Problems Walking? It May Be Your Arteries, Not Your Age

One of the main causes of discomfort is peripheral artery disease.

By Elizabeth Ratchford, M.D., Contributor | April 6, 2017, at 6:00 a.m.

A senior couple takes a walk in nature.

People may notice trouble walking or keeping up with their friends as they get older, which can be caused by many things. Sometimes, it’s due to arthritis or pressure on the spinal cord. Other times, it may be due to weight gain or lack of exercise. However, difficulty walking should not be considered a sign of normal aging. Difficulty walking may be a sign of cardiovascular disease, with one of the main causes of discomfort being peripheral artery disease.

What is peripheral artery disease?

Peripheral artery disease, also referred to as PAD, is a condition affecting the arteries – the blood vessels that carry blood from the heart to the rest of the body. In peripheral artery disease, the arteries narrow or are blocked by plaque buildup, a process called atherosclerosis. Atherosclerosis can affect arteries throughout the body. When the heart’s arteries are blocked, the condition is called coronary artery disease. When leg arteries are blocked, it’s considered peripheral artery disease. Tiredness in the legs or pain may be the first sign of a problem.

Peripheral artery disease is common. Up to 12 million Americans have it, and it affects up to 12 percent of the adult population. The rates are even higher among high-risk groups. For example, up to 29 percent of people 70 or older, or those 50 to 69 with a history of smoking or diabetes have peripheral artery disease. The majority of people with it are current or former smokers. Diabetes is also an important contributing factor.

What are the symptoms of peripheral artery disease?

Many people with peripheral artery disease have no symptoms at all. Plaque builds up in the arteries, but it doesn’t always disturb the flow of blood through the vessel, meaning it won’t cause any symptoms.

Typical symptoms of peripheral artery disease include a cramp or ache in the calf muscle, which comes on with exercise and goes away with rest. The feeling may be leg fatigue or heaviness, like walking in cement. It also may feel like a charley horse or a burning sensation. It may be in one leg or both legs; one leg may be worse than the other. Symptoms of peripheral artery disease occur because the muscles are not getting enough oxygen due to the narrowing of the artery or arteries. The muscles require more oxygen during exercise, but the blocked arteries are not able to supply enough blood flow, which leads to pain. Different muscles may hurt depending on which artery is blocked. The calf is the most common location, but symptoms can also occur in the hip, buttock or thigh.

Though the blockages build up over a long period of time, sometimes patients with peripheral artery disease can look back and pinpoint a specific day that they noticed the onset of their symptoms. This day is usually a time when they pushed themselves more than usual, like walking a long distance from the parking lot to a football or baseball game. During this long walk, they noticed that they had to stop to rest and weren’t able to keep up with their companions due to leg discomfort.

One key feature of peripheral artery disease is that the symptoms happen with walking or exercise, but they don’t occur with standing for long periods. Pain with standing is often related to problems in the spine.

How is peripheral artery disease diagnosed?

The main test for peripheral artery disease is the ankle-brachial index. A vascular technologist will place cuffs on the ankles and arms to measure the blood pressures. A hand-held Doppler uses ultrasound waves to detect the flow in the arteries, and then the ratio is calculated to figure out the ABI. Normally, the ankle pressure is higher than the arm pressure. A low ankle pressure (or an ABI less than 1.0) means that the artery is likely blocked.

Ultrasound is noninvasive and relatively inexpensive. Other more complex tests, such as computed tomography angiography or magnetic resonance angiography, are sometimes ordered by vascular specialists to plan how to fix the blocked arteries.

If I have been diagnosed with peripheral artery disease, how can I reduce the risk of complications?

The most dangerous peripheral artery disease complications are the associated cardiovascular problems, such as heart attack or stroke. Most of the time, the leg symptoms improve or stabilize, but the cardiovascular risk remains. Blocked leg arteries mean that arteries may be blocked in other places in the body; a heart attack may occur if the heart arteries are blocked, or a stroke may occur if the blood vessels in the neck or brain are blocked.

The first step toward lowering the risk of complications is to treat the issues that led to the clogged arteries in the first place. Quitting smoking is absolutely critical. Controlling diabetes, high cholesterol and high blood pressure is important, along with maintaining a healthy weight. A doctor can prescribe medications to reduce the risk of heart attack and stroke, which may include:

  • A blood thinner, such as aspirin or clopidogrel, to prevent clots from forming in the narrowed arteries.
  • A statin to lower cholesterol, which slows the plaque accumulation in the arteries and reduces the risk of heart attack and stroke. Statins are vital in patients with peripheral artery disease, regardless of their cholesterol levels.
  • An ACE inhibitor, such as ramipril, to treat the blood pressure, delay the plaque buildup and reduce cardiovascular risk.

Taking good care of the feet is essential to prevent sores or ulcers from developing; even minor wounds may not heal due to impaired circulation caused by peripheral artery disease.

How are the symptoms of peripheral artery disease treated?

Physicians call the symptom of leg pain with walking claudication. The main treatment for claudication is exercise. Since the 1960s, supervised exercise programs have been shown to be quite effective at improving leg symptoms. The ideal program is similar to cardiac rehabilitation and consists of walking on a treadmill under supervision for 30 to 60 minutes at least three times per week for 12 weeks.

The approach uses start/stop exercise that involves walking to the point of moderate discomfort, then stopping until the discomfort subsides completely, and then starting to walk again. Ideally, that point of moderate discomfort should happen within the first five to seven minutes, which over time may require increasing the pace or using an incline. Patients with peripheral artery disease should reach 30 to 60 minutes of walking time every day, not including the rest periods. Within a few weeks, they will see improvements. The change is gradual and may not be obvious from day to day, but it will be clear from week to week or month to month. Thus, keeping a chart or diary can be helpful to monitor the progress.

A regular walking program will help improve not only the symptoms of peripheral artery disease, but also overall cardiovascular health. As the fourth-century B.C. Greek philosopher Diogenes said, “Solvitur ambulando,” which means “It is solved by walking.”

What are the other options?

If the leg symptoms are still interfering with daily life after three months of an aggressive exercise regimen, then other treatment options may be considered. The medication cilostazol may be prescribed to improve the claudication symptoms, though it has some unpleasant side effects. Cilostazol dilates the blood vessels, but how it works to improve the leg pain is not completely understood. In more severe cases, restoration of blood flow may be required to relieve the pain or to heal a wound. Advanced imaging, such as CTA or MRA, may be needed. Then, a vascular specialist will often perform an angiogram, which is a procedure that uses injected contrast (dye) to visualize the blood vessels. The team may use balloon angioplasty to open up the blocked artery and then insert a stent to keep the artery open. Bypass surgery may be needed to reroute the blood flow around the blocked artery if the balloon and stent procedure isn’t possible. However, the large majority of people with peripheral artery disease do well with medications and a good exercise regimen.

Take-Home Points

1. Difficulty walking can be a sign of peripheral artery disease. You should see your doctor if you develop this problem.

2. Peripheral artery disease symptoms vary and may include a cramp or ache in the leg that comes on with walking and goes away with rest.

3. Diagnosing peripheral artery disease is done via a simple blood pressure cuff test called the ankle-brachial index, or ABI.

4. Treatment of peripheral artery disease focuses on decreasing the risk of heart attack and stroke, and improving the leg symptoms. To achieve these two goals, patients should have regular medical visits with a vascular specialist who is experienced in treating this condition.

5. A walking regimen, either at home or in a supervised setting, is effective in improving the leg symptoms.

12 Springtime Activities for Seniors

Posted On 05 Apr 2016

There’s just something so rejuvenating about spring. Whether it’s the birds chirping, flowers or sunshine; spring does wonders for the senior soul.Springtime Activities for Seniors

Springtime is a favorite season for seniors because many of them are retired and have spent the winter being cooped-up indoors. There’s nothing like breathing fresh air, feeling the warmth of the sun on the skin and soaking in a little Vitamin D to renew the spirit and enhance quality of life. Being closer to nature, going on outings and socializing help break the monotony of daily living that can often be boring for seniors.

Springtime Activities for Seniors

Taking some time to partake in fun springtime activities can help to not only improve cognitive function but happiness as well, according to the National Institute of Health. Even if mobility is a problem, you can choose adventures and venues that cater to the handicap and are wheelchair accessible.

Here are a few favorite springtime activities for seniors that are good for the soul:

1. Choose a local park or nature trail for walks.

Many landmarks, local parks and even nature trails are appropriate for seniors (and are wheelchair accessible)! Do a little research ahead of time to find out what outdoor nature destination is a good choice for your loved one.

2. Visit a farmers market.

There’s nothing like fresh fruits, vegetables and local arts and crafts to inspire elders. Getting out into the fresh air with other adults, children and often pets is also beneficial for seniors. It might be fun to choose a recipe before the outing to help inspire the palette with organic food as you peruse the market.

3. Partake in spring cleaning.

When there’s light outside coming in through the windows, clutter and dust are suddenly visible. It’s always healthy to do a little spring cleaning to create a comfortable ambiance. You might even want to put up a spring wreath and other fresh decorations. Here are some decorating tips to help with the transformation.

4. Go fishing.

If your elderly loved one is mobile, you can venture to many fishing spots, but even those who are wheelchair bound can cast from a pier or bridge over a creek or river. Peruse your area for the perfect fishing spot.

5. Enjoy tourist attractions.

Whether it’s local landmarks, historical sites or sporting events, tourist attractions are good for the mind and for combating cabin fever. Let your senior choose their destination.

6. Eat outdoors at a fancy restaurant.

Good company, food and a fancy ambiance are all a recipe for success for your elder. Satisfy their palate and take time for quality bonding.

7. Visit a nursery.

Nurseries are an excellent place for seniors to visit because they can partake in their indoor and outdoor plant preferences, which adds to the excitement factor. Beautifying both indoors and outdoors provides some color and enjoyable ambiance for your senior.

8. Go on a picnic.

Pack a delicious lunch with a comfortable blanket and enjoy the outdoors, picnic style. You can bring binoculars for bird watching, books to read, or cards for some outdoor game-fun.

9. Invest in a bird feeder for bird watching.

Birds provide beautiful visuals and entertainment for seniors, and springtime bird chirping signals the opportune time to invest in a feeder. Whether blue jays or hummingbirds, bird feeders attract nature to your yard. You and your elder can even build your own for a little extra fun.

10. Watch the Food Network for savory spring recipes.

The Food Network offers great cooking shows and recipe ideas for springtime rejuvenation and healthy living. Watch a show with your loved one and compliment the meal with one of these delicious water-infused recipes.

11. Plant an herb garden.

To go along with healthy eating, a modest herb garden provides not only gardening fun, but also healthy and tasty ingredients for your favorite dishes.

12. Go see a show.

Whether a local theatre production or a fancy opera; getting dressed up and having a fun evening watching a show adds not only a little fun to senior-life, but also some culture.

Have we left anything out from our springtime activities for seniors list? Please share your suggestions with us in the comments below

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Aging While LGBT: Unique Challenges and Inequities

Resilience and community support help buffer seniors from health disparities.

By Lisa Esposito, Staff Writer | March 8, 2017, at 11:01 a.m.

Aging While LGBT: Unique Challenges and Inequities
Senior man resting hand on side of armchair, close-up of hand

Many older LGBT adults who need assistance from residential facilities fear potential victimization and discrimination from other community members. (GETTY IMAGES)

Whether it’s transgender teens trying to find informed providers to help them navigate their life-changing physical transformations; lesbians who are less likely than others to get preventive breast-cancer care; or gay and bisexual men who had to push an indifferent health care system to respond to the early AIDS epidemic, LGBT individuals have faced many challenges in the health space. As researchers look for ways to improve LGBT health, one issue hasn’t received much attention with respect to this population, although it is an equal-opportunity process: aging. Now, groundbreaking research is taking a closer look at the unique ways middle-age and older LGBT adults experience getting older, revealing some key obstacles and disparities.

The National Institutes of Health-funded study tracking more than 2,400 LGBT U.S. adults shows gaps in their physical and emotional health, as well as widespread concerns about safe options for accessing high-quality health care and long-term care.

An estimated 2.4 percent of the older population self-identifies as LGBT, with many more who haven’t yet “come out,” according to Karen Fredriksen-Goldsen, principal investigator of the multifaceted study, “Aging With Pride: National Health, Aging and Sexuality/Gender.” “We need to develop interventions to reduce disparities, promote health in these communities, and ensure we have services for these older adults that are culturally competent,” she says.

On the brighter side, her research team also discovered the health-promoting power of resilience among LGBT seniors who are leveraging communities of mutual support. That support, she found, can provide a buffer, of sorts, against some of the disparities identified.



LGBT Caregiver Perspectives

Sexual and gender orientation raise unexpected issues.

Fredriksen-Goldsen highlights some of the most important study findings:

  • More than two-thirds of participants had experienced victimization, such as physical and verbal assaults, and discrimination more than three times in their lives, says Fredriksen-Goldsen, who is also a professor of social work and director of the Healthy Generations Hartford Center of Excellence at the University of Washington.
  • “LGBT seniors are more likely to have poor general health, more chronic conditions, higher rates of disability and more psychological distress,” she says. Discrimination and victimization are the strongest predictors of poor aging, she adds. In particular, gay and bisexual older men are more likely than heterosexual men to have poor general health and to live alone.
  • Lesbian and bisexual older women have higher rates of cardiovascular disease, and are more likely than heterosexual women to have multiple chronic conditions. “In our study, about 47 percent have a disability,” Fredriksen-Goldsen says. “And disability starts at younger ages, likely due to higher rates of chronic conditions and other stressors.”
  • Among LGBT people, transgender and bisexual older adults are at even greater risk for victimization and discrimination, and bisexual and transgender adults are more likely to live in poverty, which heightens their risk for health care disparities and poor health.
  • Within the LGBT population, greater health disparities exist for older adults in racial and ethnic minority groups, Fredriksen-Goldsen says. However, she adds, “religious and spiritual activities are also greater in those communities, which tends to offset some of the risks.”
  • Social support matters. “We do find that even though there are many disparities, most LGBT older adults are aging well and have good health,” she says. “Linked to that, we keep finding consistent predictors are greater levels of social support, less victimization and discrimination, more community engagement and a sense of community connectedness and belonging.”

Social Health

While she wasn’t part of the study, 72-year-old Rita Smith – who came out as a lesbian in the 1970s – embodies that sense of connectivity and social engagement. A retired community education director for recycling and waste prevention in Seattle, Smith now throws herself into activities from serving on the board of the nonprofit Generations Aging With Pride to pruning fruit trees in Seattleites’ yards and teaching them to prune via workshops – a carryover from her “idyllic” childhood among apple orchards. “It’s a way to be out with there and celebrate the fact that I’m relatively fit and capable,” she says. And her health is fine. “It could be better if I were more diligent with my exercise but I feel quite healthy,” Smith says.

Unfortunately, Smith’s situation is not the case for everyone. Past and present social biases affect the quality of care LGBT people receive – a 2009 national survey, for example, found that some LGBT patients were being refused needed care and that some health professionals were refusing to touch them – as does their attitude toward the health care system on which they become more dependent with age.

Health Consequences

Unhealthy habits that people maintain as young adults – such as smoking, overeating, being sedentary and heavy drinking – catch up to most people with age. But health consequences may be more likely in LGBT seniors, says Dr. Jesse Joad, president of GLMA: Health Professionals Advancing LGBT Equality, a U.S.-based association whose members include LGBT physicians, nurses, physician assistants, researchers and other health professionals in several countries. One example is that lesbians and other sexual-minority women tend to be more obese, she notes. The result, she says, is higher risk for heart disease, arthritis, stroke and Type 2 diabetes.

How to Come Out to Your Doctor as an LGBT Patient

With inclusive health care, there’s much less need for a big reveal.

LGBT people tend to smoke more than others, Joad says, raising their risk of chronic pulmonary obstructive disease, or COPD, and lung cancer. Added to all this is a reluctance in some LGBT people to seek out preventive health care, including screening exams like mammograms, and medical treatment for existing health problems, due to concerns about health care biases.

Evidence shows transgender people, in particular, are more resistant to seeing health providers. “Either they have been treated poorly in the past, or they’re just aware of what has happened to other people,” Joad says.

Stigma is at the root not only of health care disparities but many unhealthy behaviors in the LGBT community, Joad adds. For instance, she says, higher rates of substance abuse, smoking and problem drinking “are thought to be the ways LGBT people have coped with the stigma they face all the time.”

For Smith, substances were never an issue. “I had not been inclined to be a drinker or smoker,” she says. But others were. “Part of the reason the [Seattle-based] Lesbian Resource Center existed back in the 60s [was] it had been founded by people who were recognizing that the only place lesbians were getting together were bars,” she recalls. “So the LRC was intentionally alcohol-free.” While alcohol can act as a social lubricant, it can also provide a dicey refuge for isolated people who don’t feel accepted.

Coming out as LGBT is considered empowering and emotionally healthy. However, staying out can be tricky for older people who need assistance from in-home caregivers or residential facilities, especially if they fear potential victimization and discrimination.

“Many of the LGBT seniors, especially if they have increased needs, and don’t have the support around them, say that they feel that they have to go back into the closet when they’re most vulnerable,” Fredriksen-Goldsen explains. “If they’re going to go live in a long-term care facility, certainly it can create isolation for them.”

LGBT study participants shared fears that some facility residents might be biased, and some reported feeling bullied by other residents. “Facilities need to consider how they’ve provided a welcoming environment,” Fredriksen-Goldsen says.

Smith and her friends are at a stage where they visit others in their social circle who now live in residential facilities, and also consider their own future options. As a rule, they don’t feel particularly drawn to any of the sites. “It’s not necessarily so much that we think it would be a horrific kind of setting, but just an uncomfortable place where we feel that we don’t necessarily belong,” she says. “Where we can’t be our whole selves.”

However, she adds: “For me – bless the women’s movement – I’m more inclined to say, ‘They’ll just have to get over themselves.’ And I do tend to be pretty bold in terms of standing up for myself.”

Warning Signs a Senior Shouldn’t Be Driving

4 signs you may need to take away the keys.

Wondering at what point you should have a conversation with your parent or aging loved one about their driving abilities? Is it time to take away the keys? There are a number of issues you should take into account. It would be a lot easier if we could just assign an age when people are no longer safe drivers, but as a group, seniors are relatively safe. They’ve got years of experience behind the wheel and they tend to self-regulate when and how much they drive.

Jody Gastfriend, LICSW and VP of Care Management at lists the following considerations for deciding if it is safe for your loved one to continue driving. (If needed, get tips on talking to your parent about driving.)

  • Health status. There are various medical conditions that can decrease a person’s ability to drive safely. For example, arthritis can affect a person’s ability to move and notice obstacles when switching lanes or backing out of a parking spot. Dementia can decrease a person’s ability to obey the laws of the road and increase the likelihood of getting lost. If you’re getting concerned, schedule an appointment for your senior and a trusted physician and call ahead of time to let the doctor know what you’re worried about. When you attend the appointment, you can discuss whether your senior is considered healthy enough to drive safely.
  • Medications. Some medications can have side effects which make it unsafe for a senior to drive. Make sure you ask the doctor about potential side effects of medication before your senior begins taking it. And if your senior is taking medication that would cause him to be unsafe without — consider strategies to prevent medication errors. You might even want to count the number of pills to ensure they’ve been taken on a regular basis.
  • Recent driving record. Have there been fender-benders, near misses, or unexplained bumps and scratches on the car? These can be warning signs that your parent’s driving abilities are not what they should be.
  • Observable differences. If you can, arrange to be in the car while your loved one is driving. Observation of your parent’s abilities is one of the better ways to evaluate if it is time to have a discussion. Keep an eye out for errors with signaling, difficulty turning, driving at inappropriate speeds (too fast or too slow), increased agitation or irritation, failure to stop at a stop sign or red light, and delayed response to unanticipated situations.

Consider this: Your senior doesn’t have to take an all or nothing approach. It is possible to safely drive on local roads at speeds under 45 miles per hour, while avoiding long distances on the highway. This is an example of self-regulating one’s driving.

Additionally, there are tests that can evaluate a person’s ability to operate a car. A driving assessment may be available at the local Department of Motor Vehicles, rehabilitation center, Veterans Administration medical center, or hospital. According to the Hartford Financial Services Group, Inc., these evaluations usually cost between $200 and $500 and are rarely covered by insurance, but it may be well worth the expense.

If you are unsure whether it is time to speak with your parent about driving, ask yourself how comfortable you feel with your parent driving other people. If you do not want them driving grandchildren, it is probably time to have a conversation.