Month: October 2013

FDA Seeks To Tighten Controls On Hydrocodone Painkillers

The Food and Drug Administration Thursday announced that it wants the federal government to impose tough new restrictions on some of the most widely used prescription painkillers.

 The FDA said it planned to recommend that Vicodin and other prescription painkillers containing the powerful opioid hydrocodone be reclassified from a “Schedule III” drug to a “Schedule II” drug, which would impose new restrictions on how they are prescribed and used.

OxyContin, another opioid painkiller, is already a Schedule II drug, defined by the Drug Enforcement Administration as “potentially leading to severe psychological or physical dependence”.

In a statement posted on its website, the agency said it was taking the step after becoming “increasingly concerned about the abuse and misuse of opioid products, which have sadly reached epidemic proportions in certain parts of the United States.”

The DEA has been asking the agency to recommend reclassifying the drugs for years, citing soaring numbers of Americans becoming addicted to the drugs and dying from overdoses.

Pain specialists and their patients, however, have been fighting the move, saying that any new restrictions would make it too difficult for those suffering from chronic, debilitating pain to get the drugs they need to survive.

The agency acknowledged the emotional debate, saying it “has been challenged with determining how to balance the need to ensure continued access to those patients who rely on continuous pain relief while addressing the ongoing concerns about abuse and misuse.”

 

Carolyn Tuft and her daughter Kirsten (seen here in 2005) were the victims of a shooting at a Salt Lake City mall in 2007. Kirsten was one of five bystanders killed, and Carolyn was left in severe pain.

Shots – Health News

Painkiller Paradox: Feds Struggle To Control Drugs That Help And Harm

Among other things, reclassifying the drugs would reduce the number of refills patients could get before having to go back to see their doctor. Doctors would not be able to simply call prescriptions into pharmacies.

The FDA said it would submit its recommendation to the Health and Human Services Department by early December, and anticipated that the National Institute on Drug Abuse would concur with the recommendation. That will begin a process that would lead to a final decision by the DEA.

More than 136 million prescriptions for these products are dispensed every year, making them the most widely used prescription drugs in the country. Vicodin is probably the best-known hydrocodone-containing product, but there are many others, sold under brand names such as Lortab and Norco.

While powerful painkillers, opioids are highly addictive and are abused by millions. The number of Americans overdosing from these drugs has been increasing rapidly in recent years, and more than 15,000 now die every year, according to the Centers for Disease Control and Prevention.

Hydrocodone is a key ingredient in the prescription painkiller Vicodin.

Shots – Health News

Across America, The Grip of Prescription Painkillers Tightens

But about 100 million Americans suffer from chronic pain, and many of them and their doctors fear the change would make it difficult, if not impossible, for these patients to get drugs they need.

The move comes after an FDA advisory panel recommended the change in January.

Advocates for pain patients immediately reacted with concern to the announcement.

“The concern we have is that it may unintentionally make access for people with pain even more of a challenge than it is now,” wrote Bob Twillman of the American Academy of Pain Management in an email to Shots. “This could necessitate millions more office visits, with attendant costs approaching a billion dollars a year. The access issues will need to be addressed or we will have a lot more people with a lot more uncontrolled pain.”

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Almonds For Skinny Snackers? Yes, they Curb Your Appetite

Americans seem to have a love affair with snacking.

 As a society, we eat twice as many snacks as we did a generation ago. Women, on average, nosh on upwards of 400 snack calories per day, according to federal survey data. And men consume almost 600 calories a day in between meals.

So, if nibbling is our new pastime, researchers have a suggestion for one satiating snack that seems to help control our appetites: almonds.

According to the findings of fresh research published in the European Journal of Clinical Nutrition, people who added 1.5 ounces of almonds to their diet each day reported reduced hunger, and they compensated for the extra calories from nuts by eating less at other times of the day.

“This research suggests that almonds may be a good snack option, especially for those concerned about weight,” says Richard Mattes, a professor of nutrition science at Purdue University. “Despite adding 250 calories to the diet, there was no change in total energy intake.”

And after a month of eating almonds each day, the participants did not gain weight.

If you listen to my story on All Things Considered, you’ll hear how Glenn Reed of East Orange, N.J., manages to stay slim. We met up with him at Union Station, in Washington, D.C., during the late afternoon commuting rush.

“There’s a lot of junk and sugar here [at the train station],” Reed noted, “so I always look for something with nuts in it.”

As he munched on trail mix that included almonds and dried cranberries, he says nuts may be calorie dense and full of fat — which many Americans are wary of — but for him, nuts are the perfect snack.

“I love the crunchiness, and this is a snack that will definitely … hold you over [until dinner],” Reed told me.

So what is it about nuts that can help curb our appetites? It’s most likely a combination of factors, explains Mattes.

“The protein, the unsaturated fat composition, the fiber” all very likely play a role, he says. And almonds are low in carbohydrates, which tend to stimulate our appetites.

One other factor? Chewing. As we’ve reported, research has shown that if we don’t chew our almonds thoroughly, some of the calories move right through us — undigested.

Prior research has already shown that almonds help increase satiety, both in people of normal weight and those prone to being overweight.

The new observation here, according to Mattes, is that almonds are even “better at controlling appetite when consumed as snacks.”

His team found that eating almonds in between meals tended to blunt the rise in hunger, compared with when people ate the nuts as part of a meal.

It’s not clear whether all nuts have this effect. This study was funded by the almond industry, and researchers didn’t evaluate other types of nuts.

Mattes explains that industry-funded studies are becoming more common, especially as government funding becomes harder to obtain. But he emphasizes that the research is carried out completely independently and is peer-reviewed before being published.

“So it does have the checks and balances,” Mattes concludes.

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Dangerous Fungus Makes A Surprise Appearance In Montana

What life-threatening illness can you get from repotting plants, attending a rodeo or going spelunking? If you didn’t guess histoplasmosis, you’re not alone.

 This week’s Morbidity and Mortality Weekly Report, chronicle of all things infectious, reports on the surprising appearance of histoplasmosis, a lung infection caused by a fungus, in four people in Montana.

The fungus in question, Histoplasma capsulatum, is common in the Midwest and Midatlantic, according to the researchers at the Centers for Disease Control and Prevention and in Montana who penned the report. That was news to us. So we talked with John Bennett, chief of the clinical mycology section at the National Institutes of Health, to get up to speed.

“There are huge areas of the country where this is relatively common, including here in Washington, D.C.,” said Bennett, who wasn’t involved in the study. “The thing that made this unusual is that Montana is outside the usual area.”

Uh, exactly how common in Washington? This is suddenly starting to strike uncomfortably close to home.

Skin tests have found that a sizable number of people in the Mid-Atlantic have been infected with histoplasmosis, Bennett says. When infected you might get a cough or feel a bit fluish. But most people shake it off and never get really sick.

Indeed, histoplasmosis and other fungal infections typically are lethal only in people whose immune systems are weak. The four people in the MMWR report had other health issues that could have made them more vulnerable, ranging from chemotherapy for colon cancer to mononucleosis.

The four people who fell ill in Montana in 2012 and 2013 ranged from a 17-year-old boy who liked caving, camping and had worked as a landscaper to a 79-year-old retired rancher. The boy had had mono; the rancher had colon cancer. All recovered from their infections, though some were sick for months with pneumonia and other health problems.

Histoplasmosis, sometimes called histo, is spread by the droppings of birds and bats. It’s common in soil, so common that AIDS patients and other people with compromised immune systems are warned to have someone else repot the plants.

It’s possible that birds and bats are spreading the fungus from South Dakota and North Dakota, where it’s been known for years. Or it could be that some of these people had been exposed years earlier.

“The problem about this fungal infection, you can get infected now and not get sick until years later,” Bennett says. “The older gentleman, did he really get it in Montana? Or did he get it somewhere else and it reactivates 20 years later?”

Only one of the patients, the retired rancher, had a confirmed case of histoplasmosis, Bennett cautions. So this may not signal a looming fungal invasion of Montana.

But Dr. Henry Masur, chief of critical care at the NIH Clinical Center and an infectious disease researcher, says he wouldn’t be surprised to see histo and other infectious diseases cropping up where you wouldn’t expect to see them.

“We’re a more and more mobile society, both in terms of people and in terms of pathogens,” Masur told Shots.

OK, so you don’t live in Montana, or the Midwest or in D.C. Think you don’t have to contend with fungus? Think again.

Farmers and others in the Midwest have to contend with the fungus Blastomyces dermatitidis, which also lives in soil.

And the Pacific Northwest has been dealing with a particularly dangerous strain of Cryptococcus gatti for several years now. It has caused at least 40 deaths.

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Slaying ‘Little Dragons’: Guinea Worm Moves Toward Eradication

Hawah Alhassan, 5, contracted Guinea worm in a village near Tamale, Ghana, in 2007. The country eliminated the parasite in 2011.

The world has eradicated just one human disease: smallpox. But another illness is getting tantalizingly close to elimination.

No, we’re not talking about polio; that virus also has its back against a wall. But a report Thursday puts a parasitic worm ahead of polio in the race to extinction.

The world recorded just 89 cases of Guinea worm in the first six months of 2013, the Centers for Disease Control and Prevention said in the journal Morbidity and Mortality Weekly Report. That’s a 77 percent reduction in cases over the same period last year.

In contrast, more than 300 polio cases have occurredso far in 2013, compared with just 223 reported in all of 2012.

Guinea worm gets little attention in the media, perhaps because of its stomach-churning life cycle. The parasite grows up to 3 feet inside a person’s tissues and then emerges from a painful wound in the skin. The worm isn’t deadly, but it cripples a person for several weeks while the worm emerges.

The disease is also known as dracunculiasis, or “affliction with little dragons,” because the worm feels like hot coals as it exits from the skin.

Back in 1986, more than 3.5 million people got infected with Guinea worm each year. A campaign led by The Carter Center has slashed the number of cases in the past decade. There were only about 1,000 cases recorded worldwide in 2011, and 542 cases in 2012.

If 2013 follows the trend, then the prevalence of the disease will reach an all-time low.

The worm is now endemic in just four countries: Chad, Ethiopia, Mali and South Sudan. The vast majority of cases occur in South Sudan, and that country has made the most progress in eradicating the Guinea worm in the past several years.

South Sudan has reported an 80 percent reduction in cases so far in 2013 compared with 2012, despite a slew of challenges for health workers. A key bridge collapsed on the only road to a part of the country, slowing transportation of vital supplies. Cattle raiding caused populations to move around unpredictably, the CDC’s Dr. Sharon Roy and her colleagues wrote in the report.

The biggest challenges, however, to eradicating the parasite are probably in Mali. The country has reported just one case of Guinea worm in 2013. But violence after a coup d’etat has kept health workers out of some parts of Mail since April 2012, Roy and her colleagues write.

People get infected with dracunculiasis through contaminated drinking water. So teaching people to filter water and installing wells have been two key methods to reduce new infections.

If local health workers can’t reach people because of violence, then just one infection could quickly spread through drinking water and multiply into 50 to 100 cases.

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A baby born with HIV remains free after taking Pills

A 3-year-old girl born in Mississippi with HIV acquired from her mother during pregnancy remains free of detectable virus at least 18 months after she stopped taking antiviral pills.

New results on this child, published online by the New England Journal of Medicine, appear to green-light a study in the advanced planning stages in which researchers around the world will try to replicate her successful treatment in other infected newborns.

And it means that the Mississippi girl still can be considered possibly or even probably cured of HIV infection — only the second person in the world with that lucky distinction. The first is Timothy Ray Brown, a 47-year-old American man apparently cured by a bone marrow transplant he received in Berlin a half-dozen years ago.

This new report addresses many of the questions raised earlier this year when disclosure of the Mississippi child’s case was called apossible game-changer in the long search for an HIV cure.

“There was some very healthy skepticism,” Dr. Katherine Luzuriaga, a professor at the University of Massachusetts in Worcester, tells Shots. She’s part of the team that has been exhaustively testing the toddler’s blood and considering every possible explanation for her apparently HIV-free state.

Luzuriaga is confident the latest tests prove that the child was truly infected with HIV at the time of her birth — not merely carrying remnants of free-floating virus or infected blood cells transferred before birth from her mother, as some skeptics wondered.

The UMass researcher says there’s no way the child’s mother could have contributed enough of her own blood plasma to the newborn to account for the high levels of HIV detected in the child’s blood shortly after birth.

Similarly, Luzuriaga says, new calculations show that the mother “would have had to transfer a huge number of [HIV-infected] white blood cells to the baby in order for us to get the [viral] signal that we got early on.”

Clinching the question as far as the researchers are concerned is the infant’s response to anti-HIV drugs that she began receiving shortly after birth. The remarkable earliness of her treatment is a crucial feature that makes this child different from almost any other.

“There’s a very characteristic clearance curve of viruses once we start babies on treatment,” Luzuriaga says. “The decay of viruses we see in this baby is exactly what we saw in early treatment trials from 20 years ago when we initiated anti-retroviral therapy and shut off viral replication. That’s a very different decay curve than you would expect if it were just free virus transferred to the baby.”

It might be helpful to recap the unusual, if not unique, features of the Mississippi case.

Her mother did not receive prenatal care, so she was not identified as HIV-infected before delivery. If she had been, she would have received drugs that are highly effective in preventing mother-to-child transmission of the virus.

While the mother was in labor, she got HIV testing, as is routine for women without prenatal care. When that came up positive, Dr. Hannah Gay, a pediatrician at the University of Mississippi Medical Center in Jackson, was ready to test the newborn for infection and start anti-retroviral medicines within 30 hours of birth.

The treatment quickly cleared the virus from the baby’s blood. Normally such children would stay on antiviral drugs for a lifetime. But in this case the mother – whose life circumstances were reportedly chaotic – stopped giving the child the medication between 15 and 18 months after birth.

Gay and her colleagues caught up to the child when she was 23 months old and were astonished to discover she was apparently still virus-free despite being off treatment. Five rounds of state-of-the-art testing — at UMass, Johns Hopkins, federal research labs and the University of California San Diego — failed to reveal any trace of the virus in her blood.

That led to last spring’s report and widely reported hope that the child had been cured of HIV.

But Dr. Scott Hammer, an HIV researcher at Columbia University in New York, is not quite convinced. “Is the child cured of HIV infection? The best answer at this moment is a definitive ‘maybe,’ ” Hammer writes in a New England Journal editorial that accompanied the report.

The reason is that a couple of tests done when the child was about 2 years old found indications that her system may contain pieces of RNA or DNA from HIV. This hints that some of the nucleic acid building blocks of the virus are hanging around within her blood cells.

There’s no evidence these “proviral” remnants are capable of assembling themselves into whole viruses that can make copies of themselves. But researchers are concerned about that possibility and how it might be headed off.

“The question is whether those viral nucleic acids have the ability at some point to replicate and allow a rebound of the virus,” Luzuriaga acknowledges. “That’s why it’s important to continue to test the baby over time.” She says that means years.

But for now, the signs from the Mississippi child’s case are encouraging enough to have generated an ambitious global human experiment that Luzuriaga says is in final planning stages.

Women who present in labor without having had prenatal care will be tested for HIV and, if positive, their infants will be intensively treated within a couple of days of birth, as the Mississippi child was. Then they’ll be followed with the most sensitive tests to determine if the virus has been eradicated.

If certain criteria are met, researchers plan to decide whether it would be safe to discontinue HIV treatment deliberately and follow the children closely to see if the virus returns. (If it did, treatment would be restarted.)

If the experiment succeeds, it would be a huge advance in the prevention of childhood HIV and AIDS in many parts of the world. More than 9 out of 10 the world’s 3.4 million HIV-infected childrenlive in sub-Saharan Africa, where many women deliver without having had prenatal care or HIV treatment. Around 900 children are newly infected every day.

Meanwhile, researchers pursuing an HIV cure will convene next month in San Francisco to consider various strategies — for adults as well as children. One other recent glimmer of hope was provided this summer by Boston researchers who reported that two HIV-infected men with lymphoma remain virus-free without treatment for several months after stopping antiviral treatment.

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How sleep loss adversely affects immune system

Researchers have identified the genes that are most susceptible to sleep deprivation and are examining if these genes are involved in the regulation of the immune system.

Conducted at the sleep laboratory of the Finnish Institute of Occupational Health, the study restricted the amount of sleep of a group of healthy young men to four hours per night for five days, imitating the schedule of a normal working week.

Blood samples were taken before and after the sleep deprivation test. White blood cells were isolated from the samples, and the expression of all genes at the time of the sampling was examined using microarrays.

The results were compared with samples from healthy men of comparable age who had been sleeping eight hours per night for the week.

Researcher Vilma Aho said that they compared the gene expression before and after the sleep deprivation period, and focused on the genes whose behaviour was most strongly altered.

She said that the expression of many genes and gene pathways related to the functions of the immune system was increased during the sleep deprivation.

Aho asserted that there was an increase in activity of B cells which are responsible for producing antigens that contribute to the body’s defensive reactions, but also to allergic reactions and asthma. This may explain the previous observations of increased asthmatic symptoms in a state of sleep deprivation.

The amount of certain interleukins, or signaling molecules promote inflammation, increased, as did the amount of associated receptors such as Toll-like receptors (TLR). On the gene level, this was apparent in the higher-than-normal expression of the TLR4 gene after sleep loss. CRP level was also elevated, indicating inflammation.

The study has been published in the journal PLOS ONE.

 

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Can Cancer Be Caused – or Prevented – By Diet?

It’s almost become a running joke -”everything causes cancer.” Pessimistic humor is used to ease the painful truth that 500,000 people die annually because their own cells mutate and destroy their bodies. There is so much conflicting information about the genetic and environmental causes of cancer, it can seem impossible to do the right thing. But putting on blinders will not change the fact that 30 percent of those deaths are diet-related, according to the American Cancer Institute. And there is evidence from a variety of sources that certain foods contribute to the forming and proliferation of cancer cells, and some foods can help prevent it.

Not Your Friends

The foods that have been shown to contribute to cancer are high in substances that the body cannot effectively break down, or that create toxic chemicals in the metabolic process. These include hydrogenated oils, animal-based saturated fats, salt, sugar, fructose, artificial sweeteners, preservatives, pesticides, and genetically modified organisms. Red meat, processed meat, and cooked muscle meats contain many of these cancer-causing substances. Red meat contains the pigment haem, which can stimulate the colon to produce carcinogenic chemicals. Processed meats contain sodium nitrate and other harmful preservatives that are linked to colon cancer. A study by the Lawrence Livermore National Laboratory determined that the process of cooking meats creates tumor-causing mutagens that act like estrogen to artificially regulate cell growth. This can cause cancerous cells to reproduce rapidly.

 

Sugar deserves special mention, as excessive sugar consumption severely compromises the health of every organ and feeds cancerous cells. Soda pop is the most dangerous; each serving contains the equivalent of 10 to 18 teaspoons of sugar and other carcinogenic chemicals like caramel coloring. Artificial sweeteners are also to be avoided because of their potential side effects. A University of Minnesota study found that drinking two sodas a week doubles a persons risk for developing pancreatic cancer.

Hydrogenated oils are particularly harmful to the heart and liver. Snack foods fried in these oils usually contain trans-fat, chemical flavorings and preservatives, and the carcinogenic chemical acrylamide. Another dangerous snack food is microwave popcorn. The lining of the bag contains chemicals that can cause liver, testicular, and pancreatic cancer, which vaporize into the popcorn during the microwaving process.

The Good Guys

As with so many other health recommendations, the best way to fight cancer seems to be a diet of colorful and varied fruits and vegetables, whole grains, and lean protein. The vitamins and minerals in fruits and veggies fortify the organs to resist toxicity. The fiber they contain supports the health of the colon, and helps pass toxins and waste matter from the body more quickly. It also stimulates the colon to produce cancer-fighting chemicals. Ground flax seeds are an excellent source of fiber, as well as omega-3 fatty acids. Omega-3s reduce inflammation, and may inhibit cancer cell reproduction.

The phytochemicals in plant foods serve to protect and repair DNA, and some even fight particular carcinogenic chemicals. The chlorophyll in dark green vegetables and algae (chlorella and spirulina) helps mitigate the effects of eating meat and processed foods. The lycopene in tomatoes and grapefruit lowers the risk of prostate, breast, lung, and colon cancer. Broccoli, kale, cabbage, and other cruciferous vegetables contain protective glucosinolates, and the sulforaphane in broccoli and broccoli sprouts is a potent detoxifier. Berries are anti-cancer superheros, with several essential nutrients, flavonoids, and anti-oxidants. The ellagic acid in strawberries boosts enzymatic production. The anthocyanins in blueberries are also very helpful in preventing cancer. Carrots supply beta-carotene, falcarinol, and other nutrients that help prevent breast and cervical cancer, but it is best to cook them (whole, not chopped) to get all the anti-oxidants. While some plant nutrients have been isolated into supplements, it seems most of the healthful properties are only bio-available in the whole foods.  Aim for at least 4 servings of fresh fruit and 5 servings of fresh or steamed vegetables each day. Organic food is preferable, to avoid the potentially carcinogenic pesticides and GMOs that conventional food may contain. And whatever you are eating, do not overdo it, as obesity contributes to the development of cancer and other diseases.

The jury is still out on exactly how pivotal diet is in the quest to be free of cancer, and the jokes may continue as we grapple with this overwhelming challenge. But it is clear that we can all be served by eating fewer processed products and more healthful, whole, nourishing foods.

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Scientists discover protein that may help prevent cataract

The human eye lens consists of a highly concentrated mix of several proteins. Protective proteins prevent these proteins from aggregating and clumping. If this protective function fails, the lens blurs and the patient develops cataracts. Two research groups at the Department of Chemistry of the Technische Universitaet Muenchen (TUM) have succeeded in explaining the molecular architecture of this kind of protective protein.

Their findings, are published online in the current early edition of PNAS (Proceedings of the National Academy of Sciences), shed new light on the work of these proteins and may be able to help in the development of new treatments.

Cells have a variety of protein complexes that manage vital tasks. The functions of these “molecular machines” depend largely on their three-dimensional structure. In the first instance, proteins are long chains of amino acids, like a long piece of woolen thread. So-called chaperones help them to fold in the desired three-dimensional form after their production. If this folding process fails, the protein thread becomes an inextricable, useless tangle.

Small heat shock proteins (sHsps) are a particularly important group of chaperones. They prevent the clumping of proteins under stress conditions. αB-crystallin and the related sHsp αA-crystallin are the main representatives of the sHsps found in humans. Whereas αA-crystallin mainly occurs in the eye lens, αB-crystallin is also very common in the brain and in the heart and muscle tissue. In the eye lens, they counteract diseases like cataracts. Malfunctions of the αB-crystallin in tissue cells can give rise to cancer and neurological defects, including Alzheimer’s disease.

Many research groups have focused their work on the α-crystallins due to their medical relevance. Despite intensive efforts, up to now, none of them have managed to determine the molecular architecture of these proteins. However, TUM biochemists have now succeeded in producing αA-crystallins and αB-crystallins recombinantly in bacteria and in obtaining uniform, clearly-structured complexes. A detailed structural analysis of these proteins was carried out in cooperation with the Chemistry Department’s Center of Electron Microscopy. The research groups were able to show for the first time here that, contrary to previous suppositions, αB-crystallin forms a defined globular structure comprising 24 subunits, which are reminiscent of a perforated soccer ball.

Thanks to the identification of the three-dimensional structure of αB-crystallin, which is currently being further refined, the basis has now been established for comparing healthy and disease-promoting mutants and, based on this, for clarifying the way they function. The scientists hope that this will lead to the discovery of new treatments.

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Testosterone therapy may cut risk of cardiovascular diseases

A new study has suggested that testosterone treatment in hypogonadal (testosterone deficient) men restores normal lipid profiles and may reduce the risk of cardiovascular disease.

In this observational study, researchers from Boston University School of Medicine (BUSM), investigated the effects of testosterone treatment in 255 hypogonadal men between the ages of 33-69 and followed them for a period of five years.

They found that men treated with testosterone therapy experienced a gradual reduction of their total cholesterol, low density lipoprotein cholesterol, triglycerides and increased high density lipoprotein.

“In addition to improving their cholesterol levels, we found that the testosterone treatment resulted in marked reductions in systolic and diastolic blood pressure as well, suggesting amelioration of hypertension,” lead author Abdulmaged M. Traish, MBA, PhD, professor of biochemistry and urology as well as Research Director of the Institute of Sexual Medicine at BUSM explained.

Traish found this treatment also reduced fasting blood glucose and hemoglobin A1c, a surrogate marker of hyperglycemia, suggesting that testosterone treatment may improve insulin sensitivity and hyperglycemic control.

It also reduced the levels of inflammatory biomarkers such as C-reactive protein (CRP) and markers of liver dysfunction such as alanine aminotransferase and aspartate aminotransferase, suggesting reduction in the inflammation responses.

The study is published in the International Journal of Clinical Practice.

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What to Do About Aging Parents

If You’re Concerned About Your Parents’ Safety at Home…

Don’t rush to the conclusion that they have to move out. If a parent is physically frail but cognitively intact, you may have to swallow your fears, says Joan Teno, M.D., professor of community health and medicine at the Brown University Medical School. “If they are able to weigh risks and benefits, then let them make the decisions,” she says. For example, how likely is it that your parent will fracture a bone in a fall? How much happier would he be staying in a familiar setting?

There are ways to ensure safety while respecting a person’s autonomy. Inspect for hazards, such as loose rugs, and install handrails on all stairs and reflective nonslip tape on uncarpeted steps. Replace dim bulbs with bright ones, and add night-lights. Rearrange closets to make everything accessible.

If a parent suffers from Alzheimer’s or some other form of dementia, you may indeed have to move him or her or arrange for live-in help. Small crises can also be red flags. For instance, if Dad burns the toast and starts a little kitchen fire, that’s the time to reevaluate safety―before disaster strikes.
If You’ve Noticed the House Isn’t as Clean as it Used to Be…

Try to discern if the problem with cleaning is physical, as with arthritis or some other condition that makes reaching, bending, and sweeping hard. Mom and Dad may not even notice the dust or the mustiness as their senses deteriorate, says Charlotte Spiegelman, a clinical social worker in Los Angeles.

You can also pay for household help as a Mother’s Day or birthday present, suggests Lisa Gwyther, an associate clinical professor of psychiatry and behavioral sciences at Duke University, in Durham, North Carolina. Give a gift certificate for a cleaning service and schedule the appointment. If your parents are worried about prying strangers, hire someone you know or get a referral.
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