The Do’s and Don’ts of Social Interaction During a Pandemic

Across the nation, Americans find themselves in varying degrees of social isolation as part of a coordinated effort to try to slow the spread of the new coronavirus. Some cities are in full lockdown. Others are asking people to simply remain socially distant.

But navigating this new world of social limitations can be confusing. What should – and shouldn’t – people be doing?

That depends on your level of isolation, said Arthur Caplan, director of the Division of Medical Ethics at New York University Grossman School of Medicine.

The most restrictive level, said Caplan, is quarantine – when a person is ill or known to have been exposed to the virus and must be completely separated from others with no social interactions outside the home.

“If you have a partner or a child and can’t be completely separated in the home, at least you split the living space and keep your distance,” he said.

Being under quarantine is similar to being in lockdown, a restriction some governments are using when localities experience severely high levels of infection. In lockdown, or with a “shelter in place” order, venturing out for other than government-allowed reasons could carry a penalty such as a fine or arrest. The directives differ from place to place, but generally allow residents to take care of essential health and safety tasks, such as buying groceries, medicines, and even going for a run or walking the dog.

Residents also may voluntarily shelter in place, a type of self-isolation encouraged for those who are medically vulnerable, such as people 65 and older and those with weak immune systems, heart disease, diabetes or lung disease. As the numbers of people confirmed to be infected increase, a growing number of states and localities are asking all residents to self-isolate to slow contagion.

The new coronavirus causes COVID-19, a respiratory illness with symptoms such as a cough, fever and, in more severe cases, difficulty breathing. The American Heart Association recently released a statement advising special caution for older people with coronary heart disease or high blood pressure because they may be more likely than others to be infected by the virus and have more severe complications.

At a minimum, all Americans are being asked to practice social distancing, which means remaining at least 6 feet apart from others and limiting the number of direct interactions with other people.

“I think the guiding principle is that we’re trying to reduce the spread of the virus and one way to do that is to isolate ourselves to reduce the chance of giving it to someone else,” said Wayne Rosamond, an epidemiology professor at the University of North Carolina Gillings School of Public Health.

As a general rule, he said, that means reducing contact with other people as well as reducing contact with anything someone else may have touched.

But with the kids home from school and the entire family cooped up together, questions arise over what people should and shouldn’t be doing with their time.

Don’t visit older parents, friends or neighbors, Caplan advises. “They are at high risk. Don’t bring the kids there to see them. You just don’t know whether you’re infected or not. Call them up. FaceTime them. Use Skype. But do not visit.”

If you are venturing out with the kids, be careful about where you go and what they touch, Rosamond said. Ask yourself, “What things in the environment could other people have touched or possibly coughed on. Creating space between people is important but so is being aware of the surroundings and what you and your kids are touching.”

The National Institutes of Health warns the virus can live on surfaces for up to several days. “Kids like to touch things, they put everything in their mouths,” said Caplan. “You have to be very careful when you take them anywhere.”

Neither should you let your kids invite friends inside for a playdate, Caplan said. “They can see their friends outside if you keep them apart. But you have to watch them. No wrestling. Don’t let them jump on top of each other.”

The federal government also is asking that all non-essential dental or medical appointments be postponed during this time. Not only would such visits potentially expose people to the virus in medical offices, waiting rooms or on public transportation, but “they could be diverting resources that potentially would be needed to care for coronavirus patients,” Caplan said. Medical workers from a wide range of practices are being asked to help care for the influx of patients.

So, what can you do?

It’s important to check with local and state authorities to find out what restrictions have been issued for your area.

In general, government health agencies suggest taking a walk, going for a run or even doing yardwork if you want to get out of the house. Just stay 6 feet away from anyone else.

Many gyms and yoga studios, which have been closing down, are providing online video classes people can do at home.

“You have to get creative,” said Rosamond. “It is important to move and not to be sedentary. Get sleep, eat right and get up and be active. Staying healthy mentally and physically during this time is essential.”

If you really need to get out, activities like family camping trips are still OK, Caplan said, “as long as you go alone or with members of your household. But don’t go to a campsite with 300 people. That’s defeating the purpose.”

Source: American Heart Association

Toasted English Muffins with Honey-glazed Bacon and Eggs

Ingredients

2 English muffins
6 rindless unsmoked bacon slices
1 tbsp honey
3 oz canned corn kernels, drained
2 small tomatoes, diced
1 tbsp chopped fresh parsley
salt and pepper
4 eggs
butter

Method

  1. Preheat the broiler on a medium–high setting.
  2. Slice the muffins horizontally in half, then lay them cut sides up on a piece of cooking foil on the rack in the broiler pan. Toast until lightly browned, then turn and cook on the other side. Reserve and keep warm.
  3. Preheat the oven to 275°F/140°C.
  4. Heat a nonstick skillet over medium heat. Lay the bacon slices in the skillet and cook until lightly browned, then turn and cook the other side.
  5. Warm the honey slightly and brush each bacon slice lightly with it. Cook the bacon for an additional 1 minute or until it takes on a slight glaze. Remove from the pan and keep warm in the preheated oven.
  6. Mix the corn, diced tomatoes, and chopped parsley together in a bowl and season to taste with salt and pepper.
  7. Fry, poach, or scramble the eggs, as you prefer.
  8. Serve the honey-glazed bacon and eggs on the toasted muffins, on warmed plates. Top each with a spoonful of the corn and tomato mixture.

Makes 2 servings.

Source: Toast It!

How Sleep Protects the Brain

Karen Jaffe used to love sleeping, both in bed at night and napping during the day. But since her diagnosis of Parkinson’s disease in 2007, the 60-year-old retired physician from Cleveland has come to dread it. For one thing, certain symptoms make it tough for her to get comfortable. “Once I’m lying down, trying to roll over is ridiculous—it’s as if I’m frozen there, stiff and rigid, trapped in one position,” she says. Jaffe also has rapid eye movement (REM) sleep behavior disorder, a common symptom of Parkinson’s disease in which people experience night terrors or try to physically act out their dreams. “My problem is nightmares,” she says. “I often wake myself up with my own yelling. I’m lucky if I get four hours of sleep a night.”

Like many patients with neurologic conditions, Jaffe takes medication that can interfere with sleep. One such drug, ropinirole (Requip)—which is prescribed for restless legs syndrome and causes impulsive behavior in some people—leaves Jaffe feeling revved up and unwilling to put away a project, no matter how late it gets. “I can’t stop whatever I’m doing,” she says. The next day she pays the price. “Besides being tired, my tremors are definitely worse.”

How well we sleep impacts how we think and feel, as well as our alertness, memory, and concentration. “Sleep quality and quantity are directly related to the health of the brain,” says Beth A. Malow, MD, MS, FAAN, professor of neurology and director of the sleep disorders division at Vanderbilt University Medical Center in Nashville. Several studies have demonstrated an association between sleep disturbances such as insomnia, fragmented sleep, sleep apnea, and even excessive napping and an increased risk of cognitive decline over time, says Brendan P. Lucey, MD, assistant professor of neurology and director of the sleep medicine section at Washington University School of Medicine in St. Louis.

In 2009, a series of studies on mice conducted at Washington University were among the first to suggest that chronically sleep-deprived subjects develop higher levels of harmful amyloid beta and tau proteins—considered, along with neurofibrillary tangles, to be hallmarks of Alzheimer’s disease. “Think of tau and amyloid as the waste produced by typical nerve function,” says Charlene Gamaldo, MD, FAAN, associate professor of neurology and medical director of the Johns Hopkins Sleep Disorders Center. “Normally, the brain clears these metabolic waste products away.”

And it may clear away these proteins during sleep, according to a landmark 2013 rodent study in Science by researchers at the University of Rochester Medical Center, who showed that during deep sleep, when neural activity quiets down, cerebrospinal fluid (CSF) bathes the brain, washing away excess amyloid beta and tau proteins. A more recent study, published in the November 2019 issue of iScience, provided further insight into CSF’s function. MRI scans taken while subjects were sleeping showed that during deep sleep, blood flow in the brain diminished as pulsing waves of CSF flushed out excess amyloid beta and tau, presumably girding the brain against cognitive decline. So while it has been known that sleep has some value for survival, these reports seem to put sleep front and center in terms of protecting us from cognitive decline.

It also may be that less amyloid beta and tau are produced when we sleep than while we’re awake, says Dr. Lucey. In a 2018 study in Annals of Neurology, he and his co-authors measured the levels of amyloid beta in sleep-deprived subjects versus those who were allowed to sleep normally; amyloid beta production was 25 to 30 percent higher in the sleep-deprived group.

In other research, scientists are learning the effects that certain sleep problems may have on the brain. A 2018 meta-analysis in Sleep Medicine Reviews of multiple studies involving a quarter of a million people over 10 years showed that people with insomnia had an increased risk of developing Alzheimer’s. Those with sleep-disordered breathing, like sleep apnea, had an increased risk of dementia, and those with fragmented, nonrestorative sleep were also more likely to develop Alzheimer’s and dementia.

These findings suggest that quality and type of sleep are also important. You should be able to cycle through the two primary stages of sleep—non-REM and REM (when most dreaming occurs)—with minimal interruptions. Non-REM sleep has three subphases: drowsiness, when breathing and heart rate begin to slow; a deeper-sleep phase characterized by brain waves known as sleep spindles; and slow-wave sleep, the most restorative kind, when neural activity and blood flow are at their lowest points and CSF’s clearance action kicks in.

All phases of sleep play critical and specific roles in cognitive function and memory consolidation, according to studies. “The spindle activity of stage 2 appears to increase in response to exposure to new information—it’s possible that it is a biophysiological marker of learning,” says Dr. Gamaldo. A 2018 study in the journal Neuron reported, among other things, that when sleeping subjects had their slow-wave and spindle sleep enhanced in the laboratory, they did better on memory tests the next day.

Slow-wave and REM sleep seem to be linked to both procedural memory (the ability to automatically perform a task, like riding a bicycle) and semantic memory (recall of words, concepts, and numbers). Slow-wave sleep is associated with consolidating memory, whereby things learned in the short term and processed in the hippocampus are stored in the cortex for the long term. “But then again, so is REM sleep,” says Dr. Gamaldo, who cites a 2017 study in Neurology that showed that people who get less REM sleep may have a greater risk of developing dementia.

Other Alzheimer’s-related research is examining sleep for early markers of the condition. “With Alzheimer’s, we know that amyloid deposition can begin more than a decade before a person shows signs of cognitive impairment,” says Dr. Lucey. “This means there is the potential to screen a person for changes in sleep to assess their risk for Alzheimer’s in a noninvasive way.” It also presents the possibility of treating sleep disturbances at an earlier stage—and possibly preserving cognitive function. A 2015 New York University study published in Neurology found that seniors with sleep apnea who used a CPAP (continuous positive airway pressure) machine to help them breathe more easily during sleep experienced signs of mild cognitive decline a full decade later than those with sleep apnea who didn’t use a CPAP machine.

These results indicate that cognitive decline does not have to be an inevitable result of aging if people can regularly get a good night’s sleep. They should tell their doctor if sleep patterns change, and doctors need to ask about sleep. “The hopeful thing is that most sleep disorders are treatable,” says Dr. Lucey. “If you’re concerned about your sleep, or you’re too tired to do the things you need to do, you really should get medical attention.”

Karen Jaffe has worked with her physician to adjust the timing of her medication so it doesn’t leave her feeling revved up before bedtime. “People shouldn’t feel shy about asking for help managing sleep disturbances,” she advises. “Meds can be added or doses and timing can be changed to help you sleep better.”

Jaffe, who’s a member of the Michael J. Fox Foundation’s Patient Council, has adopted other sleep-promoting habits as well. “I try to put my electronics away before bed—that’s the main thing,” she says, adding, “I feel better when I do yoga, tai chi, or other kinds of exercise during the day. It makes me tired, so I can finally sleep for six or eight hours at a stretch.”

Source: Brain&Life

Soyfoods and Thyroid Health

KC Wright wrote . . . . . . . . .

Over the past several decades, consumption of soyfoods in the United States has increased, largely due to the legume’s potential health benefits and the increase in people following plant-based diets. According to the Soyfoods Association of North America, the US retail soyfoods industry rose from $1 billion in 1996 to $4.5 billion in 2013, with dramatic growth following the 1999 FDA approval of a health claim linking soy with heart disease reduction.

Beyond fresh soybeans (edamame), dried soybeans, tofu, soymilk, miso, soy sauce, soybean oil, meat alternatives, and more, the soy industry also has promoted the development of soy supplements and fortification of foods with soy.1

Soyfoods have been rigorously investigated for their role in chronic disease prevention and treatment. There’s evidence that they help reduce risk of coronary heart disease, breast cancer, and prostate cancer. Soy also has been shown to help alleviate menopausal symptoms, reduce depressive symptoms, improve skin health, and positively affect renal function.

Despite all the potential nutritional attributes of soyfoods, there has been much consumer concern about their interference with thyroid health, especially among individuals whose thyroid function already is compromised. “It’s a huge concern I hear from my patients,” says Stephanie L. Lee, MD, PhD, associate chief of the section of endocrinology, nutrition and diabetes at Boston Medical Center.

The two main components of soy responsible for its proposed health benefits are soy protein and soy isoflavones. US daily per capita soy protein consumption averages less than 2 g, just a fraction of the 60 to 85 g total protein typically consumed.2 For reference, a cup of soymilk contains 8 g protein (the same as cow’s milk.)

Soy protein contributes negligible amounts of isoflavones to American diets not only because the amount of soy protein consumed is small but also as a result of processing; the concentration of isoflavones in isolated soy protein used in the food industry is low. Estimated US per capita intake of isoflavones is less than 2.5 mg, compared with one cup of soymilk made from whole soybeans that contains about 25 mg isoflavones.2

In addition to providing high-quality protein, soybean’s isoflavones are phytoestrogens—plant-derived compounds with estrogenic activity. The compounds genistein and daidzein account for the majority of isoflavone content. According to Angela M. Leung, MD, an assistant professor of medicine at the UCLA David Geffen School of Medicine and an endocrinologist at both UCLA and the VA Greater Los Angeles Healthcare System, “Genistein and daidzein can interfere with the thyroid’s ability to produce thyroid hormone but can be potentially reversed by supplemental iodine.”

Much of the research on soyfoods and thyroid health has been done in animal studies, including one dating back to 1933 where rats fed raw soybeans had markedly enlarged thyroids.3 In the 1960s, case reports of infants developing hypothyroidism in response to the consumption of soy infant formula were addressed when the formula began to be fortified with iodine, a vital constituent of thyroid hormones.4,5

“The concern of soy intake on thyroid health is different for infants and children vs adults,” Leung says. “In early development, the thyroid gland is still immature, and thus even small insults to adequate thyroid hormone production may be enough to have clinically significant effects. Historically, soy-based infant formula did not universally contain iodine, thus there had been reported cases of soy formula–induced hypothyroidism. Currently, iodine is a required component of infant formula, thus this is no longer a concern.”

But the issue of soyfoods having a potential effect on thyroid health emerged again in 1999 during the approval process of a health claim for soybeans and coronary heart disease. FDA researchers raised concerns about the possibility of soybean isoflavones inducing goitrogens, substances that disrupt the production of thyroid hormones by interfering with iodine uptake in the thyroid gland.6,7

To understand how soy may affect thyroid health, it’s important to review iodine’s role and basic thyroid gland function. Iodine is an essential trace mineral naturally found in seawater, kelp, dairy, and grains, and fortified in salt.8 Only thyroid cells can absorb iodine, as the thyroid gland functions to take up the mineral and convert it into thyroxine, the major hormone secreted by the thyroid gland.

Thyroxine is also called T4 because it contains four iodine atoms. To be effective, T4 loses an iodine atom to convert to triiodothyronine (T3), which is unbound and able to enter and affect body tissues, including the brain.9 These hormones regulate many key biochemical processes (including protein synthesis and enzyme activity). They’re critical determinants of metabolism and are required for normal development in both fetuses and infants. Thyroid function is regulated by thyroid-stimulating hormone (TSH) secreted by the pituitary gland, which triggers the thyroid to take up iodine.

Without adequate iodine, TSH levels remain high, leading to goiter—an enlargement of the thyroid gland, reflecting the body’s failed attempt to sequester iodine from circulation. Thus, hypothyroidism ensues, with an occurrence rate of approximately 5 out of 100 people.10

Most cases of hypothyroidism are caused by an underactive thyroid gland and are relatively mild. Though hypothyroidism can’t be cured, the condition can be controlled with a prescribed synthetic thyroid medication. For maximum effectiveness, the medication should be taken on an empty stomach, at least three hours after eating food and at least 30 to 60 minutes before consuming food.11

Soy-Thyroid Research Debate

The ongoing debate among the research community about soy consumption and thyroid health has been long and controversial. In vitro studies have demonstrated that soy inhibits thyroid peroxidase (TPO), an enzyme involved in the synthesis of T3 and T4.7 There also has been much speculation that, for certain population subgroups, soyfoods and isoflavones may adversely affect thyroid function in susceptible individuals by interfering with the absorption of synthetic thyroid hormone.

As mentioned, the goitrogens in soy interfere with the uptake of iodine in the thyroid and can exacerbate iodine deficiency.8 Yet in a 2006 narrative review that evaluated 14 clinical trials, the authors concluded that neither soy nor isoflavones affect thyroid function in euthyroid individuals.12 The review authors acknowledged that more research needs to be conducted to address two issues: whether soy has any effect on patients with a compromised thyroid function, and whether the legume is detrimental to thyroid health in patients whose iodine intake may be inadequate.

Research later addressed the iodine issue in a 2012 study on menopausal women taking phytoestrogen dietary supplements. Subjects with adequate iodine intake weren’t at risk of developing any thyroid gland disorders.13

To determine soy’s effect on those with a compromised thyroid function, a randomized, double-blinded, crossover study of 60 patients with subclinical hypothyroidism were randomly assigned to take either a low-dose phytoestrogen supplement—30 g soy protein with 2 mg phytoestrogen (representative of a Western diet)—or a high-dose phytoestrogen supplement—30 g soy protein with 16 mg phytoestrogen (representative of a vegetarian diet).14

Results showed a three-fold increased risk of developing overt hypothyroidism with the high-dose supplement. Data also suggest that the risk of developing overt hypothyroidism was much higher in females. The authors suggested that this subgroup of people with subclinical hypothyroidism may need more careful monitoring of thyroid function.14 Lee agrees: “Only in this one category of subclinical hypothyroidism should people be concerned” about high soy intake. “The vast majority of people should have no problems at all (with thyroid function) consuming soy,” she says.

More recently, this same research group published results from another double-blinded crossover study that examined the effect of a pharmacologic dose of soy phytoestrogens on thyroid function in subjects with subclinical hypothyroidism. Forty-four patients were randomly assigned to receive either 66 mg phytoestrogens with 30 g soy protein or 0 mg phytoestrogens with 30 g soy protein. Results showed that the 66-mg pharmacologic dose of soy phytoestrogens didn’t change thyroid function in patients with subclinical hypothyroidism.15

Seventh-day Adventists, whose doctrine encourages followers to eat a plant-based diet when feasible, have been a demographic that has proven to be a good resource for epidemiologic data.16 Many Seventh-day Adventists who follow a vegan diet consume an average of 8 to 12 g soy protein daily.

One observational study examined the relationship between soy consumption and thyroid function among Seventh-day Adventists.17 Approximately one-half of the study cohort of 800 men and women aged 30 and older were vegetarians. None of the study subjects were on thyroid medication. Over a six-month period, subjects completed six 24-hour diet recalls that were compared with blood levels of TSH.

Researchers found that subjects who ate just under two servings of soyfoods daily, compared with those who didn’t eat any soy, were four times more likely to have a high TSH. These findings were evident only among female subjects; there was no association found in men. Higher TSH levels were found in women who followed either a vegan or lacto-ovo vegetarian diet. The women in the group eating the most soy averaged about 11 g per day, or about two servings.

According to Serena Tonstad, MD, PhD, an endocrinologist from the University of Oslo and the lead author of the study, women appear to have a higher risk of developing thyroid problems, especially with age.18 This study didn’t look at levels of T4 or T3 thyroid hormones.

More recently published, a systematic review and meta-analysis of 18 randomized controlled trials investigated the link between soy or soy product consumption and thyroid function via the measurement of thyroid hormone levels. The studies intervened primarily with soy protein or isoflavone supplements with doses ranging from 40 to 200 mg per day. Results showed there was a modest yet significant increase in TSH as a result of soy protein and/or isoflavone supplementation. However, the analysis found no effects of the intervention on the two primary thyroid hormones, free T4 and free T3, suggesting that, clinically, this may not be significant. The authors concluded that, overall, soy supplementation has no effect on thyroid hormones.19 “In adults, most studies have shown that soy intake does not appear to adversely affect thyroid hormone production, although there are some limited data suggesting impacts to the thyroid axis in basic and animal studies,” Leung says.

Counseling Cues for RDs

According to Lee, there’s “lots of hearsay, but not a lot of good science” demonstrating that soyfoods are detrimental to thyroid health. RDs can address consumer confusion about soyfoods by explaining that conflicting outcomes in nutrition research can be attributed to variables such as the difference between animal and human studies, as well as the type of soyfood being tested, be it fresh soybeans or soy protein isolates.

The Nutrition Source at the Harvard School of Public Health, an online research and academic resource for consumers and professionals, also emphasizes this point: “Soy is a unique food that is widely studied for its estrogenic and antiestrogenic effects on the body. Studies may seem to present conflicting conclusions about soy, but this is largely due to the wide variation in how soy is studied. Results of recent population studies suggest that soy has either a beneficial or neutral effect on various health conditions. Soy is a nutrient-dense source of protein that can safely be consumed several times a week and is likely to provide health benefits—especially when eaten as an alternative to red and processed meat.”20

Despite lingering concerns over soy’s effects on thyroid health, RDs can discuss how soyfoods can be part of a balanced diet. Soyfoods contain high-quality protein, comprising all nine essential amino acids. Soyfoods also are rich in B vitamins, fiber, potassium, and magnesium. Adults with hypothyroidism also can consume soyfoods without any detrimental effects.

Although soy has been shown to inhibit the absorption of synthetic thyroid hormone replacement medication, RDs should remind patients to consume all food, including soyfood, at least three hours before or one hour after taking the medication.21

Individuals who consume soyfoods regularly and have subclinical hypothyroidism, as determined by a high TSH level, and/or those whose iodine intake is marginal, must be counseled on ways to achieve adequate iodine intake. In fact, all individuals—independent of soy intake—should consume adequate food sources of iodine, including kelp, dairy, grains, and iodized salt. (See “Update on Iodine” in the December 2018 issue of Today’s Dietitian.)

As evident from the research, women—especially women older than 60—along with those who follow a strict high-soy, vegetarian, or vegan diet with subclinical hypothyroidism, may need additional monitoring for irregularities in thyroid hormone levels.

Finally, as with any food recommendations, it’s best to obtain soy from whole food sources—before they’ve been highly processed with the addition of substances (eg, sodium, modifiers, preservatives) or the removal of beneficial nutrients (eg, fiber, isoflavones) that change the nutrient density of the food. Industrial processing separates the oil and protein from the soybean for soybean oil and isolated soy protein. And, Lee says, “isolated soy protein has very little isoflavones.”

Edamame is the least processed source of soy and can be found fresh seasonally or frozen in the shell or shelled. When edamame is aerated to remove moisture, the result is dried soybeans. Tofu is made from dried soybeans that are ground in water, heated, and coagulated with minerals such as calcium or magnesium salt. The curds are then pressed into a block and may or may not be seasoned with flavorings. Soymilk, a stable emulsion of protein, water, and oil, is made by soaking and grinding soybeans before filtering out particulates.

Eating a couple of servings of any of these minimally processed soyfoods on a regular basis can be part of a healthful diet for most people.

Source: Today’s Dietitian

Many Older Adults Face New Disabilities After Hospital Stays For Serious Illnesses

Older adults often face new disabilities after a hospital stay for a serious illness. Among the problems they may need to adjust to are difficulties with bathing and dressing, shopping and preparing meals, and getting around inside and outside the home. These new disabilities can lead to being hospitalized again, being placed in a nursing home, and more permanent declines in well-being. The longer a serious disability lasts, the worse it can be for an older adult.

To learn more about this issue, a research team studied information about a particular group of people. They looked at individuals who were hospitalized for a medical issue but did not require critical care. The study was based on data from the Precipitating Events Project (PEP), an ongoing study of 754 people, aged 70 or older, who lived at home at the beginning of the study. At that time, the participants were not disabled and did not need assistance in four basic activities: bathing, dressing, walking inside the house, and getting out of a chair. The researchers published their study in the Journal of the American Geriatrics Society.

The participants were examined at home at the start of the PEP study and then again every 18 months, while telephone interviews were completed monthly through June 2016.

In all, 515 participants were included in the study. They were mostly around 83 years of age and had a medical hospitalization. The participants shared medical problems related to their age, living alone, and having little social support.

At months one and six after hospitalization, disability was common for study participants and interfered with their ability to leave home for medical care. Disabilities included being unable to get dressed, walk across a room, get in or out of a chair, walk a quarter-mile, climb a flight of stairs, and drive a car.

Disability at months one and six after hospitalization was also common for the kinds of activities people need to take care of themselves, including meal preparation and taking medications.

Of the people in the study, many had new disabilities after hospitalization:

  • 31 percent were newly unable to bathe themselves
  • 42 percent couldn’t do simple housework
  • 30 percent had problems taking their medications
  • 43 percent were unable to walk a quarter-mile

For those who did recover from a disability, it took between one to two months following hospitalization. Recovering also appears to have a connection to being able to perform most daily tasks, except driving. Recovering the ability to drive following a hospitalization was less common.

In many cases, recovery was incomplete even six months after hospital discharge. For example, the proportion of people who were not disabled at six months was just 65 percent for bathing, 65 percent for meal preparation, 58 percent for taking medications, and 55 percent for driving.

The research team concluded that many older adults discharged from the hospital after a serious medical illness are disabled in specific activities important for leaving the home to access care and self-manage their health conditions. They also noted that these disabilities are often new following hospitalization. Recovery from disability is frequently incomplete six months after discharge, even among persons who return home in the month after hospitalization.

Source: Health in Aging


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