Matters of Health by tc@cwpg.com

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Retire in Good Health

Planning, Preparing & Staying Sharp

Take It Outside!

Healthy Alfresco Dining

Good Reading Keeping Blood Pressure in Check

Resist! WeightBearing Moves to Enjoy

Big Shots

Important Vaccines for Older Adults

Insulin injection tips One of the most important aspects of managing your diabetes is making sure you use proper technique when injecting your insulin. The right technique is every bit as important as the right dosage and choice of insulin. By following the proper injection technique, you can avoid lipohypertrophy—the fatty lumps that can develop under your skin and may interfere with your absorption of insulin. Here are some tips to help you start and maintain the right techniques so you can stay on top of your diabetes and focus instead on living a full and rewarding life. Remember to check with your healthcare professional to make sure you’re using the proper injection technique. Injection techniques may vary for adults and children. 1. Rotate injection sites. Never overuse any given injection site. Instead, vary each and every injection using the different recommended injection sites—the thicker portions of your buttocks, thighs, upper arms and abdomen. Space injections within a site approximately one finger apart from previous injections. Use a single injection site no more frequently than every four weeks. 2. Avoid injecting into lipohypertrophy. Detect and avoid injection into areas that may have lipohypertrophy, which can affect insulin absorption. Ask your healthcare provider to check you for lipohypertrophy at least once a year. 3. Use the shortest needles available (currently the 4mm pen needle and 6mm syringe). The shortest needles are safe, effective and less painful. Insulin should be injected into the healthy fat layer below the skin. You should avoid injecting into skin or muscle.

4. Use a needle only one time. Always practice the one-and-done rule. Never reuse a needle. A used needle is no longer sterile, could cause injection pain and bleeding and can lead to the development of lipohypertrophy. So be sure to always have a new needle with you. Remember, with the right insulin injection technique, you can manage your diabetes to live a wonderfully rich and full life. Learn more about managing your diabetes at bd.com/InjectionTips

Reference Frid AH, Kreugel G, Grassi G, et al. New insulin delivery recommendations. Mayo Clin Proc. 2016;91(9):1231–1255.

AND A BETTER WAY TO MANAGE YOUR DIABETES. At BD, we know the challenges you face when diagnosed with diabetes. The last thing you need is to feel anxious about your insulin injections. That’s why we developed the BD Ultra-Fine™ Nano™ 4mm Pen Needle. So you can manage your disease and focus on what matters most—living your life to its fullest. • Greater comfort and less harm to skin1 • Simple, single-handed, no-pinch-up injection enables healthier site rotation1 Discover the difference of an improved injection experience. Ask your doctor or pharmacist about the BD Nano today.

Learn more about the BD Nano at bd.com/BDNano 1 Gibney MA, Arce CH, Byron KJ, Hirsch LJ. Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations. Curr Med Res Opin. 2010;26(6):1519–1530. © 2016 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company. MC6847

matters of ®

DeAnn Mullins, BPharm, CDE, President

4 Foreword 6 Lifestyle

CW Publishing Group

Retire in Good Health

Editor-in-Chief VP Publishing Operations Elaine Marotta

Physical, psychological and emotional preparation is key

10 Health

Good Reading Keep your blood pressure in check

Creative Associate Tamara Citroen

14 Nutrition

Make No Bones About It — Calcium plays a vital role in your health

Intern Estelle Pyper

16 Fitness

Executive VP/Sales Director Neil Agble

Resist!

Weight-bearing exercise may enhance your quality of life

Sales Manager Scott Andersen

18 Well-Being

Chasing Sleep The quest for a better night’s rest

24 Mind & Body

Senior Account Executive Elizabeth Glover

Account Executives John Bradley, Kara Giannecchini

Sex & the Older Couple Intimacy has no expiration date

Financial Controller Amanda Honeyﬁeld

28 Changes

Operations Manager Kimberly Lewis

“Is It Hot in Here?” Managing menopausal symptoms and discomforts

Group CFO James Ward

32 Immunization Big Shots

Group CEOs Dean Citroen Oren Wolf

Important vaccines for older adults

36 Food Safety

Take It Outside! Keeping alfresco dining healthy

40 Road Safety

Baby, You Can Drive My Car When getting behind the wheel is becoming a challenge

Skin Deep

Protection, prevention and “slowing down” aging

46 Oral Health Dental care is essential, regardless of your age

Published by CW Publishing Group 8-10 W. 36th St., Fifth Floor New York, NY 10018 646.274.7272 www.cwpg.com Printed in the U.S.A.

44 Solutions

Keep Smiling!

Art Director Kara A. Kablack

* FOREWORD

Dear Reader:

This edition of Matters of Health is given to you by the most accessible healthcare professional in your community: your local independent community pharmacist. As small business owners, independent pharmacists recognize the value of “keeping it local.” We employ local residents, utilize local suppliers, and we’re actively involved in enhancing the quality of life where we live and work. Whether it’s an initiative to improve medication adherence for senior citizens or an effort to fund new marchingband uniforms for the local high school, we’re committed to making this community the best it can be. But we aren’t just small business owners. We’re also your trusted advisors when it comes to your medications and healthy living. We work to improve the lives of the people we care about — friends and neighbors like you — with each prescription we ﬁll and each consultation we deliver. Hence, our support for this special publication. Understanding and being aware of illness is an integral part of your well-

being. In this issue, you’ll ﬁnd articles on such topics as oral health, taking your blood pressure, the importance of calcium, strength training, improving your sleep quality, managing menopause, food safety, immunizations for older adults, skincare solutions, and even safe driving for seniors. There’s a wealth of information here, and we believe you’ll ﬁnd it to be a great resource to help you live a healthier life. And remember this: Your community pharmacist is uniquely positioned to answer many of your health and medication questions. We can counsel you about side effects, dosage amounts, potential drug interactions, preventing drug abuse and more. We’re here to assist you, so please consider us your nearby one-stop resource for answers. On behalf of the National Community Pharmacists Association and the 22,000+ independent pharmacies it represents, thank you for picking up Matters of Health. We look forward to continuing the conversation the next time you visit your local community pharmacy. Here’s to your health!

DeAnn M. Mullins, BPharm, CDE Pharmacy Owner, Lynn Haven, FL President, 2016-2017 National Community Pharmacists Association

| MATTERS OF HEALTH

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* LIFESTYLE

| MATTERS OF HEALTH

Retire in Good Health Preparation is key

Retirement. We save for it. We dream of it. And each day that we log at work brings us one day closer to it. But all too often, this long-awaited stage heralds not blissful relaxation but a nagging feeling of … “Now what?”

“I think the underlying issue for a lot of the challenges of a good post-retirement life is that we basically don’t tend to think about or plan for that phase of our lives until we’re there,” says Bob Knight, PhD, a professor in the School of Psychology and Counseling at the University of Southern Queensland, Australia. “We have years of education to prepare us for our careers, and we spend years thinking about and planning them. We tend not to spend any time at all planning for retirement. More generally, we just don’t think about the full life span.” Yet there is plenty of time to mull over options as the time approaches, says Dr. Knight, especially given that retirement for most people today is more of a gradual transition that involves part-time paid or volunteer work before stopping work entirely. The key to a successful, happy retirement is preparation, he says, but not just the ﬁnancial kind. Too often, people forget to plan for how they will maintain their physical, psychological and emotional health. For example, they may think about relocating to a less expensive, less stressful part of the country, but fail to consider what they will do when they get there or how they will maintain the social connections so crucial to good emotional health. Dr. Knight recommends beginning to sow those connections long before you buy that retirement home. “If you plan to relocate after retirement and it’s at all affordable, spend at least a full year where you plan to move before making irreversible decisions to move,” he says. “Experience all four seasons there. See what it’s like to be a local rather than a tourist. My sense from clinical experience working with older adult clients is that we tend to underestimate the importance of friendship connections and familiarity

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What’s the Plan?

* LIFESTYLE

of place when we move, and perhaps overestimate contact with family.” He also cautions against waiting for retirement to arrive before ﬁnding activities that can ﬁll the time once dedicated to work. “It is a really useful — and often neglected — part of planning for retirement to develop and begin being active in things that you enjoy, that you can continue after leaving work,” he says. Those activities, he said, should include things that get you up and moving. “Physical exercise and maintaining a healthy weight are two of the most broadly effective things one can do to maintain physical and mental health and well-being into the later years of life,” says Dr. Knight.

A Change for the Better Even if your lifestyle has been sedentary or unhealthy, research shows that it’s not too late to reap the rewards of positive changes as you head into your older adult years. A Johns Hopkins-led multi-ethnic study of atherosclerosis, which 8

| MATTERS OF HEALTH

tracked more than 6,000 people ages 45 to 84 for more than seven years, showed that those who quit smoking, got regular exercise, maintained a healthy weight and followed a Mediterranean-style diet (including fruits, vegetables, beans, whole grains, olive oil and seafood) decreased their risk of death by 80 percent. If you smoke, quitting is particularly important to maintaining good health. Studies show that the risk of having a heart attack drops almost immediately (within 24 hours) after quitting, and that quitting during middle age can cut the risk of premature death nearly in half.

Staying Sharp Finally, the researchers at Hopkins note that not only can you teach an old dog new tricks, it may be the best thing you can do for him. Taking on new challenges, such as learning a new language or even picking up the crossword puzzle, is a great way to stay sharp and maintain good brain health — as well as keeping boredom at bay.

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* HEALTH

Good Reading Keeping your blood pressure in check Getting your blood pressure taken is a routine part of any medical visit. But if you have high blood pressure, your healthcare provider might want you to monitor it more frequently — from the comfort of your own home. While it might seem a little intimidating at first, keeping track of your blood pressure on a daily basis has numerous benefits. First, research shows that people who monitor their blood pressure at home are more likely to reach their blood pressure goals than those who don’t. But doing so also gives your provider a better picture of how well controlled your blood pressure may be. Self-monitoring can reveal whether your medications are working and whether levels fluctuate away from the medical setting, which will help your provider determine the best treatment for your condition. Both the American Heart Association (AHA) and the American Society of Hypertension recommend home monitoring for those with high blood pressure.

Taking It: When and How For most people with high blood pressure, taking two or three readings in the morning and again at night a few times a week should be sufficient, according to advice from the Harvard Women’s Health Watch. Readings should be taken a few minutes apart to ensure accuracy. Monitoring too often, however, should be avoided, as it can lead to anxiety over minor fluctuations. If major changes occur, it’s best to consult your provider.

| MATTERS OF HEALTH

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* HEALTH

The AHA recommends testing at the same time each day and recording the results using a printable or online tracker, or storing the results in the monitor’s memory if possible. This makes it easier to show the readings to your provider during checkups. The AHA also advises that you: * Refrain from smoking, drinking caffeinated beverages or exercising 30 minutes prior to taking your blood pressure. Find a quiet place to take the reading. Sit in a hard-backed chair with your * feet flat on the floor and your back straight. Rest your arm on a flat surface, such as a table, at heart level. Have your provider demonstrate how to use your home monitor properly so * that you are sure you are using the device correctly.

What the Numbers Mean There are two numbers that make up a blood pressure reading: the systolic (upper number) and the diastolic (lower number). A person with normal blood pressure will have a systolic reading of less than 120 mm Hg and a diastolic reading of less than 80 mm Hg. Someone with hypertension (high blood pressure) will have a systolic reading of more than 140 mm Hg and a diastolic reading above 90 mm Hg.

There are many things you can do to keep your blood pressure in check. Sometimes, lifestyle changes will sufﬁce. For example, stopping nicotine use (tobacco products and e-cigarettes), maintaining a healthful diet, not drinking alcohol excessively and exercising regularly can reduce blood pressure levels. Sometimes, though, lifestyle changes alone aren’t enough to improve the numbers and your provider may wish to prescribe medications. 12

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Improving Your Numbers

N O U R I S H I N G YO U R E Y E S J U S T G OT E A S I E R Tr y o u r n e w c h e w a b l e A R E D S 2 e y e h e a l t h s u p p l e m e n t . I t contains ingredients used in the AREDS 2 study conducted by the he National Eye Institute to suppor t eye health in people with a g e - r e l a te d m a c u l a r d e g e n e r a t i o n .††

N E W C H E W A B L E A R E D S 2† E Y E H E A LT H S U P P L E M E N T † Contains ingredients used in the Age-Related Eye Disease Study 2 (AREDS 2) conducted by the National Eye Institute. ††These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. © 2017 Novartis 7/17 US-ICP-17-E-0342(1)

* NUTRITION

Make No Bones About It â&#x20AC;&#x201D; Calcium plays a vital role in your health

You probably know that calcium is important for healthy bones and that itâ&#x20AC;&#x2122;s found in dairy products, especially milk. But what else do you know about this essential nutrient? For example, were you aware that calcium is the most abundant stored nutrient in the human body? But that only one percent of that calcium is found in our blood? The other 99 percent is stored in our teeth and bones. What we eat or drink has 14

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little impact on serum calcium levels because our body transfers calcium from other sources, such as bones, to our blood as needed. But that one percent performs a vital function to our health. In addition to keeping our bones strong, it affects how well our blood vessels, muscles, nervous system and hormones function, playing a critical role in blood clotting and heart health. It also affects how well our cells communicate.

Best Sources of Calcium Though the calcium in our diet won’t change our serum calcium levels, it does affect how much we’re able to store in other parts of our bodies, so it’s important that we get enough. Calcium is found in dairy products such as milk, yogurt and cheese and vegetables such as broccoli, kale, watercress, okra and bok choy. Sardines, anchovies, almonds and soy are also high in calcium. Finally, it is also found in calcium-fortiﬁed foods — such as some cereals, orange juice and bread.

Vitamin D and Other Nutrients Vitamin D is also needed to help our bodies absorb calcium. Our bodies can make vitamin D when sunlight reaches our

skin, and it is found in foods such as egg yolks, fatty fish, cheese, liver and fortified milk. Using sunblock or avoiding the sun’s UV rays to reduce the risk of sunburn and skin cancers may mean that you should consult your provider about testing for deficiencies or using supplements. Calcium and vitamin D aren’t the only two players needed to maintain a healthy calcium balance and good bone health. This also requires the help of protein and phosphorus (found in meats, poultry, fish, nuts, beans and dairy products). All four of these nutrients act together to keep our bones strong and healthy and prevent falls and fractures. Roughly 1.5 million fractures occur annually in the U.S. in those over age 60. Research shows a deficiency in any of these nutrients can increase the risk of fractures and falls, especially in the elderly. That’s why it’s important to eat a wellbalanced diet rather than focus on one or two food groups. You may wish to consult your healthcare provider or a nutritionist for advice on how to ensure that you’re getting the proper amount of each of these critical nutrients as you get older.

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Did you know that only 30 percent — on average — of the calcium we take in through what we eat gets absorbed by our bodies? Or that the recommended daily requirement for this nutrient is 1,000 mg for adults and 1,200 mg for women over the age of 50? The amount rises to 1,200 mg for men at age 71.

* FITNESS

Resist! Weight-bearing exercise may enhance your quality of life

One of the more frustrating things about getting older is that our bodies just don’t feel the same as they once did. We’re less limber. We feel aches and pains we didn’t have before. Simple tasks — such as opening a jar — can seem more difﬁcult. Our backs, knees and hips remind us that we’re just not kids anymore. Some of this results from the basic wear and tear of life. But the truth is, no matter who you are or how you’ve lived, as you age you’re going to lose some bone density, muscle tissue and cartilage. It’s normal. The good news: You do have some control over how quickly and dramatically these changes occur. Research shows that exercise — particularly weight-bearing exercise — can slow the deterioration of muscles, joints and bones and help you maintain strength, balance and ﬂexibility. This, in turn, helps to prevent falls and injuries. Most importantly, it will help you feel better and contribute to a higher quality of life.

All the Right Moves The National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Disease (NIH/ NIAMS) recommends weight-bearing exercise for anyone wishing to improve bone health, particularly those who have developed osteoporosis. Weight-bearing exercises don’t only include moves that require using weights — the term refers to the type of exercise that forces you to work against gravity, using your legs and feet to carry the weight of your body. Examples of weight-bearing exercise include weighttraining, walking, hiking, jogging, climbing stairs, playing tennis and dancing. Non-weight-bearing exercises are those in which the body’s weight is artiﬁcially supported, such as swimming and stationary cycling. These are great for building and

| MATTERS OF HEALTH

maintaining muscles and provide cardiovascular beneﬁts. They will not, however, help to improve bone health. A good exercise program can include both types of activities, but consult your healthcare team for the appropriate exercise plan to best meet your personal needs.

Getting Started Tips from the NIH/NIAMS for beginning a program of weight-bearing exercise follow. * Listen to your body. Some soreness and muscle pain is normal when you begin a new exercise routine, but extreme pain or pain that lasts more than 48 hours is not. Consult your provider if you experience pain to this degree or chest pain. * If you have osteoporosis, which renders bones weak and brittle, consult your provider and an exercise specialist. They can develop an exercise program that is safe and appropriate to your condition. * Do not rely solely upon exercise to prevent bone loss. A diet rich in calcium and vitamin D will also help to strengthen bones at any age. If you are not accustomed to regular physical activity, here are ways to get motivated. * Choose an exercise that you enjoy. Not everyone likes to run or hit the gym. If taking a long walk in the morning or after dinner seems more appealing, ﬁne. * Choose an activity that fits your lifestyle. If you like tennis but don’t live or work near any tennis courts, it’s unlikely you’ll be able to make this a regular activity. Consider taking a yoga class at your community center if that’s more convenient. Start small, and build at your own pace. Every step * counts. Do what you can, when you can, until you’ve built a routine.

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* WELL-BEING

Chasing Sleep

The quest for a better night’s rest

| MATTERS OF HEALTH

ing the night due to night sweats. “There are lots of reasons why older adults have problems with sleep,” says Michael V. Vitiello, PhD, a professor of Psychiatry and Behavioral Science, Gerontology and Geriatrics at the University of Washington and Co-Director of the Northwest Geriatrics Workforce Enhancement Center. “The important thing is to parse out the causes and treat them.”

Sleep Disorders “If you’re having chronic difﬁculty sleeping, the ﬁrst thing to do is discuss it with a physician,” says Dr. Vitiello. “If it’s the result of a sleep disorder, you need to get that diagnosed and treated. All sleep

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Getting sufficient sleep is important at any age, but doing so can become tougher as you get older. According to the National Sleep Foundation, older adults often ﬁnd it harder to fall and remain asleep, experience higher rates of sleep disorders than younger adults and suffer higher rates of insomnia. Research suggests that this is in large part due to the prevalence of chronic physical and psychiatric ailments older adults experience and side effects from the medications used to treat them. But there can be other causes, as well. Older adults tend to be lighter sleepers and more sensitive to noises and changes in their environment. Women going through menopause may wake dur-

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suicidal thoughts; have a history of drug or alcohol abuse or addiction; have a history of a sudden onset of muscle weakness (cataplexy); have a history of falling asleep often at unexpected times Selected Risk Information (narcolepsy) or daytime sleepiness; have • Do not take more BELSOMRA than lung or breathing problems; have liver prescribed. problems; are pregnant or plan to • Do not take BELSOMRA unless you are become pregnant; or are breastfeeding or plan to breastfeed. able to stay in bed a full night (at least 7 hours) before you must be active again. • Medicines can interact with each • Take BELSOMRA within 30 minutes of other, sometimes causing serious side effects. Do not take BELSOMRA with going to bed. other medicines that can make you • BELSOMRA may cause serious side sleepy unless your doctor tells you to. effects that you may not know are happening to you. These side effects • Call your doctor if your insomnia (sleep problem) worsens or is not better include: within 7 to 10 days. This may mean that • sleepiness during the day there is another condition causing your • not thinking clearly sleep problem. • acting strangely, confused, or upset • “sleep-walking” or doing other activities • Do not drink alcohol while taking when you are asleep like eating, talking, BELSOMRA. It can increase your chances having sex, or driving a car. of getting serious side effects. Call your doctor right away if you find • Do not drive, operate heavy out that you have done any of these machinery, do anything dangerous, or activities after taking BELSOMRA. do other activities that require clear thinking after taking BELSOMRA. • Do not take BELSOMRA if you fall asleep often at unexpected times • You may still feel drowsy the next day (narcolepsy). after taking BELSOMRA. Do not drive • BELSOMRA is a controlled substance or do other dangerous activities until you feel fully awake. because it can be abused or cause dependence. • BELSOMRA may cause serious side • Before taking BELSOMRA, tell your effects, including abnormal thoughts and behavior (symptoms include more doctor about all of your medical outgoing or aggressive behavior than conditions, including if you: have a history of depression, mental illness, or normal, confusion, agitation, • BELSOMRA is a prescription medicine for adults who have trouble falling or staying asleep (insomnia).

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hallucinations, worsening of depression, and suicidal thoughts or actions); memory loss; anxiety; temporary inability to move or talk (sleep paralysis) for up to several minutes while you are going to sleep or waking up; and temporary weakness in your legs that can happen during the day or at night. • The most common side effects of BELSOMRA include drowsiness the next day after you take BELSOMRA. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. Please read the adjacent Medication Guide for BELSOMRA and discuss it with your doctor. Having trouble paying for your Merck medicine? Merck may be able to help. Visit merckhelps.com.

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MEDICATION GUIDE BELSOMRA® (bell-SOM-rah) suvorexant Tablets C-IV

What should I avoid while taking BELSOMRA? • Do not drink alcohol while taking BELSOMRA. It can increase your What is the most important information I should know about BELSOMRA? chances of getting serious side effects. • Do not drive, operate heavy machinery, do anything dangerous or do • Do not take more BELSOMRA than prescribed. other activities that require clear thinking after taking BELSOMRA. • Do not take BELSOMRA unless you are able to stay in bed a full night • You may still feel drowsy the next day after taking BELSOMRA. (at least 7 hours) before you must be active again. Do not drive or do other dangerous activities until you feel fully awake. • Take BELSOMRA within 30 minutes of going to bed. BELSOMRA may cause serious side effects that you may not know are What are the possible side effects of BELSOMRA? BELSOMRA may cause serious side effects, including: happening to you. These side effects include: • See “What is the most important information I should know about • sleepiness during the day BELSOMRA?” • not thinking clearly • abnormal thoughts and behavior. Symptoms include more outgoing or • act strangely, confused, or upset aggressive behavior than normal, confusion, agitation, hallucinations, • “sleep-walking” or doing other activities when you are asleep like worsening of depression and suicidal thoughts or actions. eating, talking, having sex, or driving a car. • Call your doctor right away if you find out that you have done any of • memory loss • anxiety the above activities after taking BELSOMRA. • temporary inability to move or talk (sleep paralysis) for up to several What is BELSOMRA? minutes while you are going to sleep or waking up. • BELSOMRA is a prescription medicine for adults who have trouble • temporary weakness in your legs that can happen during the day or falling or staying asleep (insomnia). at night. • It is not known if BELSOMRA is safe and effective in children under the The most common side effects of BELSOMRA include drowsiness the age of 18. next day after you take BELSOMRA. BELSOMRA is a federally controlled substance (C-IV) because it can be The following additional side effects have been reported with BELSOMRA: abused or cause dependence. Keep BELSOMRA in a safe place to prevent • abnormal dreams misuse and abuse. Selling or giving away BELSOMRA may harm others These are not all the possible side effects of BELSOMRA. and is against the law. Tell your doctor if you have ever abused or have For more information, ask your doctor or pharmacist. been dependent on alcohol, prescription medicines or street drugs. Call your doctor for medical advice about side effects. You may report Who should not take BELSOMRA? side effects to FDA at 1-800-FDA-1088. Do not take BELSOMRA if you fall asleep often at unexpected times (narcolepsy). How should I store BELSOMRA? • Store BELSOMRA at room temperature between 68°F to 77°F (20°C to 25°C). What should I tell my doctor before taking BELSOMRA? • Store in the original package until use, to protect from light and moisture. Before taking BELSOMRA, tell your doctor about all of your medical • Keep BELSOMRA and all medicines out of reach of children. conditions, including if you: • have a history of depression, mental illness, or suicidal thoughts General information about the safe and effective use of BELSOMRA. • have a history of drug or alcohol abuse or addiction Medicines are sometimes prescribed for purposes other than those • have a history of a sudden onset of muscle weakness (cataplexy) listed in a Medication Guide. Do not use BELSOMRA for a condition for • have a history of falling asleep often at unexpected times which it was not prescribed. Do not give BELSOMRA to other people, (narcolepsy) or daytime sleepiness even if they have the same symptoms that you have. It may harm them. • have lung problems or breathing problems This Medication Guide summarizes the most important information • have liver problems about BELSOMRA. You can ask your pharmacist or doctor for • are pregnant or plan to become pregnant. It is not known if information about BELSOMRA that is written for health professionals. BELSOMRA can harm your unborn baby. • are breastfeeding or plan to breastfeed. It is not known if BELSOMRA For more information, go to www.BELSOMRA.com or call 1-800-622-4477. passes into your breast milk. What are the ingredients in BELSOMRA? Tell your doctor about all the medicines you take, including prescription Active ingredient: Suvorexant Inactive ingredients: Polyvinylpyrrolidone/vinyl acetate copolymer or over-the-counter medicines, vitamins, or herbal supplements. Medicines can interact with each other, sometimes causing serious side (copovidone), microcrystalline cellulose, lactose monohydrate, croscarmellose sodium, and magnesium stearate. The film coating effects. Do not take BELSOMRA with other medicines that can make contains: lactose monohydrate, hypromellose, titanium dioxide, and you sleepy unless your doctor tells you to. Know the medicines you take. Keep a list of your medicines with you to triacetin. The film coating for the 5 mg tablets also contains iron oxide yellow and iron oxide black, and the film coating for the 10 mg tablets show your doctor and pharmacist each time you get a new medicine. also contains iron oxide yellow and FD&C Blue #1/Brilliant Blue FCF How should I take BELSOMRA? Aluminum Lake. • Take BELSOMRA exactly as your doctor tells you to take it. • Only take BELSOMRA 1 time each night, if needed, within 30 minutes This Medication Guide has been approved by the U.S. Food and Drug Administration. of going to bed. usmg-mk4305-t-1605r002 • Only take BELSOMRA when you can get a full night’s sleep (at least 7 hours). Issued: 05/2016 • Do not take BELSOMRA if you drank alcohol that evening or before bed. Copyright © 2017 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. • BELSOMRA may be taken with or without a meal. However, BELSOMRA may take longer to work if you take it with or right after meals. NEUR-1218021-0000 05/17 • Call your doctor if your insomnia (sleep problem) worsens or is not better within 7 to 10 days. This may mean that there is another condition causing your sleep problem. • If you take too much BELSOMRA, call your doctor right away or get emergency treatment.

WELL-BEING

disorders are treatable.” Sleep apnea — a sleep disorder in which breathing is disrupted during sleep, often associated with loud snoring — can be treated with a face or nasal mask worn during the night known as a CPAP (Continuous Positive Airway Pressure) machine. The mask is connected to a pump, which sends a ﬂow of air into the nasal passages to keep airways open as you sleep. Restless leg syndrome, another common sleep disorder, causes an irresistible urge to move the legs during sleep. It can be treated with medication, says Dr. Vitiello.

Patterns and Changes

you sleep. Nobody should expect the sleep you have at 75 to be the same sleep you had when you were 18. But the vast majority of older adults — if they’re healthy — find even with these changes in sleep they are still functional during the day and can go about their daily routine just fine.” That doesn’t mean that older adults need less sleep than younger ones, says Lawrence J. Epstein, MD, Assistant Clinical Director of the Sleep Clinic, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital. “It’s a myth that older people need less sleep,” he says. “They still need at least seven hours of sleep every night. It’s just harder for them to get it in a single block.” Some people use daytime naps to meet part of their daily sleep requirement as they get older, says Dr. Epstein, which is fine as long as those naps are part of a regular routine. “You have to set aside that time every day to get it — otherwise you’ll be sleep deprived,” he says.

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What’s not treatable, he says, are age-related changes to the body’s sleep regulatory drive and circadian rhythms that cause older adults to sleep more lightly and want to go to sleep earlier and wake earlier than they did when they were younger. “There are changes occurring in the brain that change how

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* WELL-BEING “Napping can also be a double-edged sword,” Dr. Epstein says. “It will restore your alertness, but the more you sleep during the day, the less you sleep at night.”

When You Don’t Get Sufficient ZZZs Not getting enough sleep can be harmful. Lack of sleep can cause difﬁculty concentrating and memory loss, may make people more accident prone and more susceptible to illness. Poor sleep has been associated with health problems such as cardiovascular disease, diabetes, depression, arthritis, acid reﬂux, renal failure and immune disorders. “We are learning more and more that long-term sleep issues contribute to major illnesses,” says Dr. Vitiello. “If you’re experiencing long-term problems with sleep, the best thing to do is get some help — sooner rather than later.”

Dos & Don’ts

| MATTERS OF HEALTH

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Fortunately there are steps you can take to improve your chances of getting a good night’s rest. Suggestions from the Division of Sleep Medicine at Harvard Medical School follow. * Avoid caffeine, alcohol, nicotine and other chemicals that interfere with sleep. * Make your bedroom conducive to sleep by keeping it quiet, dark and cool in the evening and restricting activities in this room to sex and sleep (no computers, TVs or work materials). * Establish a pre-sleep routine such as taking a bath, reading a book or practicing relaxation techniques. * Keep a consistent sleep schedule. Going to bed and waking up at the same time each day helps to set your “internal clock.” * Nap early or not at all. Napping late in the afternoon can make it more difﬁcult to fall asleep at night. * Exercise early in the day. Exercising releases the hormone cortisol, which keeps the brain alert. * Don’t eat anything heavy before bed, as this may cause indigestion. * Balance ﬂuid intake. Stay hydrated but don’t drink so much before bedtime that you have to get up during the night to use the bathroom.

* MIND & BODY

Sex & the Older Couple Intimacy has no expiration date

| MATTERS OF HEALTH

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Growing older brings many changes in life that require adjustment — you may change jobs or retire from work, relocate to a less stressful environment, or learn to adapt to changes in your health and physical well-being. Likewise, many people may ﬁnd they need to make adjustments to their sex lives. But one thing they do not need to do, stresses Maggie Syme, PhD, MPH, an assistant professor at Kansas State University Center on Aging, is give up intimacy. “Sex is not something that has an expiration date. We engage in, need and enjoy sexual intimacy throughout our lives,” says Dr. Syme, also a counseling psychologist who recognizes that this topic is one many healthcare practitioners are failing to address with older patients. She developed a questionnaire that helps healthcare providers — be they doctors, nurses, psychologists or anyone else working with older adults — raise and discuss sexuality issues with seniors more comfortably. For example, doctors are encouraged to begin by saying something such as, “A lot of my patients are interested in improving their intimate lives. Is there anything that you need to discuss in this area?” Dr. Syme says this “normalizes the issue for older adults, which is important because a lot are ashamed to discuss their sex lives. That’s because in our society, we act as if older adults are not allowed to have a sex life.” This is partially due to negative images in the media and advertisements that send the message that sexuality is something reserved for the young and beautiful, says Dr. Syme, adding that television and other media are full of characters who reinforce the myth that seniors cannot or should not be sexually active. “There’s the Dirty Old Man, the Old Bitty, the Cougar. We’ve made

older adults asexual in our portrayals of them or we’ve made sex dirty or a joke. If you get exposed to that across your lifetime, you internalize that and start to feel embarrassed or ashamed of your sexual feelings when you get older.” Dr. Syme says she tells her patients that “there’s no need to be embarrassed about your wants. You’re normal. Giving up sex would leave a big, gaping hole in your life if you decided to just cut it out, if it’s been something that’s important to you throughout your life.” The most common sexual issues older adults encounter include erectile dysfunction for men (ED) and vaginal dryness for women. ED can often be treated with medication and dryness can be treated with over-the-counter lubricants. However, it’s important to discuss these issues with your healthcare provider to explore potential causes and ensure you are getting the appropriate treatment. In addition to the normal aging process, illnesses, disabilities, depression, medication side effects and surgery may impact a person’s ability to enjoy intimacy. Relationship issues can affect intimacy at any age. Chronic pain may make it difficult to enjoy certain sexual positions. Dr. Syme says she encourages patients to communicate with their partners and be open to discussing new ways of finding satisfaction that allow them to continue to enjoy an intimate relationship. Maintaining a satisfactory sex life remains important to the vast majority of adults — both men and women — as they grow older, according to a 2009 study conducted by the University of Chicago Center on Aging. The study found that 71 percent of women and 76 percent of men ages 57 to 64 reported that satisfactory sex was an essential element to maintaining a good relationship. The percentage rose slightly for women ages 75 to 85 (to 73 percent) and fell slightly for men in this age-group (71 percent). The study also found that while fewer adults were sexually active in their later years, those who were active reported having sex fairly often — at least once or twice a week. In fact, the National Institute on Aging advises that many older adults actually find sex more satisfying, because they have fewer distractions, more time and privacy with their partners along with no worries about unwanted pregnancies. However, the agency also stresses that age does not protect against sexually transmitted diseases, and encourages older adults to continue to practice safe sex. Finally, Dr. Syme notes that even when physical limitations may make certain levels of sexual activity difficult or impossible, couples can still enjoy other practices that allow them to remain intimate: “Cuddling, kissing, holding hands, gazing into each other’s eyes, masturbating — whatever it is, there are many ways for couples to express these feelings and find satisfaction.” 26

| MATTERS OF HEALTH

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“Is It Hot in Here?” Managing menopausal symptoms and discomforts

Hot Flashes

* Avoid things that may trigger a flash — such as spicy foods, caffeine, alcohol, stress or environments with high temperatures. * Keep a fan at home or at work for when hot flashes may occur. * Dress in layers that you can remove if you feel a hot flash coming on. * If symptoms are severe, your healthcare provider may prescribe low-dose oral contraceptives, Menopausal Hormone Therapy (MHT) or other medications. Vaginal Dryness

vaginal lubricants and moisturizers can help. * Over-the-counter * MHT can be prescribed for severe dryness.

Mood Swings

* Staying physically active and getting a good night’s rest can improve your mood. * Recognize stress and learn coping mechanisms for it, such as organizing tasks into manageable lists; setting limits and boundaries; stretching regularly; taking time for yourself; maintaining social contacts; getting tense muscles massaged; and seeking professional help if needed. * If you experience depression, seek medical assistance from your healthcare team. Depression is a serious illness that can be treated. * MHT can also help to improve mood. Memory Issues

* Regular exercise along with getting a sufﬁcient amount of sleep can help with memory. If forgetfulness is causing serious issues in your daily life, see your provider. Urinary Incontinence

* Speak to your provider about ﬁnding the right treatment, which may include behavioral changes, medication, medical devices or surgery. You may also experience changes in appearance associated with menopause and/or aging. Here are tips to help you cope.

Weight Gain Many women gain weight around the same time they experience menopause or perimenopause, or find that it’s increasingly difficult to maintain the same weight or to lose weight. According to experts at the Mayo Clinic, this may have less to do with menopause than the normal aging process, as well as genetic and lifestyle factors. As we age, muscle mass decreases while fat increases and our need for calories decreases slightly. The Mayo Clinic advises women who wish to reduce or prevent excess weight gain during this period to increase physical activity and to eat a more healthful diet — including fruits, vegetables, whole grains, foods high in fiber and healthy proteins, such as soy,

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Menopause signals the end of the childbearing years for women and the beginning of a new period of life. While some women pass through this phase with only mild discomfort, others find the transition anything but smooth. The beginning of this process is called perimenopause, which typically begins in the 40s and ends in the early 50s, lasting from one to ten years. However, every woman is different and ages will vary. A woman is not considered to be in menopause until one year has passed since her last menstrual period. Perimenopause is often accompanied by symptoms such as hot flashes, night sweats, irregular periods, difficulty sleeping, vaginal and urinary problems, mood changes and other issues — such as forgetfulness, weight gain, hair loss or unwanted hair growth, and body aches or stiffness. While the process is normal and does not require medical treatment, some women may wish to see a healthcare professional for relief of uncomfortable symptoms. The Office on Women’s Health, a division of the U.S. Department of Health and Human Services, offers advice on managing some of the more common symptoms of menopause, such as hot flashes, vaginal dryness, mood swings, memory issues and urinary incontinence.

* CHANGES meat, ﬁsh, chicken, nuts and legumes. Reducing alcohol and sugar intake will also help to control weight gain.

Hair: Loss, Thinning and Unwanted Growth Estrogen and progesterone help hair to grow and to remain fuller longer. When levels drop during menopause, hair may grow more slowly and begin to thin. Steps to reduce hair loss include using a good conditioner that promotes healthy hair growth and avoiding the use of curling irons, blowdryers or straighteners, which can weaken hair or cause it to break. Wearing a swim cap while in a swimming pool will also help to protect hair from damage due to chlorine. Dying hair, which many women do at this age due to graying, can also damage hair if harsh chemicals are involved, so ask your colorist or pharmacist about using natural color products. Androgens — which are male hormones — can also increase during menopause, causing hair to grow on a woman’s face and in other unwanted areas. Ridding yourself of unwanted hair — on the upper lip, for example — can be done by waxing, laser treatments, tweezing, threading or with a variety of over-the-counter hair-removal creams and other products.

Aging Skin

| MATTERS OF HEALTH

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Hormonal changes during menopause can also lead to skin changes, such as increased breakouts, loss of elasticity and an increase in wrinkles. Women who smoke and those with sun damage may experience more dramatic increases in wrinkles. Moisturizers and other skincare products — such as vitamin A (retinol) and vitamin C creams — can help build collagen in the skin, to reduce the aging process.

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| MATTERS OF HEALTH

Big Shots

Important vaccines for older adults Vaccinations play an important role in preventing serious, life-threatening illness and disease, particularly during the earliest years of life. But babies and growing children aren’t the only ones who need them. As we grow older, protection from some of those childhood vaccines may wear off. We may also be exposed to other vaccine-preventable diseases through work, travel or other conditions and can grow more vulnerable to serious health consequences as we age. Some of the shots you should consider taking if you are over the age of 50 follow.

Flu Shot According to the Centers for Disease Control and Prevention (CDC), more than 60 percent of seasonal flu-related hospitalizations occur in people age 65 and older. The flu is a contagious respiratory disease that can also kill. Those with weakened immune systems — including the elderly — are at considerably higher risk for the flu to cause serious harm. The CDC recommends that all adults receive a flu vaccine every year, but places special emphasis upon the need for people with chronic health conditions, pregnant women and older adults to do so.

Any child who has ever had chicken pox can tell you that this itchy, blistery condition creates nothing short of misery. But what many people don’t realize is that long after the chicken pox are gone, a virus remains in your system that can reappear during adulthood in another form. Shingles, also known as zoster or herpes zoster, is an extremely painful rash that erupts in people who have previously suffered from chicken pox. The CDC estimates one in three Americans will develop shingles. There are an estimated one million cases per year, half of which occur in men and women age 60 or older. The zoster vaccine reduces the risk of developing shingles by 51 percent and the risk of developing a longer-lasting form of shingles known as post-herpetic neuralgia (PHN) by 67 percent. The vaccination is given as a single shot and is recommended for anyone age 60 or older.

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Zoster Vaccine/Shingles

* IMMUNIZATION

Today, children in America receive a Tdap (tetanus, diphtheria, pertussis — also known as whooping cough) booster shot at age 11 or 12, because protection from the vaccines for these three diseases, given earlier in childhood, fades over time. But this booster did not exist prior to 2005, so many adults may not have gotten it. If you haven’t received it, you should. All teens and adults need a Td (tetanus) booster every ten years. It is extra-important for adults who will be around infants since whooping cough is a serious infection for young children.

Pneumonia Pneumonia, an infection of the lungs, can become serious and even deadly in older adults, whose immune systems may not be as strong as they used to be. The pneumococcal vaccine, therefore, is recommended for all adults age 65 and older and those younger than 65 who suffer from chronic conditions. Ask your provider if you need the following vaccines as well.

MMR This shot protects against measles, mumps and rubella. Most Americans receive this vaccination in two doses by the age of six. The CDC recommends that any adult who has not received this vaccine do so, especially if traveling outside the U.S., as measles is still common in some countries and those who are unprotected may get it while abroad and bring it home.

Hepatitis There are three types of hepatitis: A, B and C. Vaccines are available for types A and B, but not for type C. 34

| MATTERS OF HEALTH

Hepatitis A is an infection in the liver caused by a virus, spread through contact with fecal matter or by eating or drinking food or water infected with the disease. The CDC recommends that those over the age of one year receive this vaccine if they: live in an area with a high rate of hepatitis A; work in or travel to countries with high rates of the disease; use street drugs; are a male having sex with other men; have long-term liver disease; receive blood products to help clot their blood or do research on HAV or work in a lab with HAV-infected animals. Hepatitis B is an infection of the liver caused by a virus transmitted when blood, semen or other bodily ﬂuids of an infected person enter the body of someone not infected, by sexual contact, needle-sharing or from mother to baby during childbirth. The vaccine is given in three doses and is recommended for all children, as well as adults who live in or travel to areas with high rates of hepatitis B; have sex with more than one partner; have diabetes and are under the age of 60; work in healthcare and may be exposed to patients with hepatitis B; have HIV or end-stage renal disease; are on dialysis; inject drugs; have chronic liver disease; and have other special circumstances. Hepatitis C is a serious liver disease spread primarily through contact with the blood of an infected person.

Meningococcal Disease Meningococcal disease is the leading cause of bacterial meningitis, an infection around the brain or spinal cord that kills one in ten people who develop it. The CDC advises vaccinating all children and young adults, as well as some older adults at higher risk, such as those who travel to areas with high rates of the disease. Some older adults should not get this vaccine, so consult your provider about whether it’s appropriate for you.

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Tdap/Td

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| MATTERS OF HEALTH

FOOD SAFETY

Take It Outside! Keeping alfresco dining healthy

With summer comes picnic and barbecue season, a time to socialize with friends and family while relaxing outdoors. But with temperatures heating up, it’s important to remember that some foods aren’t meant to be sitting in the sun for hours and the last thing anyone wants is for foodborne illness to spoil the fun.

Avoiding Foodborne Illness According to the Centers for Disease Control and Prevention (CDC), each year one in six Americans — roughly 48 million people — gets sick due to foodborne illness. Of those who get sick, 128,000 are hospitalized and 3,000 die. Foodborne illness tends to rise during the summer months, in part due to the higher temperatures and more foods being served outdoors.

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* FOOD SAFETY

| MATTERS OF HEALTH

cooked thoroughly. * Do not allow perishable food to sit outside for more than two hours. When temperatures rise above 90° F, the maximum time should be one hour. * After cooking meat on the grill, keep it hot by setting it to the side of the grill rack until served. * Serve cold foods in small portions, and reﬁll from the cooler as needed. * Thaw frozen meat ahead of time in the refrigerator — never thaw it outdoors.

When to See Your Provider Should you or anyone else become ill after eating, seek medical help for any of the following conditions. * Diarrhea that lasts more than 48 hours (in an adult) and 24 hours (in a child). * Dehydration — which is indicated by severe weakness, lightheadedness, dark-colored urine or little-to-no urine. * AA fever. * dark or bloody stool.

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Safety tips on how to prepare, store and serve your family’s picnic and barbecue favorites during the warm-weather season follow. * Store and carry foods in insulated coolers packed with ice or frozen gel packs. Frozen foods can also double as ice packs. * Fill your coolers. A full cooler maintains its temperature longer than one that is partially ﬁlled. * Keep coolers out of direct sunlight. Store and serve foods in the shade. * To keep the cool air in your coolers, avoid repeatedly opening the ones that contain food. * Foods that must be kept cool include raw meat, poultry, seafood, deli and luncheon meats or sandwiches, summer salads (tuna, chicken, egg, pasta, seafood), cut-up fruits and vegetables and dairy products. * Use separate cutting boards and utensils for raw meat. Do not reuse these items for cutting vegetables, bread or other foods. Keep perishable items cold until you’re ready to cook them. * Use * a food thermometer to ensure that meat and poultry are

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* ROAD SAFETY

Baby,You Can Drive My Car When getting behind the wheel is becoming a challenge

Getting older often means accepting that you can’t do all the things you did when you were younger, or that you can’t do them quite as well as before. But some changes are easier to accept than others. Perhaps one of the toughest limitations people face as they age is the loss of independence. Whether it’s a decrease in physical mobility or finding that driving has become more challenging, it’s just not easy to acknowledge that the time may have come to depend upon others for something as basic as the ability to come and go as you please. Yet your safety — and the safety of others with whom you come into contact — may depend upon it. According to the Centers for Disease Control and Prevention (CDC), the risk of being injured or killed in a motor vehicle crash increases with age. In 2014, more than 5,700 adults ages 65 and older were killed and more than 236,000 were treated in emergency rooms for injuries sustained during motor vehicle crashes. But as the population grays, the number of older drivers is on the rise. In 2015, there were more than 40 million licensed older adults on the road, which is a 50-percent increase from 1999. Of course, many older drivers are perfectly fine behind the wheel. With more experience than younger drivers and less need to be on the road if they’re no longer commuting to work, many may find they’re safer than ever. Others, however, may begin to experience health issues — such as vision and hearing loss, dementia or slower reaction times and reflexes — that make driving dangerous.

There are steps you can take to increase your safety, regardless of your age. For example, the National Institutes of Health/National Institute on Aging (NIH/NIA) suggests that if your reaction times seem slower, you should leave more space between your car and the one in front of you, giving you a greater distance in which to slow down should you need to stop suddenly. The agency also

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Avoiding Danger on the Road

* ROAD SAFETY

Time to Assess So how do you know if it’s time to give up your license and ask for a ride? The NIH suggests asking yourself the questions that follow to help determine if it’s time to let someone else take the wheel. 42

| MATTERS OF HEALTH

other drivers often honk at me? * Do Have I been having accidents, even if they are “fender * benders?”

I get lost, even on roads I know? * Do Do other cars or people walking seem to appear out of * nowhere?

I get distracted while driving? * Do Are * family and friends worried about my driving? I have trouble staying in my lane? * Do Do * I have trouble moving my foot from the gas to the brake pedal? Do I ever confuse the two? I drive less because I’m feeling unsure on the road? * Do Have I been pulled over by a police ofﬁcer because of my * driving?

If you’ve answered yes to one or more of these questions, consider having a talk with your healthcare provider or taking a driving assessment to see if you’re still safe behind the wheel.

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suggests that you start braking earlier and avoid heavy trafﬁc whenever possible. Medications can also affect your driving ability. The NIH warns against driving when feeling lightheaded or drowsy and advises reading all medication labels carefully for warnings related to driving. Your pharmacist is happy to answer questions about medications and safe driving. If night vision has become a problem, consider limiting your driving to daylight hours. It may also be helpful to take a defensive driving course to freshen up skills. Some insurance companies will also lower your rates if you pass such a class.

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Skin Deep

Prevention, protection and “slowing down” aging

Use Sunscreen and Moisturizer The cancer-prevention benefits of a good sunscreen (broad-spectrum protection with SPF 30 or above) apply to people of all ages. And a 2013 study in the Annals of Internal Medicine found that adults who wore sunscreen every day — regardless of the weather — could slow the appearance of aging by keeping skin smoother and more resilient. Other steps you can take to keep your skin healthier and younger-looking include using a moisturizer daily (not just on the face but on the neck and décolletage as well); taking fewer baths and using milder soaps and skin products to prevent dryness; and limiting sun exposure by choosing long-sleeved shirts and staying in the shade (in addition to using sunscreen).

Break Bad Habits Other factors that affect the health and appearance of skin include smoking, drinking alcohol to excess, stress and failing to adequately hydrate — all of which contribute to skin damage. Obviously we have some control over these factors. If

you quit smoking, drink only in moderation, reduce stress and drink lots of water, you’ll have healthier skin.

Change Is Inevitable Skin naturally becomes thinner and loses some of its elasticity over the years. Many people suffer from dry spots or discoloration, known as age spots, and find bruises are slower to heal.

For Psoriasis Sufferers If you already have a skin condition, such as psoriasis — an immune-mediated disease that causes skin cells to grow at an abnormally fast rate, causing lesions on the elbows, knees and scalp — you may notice that it grows worse with age. The National Psoriasis Foundation (NPF) recommends that people with psoriasis use creams (rather than lotions or gels) that are fragrance-, alcohol- and chemical-free, as well as hypoallergenic, so that they don’t further irritate the skin. Because ceramides, lipids and hyaluronic acid — vital to healthy skin — naturally decrease with age, the NPF recommends using moisturizers that contain these three components. And while sunlight helps psoriasis because it furnishes the skin with vitamin D, the NPF cautions against overexposure and encourages the use of a high- SPF sunscreen to prevent skin cancer. People with psoriasis must be careful to take care of all of their skin — including the skin on the top of their heads. Since many people choose to color their hair as they get older, it’s important to consider using products that won’t irritate the scalp. The NPF recommends avoiding shampooing the day before getting your hair colored, as well as applying a rich mask to your hair the night before and leaving it on overnight. If your healthcare provider has prescribed a scalp psoriasis solution, use it prior to any dye being applied to keep your scalp calm. It’s also a good idea to ask your stylist to refrain from using her nails while scrubbing the scalp to avoid additional irritation.

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It’s no secret that aging affects how your skin looks and feels, or that some people manage to escape the so-called ravages of time better than others. The good news is that it’s not all just luck or good genes that keep skin looking great — there is much we can do to protect our skin as we grow older. First, it’s never too soon to start. Research shows that the sun exposure we get during childhood can increase our risk for skin cancer later in life. Even a single, brutal sunburn during summers at the beach when you’re a child can double the risk of developing melanoma later in life. And skin that has had too much exposure to the sun ages faster than skin that has been better protected over the years. But that doesn’t mean it’s too late to take care of your skin once you reach adulthood.

* ORAL HEALTH

Keep Smiling! Dental care is essential, regardless of age

There was a time when many people associated growing older with wearing dentures, conjuring up the image of Grandma putting her teeth in a jar at night. Indeed, many older Americans continue to wear false teeth or have dental implants — according to the American College of Prosthodontists more than 35 million Americans don’t have any natural teeth — but we should not assume that losing your teeth is a normal part of aging.

Good oral care can help prevent tooth loss, which is caused by tooth decay, gum disease, injury, cancer or tremendous wear and tear. In fact, caring for teeth and gums should always be a regular part of good, daily hygiene regardless of age. In addition to brushing after meals (at least twice daily with a fluoride toothpaste) and flossing — important daily activities for people of all ages — older adults should pay close attention to any signs of trouble associated with oral health and be sure to report potential problems to a dentist during routine, twice-yearly checkups and cleanings. Quickly flagging troublesome issues — such as gum recession — can help prevent further deterioration. What’s more, problems with teeth and gums may signal problems elsewhere in the body. For example, dry mouth and gum disease often occur in people who have diabetes, but may not yet know it. Good blood glucose control, therefore, is also important in preventing oral health problems. Some of the more common issues older adults encounter with oral health and what you can do to prevent or treat them follow. 46

| MATTERS OF HEALTH

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Preventing Dental Issues

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* ORAL HEALTH

Xerostomia occurs in roughly 30 percent of adults 65 or older and 40 percent of those 80 years or older. While dry mouth is often a side effect of medication — particularly if a patient is taking multiple medications — it can also occur as a comorbidity of diabetes, Alzheimer’s disease or Parkinson’s disease. Having less saliva in the mouth raises the risk for tooth decay and can also make dentures uncomfortable, so it’s important not to ignore this condition. It can be treated by drinking or sipping water throughout the day, avoiding alcoholic beverages or those high in sugar or caffeine, using artiﬁcial saliva (sold over-thecounter in most pharmacies), sucking on sugarless hard candy or changing medications and/or medication dosages.

Gum Disease Gum disease develops when plaque builds up along and under the gum line, causing the gums to recede. There are two kinds of gum disease: gingivitis, a mild condition that is reversible; and periodontitis, a more severe form that causes the gums to pull away from the teeth, forming pockets where infections can grow. It also damages the bone and connective 48

| MATTERS OF HEALTH

tissue that holds teeth in place. Ultimately, this can loosen teeth and cause them to fall out. You can prevent gum disease by brushing thoroughly (brushes that rotate in a circular motion are recommended), ﬂossing and having regular cleanings. Eating a well-balanced diet and not smoking or chewing tobacco will also help.

Oral Cancer The risk for developing oral cancer increases with age, especially if you smoke or drink a lot of alcohol. The human papilloma virus (HPV) has also been associated with some oral cancers. Certain strains are covered in the HPV vaccine that is given in adolescence. Report any changes in your mouth, especially pain, to your provider immediately, as treatment for oral cancer works best if caught early. Symptoms include irritations, lumps or thick patches in the mouth, lip or throat; white or red patches in the mouth; the sense that something is caught in your throat; difﬁculty chewing or swallowing or moving the jaw or tongue; numbness in any part of the mouth; swelling of the jaw; or pain in one ear without any hearing loss.

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Talk to your pharmacist about any of your medications, both prescription and over-the-counter medications. Pharmacists are medication experts, so donâ&#x20AC;&#x2122;t hesitate to take advantage of our knowledgeâ&#x20AC;&#x201D;think of us as your one-stop resource for answers. In addition, your pharmacist can offer insights related to managing diabetes, heart disease, chronic conditions, and many other issues affecting your well-being. Your support of your local pharmacy helps us contribute more to our community. Thank you.

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