Elderly and Exercise

Exercising three times a week could be more effective than medication in relieving the symptoms of major depression in elderly people and may also decrease the chances that the depression will return over time.

Researchers at Duke University Medical Center, in Durham N.C., studied 156 majorly depressed patients 50 and older and found that after 16 weeks, those who exercised showed significant improvement compared to those who either took medication alone or those who combined the therapies. In a six-month follow-up study, Duke psychologists found that depression returned in only 8 percent of the patients in the exercise group, versus 38 percent for the drug-only group and 31 percent for the drug and exercise combined group.

Study participants in the exercise group engaged in one half-hour of brisk walking three times a week.

“The main conclusion is that maintaining an exercise program can significantly help in reducing depression,” says the study’s lead researcher, Duke psychologist James Blumenthal, whose work is published in the current issue of the journal Psychosomatic Medicine. He believes this is the first study that actually looks at exercise as a treatment for depression for any age group, but says the results, “just confirm what a lot of people think exercise can do anyway.”

Number One Anti-Aging Medicine

“If exercise could be put in a pill it would be the number one anti-aging medicine and the number one anti-depression medicine,” agrees Dr. Robert N. Butler, President of the International Longevity Center, at Mount Sinai Medical School in New York City. “It’s also cheap, and it avoids problems such as the side-effects of medication.”

Depression is prevalent for the elderly. A recent report by the National Institute of Mental Health called depression in the elderly “widespread” and “a serious public health concern.” Surveys suggest more than 15 percent of the elderly population experiences depression at some point, while an additional 25 percent of elderly individuals have periods of persistent sadness that last two weeks or longer.

Contributing to depression in the elderly are medication side effects; the onset of Alzheimer’s disease and other ailments and a sense of loss that is perhaps different from depression younger people may experience. The elderly are more subject to depression because they tend to experience more loss and they “no longer get the income of self-esteem” that comes with working, says Norman Abeles, professor of psychology at Michigan State University in East Lansing.

Abeles, who is the former president of the American Psychological Association, called the Duke finding “interesting” and added that exercise could serve as an adjunct to the counseling often recommended for the elderly because antidepressants may adversely interact with the other medications the elderly take.

“If you bring up medication, often people don’t want to take it,” says Dr. Joseph Gallo, assistant professor of Family Practice and Community Medicine at the University of Pennsylvania in Philadelphia. He says that elderly patients often deny depressive symptoms, and that using exercise to treat those symptoms could be effective because exercise builds on “self-efficacy and self-confidence.”

But not everyone will benefit from exercise, cautions Gallo. Because depression plays a role in how people take care of themselves, he points out it’s unlikely all depressed people will be motivated to start or keep exercising. Additionally, older adults may have medical complications that prohibit them from being active. The disability can contribute to their depression, he says, but also makes movement an impossible treatment for them.

Study leader Blumenthal says it’s still unclear how exercise affects depression. Further studies will examine whether the improvements experienced in the exercising group actually came from the social support of exercising with others. He plans to look at a home-based exercise versus group-exercise group to establish what impact the exercise is actually having. For more information visit http://www.abcnews.com

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Practicality And Fun for Seniors

In Great Britain and Japan, playgrounds are being built for seniors. In Manchester, United Kingdom, seniors can use low impact exercise equipment in Dam Head Public Park. In Japan, with birthrates falling and the numbers of senior citizens increasing, underused playgrounds are being renovated for seniors.


In an article titled, “Japan’s elderly playgrounds show fun is for everyone,” Chika Osaka notes that playgrounds are not just for children. In Japan, with fewer people having children, and nearly 400,000 centenarians, Japan has the world’s oldest population. As a result, local governments are disassembling children’s playgrounds to convert them to fitness parks for older persons.

Soichiro Saito, a 79 year old who participates in a weekly exercise class at a Tokyo park said, “If I’m at home, I tend to slouch or lie down, but if I come here, I straighten my back.” Saito’s class uses a climbing frame, walks on balance beams and does stretching exercises under supervision.

The seniors not only enjoy the exercise but also the socialization. Many feel isolated from the community. Some report experiencing a heightened sense of well-being after the exercise.

The cost of an elderly playground may start at 8 million yen ($87,220) including installation and fees for trainers. The Association of Physical Fitness Promotion And Guidance says demand has been growing. Over 15,000 pieces of workout equipment have been installed in parks in Japan, and the number of seniors using the playgrounds daily has doubled.

“No one is ever too old to have fun,” said the association’s Saijo. “Anyone can try this workout. No experience or preparation is needed. All you have to do is come out here and start working out.”

In “Playtime for Grandma: Council opens new playground for the over-60s,” Niall Firth reports on visitors using the first playground for seniors in the UK. Named the Older People’s Play Area in Dam Head Park, Blackley, users can enjoy gentle exercise for hips, legs and torsos. There are stations for pull-ups, push-ups and pedaling.

Based on a German idea, the park was built by the residents’ association. It cost 15,000 British pounds. The park adjoins a children’s park so that grandparents and their grandchildren play together. Joan Fitzgerald, chairman of the residents’ association, who also uses the park, said, “When we tested it all the people we took in were over 70.” She added, “And I have never heard so much laughing! I believe you are never too old to play and this helps you keep fit,” Joan said, echoing Saijo.

Peggy Yuill, 74, who was one of the test group, said, “It makes you feel 21 again.” The playground also helps the infirm, providing equipment that can be used by someone in a wheelchair who wants to develop upper body strength.

“Many older people aren’t exercising enough,” Gordon Lishman, director general of Age Concern, said. “We are really keen for local authorities to offer a range of accessible and affordable facilities that promote physical activity in later life.”

Senior playgrounds exist in England, Germany, Japan, New Zealand, and Canada. Besides games like Wii suggested ways of getting healthy outdoor exercise are: walking, biking or playing catch with the grandkids. But an even better exercise might be urging city councils to add playgrounds for the elderly.

http://in.reuters.com/article/lifestyleMolt/idINTRE59P0XG20091026?sp=…
http://www.dailymail.co.uk/news/article-511253/Playtime-Grandma-Counc…
http://www.caring.com/blogs/caring-currents/senior-playgrounds

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The Aging Brain

A large body of research about aging tells us that as we cross the threshold into middle age, neural connections that receive, process and transmit information can weaken from age and disuse. It may take us longer to learn new information. We often can’t think as sharply or as quickly. Our reaction times may be slower.

Researchers also tell us that older people have a harder time multitasking. We can become more forgetful, resulting in those tip-of-the-tongue moments where familiar words, names and concepts lie just out of reach. An older person is more easily distracted and more prone to daydreaming and errors.

Disconcerting, yes, but also an incomplete picture.

In his book, “Major Issues in Cognitive Aging,” Timothy A. Salthouse, professor of psychology and director of the Cognitive Aging Laboratory at the University of Virginia, writes, “Although there is no shortage of opinions about cognitive aging, it sometimes seems that relatively few of the claims are based on well-established empirical evidence … assertions about cognitive aging may be influenced as much by the authors’ preconceptions and attitudes as by systematic evaluations of empirical research.”

Salthouse goes on to make two more significant observations about cognitive aging: Discoveries of decline in the laboratory do not necessarily correlate to success out in the real world, and there is often considerable variation among different people of the same age.

Place these findings alongside research about the power of suggestion (both deliberate and otherwise) and how response expectancies — the ways in which we anticipate a specific outcome — drive subsequent thoughts and behaviors that will actually help to bring that outcome to fruition. And suddenly you have a whole new narrative about the possibilities of healthy aging.

As Ron, one of our readers, pointed out in a Facebook message following this story of a few weeks ago, A creative life is a healthy life: “Want REAL innovation? Bring in the seniors.”

Like a fine wine

Research details a number of ways in which the brain actually improves with age. And what’s even more interesting is that many of these advanced abilities correlate with key conceptual elements of innovation and creativity.

This is particularly true for the human-centered design process — empathize, define, ideate, prototype, test — as outlined by the Institute of Design at Stanford, also known as “the d.school” where, in the interest of full disclosure, I have coached a design course called Sustainable Abundance.

“There are neuro-circuitry factors that can favor age in terms of innovation,” observes Dr. Gary Small, professor of psychiatry and director of the UCLA Center on Aging.

First there is empathy, “the foundation of a human-centered design process.” Empathy is critical to design because of the need to understand the people for whom you are designing.

Older people have a greater capacity for empathy because empathy is learned and refined as we age.

“How many adolescents do you know with the gift of empathy,” asks Kathleen Taylor, a professor at St. Mary’s College of California and an internationally recognized authority on adult learning. “Not many. It’s a developmental stage that lasts through the teen years and into the 20s — longer for some people.”

According to Taylor, younger people are more likely to connect with others from their own place of need. A 22-year-old may have an idea, and that idea may be quite brilliant and useful, but more than likely it’s all tied up in how that young person feels.

“Because of their greater capacity to empathize, older people can have a better sense of the things that may charge up another person’s brain and get them excited.”

Older people are also highly capable when it comes to the “define” aspect of human-centered design — that is, the unpacking and synthesizing of empathy findings into compelling needs and insights.

An aging brain can better tease out patterns and see the big picture, Small says.

Whereas younger people may have better short-term and get-to-the-point-quickly memory, older folks have had a greater variety of experiences and are better able to build a wider image out of a lot of different parts of memory. They can make more connections because they have more things that have happened to them.

Put another way by design legend Steve Jobs when he spoke to Wired in the 1990s: “A lot of people in our industry haven’t had very diverse experiences. So they don’t have enough dots to connect, and they end up with very linear solutions without a broad perspective on the problem. The broader one’s understanding of the human experience, the better design we will have.”

Of course, seniors “can sometimes lose those dots,” Taylor jokes. “But only temporarily, because remember: We absolutely never reach the full capacity of our brain.”

As we get older, so much more is stored in our brain; it’s like having overfull drawers. And those things you can’t quite recall? They haven’t disappeared. They’re just tucked away in the folds of your neurons. You can’t necessarily find everything in it, but it’s all still there.

Ignorant fearlessness

As we age, we are better able to anticipate problems and reason things out than when we were young. Small’s research shows that our complex reasoning skills continue to improve as we get older.

But that particular capacity can also serve as a double-edged sword.

Albert Einstein famously said that we can’t solve problems through the same kind of thinking as when we created them. As we age, yesterday’s thinking can form an invisible box that some may resist venturing out of today.

“Young people don’t try to solve problems with yesterday’s solutions because they don’t know them,” Taylor says. “They have no clue about the places where they shouldn’t be treading. And ultimately, they go outside the box because they don’t know there is a box.”

There’s a certain fearlessness to ignorance. But balance fearlessness against wisdom — an equally inchoate and difficult-to-quantify gift — that can guide the aging brain to greater insights to advance creativity and innovation.

Small also emphasizes the importance of mindfulness. “As I get older, I think more in terms of what is meaningful in my life right now, rather than what can I do to make things better in the future,” Small says.

Maybe it’s because you realize that the future is briefer, so you tend to live more in the present. That contributes to creativity. You are able to notice more about yourself and others in your environment, leading to new ideas that can be incredibly useful.

Believing in your power

So is the future bright for the older would-be innovator?

Absolutely, says Taylor, the picture is rosy. But as with any rose, there are thorns.

Debra Dunn, an associate professor at the d.school. was a senior executive at Hewlett-Packard for 22 years.

Steeped in Silicon Valley culture, Dunn says: “Some of the most wonderfully innovative engineers I have known were older-timers.”

Ultimately, though, Dunn believes that older people’s perceptions of their own ability to contribute become powerful predictors of what they can and cannot achieve.

“What you think, you become,” she quotes Buddha.

Small agrees. “The older brain is quite resilient and can be stimulated to innovate, create and contribute in extraordinary ways. We need incentives to encourage older people to continue to be creative because I think … what they have to offer is tremendous.”

The decline in creativity can also result from people’s capabilities not being challenged.

“Take my area as a university professor,” Small says. “You go from researching, writing and coming up with new ideas to becoming a manager and department dean, where you’re basically writing speeches and managing people and institutions, which does not really bring out a whole lot of creative energy.”

Nudge your neurons, Taylor suggests. Shake things up. Stay physically active. Keep doing different things. Challenge your assumptions. Become comfortable with ambiguity. Listen to differing points of view and develop the ability to accept differences. Travel. Learn different languages.

“You can seek out new environments that support your insights and creativity, but it becomes harder because you are more accustomed to the way things are,” Taylor says. “If you have had 30 years of having been in a groove, it becomes really difficult to get out of that groove.”

As I was attempting to complete this story, I glanced through the reams of jaw-dropping research I simply could not fit in. The true picture of healthy, productive aging is so much more interesting and complex than any of us can begin to imagine.

What’s the secret to longevity?  Keep breathing.

What’s the secret to innovation?  You might have to ask the old folks.

For more information, go to http://www.cnn.com/2012/06/19/health/enayati-aging-brain-innovation/index.html

 

At Home Instead Senior Care, we can help with daily, non-medical needs. If you would like more information on our services, please call our office at 360-782-4663.

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Effectiveness of Shingles Vaccine in Seniors

The shingles vaccine works, but it works better for those under 70 years old, according to a new evidence review from The Cochrane Library. Shingles, which originates from the same virus as the childhood disease chickenpox, is painful and can severely impact quality of life for weeks or months.

Older adults who get the shingles vaccine have a nearly 50 percent reduced risk of developing the often debilitating disease, finds a new evidence review from.

The vaccine is more effective for those 60 to 69 years old compared with people 70 and older since younger adults typically have a stronger immune system. However, those in their 60s may experience more frequent side effects from the vaccine.

“The herpes zoster disease is an extremely painful condition that impacts the quality of patients’ lives. People over 60 are particularly susceptible to developing the disease, but fortunately nowadays we have a vaccine for it,” says lead study author, Anna Gagliardi, Ph.D., professor of geriatrics and gerontology at Federal University in Sao Paulo, Brazil.

The shingles virus remains dormant in the nervous system of anyone who had chickenpox. Later in life, when the immune system is more compromised, the virus may reappear in the form of shingles, a painful inflammation of sensory nerves.

Gagilardi noted, “Adults over 70 have less immunity reaction from the vaccine, but the vaccine works. In general, the vaccine is well tolerated and it produces few systemic adverse reactions and only a mild or moderate adverse reaction at the site of the vaccination.”

Researchers analyzed the effectiveness of the zoster vaccine from eight randomized controlled trials that included 52,259 people in several European countries and the U.S. The principal study, the Shingles Prevention Study, followed 38,546 participants for at least 3 years and one month after being vaccinated.

Jonathan S. Anderson, M.D., internist with the Dean Health System in Madison, Wisconsin, said, “The meta-analysis confirms what we knew before and what we see in practice: that the zoster vaccine reduces the risk of developing shingles over subsequent years.

“Over the three years the study looked at the effects of the vaccine, the risk was cut in half. Fifty people would need to receive the vaccine for one person to benefit by not getting shingles. This is reasonable given that shingles is not only very painful, it can develop into a chronically painful condition which is often difficult to treat.”

Anderson added, “While the results of the study weren’t surprising it may provide some impetus to vaccinate people sooner when they are still in their 60s instead of waiting and continuing to discuss it with patients over time.”

The research is reported by the Health Behavior News Service, part of the Center for Advancing Health.
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Elderly and Medications

 A commonly prescribed class of drugs may cause elderly patients to slow down both mentally and physically, researchers from Wake Forest University School of Medicine have found.

Drugs in the anticholingeric family prevent the neurotransmitter acetylcholine from binding to nerve cells. This slows down communication between the cells in the brain. The drugs are used to treat a variety of conditions, including acid reflux, high blood pressure, Parkinson’s disease and urinary incontinence.
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In one study, published in the Journal of the American Geriatrics Society, the researchers found that residents of nursing homes who were taking both dementia medication and an anticholingeric incontinence drug lost mental function 50 percent faster than patients taking only the dementia drugs.

“Over a year’s time, the decline we observed would represent a resident going from requiring only limited assistance in an activity to being completely dependent,” researcher Kaycee M. Sink said.

All study participants had taken dementia drugs known as cholinesterase inhibitors, which increase levels of acetylcholine in the brain. Yet 10 percent were also taking a urinary incontinence drug in the anticholingeric family.

“The two drugs are pharmacological opposites,” Sink noted.

In a second study, presented at the annual meeting of the American Geriatrics Society in Washington, D.C., the researchers examined the physical effects of anticholinergics on elderly patients. They found that seniors who took anticholinergics were more likely to have more trouble walking and to walk more slowly than seniors not on the drugs.

“The results were true even in older adults who have normal memory and thinking abilities,” Sink said. “For older adults taking a moderately anticholingeric medication, or two or more mildly anticholingeric medications, their function was similar to that of someone three or four years older.”

The anticholinergics being taken included nifedipine (a blood pressure drug marketed as Adalat or Procardia), ranitidine (an acid reflux drug marketed as Zantac) and tolterodine (an incontinence drug marketed as Detrol).

Sources for this story include: www.washingtonpost.com.

At Home Instead Senior Care, we can help you or your loved ones with non-medical needs.  We can send a highly trained CAREGiver to your residency and help remind people to take their medications. Please call us at 360-782-4663.

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Tai Chi Can Help Elderly Sleep Better

Elderly adults who practice tai chi sleep better than those who do not, according to a study conducted by researchers from the David Geffen School of Medicine at the University of California-Los Angeles, and published in the journal Sleep.

Researchers asked 112 healthy adults between the ages of 59 and 86 to fill out a questionnaire based on the Pittsburgh Sleep Quality Index, which rates the duration and quality of sleep, as well as sleep disturbances, over the course of one month. Participants were then assigned either to practice 20 simple tai chi moves, or to take part in health education classes to learn healthier sleep, diet and stress management habits. After 25 weeks, the participants took the sleep survey again

People in the tai chi group showed significant improvement on measures of sleep quality, duration and disturbances in comparison with the control group.

The findings have the potential to improve life for vast numbers of people, lead author Michael Irwin said.

“Poor sleeping constitutes one of the most common difficulties facing older adults,” said Irwin, noting that 58 percent of people aged 59 or older self-report sleeping difficulty on at least a few nights per week.

Yet in 85 percent of these cases, the problem goes untreated. Those who do receive treatment are usually given sedative drugs, which can have dangerous side effects.

“It’s not uncommon for older adults to experience daytime confusion, drowsiness, falls and fractures, and adverse interactions with other medications they may be taking,” Irwin said.

Tai chi, in contrast, improves health in general. And unlike other forms of exercise with similar health benefits, tai chi is composed of gentle, flowing movements that are not difficult or dangerous for the elderly.

“It’s a form of exercise virtually every elderly person can do, and this study provides more across-the-board evidence of its health benefits,” Irwin said.

Sources for this story include: www.upi.com; www.sciencedaily.com.

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Vitamin D is Beneficial

Researchers from Wake Forest University (WFU) in North Carolina recently completed a study on the physical health of seniors in relation to their vitamin D levels. The study revealed that seniors with the highest vitamin D levels had far better mobility and physical health than those with the lowest levels.

Presented at the American Society for Nutrition at Experimental Biology 2010, the study is just one of many recent vitamin D studies illustrating the fact that the vitamin has powerful health-promoting and disease-preventing capabilities.

Dr. Denise Houston and her colleagues at WFU evaluated over 2,700 healthy seniors from Memphis and Pittsburgh over the course of four years. The team analyzed blood levels of 25-hydroxyvitamin D, the precursor of vitamin D, and found that those folks with the highest levels could walk faster, move more easily, and remain better balanced, than those with the lowest levels.

Learn more:http://www.naturalnews.com/029613_vitamin_D_elderly.html#ixzz2850uzGUY

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Exercise Can Help Elderly With Dementia

(NaturalNews) Elderly dementia patients who exercise regularly have better mental and physical health than those who do not, according to the findings of two recent studies.

In the first study, conducted by researchers from Dong-Eui University in Busan, South Korea, and published in the International Journal of Sports Medicine, 30 elderly women who had been diagnosed with senile dementia were divided into two groups. Half of the women exercised for 30 to 60 minutes a day for two or three days a week, while the other half did not undergo any exercise regimen. The average participant age was 80.

Both groups of women were given regular tests of memory recall, object identification and memory, reading, writing, and orientation to place and time. After six months, the scores of the women in the exercise group had improved by an average of 20 percent, and after one year they had improved by 30 percent. In contrast, there was no significant change in the scores of women in the control group.

Women in the exercise group also demonstrated an improved ability to perform daily acts such as getting dressed, bathing and eating. Exercise capacity and muscle strength also improved.

In the second study, researchers from the Alzheimer’s and Memory Program at the University of Kansas School of Medicine used magnetic resonance imaging (MRI) scans to measure the brains of 57 people in the early stages of Alzheimer’s disease. They also evaluated the participants’ fitness by measuring their peak oxygen demand during a treadmill test.

Participants who scored higher on the physical fitness tests experienced significantly less brain shrinkage than those who scored more poorly.

Prior research has demonstrated that the brains of Alzheimer’s patients shrink twice as fast as the normal rate due to aging. The connection between brain shrinkage and Alzheimer’s symptoms is not clear, however.

In the current study, there was no difference in scores on mental performance tests between those who were more and less physically fit.

Sources for this story include: www.reuters.com; www.nola.com.

At Home Instead Senior Care, we can help you or a loved one with daily, non-medical needs.  Please call our office at 360-782-4663.
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Yogurt Can Help Lower Blood Pressure

The benefits of consuming probiotic-rich yogurt extend a whole lot further than just promoting digestive health, according to a new study presented at a recent medical conference in Washington, D.C. It turns out that people who regularly eat yogurt as part of a healthy diet tend to have a lower risk of developing high blood pressure, a condition that can cause more serious problems like stroke, heart attack, congestive heart failure, kidney damage, or blindness later on down the road.

Researchers from Tufts University in Boston, Massachusetts, studied and tracked more than 2,000 adults who were part of the Framingham Heart Study, all of whom did not have high blood pressure at the start of the study. Participants answered questionnaires at three intervals during the study, and the study team evaluated and compared rates of yogurt consumption to rates of high blood pressure during a 14-year follow-up period.

Upon analysis, the team, which was headed by Dr. Huifen Wang, Ph.D., found that participants who ate the equivalent of at least one serving of yogurt every three days were 31 percent less likely to develop high blood pressure than participants who ate no yogurt at all. Levels of systolic blood pressure, which indicate the force of blood against arterial walls while the heart is beating, were also generally lower among those who ate yogurt compared to those who did not.

“Higher yogurt intake, as part of a healthy diet pattern, may be beneficial for blood pressure control and hypertension prevention,” said the research team about the findings.

Eating yogurt without taking blood pressure medication even more beneficial

Overall, the amount of yogurt consumed by participants that experienced blood pressure benefits was relatively low, averaging as little as one-third of a serving of yogurt per day. But even more surprising was the researchers’ observation that those participants who ate yogurt but were not taking any blood pressure medications actually fared better in the blood pressure department than those who ate yogurt as well as took the medications.

What this means is that blood pressure medication may be completely unnecessary for many people who simply revamp their diets to include foods like yogurt that appear to improve blood flow and ease arterial inflammation and other factors that can lead to high blood pressure. When consuming yogurt, be sure to look for organic, grass-fed varieties that have not been homogenized, and that preferably contain part or full fat content.

Sources for this article include:

www.medpagetoday.com/Cardiology/Hypertension/34859

http://www.ktvq.com

http://blogs.laweekly.com

Here at Home Instead Senior Care, we can ensure that you or a loved one is eating properly on a daily basis. We have highly trained CAREGivers that will come to you or a loved one and help with daily, non-medical needs. Please call us at 360-782-4663.
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Seniors and Flu Shot

The flu season is upon us and you may be wondering whether or not you should get vaccinated. Recent evidence would suggest that flu shots aren′t very effective, especially for those most at risk – the elderly. These are the people most likely to come down with the flu, followed by complications like pneumonia. Flu shots also don′t seem to do a very good job at protecting young children.

So what can you do? There is good evidence that vitamin D wards off the flu and common cold. If you live far from the equator, you simply won′t get enough sun at this time of the year to make all the vitamin D you need. Given the importance of the sunshine vitamin for all aspects of your health, supplementation with vitamin D makes sense whether or not you decide to get the flu shot.

Influenza vaccination

“Flu Shots For The Elderly Are Ineffective”. That′s the headline of an Oct. 23, 2008 release from the Orthomolecular Medicine News Service (1). The article picks up on a Sep. 2, 2008 report in the NY Times which claimed that “Doubts Grow Over Flu Vaccine in Elderly” (2).

“A growing number of immunologists and epidemiologists say the vaccine probably does not work very well for people over 70, the group that accounts for three-fourth of all flu deaths.” (2)

The evidence for and against the flu shot′s effectiveness

Flu shots are effective if you believe the results of dozens of observational studies carried out over the last forty years or so. These studies seemed to show that flu shots cut the risk of dying in winter from any cause by almost 50% and reduced the need for hospitalization by nearly 30%. It should be pointed out that unambiguous evidence is hard to come by in this field, since doctors rarely confirm influenza with lab tests.

The only randomized placebo-controlled trial to date, a study published by a Dutch group in 1994, found that the vaccine prevented the flu in about 57% of patients in their sixties. For patients past seventy the rate dropped to just 23%.

A 2005 article, on the other hand, painted quite a different picture. That paper pointed out that, even though the percentage of elderly getting an annual flu shot more than tripled from 1980 to 2001, there was no corresponding drop in the death rate. The authors concluded that the flu probably causes just 5 – 10% of all winter deaths in the elderly.

Vaccination doesn′t appear to protect small children very well either, judging by the experience with the 2003 – 2004 and 2004 – 2005 vaccines. Investigators looked at laboratory-confirmed influenza cases in children 6 to 59 months of age, their vaccination status, and their influenza-related inpatient/outpatient visits to emergency departments and outpatient clinics. Here are the authors′ conclusions: (3)

In 2 seasons with suboptimal antigenic match between vaccines and circulating strains, we could not demonstrate [vaccine effectiveness] in preventing influenza-related inpatient/[emergency department] or outpatient visits in children younger than 5 years. Further study is needed during years with good vaccine match.

A new 2008 Lancet article questions earlier findings that flu shots are effective (4). The authors of that paper suggest that the very decision to get vaccinated simply sets healthy seniors apart from the sick and frail. They theorize that healthier and more health-conscious patients are more likely to take the initiative to get a flu shot. Seniors who may have trouble taking care of themselves might simply not get to a doctor′s office for the vaccine. In other words, lower influenza rates in the vaccinated may have little to do with the vaccine′s effectiveness; seniors who get vaccinated may simply be healthier to begin with.

Needless to say, this view isn′t universally shared by the health care community. Proponents of immunization maintain that any reduction in the number of influenza cases has to be welcome, even if there is no sound evidence that this reduction is due to the flu shot. Doubters, on the other hand, simply see this attitude as a triumph of marketing over science.

Why would flu shots be ineffective?

First, there are some 200 to 300 different influenza virus strains, but the vaccine usually contains antigens of only a few. Preparing vaccines for the coming flu season is an annual guessing game. More often than not the vaccine doesn′t contain antigens of the most virulent strains.

Secondly, our immune system weakens with age; older adults do not respond as well as younger people to vaccines. For example, elderly patients may need as much as four times the amount of antigen for the same immune response as people under forty.

Thirdly, flu shots and other vaccines have harmful side effects. The Vaccine Adverse Effect Reporting System (VAERS) of the U.S. Food & Drug Administration (FDA) receives around 11,000 serious adverse reaction reports per year. Serious reactions are defined as death, life-threatening illness, hospitalization, or disability resulting from a vaccine. The FDA admits that in all probability only about 10% of adverse reactions are actually reported. The U.S. National Vaccine Information Center puts that ratio at only 3%.

In addition, the elderly take more medications than younger people. Combined with an already weakened immune system and potential vaccine side effects, the risk of adverse reactions can only grow with age.

What can you do to protect yourself?

Whether or not you decide to get the flu shot, you should do everything you can to strengthen your immune system. As the article from the Orthomolecular Medicine News Service puts it:

“Is there an available alternative? Yes, there may be: give the elderly more nutrients, rather than more needles. Older people often have inadequate diets. With ageing and illness, their bodies′ need for vital nutrients goes up, yet frequently their intake actually goes down.” (1)

and

“Over-reliance on vaccinating the elderly ignores their fundamental problems of poor diet and vitamin/mineral deficiencies. These are underlying reasons for a susceptible immune system. Supplemental nutrition is the “other” immune system booster. It is time to use it.” (1)

The authors point out that high doses of vitamin C have been shown to reduce the frequency and severity of influenza. Vitamin D and the minerals selenium and zinc have also been found effective.

The nutritional approach shouldn′t just be seen as a replacement for immunization. Even an effective vaccine still requires a functioning immune system. A vaccine presents the patient′s immune system with a weakened or dead virus. The immune system responds to that viral preparation in exactly the same way as it would to the real thing. By trial and error, the adaptive immune response develops antibodies and memory B and T cells against the viral strains it encountered; this process can take days if not weeks.

The difference between the live virus and the vaccine – and the idea behind vaccination – is that during that delay the live virus multiplies rapidly and may overwhelm the patient, whereas the weakened or dead viral strains cannot. If the vaccination worked, the patient′s adaptive immune system is prepared to respond immediately when it encounters the live virus.

Over-reliance on vaccinating the elderly, as the article from the Orthomolecular Medicine News Service puts it, also ignores another potent component of the host defenses – the innate immune system. Strengthening innate immunity may well pay larger dividends than the focus on adaptive immunity.

This is where vitamin D comes in.

Influenza and vitamin D

The new influenza model

One of the unusual aspects of influenza outbreaks is their seasonality; in temperate climates winter is flu season. The connection between the amount of sunlight and the disease was obvious enough, but the reason for this connection has only recently been understood (5). Vitamin D is essential to innate immunity, and most of our vitamin D is made by exposure to UV-B radiation from the sun; there simply are no significant dietary sources of vitamin D. Unless we supplement in the winter, our innate immunity will be compromised.

It is now believed (5) that much of the population carries various strains of the influenza virus year-round. During the summer months vitamin D is plentiful – unless one avoids the sun – and innate immunity can keep the virus in check. As winter approaches, vitamin D stores drop and the virus gains the upper hand.

That is when people get the flu and spread it. However, it seems that only a minority of influenza carriers are efficient transmitters of the virus. They will infect and sicken those that they come in contact with, but most of the newly infected will not pass the virus on; the epidemic is usually self-limiting.

Vitamin D′s mode of action

The adaptive immune system creates taylor-made antibodies to pathogens by trial and error. It is a match for any pathogen, but that process takes time. The innate immune system, on the other hand, produces antimicrobial peptides (AMPs) with broad-spectrum antimicrobial effects against intact microbes and “Pathogen-Associated Molecular Patterns (PAMPs)”. These AMPs will not be a match for every pathogen, but when they are the innate immune system springs into action immediately.

The influenza virus is spread by coughing and sneezing, and inhaled. The epithelia in the upper airways are surrounded by a thin aqueous layer of AMPs covered by mucus. This double layer of antimicrobiol peptides and mucus creates an antimicrobial shield that rapidly and irreversibly damages the membranes of virus particles that penetrate it.

Viruses that somehow make it through that shield to the endothelium induce endothelial cells to emit a burst of new antimicrobial peptides. These inducible AMPs bind to the carbohydrate portion of a viral glycoprotein, hemagglutinin A, thereby blocking the fusion between virion (virus particle) and endothelial cell; the virion can no longer penetrate the endothelium. The inducible AMPs also recruit macrophages and other white blood cells to limit further damage and clean up the debris.

Where does vitamin D come into the picture? When microbes like the influenza virus end up in the upper airways, they stimulate the production of an enzyme that converts 25(OH)D, the circulating inactive form of vitamin D, into the hormonally active 1,25(OH)2D (1,25-dihydroxyvitamin D). 1,25(OH)2D is required to turn on the genes that code for antimicrobial peptides. Without vitamin D there is no innate immunity.

There is convincing evidence that supplementation with a sufficient amount of vitamin D can prevent the onset of a flu or cold. An analysis of a randomized controlled trial showed that post-menopausal African American women taking 800 IU/day of vitamin D were three times less likely to come down with the flu or cold than those receiving placebo. 2000 IU/day essentially eliminated cold and flu cases altogether (5).

Vitamin D recommendations

The amount of 2000 IU/day is considerably higher than the current recommendations from the Food and Nutrition Board of the U.S. Institute of Medicine: 200 IU/day from birth to age 50, 400 IU/day fom 50 to 70, and 600 IU/day for anyone over 70.

These values were originally chosen because they were found to prevent osteomalacia (bone softening) and rickets. It is now recognized that vitamin D has many additional physiological functions, for which these levels are totally inadequate. A number of scientists are therefore calling for the Food and Nutrition Board in the U.S. and its counterparts abroad to reassess their current recommendations (6).

Experts in the field now believe that 25(OH)D blood concentrations should at least be 50 ng/ml (nanograms per milliliter), the level normally reached by sun exposure during the summer months. In the flu season, when there simply

isn′t enough sunlight, supplementation with at least 2000 IU/day is needed to get to that level. You′ll get that from 2 tbsp of cod liver oil. That amount is considered perfectly safe. A recent risk assessment put the safe tolerable upper intake level (UL) of vitamin D at 10,000 IU/day, i.e.five times the amount now believed necessary.Summary

Don′t just rely on vaccination to get you through the flu season; flu shots simply don′t seem to be very effective, especially for the most vulnerable groups in society – the very young and the elderly. There are a number of possible reasons for this. The vaccine may not target the most virulent influenza strains, the patient′s immune system may already be too weak to mount an immune response, or the vaccine may have side effects.

Vaccines containing weakened or dead viruses are meant to prepare the adaptive branch of the immune system for the onslaught of the live virus. When everything works, the adaptive immune system is capable of matching any pathogen, but the process takes time. The innate branch of the immune system, on the other hand, has a fixed repertoire of peptides that match the most common pathogen-asociated molecular patterns. There may not always be a match, but when there is then innate immunity is ready immediately.

The proper functioning of the innate branch of the immune system depends on the patient′s stores of vitamin D. If you live in a temperate zone, you simply cannot get enough sun exposure in the winter to reach the necessary vitamin D levels; you need to supplement, for example by taking cod liver oil. Given all its other health benefits, such as improvements in bone strength, insulin regulation, muscle strength, cardiovascular function, and a decrease in the risk of certain cancers, the decision to supplement with vitamin D should be a no-brainer.

If you need a highly trained CAREGIver to take you or a loved one to get your flu shot, at Home Instead Senior Care, we can help you meet that need.  Please call us at 360-782-4663.
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