local chapters of these organizations in the phone book or online.
Older people often experience vision problems such as cataracts (cloudy or hazy spots on the lens of the eye), macular degeneration (the breakdown of the part of the retina that gives us sharp, central vision), and glaucoma (a condition in which pressure builds up in the eye and damages the optic nerve). These conditions can lead to impaired vision or vision loss, which can interfere with your quality of life and increase your risk of falls and fractures. Having diabetes can affect your eyes as well. It doubles your risk for glaucoma, and it can cause a condition called retinopathy, in which damage to the retina causes vision loss.
You can help prevent diabetes-related eye problems by keeping your blood glucose level as close to normal as possible. The next best thing to prevention is early detection; catching eye problems early makes it easier to treat them successfully and prevent vision loss. Because glaucoma and retinopathy often show no symptoms until you start to lose vision, it’s important to get screened for them regularly. The American Diabetes Association recommends having a dilated eye exam every year, even if you don’t notice any changes in your vision. If you do notice vision changes, especially sudden ones, don’t wait for your annual exam — let your health-care provider know right away. Medicare Part B covers one dilated eye exam each year for people with diabetes. If you don’t have Medicare, check to see what your plan covers.
Having a social network is important to the body, mind, and spirit. People who are socially active tend to be healthier, happier, and less likely to become depressed. Yet many women have less contact with other people as they get older, sometimes because of a disability that makes getting out of the house difficult, sometimes because friends and family members die or move away over time. If women don’t make new friends and social contacts, they may experience social isolation, which can lead to feelings of loneliness and affect their sense of well-being.
To stay socially active, make a point of getting out of the house. Make dates with your friends to go out to lunch or to the mall. Better yet, make plans to exercise regularly with a friend or group of friends. Exercising with others is usually more fun than exercising on your own, and it can help you stick with your exercise program.
Some other ways to increase your social interaction include volunteering at a school, library, museum, park, or nonprofit organization; participating in a church group or choir; taking a class at a community college; and joining a book club through your public library or a nearby bookstore. Contact your local senior center to see if it serves lunch, shows movies, or offers dance, exercise, craft, or other kinds of classes. You can also check with your senior center to see if your town has a reminiscence group that you can take part in. Attending a diabetes support group is a good way to meet and socialize with other people who have diabetes and may be facing the same challenges as you are. Check with your senior center or local hospital to see if it offers one. If you live in a retirement community, take advantage of the social and recreational activities offered.
If transportation is a problem for you, see if your senior center offers rides to its events. You can also have family and friends come to you — invite them to your house for parties, meals, or card nights. And don’t forget about using the phone, e-mail, or letters to stay in touch with friends and loved ones — whether they live close by or far away.
All too often, older women with hearing problems are reluctant to socialize because they find it difficult or embarrassing to try to communicate with others. If a hearing impairment is keeping you from socializing with others, talk to your doctor. You may benefit from using hearing aids.
The more you do to stay healthy, the better you will feel. And now that you’re equipped with these ten tips you know just what to do. But don’t try to change everything at once. Begin with small changes to your routine — such as devoting a few minutes each day to foot care, scheduling more social outings with your friends, or remembering to get your flu shot — and work up to the bigger ones, such as stopping smoking. Incorporate the advice we’ve given into your routine tip by tip until you follow all 10. The payoff could be a healthier, happier life in the years to come.
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