Balance Problems in Seniors

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As people grow older, they may have difficulty with their balance. Nearly 8 million American adults report having a chronic problem with balance. An additional 2.4 million American adults report having a chronic problem with dizziness alone.

Having good balance means being able to control and maintain your body’s position, whether you are moving or remaining still. An intact sense of balance helps you

* walk without staggering
* get up from a chair without falling
* climb stairs without tripping

Good balance is important to help you get around, stay independent, and carry out daily activities.

Many people experience problems with their sense of balance as they get older. Disturbances of the inner ear are the main cause. People feel unsteady, or as if they were moving, spinning, or floating.

Vertigo, the feeling that you or the things around you are spinning, is also a common symptom.

Balance disorders are one reason older people fall. Falls and fall-related injuries, such as hip fracture, can have a serious impact on an older person’s life. If you fall, it could limit your activities or make it impossible to live independently. Many people often become more isolated after a fall.

According to the Centers for Disease Control and Prevention, more than one-third of adults ages 65 years and older fall each year. Among older adults, falls are the leading cause of injury deaths.

There are many types of balance disorders. One of the most common is benign paroxysmal positional vertigo, or BPPV. With BPPV, you experience a brief, intense feeling of vertigo that occurs when you change the position of your head.

You may also experience BPPV when rolling over to the left or right, upon getting out of bed in the morning, or when looking up for an object on a high or low shelf. BPPV is more likely to occur in adults ages 60 and older, but can also occur in younger people.

In BPPV, small calcium stones in the inner ear become displaced, causing a person to feel dizzy. The reason they become displaced is not known, although it may be caused by an inner ear infection, head injury, or aging.

Another type of balance disorder is labyrinthitis. This is an infection or inflammation of the inner ear causing dizziness and loss of balance. The labyrinth is the organ in your inner ear that helps you maintain your balance.

Ménière’s disease is a balance disorder that causes a person to experience

* vertigo
* hearing loss that comes and goes
* tinnitus, which is a ringing or roaring in the ears
* a feeling of fullness in the ear.

It affects adults of any age. The cause is unknown.

There are many ways to treat balance disorders. Treatments will vary depending on the cause. See your doctor if you are experiencing dizziness, vertigo, or other problems with your balance.

What is Adult Day Care?

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What is Adult Day Care?

Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day. The program offers relief to family members or caregivers and allows them the freedom to go to work, handle personal business or just relax while knowing their relative is well cared for and safe.

The goals of the programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. There are two types of adult day care: adult social day care and adult day health care. Adult social day care provides social activities, meals, recreation and some health-related services. Adult day health care offers more intensive health, therapeutic and social services for individuals with severe medical problems and those at risk of requiring nursing home care.

Seniors generally take part in the program on a scheduled basis and the services that are offered may include the following:

  • Counseling
  • Education
  • Evening care
  • Exercise
  • Health screening
  • Meals
  • Medical care
  • Physical therapy
  • Recreation
  • Respite care
  • Socialization
  • Supervision
  • Transportation
  • Medication Management

How Do Adult Day Care Centers Operate?

These centers are usually open during working hours and may stand alone or be located in senior centers, nursing facilities, churches or synagogues, hospitals, or schools. The staff may monitor medications, serve hot meals and snacks, perform physical or occupational therapy, and arrange social activities. They also may help to arrange transportation to and from the center itself.

Who Can Benefit From Adult Day Care?

The following case study is an example of a senior who may need adult day care services, both for his own well being and that of his family caregivers: Paul is 69 years old and recently suffered a stroke. He needs some care and supervision so he lives with his son and daughter-in-law, David and Kira. However, because David and Kira both work, they need help to care for Paul during the day. They found a solution to their problem by having Kira drop off Paul at the local adult day care center in the morning, and having David pick him up when he gets off work in the evening. The center monitors Paul’s medications and offers him lunch, some physical therapy, and a chance to socialize with other seniors.

What Should I Look for in an Adult Day Care Center?

All states do not license and regulate adult day care centers. There may be a great deal of difference between individual centers; therefore it is important to learn more about each of the centers near you. You will probably want to visit the centers closest to you, and talk with the staff and other families that use the centers to determine if the facilities and programs available meet your individual needs. You may want to find out if your state has an Adult Day Care Association.

How Do I Pay for Adult Day Services?

Costs vary among adult day centers. Costs range from $25 a day to over $100 per day depending on the services offered, type of reimbursement, and geographic region. While an adult day care center is not usually covered by insurance of Medicare, some financial assistance may be available through a federal or state program (e.g., Medicaid, Older Americans Act, Veterans Administration).

Where Can I Learn More About Local Services?

To find out more about the specific adult day care centers where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging (at 1-800-677-1116 or www.eldercare.gov) can help connect you to these agencies.

Genetic abnormality predicts benefit from treatment for a rare brain tumor

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NIH-funded study shows doubling in survival time for patients with two different chromosomal deletions

 

A clinical trial has shown that addition of chemotherapy to radiation therapy leads to a near doubling of median survival time in patients with a form of brain tumor (oligodendroglioma) that carries a chromosomal abnormality called the 1p19q co-deletion. This abnormality is characterized by the simultaneous deletion of the short arm of chromosome 1 and long arm of chromosome 19. The presence of the chromosomal abnormality was associated with substantially better prognosis and marked improvements in survival in a treatment program of combined chemotherapy and radiation therapy compared to radiation therapy alone.  Oligodendrogliomas are characterized by tumors that form in the nerve tissue of the brain. The study was supported by the National Cancer Institute (NCI), part of the National Institutes of Health.

In the trial, 286 patients with aggressive oligodendrogliomas were randomly assigned to study groups of equal size to receive radiotherapy alone or radiotherapy plus PCV chemotherapy, which includes the drugs procarbazine, lomustine and vincristine.  Tumor tissue from all patients was collected and stored for genetic tests.  The analysis was performed when about half of the patients had been followed for just over 11 years.

Oligodendrogliomas occur primarily in adults, and the average age at diagnosis is 35.  The tumors comprise 9.4 percent of all primary brain and central nervous system tumors.

A pathology slide showing cells from a slice of tissue of a oligodendgroglioma tumor.  The normal cells are purple and regularly shaped while the cancer cells are pink and irregularly shaped

For the entire study population, the median overall survival time for patients receiving radiotherapy alone or radiotherapy plus PCV chemotherapy was similar. However, the 126 patients with 1p19q co-deleted tumors had much longer median survival times than the 135 patients whose tumors did not carry the 1p19q co-deletion: 8.7 years versus 2.7 years.  This observation suggests that patients whose tumors contain the chromosomal abnormality will live substantially longer than patients whose tumors don’t carry it, regardless of treatment.  Even more impressive, however, was the finding that 1p19q co-deletion predicted the benefit from adding chemotherapy to radiotherapy. Patients with 1p19q co-deleted tumors who received PCV chemotherapy plus radiotherapy (59 patients) had a median overall survival time of 14.7 years, compared with only 7.3 years for patients with co-deleted tumors who received radiotherapy alone (67 patients). Patients whose tumors did not have the chromosomal abnormality did not show an improvement in survival from the addition of chemotherapy.

The study, known as RTOG 9402, was led by the Radiation Therapy Oncology Group (RTOG) with the participation of the North Central Cancer Treatment Group, the National Cancer Institute of Canada Clinical Trials Group, the Eastern Cooperative Oncology Group, and SWOG (formerly the Southwest Oncology Group).

“The Radiation Therapy Oncology Group and other participating cooperative groups are to be congratulated for conducting this randomized clinical trial in a rare form of brain tumor that took many years,” said Jeffrey Abrams, M.D., associate director, Cancer Therapy Evaluation Program, NCI.  “Their persistence and dedication was rewarded as this genetic abnormality has a powerful effect on survival, and the results will change how patients with this disease are treated. This clinical trial also highlights the necessity for collecting tumor tissue for genetic studies to define more precisely the patients who benefit most from specific therapies.”