Disease Management in Greater Boston

Specialized care addressing the needs of people living with ALS includes:

• Attention to learning to communicate with the client; verbally and non-verbally.
• Establish and maintain a meaningful relationship with the client.
• Maintain safety with environmental modifications, use of assistive devices, safety prompts, and assistance with walking.
• Assessment and sustained management of discomfort such as spasticity, choking, and respiratory distress.
• Medication management and education.
• Education about and monitoring of worsening symptoms.
• Range of motion exercises.
• Continence management.
• Assessment of skin with interventions as necessary.
• Dietary modifications include: swallow precautions, adequate hydration, and constipation prevention.
• Assistance with personal care and grooming.
• Encouragement prompts, and assistance as needed to maintain participation in meaningful activities as long as possible; making modifications when necessary.
• Maintain dignity as progressive symptoms cause physical and emotional distress.
• Ongoing communication with the medical care team to ensure prompt response to changes in condition in order to prevent ER visits or hospitalization.
• Accompaniment to health care appointments.

Eleven percent of older adults on Medicare were treated for Alzheimer’s Disease or another form of dementia. Alzheimer’s Disease is one specific type of dementia—a condition that causes memory loss and difficulty thinking or problem-solving to the point that it interferes with every day activities. Dementia is not a normal part of aging and is caused by changes in the brain over time.

The biggest risk factors for these chronic conditions are things you often can't control, including age, family history, and genetics, but studies have suggested incorporating the following habits into your lifestyle could slow or prevent onset.

• Exercise. Staying active isn't just good for your heart; it's also great for your brain.
• Sleep. Your brain does important stuff while you are sleeping, so getting at least 7 hours of deep sleep a night is crucial.
• Be smart about your diet. Research suggests that some foods can negatively affect your brain.

Twenty-seven percent of older adults were treated for diabetes – a disease that occurs when your body is resistant to, or doesn’t produce enough, insulin. Insulin is what your body uses to get energy from food, and distributes it to your cells. When this doesn’t happen, you get high blood sugar, which can lead to complications such as kidney disease, heart disease, or blindness. Chances of having diabetes increases after age 45.

To keep you from developing diabetes or to manage this condition, your doctor may suggest:

• Eating a healthy diet, including monitoring your carbohydrate and calorie intake, and talking to your doctor about alcohol consumption.
• Exercising for 30 minutes five times a week to keep your blood glucose levels in check, and to control weight gain.
• Safely losing 5-7% of body weight if you are diagnosed with pre-diabetes.

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Fourteen percent of older adults were treated for heart failure — a condition that occurs when the heart cannot adequately supply blood and oxygen to all of the organs in the body. The heart might become enlarged, develop more muscle mass, or pump faster in order to meet the body’s needs, causing you to feel tired, light headed, nauseous, confused, or lack an appetite. The best prevention is to follow a doctor's recommendations to decrease your risk for coronary heart disease and high blood pressure.

Thirty-one percent of older adults were treated for arthritis – an inflammation of your joints, which causes pain and stiffness and is more common in women.

There are steps you can take to delay the onset of arthritis or manage the symptoms, including:

• Exercise at least 5 times per week, for 30 minutes each time, to improve function and decrease pain. Try to include a mixture of aerobic, strength-building, and stretching movements.
• Stay within the recommended weight for your height—losing one pound can remove four pounds of pressure on your knees.
• Make sure your back, legs, and arms are always supported.
• Take precautions to avoid joint injuries.
• Do not smoke.

Fifty-eight percent of older adults were treated for hypertension – a common condition that involves both how much blood your heart pumps, as well as how resistant your arteries are to the blood flow. When your heart pumps a lot of blood, and you have narrow arteries which resist the flow, that’s when you get high blood pressure, also known as hypertension. The danger of hypertension is not only that you can have it for years and not know it, but it can cause other serious health conditions, like stroke and heart attacks.

Things you can do to try to prevent, or reduce, high blood pressure include:

• Maintaining a healthy weight. Losing just 10 pounds can reduce blood pressure
• Regulate your stress levels
• Limit salt and alcohol consumption
• Exercise daily, including a combination of moderate to vigorous-intensity aerobic activities, flexibility and stretching, and muscle strengthening
• Check your blood pressure regularly—the quicker you catch pre-hypertension, the more likely you are to prevent high blood pressure

Forty-sevent percent of older adults were treated for high cholesterol – a condition that occurs when your body has an excess of bad fats (or lipids), resulting in your arteries getting clogged, which can lead to heart disease.

Lifestyle factors you can control when it comes to preventing or managing high cholesterol include:

• Abstaining from smoking and excessive alcohol consumption
• Being active each day
• Managing your weight
• Minimizing saturated fats and trans fats in your diet

Fourteen percent of older adults sought treatment for depression – a treatable medical condition that is not a normal part of aging. Depression causes persistent feelings of sadness, pessimism, hopelessness, fatigue, difficulty making decisions, changes in appetite, a loss of interest in activities, and more.

Steps you can take to help with depression include:

• Manage stress levels. Reach out to family and friends during rough spells and consider regular meditation.
• Eat a healthy diet. What you put into your body can affect your mood, so focus on foods that are high in nutrients and promote the release of endorphins and those "feel good" chemicals, and limit consumption of things like alcohol, caffeine, artificial sweeteners, and highly processed foods.
• Routine exercise. Exercise has a number of physical and psychological benefits, including improving your mood through the release of endorphins and other "feel good" brain chemicals, boosting self-confidence and self-worth through meeting goals and improving your physical appearance, and increased socialization through interactions at gyms and group classes.
• Talk to your doctor. If you've experienced any of the warning signs of depression, talk to your doctor, and ask about your treatment options. Antidepressant medications or psychotherapy could be right for you.

If you or someone you love has had thoughts of suicide, call the National Suicide Prevention Lifeline at 1.800.273.8255 (TALK).