Mom is 75 years old, very small and weak, often falls. But she seems obsessed with walking everywhere to exercise, which she thinks will make her stronger. I’m afraid the more she walks, the more likely she will fall. Am I right or is exercise good for her?
Exercise, especially walking, is beneficial for a 75-year-old. It strengthens bones and muscles, and has other benefits such as preventing heart disease and helping to stop feeling lonely.
But falls are a serious problem, particularly for the elderly and frail—and the cause of thousands of hospitalizations and even deaths each year.
So this is a classic case of evaluating risks and benefits.
The GP should be able to refer anyone who falls regularly to a falls clinic. There, the evaluation will look at all possible causes — such as medication side effects or heart problems — and come up with strategies for mitigation, including safer ways of exercising than walking.
Today’s reader is concerned that her mother’s walking habit is an unnecessary risk
The Royal Osteoporosis Society (theros.org.uk) has excellent fact sheets and videos on exercises to help maintain balance and strength. On the site’s home page, click the “Information and Support” tab and then select “Exercise and physical activity for osteoarthritis” from the drop-down menu. Scroll down until you see the “Maintaining Steady” subheading, then click on the link below and you will be in the right place. Age UK also offers exercise classes in some areas.
Fitted, supportive shoes and insoles can also help, as well as making sure you get your eyes checked regularly. Inside the home, loose rugs, clutter, and dim lighting should be avoided.
My doctor told me last year that I should come off citalopram, the antidepressant I’ve been taking for years, because they don’t work on people over 65. Mirtazapine was put on me and I was left feeling very anxious and depressed again. I read in your column recently about a 72-year-old who was told by his doctor to take citalopram. Was my doctor wrong?
Citalopram is part of a family of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. It is one of eight commonly prescribed for a variety of conditions, including depression, anxiety, obsessive-compulsive disorder, eating disorders, and pain conditions. Some are specific – eg escitalopram for anxiety.
The practice of different GPs can vary according to their experience, but in general we all follow guidance from either the National Institute for Health and Care Excellence (NICE) or specialist psychiatry data such as Maudsley’s guidelines for prescribing.
Geriatric psychiatry is a specialty in itself, as the way mental health problems manifest changes with age. Other problems come into play, such as memory loss. If a patient is taking several medications, we need to be careful that they do not interact – and for these reasons we often use lower doses of antidepressants in the elderly.
Sertraline, citalopram, and escitalopram are recognized in geriatric psychiatry as the SSRIs that should be used. Your medication may have been discontinued for other reasons, such as possible side effects, bleeding from the intestines, glaucoma or heart disease.
If someone is taking anti-inflammatories on a regular basis or the blood thinner warfarin, for example, we would advise against taking an SSRI because of the bleeding risks of taking them together. Mirtazapine would be a good alternative.
Switching antidepressants is not easy for the patient because it can cause side effects while the new medication is settling in, although after a while those things lessen again. However, this must also be evaluated as part of the process.
For the past 2 months my urine has been smelling bad and looking rather dark. It’s similar to when I had a urinary tract infection, but I don’t have a burning sensation or pain when I go to the toilet. I have increased my fluid intake and switched to decaf but nothing has changed. I take heartburn pills omeprazole and naproxen for my sore knees. Can you help?
A prolonged change of urine should be achieved by a GP. The best place to start is by asking if you can leave a sample for testing and having a phone consultation with the results. Urinary problems are an important reason for going to the GP for people of all ages.
The most common change in urine odor due to infection occurs, especially in women.
This may be accompanied by burning, pain, and a frequent urge to urinate often in small amounts. But the symptoms can be milder once the odor changes or cloudiness.
A prolonged change of urine should be achieved by a GP. The best place to start is by asking if you can leave a sample for testing and having a phone consultation with the results
This can be diagnosed with a urine dipstick test and urine culture in a lab, which takes about two days to complete.
A change in urine is vital to check for the presence of blood. This can be seen in the dipstick test as well. Although we all recognize a visible amount of blood in the urine, small amounts can also occur and not be so obvious. It may appear dark rather than red. Blood in the urine can be more commonly from an infection or kidney stones, but it can also be a sign of bladder cancer or serious kidney problems.
Naproxen is a non-steroidal anti-inflammatory drug, or NSAID, used to target joint pain or swelling, and in the long term is also known to pose a risk for kidney problems.
Less commonly, changes in the odor and color of urine can also be a sign of type 2 diabetes or liver problems.
This “mild” covid is still a threat
There is a lot of Covid going around at the moment and last week, I caught it! I was intrigued because my virus seemed to follow the same pattern I had seen in friends recently – it felt like a normal cold, it lasted two days. I had a mild cough which strangely disappeared once my test turned positive. Everyone I’ve spoken to who’s had Covid in the past month or so seems to have had the same experience, with none of the old warning signs like a high temperature or a change in taste or smell.
This may indicate that, after three years, Covid-19 is a very different virus than the one we started with. Having said that, people who are extremely at risk, such as leukemia patients or people awaiting transplants, should still be careful.
It’s estimated that 1 in 25 people currently has the virus, so there’s a reasonable chance any of us will catch it.
The “superpower” in Paris is nothing to be envied
Reality TV star Paris Hilton took to the interview circuit last week to promote her memoir and talk about growing up with ADHD – attention deficit hyperactivity disorder.
I know there are those who think ADHD doesn’t exist, but I’m not one of them.
Symptoms include inattentiveness and impulsivity, and can have a significant impact on patients’ time at school and work and their relationships. Diagnosis and treatment, both in childhood and as an adult, can be a huge benefit.
The 42-year-old real estate heiress, who was diagnosed with the condition as a child, takes medication and now considers it her “superpower”. I’m all for that kind of positive approach.
But I cringe when I hear people say “I have a little ADHD” or that they’ve self-diagnosed using an online questionnaire, when they’ve never seen a doctor. It is a serious condition and it is important not to underestimate it.
Reality TV star Paris Hilton took to the interview circuit last week to promote her memoir and talk about growing up with ADHD – Attention Deficit Hyperactivity Disorder
