Category: General

The Importance of Sleep for Older Adults

By: Brad Hankins

Sleep is important at any age, think back to when you had a newborn and neither of you slept more than an hour or two.   As we age sleep shifts from being more about rest and recovery to an important part of our physical and mental wellbeing https://www.nia.nih.gov/health/sleep/sleep-and-older-adults .

All adults require basically the same seven to nine hours of sleep each night.   However, as we age multiple factors can affect the amount and quality of sleep.  The first sleep change is we typically go to bed earlier and rise earlier than younger adults.  This is, by itself, is only problematic if your bedtime is out of sequence with others in your house who’s evening activities may keep you awake or only lightly sleeping.  The bigger issue is quality of sleep, i.e. REM vs non-REM sleep.

The two major types of sleep are rapid eye movement (REM) and non-REM. Both are connected to patterns (waves) of electrical activity in your brain. Non-REM sleep is when your brain in is quietest while REM sleep is when brain activity more resembles being awake and is when dreams usually occur. REM and non-REM sleep occur in cycles, usually three to five each night. REM sleep helps you store memories while non-REM sleep improves focus and energy.

Sleep is a complicated body function involving brain chemicals, feedback loops in your nervous system, brain function and overall health.  Homeostasis https://my.clevelandclinic.org/health/articles/homeostasis, or our body’s self-regulating mechanism, helps our sleep patterns by allowing us to be more physically and mentally balanced both day and at night.    Brain chemicals and hormones play a big role in the sleep cycle, especially melatonin, a hormone your body releases as it gets dark outside and makes you feel sleepy.  Chemicals such as adenosine are at play here as well, with the overall path to improved sleep being a better balance of these chemicals and happier homeostasis.

Quality sleep helps protect against disease and keeps our brains, heart and lungs healthy. Restful sleep also improves our ability to create new memories, helps us solve problems quickly, improves decision making, and improves our general mood and life outlook.  While not getting enough sleep, or sleeping poorly, can affect our health and increase the risk of diabetes, heart disease and high blood pressure as well as increasing fall risk,

What can help both the quality and quantity of sleep? Please consider the following suggestions:

• First, ask your medical provider to review your medications for side effects that may affect your sleep. This not only the individual medications but the interactions of two or more medications when combined.
• Avoid caffeine late in the day. This varies greatly from person to person and most of us know what that time of day is. However, be wary of evening caffeine in the form of chocolate, beverages and sneaky snacks.
• Establish a sleep schedule by going to bed and waking the same time each day, including when traveling and on weekends.
• This can be a tough one, avoid napping in the evening or late afternoons. Naps are good, there is nothing wrong with naps, but consider limiting them to 10 to 20 minutes and no later than 3:00 PM.
• Time your last meal of the day to no closer than two to three hours before bedtime or limit your last meal of the day to a specific time, say no later than 6:00 PM.
• Limit screen time before bed. This can be another tough one but try experimenting with small steps such as no screens in bed and/or no screens 30 minutes before bed.
• Limit alcohol to three hours before bedtime – even in small quantities.
• Ensure you room is comfortable for sleeping, this includes the amount of light, temperature and ambient noise. Many products are now available to help regulate bed temperature, generate white noise (or block it), or reduce/block light coming through windows.
• Exercise regularly, but not within three hours of your bedtime.
• Establish a bedtime routine that includes a brief brain wind-down such as reading a book or listening to music.

If insomnia or interrupted sleep is a consistent issue, please consult your medical provider.  Many medical conditions including sleep arena and hormone imbalances (such as high thyroid levels) can contribute to a poor night’s sleep.  Many of these conditions are easily addressed, if your provider has a sleep history to review.  Keeping a sleep diary for several weeks will help your provider establish a diagnosis.  Include in your diary; the times you went to bed, the times you woke up during the night, if you had night sweats or night terrors, the times of your last meal of the day, and if you had caffeine or alcohol during the day/evening.

A good night’s sleep is foundationally important, how we spend the night directly relates to how we spend our day.

 

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT

 

Hydration for Older Adults

By: Brad Hankins

What better month than July to explore hydration. The most common hydration question I am asked is how much fluid should I drink?  The answer is it depends – on a lot of things.  A basic rule of thumb  https://www.ncoa.org/article/how-to-stay-hydrated-for-better-health/  is to divide your body weight by 1/3 and that will be the minimum number of ounces of fluid you should drink in a twenty-four-hour period.   For me that is 68 ounces, 8.5 cups or a little over 2 liters per day.  At age 51 and above The National Academy of Medicine recommends 13 cups (3 liters) of fluid per day for men and 9 cups (2.25 liters) for women every 24 hours. Again, these are minimum recommendations for a normally health older adult.

Please notice I am using the term “fluid” and not limiting fluid to just water.  Most liquids and some foods count https://health.clevelandclinic.org/drink-up-dehydration-is-an-often-overlooked-health-risk-for-seniors toward your daily intake.  The outliers are alcohol and high levels of caffeine which are diuretics and reduce fluid volume in the body.  So, juice, milk, coffee (in moderation), soup and even popsicles count (keep an eye on sugars if you are diabetic or have other metabolic conditions). Foods such as cucumbers, tomatoes, apples, bell peppers, watermelon and celery are also high in fluids. And, both meat and fish are high in fluids as well.  I get quizzical looks when adding meat to the fluid list but consider marine mammals such as seals cannot drink sea water and get their fluids through fish and other marine life they eat.

Having a few miles on the odometer means we can become dehydrated easier than in our 20’s and 30’s.  There are many reasons for this, with a decline in total body fluid being toward the top of the list.  If you recall from previous posts, our muscles are our water tank and as muscle mass declines with age our ability to store water literally shrinks.  More muscle equals more stored water which equals more fluid reserves when challenged by heat, exertion, injury or acute health conditions – especially those resulting in vomiting and diarrhea.  Yes, you need to lift weights.

Another age-related dehydration issue https://www.healthline.com/health/symptoms-of-dehydration-in-elderly is decreased thirst response.  Simply put, with age we become more dehydrated before feeling thirsty.  This is because our thirst center, located in our brain’s hypothalamus, becomes less responsive as we age.  In turn this makes it important to drink/eat fluids over the course of the day – don’t wait until you are thirsty.  We can balance our hydration level by being aware of the need for morning and mid-day drinks and taking in more fluids with meals and snacks.  A suggestion is as soon as you are out of bed, before coffee or food, drink one or two cups of plain water.  This is because as we sleep our brain dehydrates through our breathing, and as our brain is very fluid dependent the extra water first thing in the morning gives it a boost.  Also consider a cup or two of water with your second cup of coffee in the morning and with your tea or soda in the afternoon.

Early signs of dehydration need to be responded to quickly by resting and drinking more water.  These signs include dry or sticky mouth, dark yellow urine, decreased urination, headache, muscle cramps, dizziness and fatigue.  Be especially aware of these symptoms during hot and/or humid weather and increase your fluid intake as temperatures and humidity rises to help prevent the symptoms from occurring.

When exercising, the best hydration plan is to be fully hydrated before stepping into the gym.  This means drinking 15-20 ounces (2 to 2.5 cups or a half liter) of fluid in the hour prior to exercise.  During exercise 10 ounces (approx. 1 cup) of fluid for every 20 minutes of exercise.  And after exercise slowly drinking a liter (approx. 4 cups) of fluid with a fibrous snack such as a banana (to slow water absorption), will ensure you are fully rehydrated and ready for the day.

Sports drinks, or electrolyte replacements, are usually not necessary when exercising for an hour or less – water works exceptionally well https://extension.unh.edu/blog/2023/09/hydration-are-electrolyte-drinks-better-water   .  However, sports drinks do have a place such as after strenuous exercise in warm weather, e.g. 10k run or a day of summer mountain hiking. They are also beneficial during an illness when experiencing prolonged sweating, diarrhea or vomiting.  People with hypertension need to be aware of the high levels of sodium and potassium in these drinks which can increase blood pressure.  Electrolyte drinks are not meant to be consumed throughout the day as if they are water but do have their place in certain circumstances.

In summary:

1. Rehydrate early each day and remind yourself to stay hydrated over the course of day (at least 2-3 liters over 24 hours).
2. Ensure you are hydrated before exercise (1/2 liter), hydrate during exercise (1/2 to 1 liter) and slowly rehydrate after exercise (1 liter ).
3. Be aware of the early signs of dehydration and respond quickly with additional fluids and rest as they appear.

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT

 

Navigating The American Health Care System as An Older Adult

By: Brad Hankins

Consult Your Primary Care Provider Before Making Changes to Your Medications, Diet or Beginning/Changing an Exercise Program

I have spent 43 years in the American healthcare system, as a clinical Nurse, clinic administrator and hospital COO.  When I entered healthcare in 1982 records were kept on paper, a patient chart was a few pages thick and hospital admissions were published in local newspapers.  Things have changed.

Over the course of my career one of the biggest changes I have witnessed is healthcare moving from a human service provided and governed at the local level to the rise of regional and national for profit health care systems such as HCA and Tenet. Though most hospitals remain non-profit, approximately 36 percent are now for profit up from less than 10 percent in 1982.

I have also been witness to near unbelievable transformations in technology, from MRI and PET scanners to robotic assisted surgery and recombinant DNA medications.  Technology has not only improved the quality of healthcare but also safety and accessibility.  However, it has come at a literal cost.

The ever-increasing cost of medical technology has been one, but far from the only, cause of escalating healthcare costs.  The aging of the American population and associated demand for healthcare services also has increased costs of staffing, education, buildings and information infrastructure.

As the American healthcare system has grown so has its regulatory oversight as well as billing/reimbursement processes.  Both of which play their own role in increasing costs while at the same time helping ensure the quality of, and payment for, healthcare services are at par across the nation.

With all that said, most health care consumers feel that access, quality and cost of care is getting worse, not better. As I write this in May of 2025, there does not appear to be a clear national path through this escalating quagmire of increasing costs, decreasing access and stalled quality of care.  Doubtless, what we are currently experiencing in our healthcare systems will be with us for the foreseeable future.

At the same time, please be assured the vast majority of American healthcare workers and providers are skilled, dedicated and focused on service to others. However, they are limited by the systems they work in.  As patients and healthcare consumers how do we successfully navigate our current national and local healthcare systems while maintaining a high level of self-advocacy and results?

I suggest recruiting your own healthcare team, with you as team manager. First, you probably have professional resources available you don’t fully use, pharmacists are an example. They are an excellent consulting/educational resource, they provide injections/vaccinations and are strong advocates.  You need a pharmacist on your team, preferably one at a local pharmacy who knows your name.

If you attend exercise classes or work with a personal trainer you also have these professionals readily available as team members.  Typically group exercise leaders (yoga, dance, Pilates etc.) and trainers are well versed in the body’s response to exercise and stress and are often underutilized as consultants.  Build a consulting relationship with your exercise instructor or trainer, ask them questions and you will be surprised at the value they bring to your team.

A readily accessible medical provider is a must-have team member, with options available from in person to online. Considering today’s access issues, I suggest finding an urgent care clinic that works well for you.  Granted you will probably see a different provider each trip, but if the clinic suites you overall, and you go there routinely for minor health issues, e.g. lingering colds, sore throats etc., they will become important immediate care team members.

A medical provider who helps manage your general health is mandatory, especially if you have chronic health conditions such as diabetes or high blood pressure. This may be an MD, DO, Nurse Practitioner, or Physician Assistant that 1) you trust 2) communicates clearly 3) follows up thoroughly/quickly and 4) develops a successful track record of listening to your needs and responding appropriately at each visit.  You may have already been their patient for 25 years or you may be currently searching for the right provider, the point is to have a general medical provider on your team who consistently has your best interest at heart and fulfills their obligation to you in a way that meets your expectations and needs.

Specialists are also team members, Neurologists, Orthopedists and Nephrologist being examples.  If you are not satisfied with a specialist referral, ask your general provider for a new referral.  This may slow access as the new referral is processed but can gain time on the recovery end by assuring you have a specialist who successfully meets your needs.  Specialists are important team members and their communications with your general provider is an important part of being on your team – always ensure they send medical records to your general provider.

There are also growing numbers of independent health care professionals who are available either face to face or online.  Dieticians, Nurses, Exercise Specialists and Nutritionists are some of the professionals who can be added to your team as consultants and advocates.  These services are available on an as-needed basis but are being used more frequently as permanent team members to help navigate care, give professional advice/education, and provide advocation or help develop good self-advocacy skills.

As team manager it is important to have your health care information and data readily available.  I recommend becoming your own health records manager.  As you add team members, access specialty care or find yourself visiting providers outside your general healthcare system 1) sign up to the patient portal of each clinic or provider 2) download and print your healthcare information from all providers [including your general provider] as it becomes available 3) keep these records at home 4) ensure your general provider has copies of any record outside their system by either delivering printed copies or sending electronic copies.

There are many paths to becoming a good self-advocate and healthcare navigator, these are only my suggestions. However, from years of seeing navigation success and failures I feel an organized team approach gives broad continuity of care and provides access to information from multiple sources to be used in thoughtful decision making.  All together an organized team-based plan will help ensure your voice is heard and your healthcare needs are met in a safe, efficient manner.

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT

 

By: Brad Hankins

Consult Your Primary Care Provider Before Making Changes to Your Medications, Diet or Beginning/Changing an Exercise Program

In this fourth, and last, article in our brain health series, we are looking at how nutrition and exercise can help our brains.  In consideration of processing speed, cognition and memory what are things we can do on a routine basis to make our brains happy?  There are quite a few actually, and since they make our brain happy, they will make us happy as well.  A happy brain rule of thumb to remember is, anything that is good for your heart is also good for your brain.

Brain Food

Brain nutrition is worth its own section, because it is that important. You have probably heard of the Mediterranean diet  https://my.clevelandclinic.org/health/articles/16037-mediterranean-diet .  This diet is the proven go-to to prevent or manage most chronic and inflammatory diseases and it is also the base nutrition of a happy brain. For any diet to work it must be sustainable and maintainable for all involved, including family members. The Mediterranean diet has a great variety of foods which should help keep you and your family members interested, while at the same time focusing on more plant-based food and good fats.   Please see the link above for details, but essentially the diet is:

• Whole grains, to included whole wheat bread and brown rice.
• Lots of extra virgin olive oil.
• A change to less red meat and more fish and poultry.
• A wide variety of vegetables to include potatoes.
• A slight step away from sweets and sugary drinks, but this is the Mediterranean diet after all so one must always consider the occasional gelato and tiramisu.
• About every fruit you can imagine and near limitless seeds, nuts and beans.
• Even a moderate amount of wine with meals.

Along with the Mediterranean diet, daily coffee and tea (about two and half cups of coffee or 200 mg of caffeine) has been shown to be brain friendly as well, especially when it comes to solidifying new memories.  In the vegetable category the foods research suggests are most brain healthy are leafy greens such as kale, spinach, collards and broccoli, due to the high concertation of vitamin K, folate and beta carotene.

As you recall the brain is mostly fluid, so avoiding dehydration is as important as maintaining adequate hydration.  As we age, we can become more vulnerable to dehydration, https://www.ncoa.org/article/how-to-stay-hydrated-for-better-health/ some of these reasons include medications, body composition changes (decreased muscle mass), and a change in thirst response – we don’t realize we are dehydrated as early as when we were younger.  Daily routine fluid intake for older adults should be nine cups of water per day for females and fifteen cups of water per day for males.  Keep in mind all fluids count except alcohol (which can dehydrate you), to include coffee, tea and soups.  Regarding exercise, an extra liter of water after exercise is suggested along with a fibrous snack such as an orange or banana to help slow absorption.

Brain Supplements (in case you are interested) – DO NOT BEGIN TAKING SUPPLEMENTS WITHOUT FIRST CONSULTING YOUR MEDICAL PROVIDER.  ALWAYS CONSULT YOUR MEDICAL PROVIDER FOR DRUG-SUPPLEMENT INTERACTIONS BEFORE TAKING ANY SUPPLEMENT.

As a Nurse I do not prescribe nor suggest taking particular supplements.  With that said, the worldwide supplement business is a massive $360 billion a year industry that does not always have your best interest at heart.  Always research and think through considering taking any supplement, and do not rely on your neighbor, Instagram or the sticker on the back of a package for sound advice – consult a health care professional.

Yes, there are supplements medically proven to help cognition and brain function https://pmc.ncbi.nlm.nih.gov/articles/PMC10746024/ .  Folic acid (part of the vitamin B group) and vitamins B6 and B12 taken together over an extended period (up to 24 months) have been shown to improve cognitive scores and reduce some amyloid proteins.   Also, magnesium, vitamin D, vitamin C and DHA (an omega 3 fatty acid found in cold water fatty fish -salmon is an example) taken together has been shown to improve memory and augment cognition – please see the linked journal article above for details.

HOWEVER, the main issue with all over-the-counter supplements is lack of regulation – the FDA does not oversee product testing or ingredient accuracy of supplements.   In other words, you are not assured of the dosage nor bioavailability of over-the-counter supplements.  I suggest talking with your medical provider to determine the correct supplement, its dosage and timing and then ask that those supplements be prescribed to you.  This can be (but not always depending on your insurance) a more expensive route, but you are then assured of the quality, dosage and bioavailability of the supplement.

Exercise – Consult Your Medical Provider Before Beginning or Changing an Exercise Program.

Your brain, though it may initially rebel, likes being challenged physically as well as mentally.  You need to exercise at least three times per week, with a goal of five times or more per week for a minimum of an hour each time.  The trifecta of exercise is a motion practice (yoga, tai chi, pickleball), a cardio practice (walking, running, swimming) and a resistance/weight training practice – yes, you need to lift weights.

Start slow, seek guidance from a personal trainer or a senior exercise specialist and be open minded (pun intended) to types of exercise you haven’t tried before.  Explore the different classes and group exercise sessions at your local SSYMCA branch, don’t be afraid to ask questions and work with your trainer to get past any feelings of intimidation– everyone starts their exercise journey at the beginner level.

There is not a form of exercise that is more brain friendly than another, all exercise either challenges or sooths (or do both) your brain in one way or another.  There are the neuro-cognitive challenges of fast-paced courts sports such as basketball and pickle ball.  The Zen of yoga, Tai Chi and lap swimming presents an opportunity to calm your mind as well as challenge your body.  Weightlifting is often unrecognized for its own unique Zen, while sharpening focus and neuro-cognitive connections.  The main point with brain happy exercise is – start goal focused exercising regularly across multiple disciplines to build an exercise program that best meets your personal needs.

When considering a weight training program, a personal trainer is a good choice to help you begin in a safe manner and help move you toward quality exercises which best fit your goals and limitations.

Slight, but sustainable, changes to both diet and exercise can make a difference in cognition, brain function and processing speed.  Challenge yourself, try different things, and experiment with combinations.  When you get bored or plateau, do it all over again – there is no right or wrong way to begin a fitness/happy brain journey.

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT

 

By: Brad Hankins

Consult Your Primary Care Provider Before Making Changes to Your Medications, Diet or Beginning/Changing an Exercise Program

This is our third in series of columns on brain health, this month we will explore memory.  It goes without saying that memory is a vital human process, for example social interactions would be limited if you couldn’t recall who your family members are, plus it would make Thanksgiving awkward.  We use memory for problem solving, like answering test questions or assembling Ikea furniture.  It keeps us safe through planning and navigating familiar and unfamiliar places and avoiding things that previously harmed us.  In a large sense we are our memory, and our memory is us.

There are three types of memory:

1. Sensory memory, or sensory register, is a quick (0.2 – 2 seconds) collection of information from our senses. Once the information collection is complete it moves to either your short-term memory or other parts of the brain for memory storage. Those memories are brief. Our capacity for sensory memory is huge, because we are usually using multiple senses at the same time. Sensory memory ensures we are aware of what we are immediately experiencing, it helps keep us safe and at the same time enjoy the world around us. Some examples of sensory memories are:

• The melody of a song continuing after the song has finished playing
• Continuing to feel the touch of someone after they let go of your hand
• The taste of food after you have finished eating
• Seeing the colors of fireworks after they have faded
• Continuing to smell bread after walking out of a bakery

2. Short term memory https://www.ncbi.nlm.nih.gov/books/NBK545136/ , or active memory, temporarily holds information from seconds to minutes and this information is (supposedly) easily accessible. While sensory memory stores experiences, short term memory stores information you have learned. Short term memory receives and process sensory information and converts short term memories into long term memories. On a good day you can hold five to seven items in your short-term memory, like a phone number or a license plate number, for about 15 to 30 seconds.  After that the information is moved to your long-term memory.  However, there is a difference between working memory and short-term memory.  Working memory is temporary story of information you can change, or manipulate to help with reasoning, learning and understanding while short term memory is a temporary storage space of unchangeable information, not unlike a sticky note.  Short term memory is an essential part of your cognitive functioning.  It may be temporary storage, but it has an important role.  For instance, by the time you finish reading this sentence, your short-term memory has already removed the previous sentence from its temporary storage space to make room for this sentence.
3. Long term memory https://www.ncbi.nlm.nih.gov/books/NBK549791/ is a nearly permanent storage space for learned information and experiences. The main function of long-term memory is to be an archive – to make short term memories more permanent. There are two main types of long-term memory:

• Explicit memory is the storage of facts, events, and locations. You are always adding to this storage space and recalling this information as needed.
• Implicit memory is the storage of learned skills, habits and relationships. You are not consciously aware of when you are learning this information, but you can recall it at any time.

Together these two areas (and their multiple subareas) allow us to learn and perform tasks, relate to past experiences, make connections, adjust to our environment, and recall how to tie your shoes and turn on your phone – along with a yet-to-be fully understood multitude of other functions and processes.  An astounding number of memories last years or decades and some a lifetime.

We have previously discussed things can affect all three memory types such as poor blood flow but other conditions impact memory as well such as traumatic physical injuries, acute and chronic disease, and psychological/emotional trauma https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/memory-problems-forgetfulness-and-aging .

How can we exercise our memory? Every activity listed above is a memory exercise, and we can also add the following:

• Focus – be aware where you set your car keys or phone down. Reduce distractions (both internal and external), the object is to seamlessly move information from sensory to short term to long term memory.
• If you don’t already, start journaling – on paper using a pen. If you already journal, make it a daily practice.
• Put puzzles and Lego projects together – activities requiring you to remember instructions/sequences and placements.
• Play memory games such as Sudoku, do a daily online cross word, play online word games such as Wordle, Strands and Letter Boxed.
• Play chess, checkers, even video games.
• Memorize your shopping list, begin by memorizing five items then work your way up.
• Become and stay organized in your home – make a happy place for everything.
• Stay physically active, exercise regularly – at least three days a week for an hour or more.
• Learn new skills – a new language or musical instrument.
• Listen to complex music (to suit your taste) such as classical and jazz.
• Learn new physical activities – dance, Taichi, yoga, pickleball, martial arts.
• Stay social, which has different meanings in these modern times, and stay connected to others.
• Read books, the kind made of paper.
• Improve you sleep patterns and sleep time – we could do an entire series on this subject alone – but research, explore and experiment with new ways to help you sleep.
• If you don’t already, meditate daily. If you don’t meditate or haven’t in a while explore the numerous apps out there to help you ease into a daily practice.
• Take your medications as prescribed and explore all available resources to help manage chronic health conditions.

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT