The Healthy Geezer
Q: Do older people need more sleep?
A: Seniors need about the same amount of sleep as younger adults—seven to nine hours a night.
Unfortunately, many older adults don’t get the sleep they need, because they often have more trouble falling asleep. A study of adults over sixty-five found that thirteen percent of men and thirty-six percent of women take more than thirty minutes to fall asleep.
Also, older people often sleep less deeply and wake up more often throughout the night, which may be why they may nap more often during the daytime. Nighttime sleep schedules may change with age too. Many older adults tend to get sleepier earlier in the evening and awaken earlier in the morning.
Many people believe that poor sleep is a normal part of aging, but it is not. Sleep patterns change as we age, but disturbed sleep and waking up tired every day are not part of normal aging. If you are having trouble sleeping, see your doctor or a sleep specialist.
Here are some pointers to help you get better sleep:
Go to sleep and wake up at the same time, even on weekends. Sticking to a regular bedtime and wake time schedule helps keep you in sync with your body’s circadian clock, a twenty-four-hour internal rhythm affected by sunlight.
Try not to nap too much during the day—you might be less sleepy at night.
Try to exercise at regular times each day. Exercising regularly improves the quality of your nighttime sleep and helps you sleep more soundly. Try to finish your workout at least three hours before bedtime.
Try to get some natural light in the afternoon each day.
Be careful about what you eat. Don’t drink beverages with caffeine late in the day. Caffeine is a stimulant and can keep you awake. Also, if you like a snack before bed, a warm beverage and a few crackers may help.
Don’t drink alcohol or smoke cigarettes to help you sleep. Even small amounts of alcohol can make it harder to stay asleep. Smoking is dangerous for many reasons, including the hazard of falling asleep with a lit cigarette. Also, the nicotine in cigarettes is a stimulant.
Create a safe and comfortable place to sleep. Make sure there are locks on all doors and smoke alarms on each floor. A lamp that’s easy to turn on and a phone by your bed may be helpful. The room should be dark, well ventilated, and as quiet as possible.
Develop a bedtime routine. Do the same things each night to tell your body that it’s time to wind down. Some people watch the evening news, read a book, or soak in a warm bath.
Use your bedroom only for sleeping. After turning off the light, give yourself about fifteen minutes to fall asleep. If you are still awake and not drowsy, get out of bed. When you get sleepy, go back to bed.
Try not to worry about your sleep. Some people find that playing mental games is helpful. For example, tell yourself it’s five minutes before you have to get up and you’re just trying to get a few extra winks.
If you are so tired during the day that you cannot function normally and if this lasts for more than two to three weeks, you should see your family doctor or a sleep disorder specialist.
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Mineral makeup—a sun-safe supplement to winter protection
—Erin Mulvey and Jamie Sylves, The Skin Cancer Foundation
Since the face is one of the only body parts that receives year-round sun exposure, it is often the site of basal cell and squamous cell skin cancers. Now however, with the help of mineral makeup and other sun protective cosmetics, it’s easier than ever for women to incorporate sun protection into their daily routine.
“Sun protection has come a very long way since we established the Foundation,” says Dr. Perry Robins, President of The Skin Cancer Foundation, which is about to celebrate its thirtieth anniversary. “Sunscreen ingredients are much more aesthetically appealing and can be found in daily use cosmetics such as moisturizers, foundations, and powders.”
Although the temperature may be frigid and sunlight is less intense, the amount of the sun’s damaging ultraviolet (UV) rays reaching the surface of the earth remains fairly constant and very strong throughout the year. During the winter months, snow reflects about eighty percent of the UV light from the sun, further increasing the risk for skin cancer and premature aging during the winter months. And skiing sites and winter resorts tend to be located at high altitude, where UV radiation is stronger. This means the damage to skin, especially the face, could be greater for some people in the winter than in the summer.
In addition to traditional sunscreens, there is a range of products that protect against the sun. Many daily moisturizers, makeup such as foundation and powders, lip balms, and eye creams include ingredients to filter out both UVA and UVB rays. It’s also important to wear UV-blocking sunglasses and cover up with a hat, scarf, and gloves to protect areas of the skin that often are missed when applying sun protection.
Mineral Makeup As Sunscreen
Mineral makeup is a great option to layer over an SPF 15+ product during the winter to further protect the face. Mineral makeup is loose pressed powder consisting of naturally occurring inorganic materials such as bismuth oxychloride, boron nitride, mica, talc, titanium dioxide, and zinc oxide. Because the natural minerals in the makeup are water resistant and “bond” to the skin, they won’t wash away, smear or “melt” when you sweat or when rain or snow lands on your face, making mineral makeup ideal as a sunscreen supplement.
Titanium dioxide and/or zinc oxide are the keys to the sun protection offered by such makeups. These inorganic, insoluble minerals are considered “physical sunscreens,” and they work by reflecting the sun’s ultraviolet radiation (UVR) away from the skin, as opposed to chemical/organic sunscreens, which absorb rather than reflect UVR.
“For incidental exposure—if you go out for a short while—mineral makeup used without a separate sunscreen is fine if the makeup’s SPF is at least fifteen,” says Diane S. Berson, MD, Associate Professor of Dermatology at Weill Medical College of Cornell University in New York City. In addition, you can touch up makeup while reapplying sunscreen during the day for further protection.
When you’re planning to stay out in the sun for longer than fifteen minutes, “Mineral makeup with SPF can enhance your protection if layered over a sunscreen product,” explains Leslie Baumann, MD, Director of the Cosmetic Dermatology Division at Miller School of Medicine, University of Miami. The powder, applied on top of sunscreen, will probably catch any spots you may have missed.
About The Skin Cancer Foundation
The first organization in the U.S committed to educating the public and medical professionals about sun safety, The Skin Cancer Foundation is still the only global organization solely devoted to the prevention, detection, and treatment of skin cancer. The mission of the Foundation is to decrease the incidence of skin cancer through public and professional education and research. For more information, visit www.skincancer.org.
New Mexico earns a “D” for its lack of support of emergency patients
Widespread problems within New Mexico’s emergency healthcare system result in national ranking of 49th
—Elaine Salter, American College of Emergency Physicians
New Mexico’s emergency care system is failing and requires immediate attention, according to a new Report Card released today by the American College of Emergency Physicians (ACEP).
The Report Card comes at a time when the national picture looks bleak: job and insurance losses, a rapidly growing senior population, and a recent survey forecasting critical shortages of primary care doctors all point to escalating emergency patient populations.
New Mexico received an F and ranked 49th in the nation in the category of Access to Emergency Care, due to factors including workforce shortages, inpatient bed shortages, and a lack of health insurance among its population. The state is facing a severe per capita shortage of neurosurgeons (the state ranks 49th nationally); ear, nose, and throat specialists (45th); plastic surgeons (38th); orthopedists and hand surgeons (35th); registered nurses (50th) and primary care providers. With 24.8 percent of adults and 17.9 percent of all children without health insurance, New Mexico has one of the highest uninsured populations in the country. The state also ranks 43rd for the number of staffed inpatient beds, and 51st out of fifty-one for its lack of pediatric specialty centers.
“New Mexico must act immediately to address hospital crowding and emergency department patient boarding,” said Pamela V. Cutler, MD, president of the New Mexico Chapter of ACEP. “Emergency physicians practicing here report that these issues have reached critical proportions throughout our state. The severe shortage of specialists and registered nurses is among the worst in the nation.”
In the category of Medical Liability Environment, New Mexico received a grade of D and a national ranking of 30th. New Mexico’s average medical liability premiums are higher than the national average, and the state has failed to enact expert witness rules that require the witness to be of the same specialty as the defendant or be licensed in the state. The state also does not have special liability protection for those providing federally-mandated emergency care, which results in fewer specialists who are willing to provide on-call services for emergency patients.
“Policymakers should enact medical liability reforms immediately to encourage specialists to take call in the emergency department,” said Dr. Cutler. “Our state must also institute broad recruitment efforts to address the severe physician workforce shortages here.”
In the category of Disaster Preparedness, New Mexico received a grade of D+ and a national ranking of 39th due primarily to a lack of accreditation by the Emergency Management Accreditation Program, no written plans to supply medications to patients with chronic conditions or to supply dialysis for patients in need, and failure to enact a statewide patient tracking system. Additionally, New Mexico does not require training in disaster management or response to biological and chemical terrorism for essential hospital personnel, and does not have a verified burn center in the state.
New Mexico did not fare well in the category of Public Health and Injury Prevention, receiving a grade of D+ and a ranking of 32nd. The state is among the worst five states for high rates of fatal injuries, including those due to falls, homicides and suicides, and traffic fatalities. The state has no motorcycle helmet law and a disappointing zero percent of tobacco settlement funds were spent on health-related services or programs.
New Mexico earned its highest grade of C- and ranked 32nd in the category of Quality and Patient Safety Environment. Contributing to this positive grade was the fact the state provides funding for quality improvement in the EMS system and has a state EMS medical director position. New Mexico also has a uniform system for providing pre-arrival instructions and a statewide trauma registry. In addition, a high percentage of hospitals use electronic medical records (57.9 percent) and computerized practitioner order entry (39.5 percent) to promote greater accuracy, tracking, and safety.
“The weakened economy combined with a failing healthcare system mean that growing numbers of people will need emergency care,” said Dr. Nick Jouriles, president of ACEP. “In fact, the role of emergency care has never been more critical to this nation, which is why emergency patients must become a top priority for healthcare reform. We are urging President-elect Obama and the new Congress to strengthen emergency departments, because they are a healthcare safety net for us all.”
The nation’s failure to support emergency patients resulted in a C- for the country overall. Massachusetts earned the highest overall grade of a B and Arkansas ranked last (51st) in the nation with a D-. The national grade was calculated using the same methodology used for the overall state grades and is a weighted average of the nation’s category grades.
The grades are from ACEP’s National Report Card on the State of Emergency Medicine, a comprehensive analysis of the support that states provide for emergency patients. The new Report Card contains more than twice the measures of ACEP’s first Report Card in 2006, as well as a new category for disaster preparedness, which makes it more comprehensive, although not directly comparable to the previous Report Card.
The five Report Card categories (and weightings) are: Access to Emergency Care (thirty percent), Quality and Patient Safety Environment (twenty percent), Medical Liability Environment (twenty percent), Public Health and Injury Prevention (fifteen percent) and Disaster Preparedness (fifteen percent).
The National Report Card on the State of Emergency Medicine was made possible in part by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of The WellPoint Foundation and the Robert Wood Johnson Foundation.