Be a Quitter! Take Part in the 2016 Great American Smokeout

by Nervana Elkhadragy, PharmD, and Karen S. Hudmon, DrPH, MS, RPh, Professor of Public Health Pharmacy, Purdue University College of Pharmacy

smoking_stopWith the 2016 Great American Smokeout just around the corner (November 17), there is no better time to start planning an attempt to quit smoking! The Smokeout challenges smokers to quit for a full 24 hours, with the hope that this day will be the first of many, many more without tobacco.

Individuals who are interested in quitting often ask, “What’s the best way to quit?” Fortunately, there are countless research studies that collectively inform our knowledge base and provide effective strategies for quitting. However, there is one big problem: Most individuals attempt to quit on their own…without help…and this is the LEAST effective approach to quitting.

Here we describe how to treat tobacco dependence as two parts – specifically, we discuss the importance of: (1) treating the nicotine dependence and (b) receiving professional counseling to address the behavior of smoking. We also suggest different resources for quitters as well as for health care professionals who want to help their patients.

PART 1: Nicotine Dependence

First a few words on nicotine, which is the addictive component in tobacco. Nicotine is not the harmful part of tobacco, but it’s the reason why quitters feel anxious and irritable when they’ve gone too long without a cigarette. Fortunately, there are seven different medications that can make individuals more comfortable by helping to alleviate withdrawal. Three of these are sold without a prescription (nicotine patch, gum, and lozenge), and four require a prescription (nicotine inhaler, nicotine nasal spray, bupropion SR, and varenicline). With so many options, which is best? It depends. All of these options are effective, and several can be used in combination. Below, we list some factors to be considered – with a key factor being the individual’s ability to adhere to the recommended dosing regimen. Cessation medications must be taken according to a fixed schedule to “prevent” withdrawal symptoms, rather than to “treat” them after they occur.

Nonprescription Medications

  • Nicotine gum and lozenge: The nicotine gum and lozenges are available in 2 mg (if you smoke your first cigarette > 30 minutes after waking) and 4 mg (if you smoke < 30 minutes after waking). These products can serve as an oral substitute for tobacco, and they can be titrated to adjust for withdrawal symptoms throughout the day. The challenge, however, is that gum and the lozenge are short-acting formulations and must be dosed every 1-2 hours while awake, with a minimum of nine 9 doses a day initially for the first 4 to 6 weeks. If an individual is not able to adhere to this rigorous dosing schedule, then the gum and lozenge should be ruled out as an option (unless combined with the nicotine patch – more on this later). The gum is more viscous than normal chewing gum and therefore is not recommended for persons with significant dental work or with jaw disorders. Proper chewing technique, as described on the box, is necessary to ensure appropriate release of the nicotine from the gum.
  • Nicotine transdermal patch: The nicotine patch is available in 7 mg, 14 mg, and 21 mg, and the initial strength is based on the number of cigarettes smoked per day. The most important benefit of the patch is its ease of use – it’s a long-acting formulation that is applied only once daily and therefore is ideal for individuals who are unable or unlikely to be able to take the minimum of 9 doses a day initially that is required for the short-acting NRT formulations. The patch can be combined with a short-acting NRT product, such as the gum, lozenge, inhaler, or nasal spray. The patch delivers consistent nicotine levels over 24 hours and the short-acting products are then used as a supplement for situational cravings. The patch is not recommended for persons with dermatologic conditions because nicotine and the patch adhesives can be irritating to the skin.

Prescription Medications

  • Bupropion SR (Zyban) and Varenicline (Chantix): Bupropion SR and varenicline are both tablets that are taken by mouth twice a day (after an initial few days of titrating the dosage upward). Bupropion use requires a discussion with a healthcare provider about potential contraindications and warnings, and both medications require a discussion about monitoring for potential neuropsychiatric symptoms. Bupropion use can lead to increased seizure risk in certain individuals.
  • Nicotine inhaler and nasal spray: The nicotine inhaler is designed to release nicotine as a vapor into the mouth (not the lungs) where it is absorbed across the buccal mucosa, and the nasal spray is absorbed across the lining of the nasal passages. These are both are effective when used as prescribed but are short-acting and therefore require frequent dosing throughout the day. Individuals with chronic nasal disorders should avoid use of the nasal spray, and individuals with any type of bronchospastic disease or airways disorder should consider other options.

Combination Therapy: There is abundant evidence to suggest that combination therapy (using two or more cessation medications) outperforms monotherapy (use of one medication alone), and it should be recommended with confidence for most patients who are quitting smoking. This approach, which is likely new to many tobacco users, typically involves the nicotine patch plus one of the short-acting NRT medications. Another option is to combine the nicotine patch with bupropion SR. Combination therapy should be a regimen of choice for anyone who: (a) has a high level of dependence, e.g., smoking a pack or more of cigarettes a day, or (b) has tried to quit before using one medication but suffered significant withdrawal symptoms (despite appropriate dosing of their medication) that led to relapse.

In general, all of these medications work well – when taken as directed – but the tips provided above will help patients decide which approach is best for them. Whether you are a patient talking with a healthcare professional, or a clinician trying to help a patient, be sure to discuss how many cigarettes are smoked daily, how soon after waking the first cigarette of the day is smoked, and whether it will be possible to stick to a frequent dosing schedule (e.g., 9 or more times a day).

PART 2: Changing Behavior

smokingEqually important, if not more important than using cessation medication(s), is the need to focus on changing smoking-related behaviors. Several strategies have been shown to enhance the rate of quitting and prolong abstinence. A strategy that can help is to consider the “5 R’s”:

Relevance: Think about reasons why quitting is important for you or might be important for your family – it could be that you have children and do not want to expose them to second hand smoke, that you want to be a good role model, or that you want to live to see your grandchildren.

Risk: Identify the potential negative consequences of smoking on your health – these could include difficulty with breathing, increased risk of cancers, reduced ability to conceive, or reduced heart function.

Rewards: Identify the potential benefits of quitting – examples range from improved health, ability to exercise or be more active, or reduced skin wrinkles.

Roadblocks: Write down what’s keeping you from quitting and what coping strategies you can use to overcome those barriers. Be honest and explicit when thinking about those roadblocks, it could be fear of failure, or concern about weight gain.

Repetition: Continue to reassess and revisit your 5 R’s, determine new coping methods, and repeat interventions.

In addition to thinking about the 5 R’s, consider accessing one or more of the variety of available services, such as individualized tobacco cessation counseling sessions via the Tobacco Quitline (call 1-800-QUIT NOW), local group programs, or web-based programs such as www.quitnet.com. In general, the more help you get, the better the odds are of quitting for good. But that’s not enough – remember, when you sign up for those sessions, make sure you do the “homework” assigned to you during the program. Moreover, when enrolled in a program, be sure to learn effective coping strategies for withdrawal symptoms; those who have effective coping methods have better results.

Whether you have no previous experience with quitting tobacco, or you’ve had numerous quit attempts, having the right tools, knowledge, and support is important for long-term success! There has never been a time when resources that provide individualized support and reliable information was so widespread and accessible. Why not make the most of it?

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And for the history buffs, a little background on the Great American Smokeout… it was started by Fred Mayer, a pharmacist in Marin County California, back in 1977.Fred is widely regarded as the “Father of Public Health Pharmacy,” not only for his initiation of the Great American Smokeout, but also for his work in promoting safety caps on prescription vials, working with the Drug Enforcement Agency for Medication Take Back Day programs, and reducing unplanned pregnancies and sexually transmitted diseases and infections by promoting condom awareness campaigns, advocating for sex education in schools, and working in tandem with Planned Parenthood and PTAs in school districts.

ADDITIONAL RESOURCES

For healthcare providers:

For individuals who want to quit:

  • 1-800-QUIT NOW – tobacco cessation quitline for individualized counseling
Posted in Guest Posts, National Health Observance, Smoking Cessation | Tagged , , , , , , , , , , | Leave a comment

Self-Management Plays a Key Role in Controlling Diabetes

by Misty Kevech, HHQI RN Project Coordinator

161843047November is American Diabetes Month and World Diabetes Day is November 14, 2016. The Centers for Disease Control and Prevention (CDC, 2016) reports there are over 29 million Americans living with diabetes and 86 million with prediabetes. Diabetes is the 7th leading cause of death which is under-reported (CDC, 2014). Complications from diabetes adds a great burden to patients, families, and our health systems. Diabetes is the leading cause of:

  • Kidney failure
  • Non-traumatic lower-limb amputations
  • New cases of blindness in adults

Socioeconomic status and other underserved population factors can greatly affect the management of diabetes and preventing complications. There can be many reasons that affect a patient’s ability to self-manage, including lack of fresh foods (food deserts) in both urban and rural areas, lack of or inadequate transportation assistance for medical appointments, and health literacy issues, just to name a few.

Home health agencies (HHA) are a great setting to teach patient diabetes self-management to prevent incidence, exacerbations, complications, and deaths. There are plenty of evidence-based tools and resources to assist HHAs and their clinicians to assist with develop culturally appropriate plans of actions with patients. HHQI’s Disease Management: Diabetes Best Practice Intervention Package (BPIP) provides evidence-based practices, tools, and resources for caring for your patients with diabetes.

Adult learners, including patients and clinicians, learn better if information is presented in various formats. HHQI offers free multimedia modules as a way to supplement education. Each module and can be downloaded from the HHQI website to your laptop or tablet and played in the patient’s home. The modules are also available on HHQI National Campaign’s YouTube channel.

Clinician

11-8-16-foot-diabetesThere are two clinician multimedia modules to support clinical diabetes management (about 15 minutes each).

Patient

prediabetes-hhqi-resource-thumbnailThere are several patient multimedia modules and videos to support or reinforce diabetes management education (about 5 minutes each).

  • Prediabetes and Signs & Symptoms of Diabetes
    • Provides information on prediabetes – what it is and risk factors.
    • Discusses signs/symptoms of type 2 diabetes and the need for medical follow-up.
  • Healthy Eating
    • Learn simple healthy eating practices that can be included in every day meals.
    • Learn how to read and understand food labels to make good food choices.
  • Diabetes Self-Care
    • Discusses the importance of regular exams and tests including A1C levels, foot care, blood pressure measurement, eye exams, and lipid levels.
  • HHQI Cardiovascular Health Patient Video: Diabetes & Your Heart
    • Discusses the effects and complications of high blood glucose on the cardiovascular system.

 

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Face the Facts: Stroke is Treatable

By Julia Richards, Manager, Stroke Survival Programs, National Stroke Association

Lives can improve with better awareness, access and action.

Julia Richards

World Stroke Day is October 29, 2016. On this day the National Stroke Association, along with other agencies across the globe, will join together to raise awareness about stroke.

The theme for this year’s World Stroke Day campaign is, “Face the Facts: Stroke is Treatable.” Participating organizations around the world will focus on raising awareness about stroke and stroke treatments, improving public understanding of different types of treatments and post-stroke care, and steps that anyone can take to influence laws that affect healthcare for individuals, families and others affected by stroke.

For this year’s campaign, the National Stroke Association launches an interactive infographic that is part of a digital day of engagement on the topic of strokes. The infographic features facts vs. fictions about stroke incidence, treatment and recovery.

There are many misconceptions about stroke and stroke recovery in the general public. Many people think that stroke only happens to older individuals, that stroke is a death sentence, or that recovery ends at three months. The National Stroke Association would like to use the opportunity of World Stroke Day 2016 to educate the public on the truths about stroke, and provide a way for people to take that message out into their communities.

The National Stroke Association will provide a sharing option as part of the social media campaign for World Stroke Day. People who view the interactive infographic will be 10-21-16_nsa_hope_blubluencouraged to share it via Facebook and Twitter, spreading the word about the treatable nature of stroke.

For World Stroke Day 2016, please join the National Stroke Association and others around the world in raising awareness about stroke.

HHQI REMIDNER: In observance of World Stoke Day, HHQI would like to remind you of our many resources including an 8-minute patient video on the risks for stroke that you can watch on YouTube or download the MP4 to save to your laptop, tablet or flash drive.  There are also many other patient resources on the risks and signs of heart attach & stoke on our HHQI webpage including My Healthy Heart Workbook available in many languages.

There are many other clinician and patient resources on our HHQI Website . Check out the Cardiovascular Health Part 1  and Cardiovascular Health Part II  Best Practice Intervention Packages (BPIP’s) as well as other patient videos on Cardiovascular Lifestyle Modifications, Cardiovascular Risk Factors, Cardiovascular Blood Pressure Medication Management, and Smoking & Your Heart.

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September is Cholesterol Education Month – Learn About Cholesterol: The Good, the Bad, and the Ugly

9-16-16_chelsea_francesby: Chelsea E. Leonard, PharmD, Clinical Pharmacist, and Frances V. Cohenour, PharmD, Clinical Pharmacist and Co-Owner, Chad’s Payless  Pharmacy, Florence, AL

According to Quaker Oats, “Cheerios can help lower cholesterol and reduce the risk of heart disease!” If there has been a commercial about something or it has been on the news, chances are your community pharmacist has already been asked about it.  Because we field questions about anything and everything dealing with health, we can be a tremendous resource for advice and guidance.  The term “cholesterol” is mentioned all the time, and most people probably know that high cholesterol is bad (especially since everyone wants to help us lower it), but what exactly does it mean to have high cholesterol?

Cholesterol is a fatty substance found in the cells and the blood.  It literally looks like blobs of grease floating in your blood. Bodies need cholesterol to make some hormones and Vitamin D, but we make all the cholesterol we need. Certain foods that we eat introduce extra cholesterol in our blood stream, and this is where the problems happen. People with high cholesterol have twice the risk of developing heart disease than people with normal cholesterol. Cholesterol levels should be checked at least every five years, although most providers choose to check it annually. When cholesterol is reported, a few different numbers are important:

  • HDL, or “good” cholesterol, absorbs bad cholesterol and takes it back to the liver to be flushed out of the body. If HDL is higher, it can reduce the risk of heart problems and strokes. We want this cholesterol to be high!
  • LDL, or “bad” cholesterol, makes up the majority of cholesterol in the body. These are the blobs of grease. When your LDL is too high, the arteries can become clogged and potentially cause heart problems and strokes. Most medications work on this type of cholesterol.
  • Triglycerides, the “ugly” cholesterol, are a type of fat found in the blood. When high triglycerides are combined with high LDL or low HDL the risk of a heart attack or stroke is increased. Triglycerides are affected by foods we eat. If I ate a giant greasy breakfast and had my cholesterol checked right after, my triglycerides would probably be sky high (and my doctor would probably freak out)! Cholesterol should always be checked when you haven’t eaten anything in the past eight hours to ensure that the results are the most accurate.

Community pharmacists are accessible, knowledgeable and trusted and can help patients and other healthcare providers manage cholesterol. Although we do not usually have access to laboratory values, we are still able to provide education and recommendations. Some pharmacists even have the capability to test your cholesterol in the pharmacy and provide the results in about five minutes! Knowing the results, we can counsel patients on what their numbers mean and what they need to do to improve them. This is a great resource for patients who may not be able to make it to their doctor’s office or want to know how they’re doing in between doctor visits.

PillsInHandThe gold star medications for cholesterol management are known as statins. Common statins include simvaSTATIN (Zocor), atorvaSTATIN (Lipitor), and rosuvaSTATIN (Crestor). These medications are most beneficial for patients with high cholesterol and heart disease. They are the strongest drugs available for reducing LDL cholesterol. Most statin medications are given once daily, and simvastatin, lovastatin, and fluvastatin should be given at bedtime. Muscle symptoms (myopathy), including cramps and weakness, are the most common side effects that are reported from statin medications. Women have a higher risk for developing statin-induced myopathy. Patients with symptoms of myopathy should be monitored and potentially changed to a lower dose of their current medication or a different statin. If the patient still reports symptoms, a nonstatin medication may be necessary. Community pharmacists can make recommendations to patients and prescribers if there is a concern regarding side effects and medications.

Nonstatin medications include bile acid sequestrants (ex. cholestyramine), fibric acid derivatives (ex. fenofibrate), niacin, and cholesterol-absorption inhibitors (ex. Zetia).  Nonstatin medications are only recommended when a patient is unable to tolerate a statin; however, a nonstatin medication may need to be added based on the patient’s cholesterol panel. If a patient has high triglycerides, they might need to be on a statin and a fibric acid derivative. If a statin has not lowered LDL enough, Zetia might need to be added to their regimen. All cholesterol regimens should be tailored to the patient’s needs.

Like any other medication, cholesterol medications are not going to be effective if the patient is not taking them properly. Pharmacists have the ability to monitor a patient’s adherence to the medication and can discuss this with them if they notice a problem. From my personal experience as a community pharmacist, adherence issues are usually due to the medication’s cost. Community pharmacists can intervene to find a cheaper alternative for the patient. Another reason for adherence issues is forgetfulness. Patients often get caught up in the chaos of their day and simply forget to take their medicine. I even forget to take my own medication sometimes! If this happens, I usually recommend that they set a reminder on their phone (if they are tech savvy) or encourage them to keep their medications where they will see them each day, such as on the nightstand or by their toothbrush. The only way to receive the maximum benefit from medications is to take them!

101471962The cholesterol guidelines recommend that lifestyle changes are implemented for at least three months before starting a medication regimen. Pharmacists are also trained to teach patients about lifestyle modifications that can lower cholesterol. Dietary changes and physical activity are two key factor that help lower cholesterol. Thirty minutes of exercise five days per week is the recommendation for most people, and a diet low in fat and high in fiber can help with cholesterol levels. If red wine is more your speed, one glass per day might also be beneficial. Although easier said than done (believe me, I know!), these modifications are crucial for cholesterol management and heart health.

In addition to prescription medications and lifestyle modifications, there are some over-the-counter medications that can also be beneficial for patients with high cholesterol. As with all over-the-counter medications, a pharmacist or prescriber should be consulted before starting something new.

  • Coenzyme Q10 (CoQ10) supplementation has shown some benefit in reducing muscle symptoms from statins. This supplement is relatively inexpensive and low-risk for patients. CoQ10 should not be taken if the patient is taking a blood thinner like warfarin.
  • Omega-3 fish oil can decrease triglycerides and increase HDL. If patients taking fish oil complain of a fishy aftertaste, freezing the capsules before taking them could help. Fish oil should not be taken if the patient is taking a blood thinner like warfarin.
  • Niacin helps to increase HDL. Many patients experience flushing, where the skin becomes red, warm, and sometimes itchy, after taking niacin. Taking an extended-release formulation of niacin and eating beforehand can lessen this effect. Some patients have also seen a decrease in flushing if they take an aspirin 30 minutes before taking the niacin.

Community pharmacists are great resources for cholesterol management and medication management. We are filled with little nuggets of wisdom to help patients and providers achieve goals. I encourage you to contact a pharmacist if you ever have any questions about cholesterol or any other medical problem.

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Improving Your Work-Life Balance – Make it a Goal

By Misty Kevech, HHQI RN Project Coordinator

stressed nurseAre you asking yourself the question, “Where did the summer go?” It seems like just yesterday when you were making plans for this summer to relax and get some quality downtime. I know, I made plans to eat lunch away from my computer four days a week (being practical), but soon realized that I continually needed to reduce that goal all summer. I think I can confidently say that I did take lunch away from my computer and eat outside four times, okay, not per week, but four times throughout the whole summer. Geez!

If you have kids, you are probably getting them ready for school. That can bring on additional stress for the next nine months – lunches, homework, and extracurricular activities. Whatever your stressful time of the year may be, many of us think we will do better the next season. A little more “me time” and a little less work, family, and everyone else time. If you are like me, that just does not seem to happen.

Does it really matter? The answer is, yes! According to the Mental Health America, 25 percent of Americans describe themselves as “super stressed.” Literature shows that the more we try to do, the less productive we really are. I am a super multitasker, are you? I juggle many projects constantly and it takes time and effort to keep the balls moving. But when I designate time to work on one project (as the self-help tips recommend), I actually do find that I am more effective and efficient.

But who has time to stop and work on one project? I am a Type A personality and thrive under stress and deadlines, but is that good for me? A certain amount of stress is good to motivate and improve performance. Too much or a constant level of stress, especially over time, can weaken our immune systems and predispose us to everything from a cold to the risk of a heart attack. We have to learn how to manage stress and balance our work life.

I often teach clinicians about “motivational interviewing” and “teach-back” skills. I explain that it is hard to do and it takes a lot of practice to hone in on those skills. Stress reduction and work-life balance is also hard, takes a lot of practice, and requires a continuous conscious effort.

Mental Health America provides the following simple tips:

  • At Work
    • Set manageable goals each day
      • Prioritize
      • Feel good about progress (I love to check off items)
      • Be realistic
      • Be efficient with your time at work
      • Don’t procrastinate (I find picking the hardest of the tasks first makes my day go better)
      • Divide big projects into smaller pieces
      • Reward yourself with completions (break, coffee, walk outside for 5 minutes)
      • Turn off e-mails for work time
    • Ask for flexibility
      • Ask if telecommuting is possible, even if it is to work on a big project
      • Flex your days to work on an off-peak day or hours if you want uninterrupted time or to facilitate family commitments
    • Take five
      • Use small breaks to clear your head and refocus
      • Spend a few minutes doing visualization (imagining yourself on the beach or at your favorite place)
    • Tune in
      • Listen to your favorite music to relax you and increase your creativity (be sensitive to others and wear a headset)
    • Communicate effectively
      • Speak up if your are feeling overwhelmed with workload and offer some possible solutions
      • Look at stressful or conflicting situations from the other person’s view, rethink your strategy or stand your ground calmly and rationally.  Look for ways to compromise.  Retreat if needed to regroup and determine better strategy to address conflict.
    • Give yourself a break
      • Remember you are not perfect
  • At Home
    • Unplug
      • Reduce availability for work for after hours, if possible
      • Decrease amount of time on electronics
    • Divide and conquer
      • Distribute home responsibilities with others
      • Communicate clearly
    • Don’t over commit
      • Learn to say no
      • Get support
      • Talk with friends or family about how you feel
    • Take advantage of your company’s Employee Assistance Program (EAP)
      • Check if your organization offers this assistance
      • Stay active
    • Exercise regularly – this reduces stress, depression, and anxiety
      • Boosts immune system
    • Treat your body right
      • Eat right, exercise regularly, and get enough sleep
      • Don’t rely on caffeine and tobacco for coping
    • Get help if you need it
      • Ask for assistance or seek help

I personally use some of these tips, but as I said before, it does take practice. Please join me in committing to setting a goal to improve your work-life balance over the next few months. Pick one or two of the above tips to try (don’t implement them all – that would cause stress overload). Find what works, add another one along the way, and hopefully we will all begin to see a better work-life balance!

Additional Resources:

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Score a Vaccination Touchdown with Pneumococcal Vaccines

by Crystal Welch, MSN, HHQI RN Project Coordinator

quarterback-73614_960_720We may be a few weeks away from the kickoff of football season, but now is the time to get your vaccination game started since August is National Immunization Awareness Month (NIAM). The Centers for Disease Control and Prevention (CDC) reports pneumococcal disease kills thousands of adults annually, including 18,000 adults aged 65 and older.

  • Pneumococcal pneumonia (lungs) kills about 1 out of 20 who contracts the disease.
  • Pneumococcal bacteremia (bloodstream) kills about 1 out of 6 who contracts the disease.
  • Pneumococcal meningitis (lining of the brain and spinal cord) kills about 1 out of 6 who contracts the disease.

There are two types of pneumococcal vaccines currently available which are PCV13 (brand name Prevnar 13®) and PPSV23 (brand name Pneumovax 23®). PCV13 is recommended for all adults age 65 and older, adults age 19 and older with certain health conditions, and adults 19 and over who are taking medicine that lowers resistance to infection. PPSV23 is recommended for all adults age 65 and older, adults with certain health conditions or who smoke, and adults 19 or older who have a lower resistance to fight infection. All adults aged 65 years and older should receive both PCV13 and PPSV23 as long as they have no contraindication for vaccination. The vaccinations need to be separated into two separate visits according to the vaccine schedule. If a person has not received any pneumococcal vaccines, then they should first receive PCV13 followed by PPSV23 at least one year later. If a person has already received PPSV23, the dose of PCV13 should be given at least one year after they got their most recent dose of PPSV23.

72969667The CDC recommends that everyone at this age, as well as those in a high risk group, get vaccinated against pneumonia twice in their lives. Because having the flu increases your chances of getting pneumococcal disease, it is important to get the influenza (flu) vaccine each flu season.

So how can we as homecare providers play a key role in increasing pneumococcal vaccination? Check out the HHQI Resources listed below for tools and resources:

Additional Resources:

Remember, if you or a loved one is age 65 or older, getting vaccinated against pneumococcal disease is the best defense for your game!

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Stop the Cavities! Tips to Improved Oral Health for Seniors

Guest post by Maria Eliopoulos, DMD, private practice family dentist

toothbrush-592102_960_720“Oh my, Dr. Maria, I haven’t had a cavity in 30 years, but now I have at least two or three every cleaning appointment. Why is this happening?”

I hear this question at least once a week from many of my older patients. These patients have good hygiene, watch their sugar intake and maintain regular cleanings and exams. So why now? Why do they seem to be prone to so many cavities along their gum lines?

The major culprit is dry mouth. The aging process alone doesn’t cause dry mouth, but common senior issues exasperate the dryness. One in three older adults suffer from xerostomia. This lack of saliva leads to many problems in the mouth. Without the wetness of saliva, food and plaque cannot be properly washed away along the gum line. So, bacteria can have a feast on the dry areas of the teeth, thus causing root caries. Also, due to the dryness of the root surface, teeth are unable to absorb minerals such as calcium and fluoride. Eventually, this causes significant tooth decay which can lead to tooth loss. Many patients experience cracks on their tongues, which can be very painful. It can also cause systemic problems such as infection and poor digestive health.

Many common medications frequently have this undesirable side effect. Common prescription drugs used to treat high blood pressure, depression, allergies and pain can increase dryness. Popular pills including Lisinopril and Norvasc (high blood pressure), Zocor (cholesterol), Metformin (diabetes), Xanax and Zoloft (depression), and Vicodin and Lorcet (pain) are all medications we are familiar with. I know my own parents take a number of these.

As if taking prescriptions are bad enough, even over the counter products can cause problems. Antihistamines, decongestants and some vitamins can dry our mouths. Always read the directions, before taking these seemingly innocent products.

Other factors include diseases such as diabetes, autoimmune diseases, nerve damage and cancer treatments. Snoring and tobacco use are also culprits.

So, what can we do?

As in all good medical care, the most important person is YOU! If you are waking up with “cotton mouth,” if you have thick and sticky saliva, if you have bad breath, trouble swallowing or mouth sores more than usual, please tell your doctor and your dentist. Don’t just assume that it’s another sign of our bodies getting old! This is a condition we can actually alleviate.

Medically, your physician might be able to adjust your prescriptions. He can review your medical history and diagnose underlying conditions. Medications, such as Salagen, can be prescribed to increase how much saliva is formed and how easily it flows in your mouth.

So, what can I, as your dentist, do? Most importantly, I can see the effects of dry mouth by a simple exam. I’m looking for root caries, red dry patches on your gums and cracked lip corners. I can treat decay while it is small, causing less damage to your teeth and your pocketbook. I can also give in-office fluoride treatments, and sometimes, prescribe a home fluoride therapy. But, once again, the most important item is a conversation about the symptoms you might have.

What can you do at home? Maintain good brushing and flossing habits. Use a mouthwash that contains fluoride but make sure the mouthwash rinse has no alcohol in it because that exasperates dryness. Drink plenty of water every day and avoid soft drinks and sugar drinks. Chew sugar-free gum (I bet you didn’t think a dentist would tell you to chew gum) and suck on sugar-free candy. Chewing gum will stimulate saliva flow. Use a humidifier at night. Try to avoid smoking, caffeine and tobacco. Limit sugary foods. I know, I might sound like a killjoy but you just need to try and curb the cookies and gummy bears in your diet, you don’t need to totally eliminate them.

Hopefully by working together we can diminish the amount of cavities that senior patients often experience. Knowing the causes of dry mouth, it becomes easier to counteract the negative effects. I would much rather hear about your grandchildren, your travels and how much better your garden is doing than mine than telling you that we have to restore five cavities!

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