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Tips for Healthy Aging
(summer 2003)

Maintaining emotional and intellectual fitness is critical for healthy aging. People who are socially and emotionally isolated live a shorter life of poorer quality than people who are active in their community do. The following tips and resources can help you on your way to maximizing your later years.

Challenge Yourself Mentally: Exercise your brain by going back to school, participate in elder hostel programs, or take a course. Read, use the Internet, play board games and solve crossword puzzles.

Keep Emotionally Fit: Stay involved with friends, neighbors and your community. Stay connected through volunteer work in your community or at your church or temple. Offer to help out at a local school or hospital. Or, provide part-time consulting expertise.

Stay Physically Fit: Do what you enjoy doing, always consulting with your physician before beginning a new exercise program. Walk, swim, take aqua aerobics classes, bicycle, and lift weights.

Make and Keep Appointments with Your Doctor: Get checkups appropriate for your age group. Particularly if you have multiple chronic medical conditions, it's important to have a primary care physician who can coordinate your care. Write down questions and concerns to take with you to your visit. Jot down any symptoms you are having. Keep up with immunizations, such as flu shots.

Drive Safely: As we age, our reflexes get slower. If some driving situations are hard, such as at night, at rush hour, or on highways, avoid these types of conditions. Like all good drivers, don't drive under stress or when you're tired. Keep distractions, such as the radio, to a minimum. You may want to check out the American Association of Retired Persons Driver Safety Program or the American Automobile Association's Safe Driving for Mature Operators course. If you are finding that other drivers often honk at you, you have had some accidents, or have had family, friends or doctors express concern about your driving, please think seriously about whether or not you are still a safe driver. Although giving up driving can be isolating, it can cut your costs (the cost to own the average car is over $6500 per year). Public transportation, community transportation, and taxi costs will probably be cheaper.

Manage Your Money Wisely: Consider using the services of a professional financial planner whom you trust, if managing money is not your forte. Don't divulge confidential information to strangers, nor count on "get rich quick" schemes.

Control Incontinence: Neurological, medical, psychological and environmental factors can all cause incontinence, the inability to control your bladder. Take measures to help control incontinence: drink plenty of fluids (which may seem counter-intuitive), use the bathroom before leaving the house or going to bed, lose weight, exercise, avoid caffeine, spicy foods and alcohol. Also check with your doctor about whether any of your medications may be contributing to incontinence.

Eat Wisely: Older people are at an increased risk of health problems from poor nutrition. Learn about nutrition and low-fat, low-cholesterol foods. If you are having difficulty preparing meals or shopping for food, consider a meal delivery program, shopping service, on-line food delivery, or hiring a home health aide to assist you. The Massachusetts Executive Office of Elder Affairs can direct you to local community resources.

Keep Your Home Environment Safe: Tack down loose electrical cords or throw rugs. Be sure your home is adequately lit. Check to see if smoke detectors are in working condition.

For additional information about healthy aging, and for elder care resources, take advantage of the LifeBalance® program, provided by your life insurance benefits. Members of the Indemnity Plan, PLUS Plan, Indemnity Medicare Extension Plan (OME) and Commonwealth PPO also have EAP benefits and comprehensive web site resources through United Behavioral Health (access code: 10910). If you are a manager or supervisor with employees preparing for retirement, Sue Cooper, the GIC's EAP Coordinator provides complimentary seminars on easing into the transition of retirement.

"20 Minutes, 2-3 Times a Week" - Incorporate Anaerobic Exercise
Into Your Schedule
(spring 2002)

While many people associate weight training with hard-bodies or big muscles, anaerobic training, which can include weight training or resistance training, is effective in stimulating muscle and maintaining bone strength. Research by the American College of Sports Medicine shows that weight training can reverse declines in strength, bone density and muscle mass that comes with aging. If bone density and strength become too fragile, the bones are likely to break under even light strain. This condition is called osteoporosis, which develops as people get older and bones become brittle. You can help prevent osteoporosis through eating a well-balanced diet and engaging in weight-bearing activities that build up muscle and maintain bone strength.

Enrollees of all ages can benefit from weight training. Contrary to popular belief, enjoying the important benefits of weight training does not require 90 minutes every day. In fact, just 20 minutes, two to three times a week can significantly increase your body strength, improve muscle mass and help:
§ Maintain healthy bones
§ Control weight/complement weight-loss programs
§ Increase your body's strength and endurance
§ Improve energy and outlook
§ Develop coordination and balance
§ Improve your heart's health and lower high blood pressure
§ Enhance sleep

While the virtues of weight training are many, it can be dangerous if performed improperly or without proper supervision. Individuals with health ailments, such as high blood pressure, back problems, or hernias, should consult a physician before beginning a weight-training program. Warm-up, cool-down and stretching activities, which should be included in each routine, will help you to avoid injury and maximize effectiveness.

The following GIC health plans offer health club discounts. Contact plans for details.

Fallon Community Health Plan: Discounts on enrollment or membership fees from over 90 participating facilities in Central Massachusetts.
Fallon Senior Plan: Eligible members receive a basic fitness facility membership at one of 90 participating facilities with specialized low-impact SilverSneakers® Fitness Classes, at no additional charge.
Navigator by Tufts Health Plan, Tufts Health Plan, and Secure Horizons: 20% discount on annual enrollment fee at 80 participating facilities.
Commonwealth Indemnity Plan, PLUS, and Medicare Extension: 25% to 60% off monthly fees at 59 Massachusetts GlobalFit network health clubs.
Harvard Pilgrim Health Care: Discounts on over 200 Massachusetts fitness locations.
Health New England: Discounts on health clubs and other facilities in the American Specialty Health network.

Patients - Do Your Part to Reduce the Overuse of Antibiotics
( Winter 2004)

Misuse and overuse of antibiotics has led to decreased effectiveness of antibiotics because of the emergence of bacteria that are resistant to them. If you take antibiotics and don't need them, the drugs lose their ability to kill bacteria when you need them. You can help preserve antibiotics' effectiveness:
· Get plenty of rest, fluids, exercise, and eat a balanced and health diet.
· Never take antibiotics for viral infections like colds or flu.
· Don't insist on an antibiotic if your doctor doesn't think one is necessary.
· If you are prescribed an antibiotic, follow the instructions as listed on the label and COMPLETE the entire course of the prescription, even if you are feeling better.
· Wash your hands often. Regular soap is just as effective as antibacterial soap.
· If you have children, check with your pediatrician to make sure their immunizations are up to date.

Pressing Your Doctor for Antibiotics Not Worth the Risk
(Fall 2001)

Cold and flu season will soon be here. And with it, the desire to have the corresponding misery eliminated. If your doctor says that you, or your child, do not need an antibiotic, don't press him or her for one. Although it is discouraging to leave a doctor's office without "a cure-all", know your doctor is doing you a favor by not prescribing an antibiotic. In fact, prescribing an antibiotic for a virus can put you at risk for illnesses from bacteria that have become resistant to antibiotics because of overuse.

The Centers for Disease Control estimates that one-third of outpatient antibiotic prescriptions are unnecessary. Overexposure to antibiotics kills benign bacteria, creating more opportunity for resistant bacteria to grow. As a result, diseases that once were easily curable are now difficult to treat or can even be fatal.

Some examples: In the 1980s only 5% of streptococcus pneumoniae (which causes cystitis, bronchitis, and ear infections) was resistant to penicillin. Now 25% to 30% of these infections are resistant to antibiotics. Antibiotic-resistant Staphylococcus aureus (Staph infection) is now common in American hospitals. The United States, Canada, and Europe have had outbreaks of drug-resistant salmonella food poisoning.

Lower your risk for antibiotic resistance:
· Don't press your doctor for antibiotics to treat viral infections; get rest, fluids, and over-the-counter painkillers recommended by your doctor
· When prescribed an antibiotic, take all of the medication - don't quit when you start feeling better
· Wash your hands with soap and water after using the bathroom, before and after preparing foods, and before eating - and get your kids to do the same thing!
· Don't reuse an unwashed raw meat plate; avoid undercooked meat
· Wash raw fruits and vegetables

For additional information on antibiotic resistance, see the Centers for Disease Control's site.

Exercise Brings Relief to Arthritis Sufferers
(Fall 2002)

For the more than 43 million arthritis sufferers, exercise can help minimize pain. Seemingly counterintuitive, exercise helps reduce common arthritis symptoms including weak muscles, stiff joints reduced mobility, and lost vitality. Exercise helps promote overall health and fitness, which gives arthritis sufferers more energy, controls their weight, decreases depression, and improves sleep. It also helps stave off other health problems such as heart disease and osteoporosis.

There are more than one hundred types of arthritis, with osteoarthritis and rheumatoid arthritis being the most prevalent. All forms of arthritis are characterized by joint and musculoskeletal pain. There are more than 100 joints connecting the body's 206 bones. The bones are tied together by ligaments and capped with cartilage. Cartilage acts as a shock absorber. In osteoarthritis, which affects 20.7 million Americans, the cartilage breaks down, or is destroyed, causing the bones to rub together. Rheumatoid Arthritis, affecting 2.1 million Americans, is an autoimmune disease; the patient's immune system attacks the lining, or synovial membrane, of the joints. Other forms of arthritis affect another 20 million Americans.

In the past, doctors advised arthritis patients to rest and avoid exercise. Now research shows that an appropriate exercise program is very important in avoiding the complications caused by inactivity. Doctors recommend a combination of the following types of exercise:
· Flexibility or stretching - these improve range of motion and are usually recommended to be performed daily, even during flare-ups, when pain is more acute.
· Muscle conditioning - Strength and endurance benefits can come from working with raising an arm or leg against gravity, lifting weights, using weight machines or elastic bands. Doctors generally recommend this type of exercise every other day, but recommend that they be avoided during flare-ups.
· Aerobic Conditioning - Aerobic exercise improves heart, lung and muscle functioning. Swimming and aquatics are frequently recommended for arthritis patients. The Arthritis Foundation's web site has a searchable Arthritis Chapter Directory, which includes area water exercise programs. Other recommendations may include walking, bicycling, or playing golf.

If you have arthritis, consult your doctor before beginning an exercise program to find out which forms of exercise are best suited to your condition. Your doctor may refer you to a physical or occupational therapist who can show you proper techniques and precautions. Remember to obtain pre-authorization from your health plan (Indemnity) or a referral (PPO and HMOs) for these services.

As with any health condition, be sure to follow your doctor's orders:
· Take medications as prescribed
· Eat a variety of foods including lots of vegetables, fruits and grain products
· Use salt and alcohol in moderation
· Maintain an ideal weight
· Use assistive devices when needed, such as a brace or cane

The following GIC health plans offer arthritis management programs for members:

Harvard Pilgrim Health Care Arthritis Management Program participants have access to a Certified Rehabilitation Nurse Specialist who will provide support, education and clinical collaboration between the Harvard Pilgrim Care Management Team and the Specialty Care Provider. See their web site or call 617-509-1280.

Health New England's Living Well Program is a six-week course program focusing on self-management techniques such as developing a personalized action plan which can include improving nutrition and physical activity. Call 1-800-842-4464 ext. 3300.

Helping Your Child Manage Asthma
(winter 2002)

Childhood asthma is the most common chronic childhood disease, and the number one cause of school absences. An estimated four to six million children are affected by asthma, five to seven percent of all U.S. children. Asthma is a chronic, inflammatory disease in which the airways become sensitive to allergens, substances that trigger an allergic reaction. When a child with asthma is exposed to allergens, the following occurs:
· Lining of the airways become swollen and inflamed
· Muscles that surround the airways tighten
· Production of mucus increases, leading to mucus plugs

Symptoms vary by child, but can include:
· Coughing (constant or intermittent)
· Wheezing
· Trouble breathing or shortness of breath while child is playing
· Chest tightness
· Fatigue
· Nighttime cough
· Noisy breathing

If your child has frequent coughing or respiratory infections such as pneumonia or bronchitis, he or she should be evaluated for asthma. With proper management of asthma, a child with asthma can conduct a healthy and active life. You and your child's pediatrician can work together to gain control over your child's symptoms, reduce the risk of severe attacks, and help maintain a normal life. The following are common components of successful asthma management:

Eliminate asthma triggers

Limit colds and infections: Asthma can be triggered by viral infections, not treatable by antibiotics. Be sure your child gets plenty of sleep, eats a balanced diet, drinks lots of fluids, exercises regularly, and limits exposure to others with colds. Your child's pediatrician may also recommend a flu shot.

Recognize and avoid irritants: Cigarette smoking irritates airways and causes them to narrow. Cigarette smoking should be eliminated in the home of children with asthma. Other irritants such as air pollution, strong odors, aerosol sprays and paint fumes should also be avoided.

Reduce cold air's impact: Breathing cold air provokes asthma in most children with asthma. Have your child wear a ski mask or heavy scarf worn loosely over the nose and mouth when they go outside this winter.

Exercise safely: Regular exercise strengthens your child's heart and lungs, which will help to limit the number of asthma attacks. However, it's important that children use their reliever inhalers as prescribed by the pediatrician before they start. Be sure your child warms up before exercise. Swimming is a great form of exercise for asthmatics because the air in the pool is usually warm and moist.

Eliminate, reduce and avoid allergens: Most asthmatics are allergic to pollen, mold, and/or animals. Asthmatics should not have furry or feathery pets in their home. If you already have a pet, keep it out of your child's bedroom. Wash dogs or cats at least once a week. Your child's pediatrician may recommend immunotherapy, allergy desensitization shots, after a skin test to determine the allergens that cause the most trouble.

Limit dust mites: Vacuum your child's room, carpet, and mattress every few days. Make sure the house is dusted regularly with a damp cloth. Wash bedding in hot water (130° F) at least once a week. Use an air conditioner or keep windows closed during pollen season. Encase mattresses, pillow and box springs in dustproof covers. Change the furnace and air conditioning filters according to the manufacturer's instructions.

Treatment
Your child's pediatrician will probably prescribe bronchodilators to provide temporary relief of asthma symptoms and will let you know when it should be used (e.g. before exercising, breathing cold air, or at night, depending on what is prescribed). Be sure to find out how to use these correctly. The pediatrician may also prescribe long-term treatment anti-inflammatory drugs.

Action Plan
Asthma is an ongoing condition that needs to be regularly monitored and treated. The plan you develop with your child's pediatrician will include regularly monitoring your child's breathing with a peak flow meter (PFM). A PFM is a device that measures the amount of air a person can blow air out of the lungs.

The following GIC health plans offer asthma management programs to complement services provided by your child's pediatrician. These are available at no charge for plan members.

Fallon Health Plan Asthma Program 1-800-868-5200- Telephone nurse evaluation and follow up and an educational class.
Health New England Pediatric Asthma Management Program 1-800-842-4464 - Educational materials, contests, incentive program and prizes, peak flow diaries, home/environmental assessments, and educational classes.
Harvard Pilgrim Health Care Asthma Management Program 1-800-742-8326 ext. 31168 - Educational materials and an action plan with telephone nurse educator support and counseling. Includes referrals to asthma management programs in your area.
Neighborhood Health Plan's Asthma Program 617-772-5641 - customized quarterly site report and biweekly asthma trigger report provided to member's health center. Asthma case manager support. By clinician referral, asthma home visitation program by specially trained respiratory therapist or nurse.

For more information on childhood asthma, see the following web sites: allergy and asthma network, American Academy of Allergy, Asthma and Immunology, American Lung Association, and Asthma and Allergy Foundation of America.

Get Out on Your Bike -- Safely (spring 2000)

Ready to shake the winter doldrums? Get outdoors and hop on your bike. However, use your head, that is a helmet on your head, along with bicycle safety practices. Leftover winter sand on the street can be particularly hazardous. And, you need to share the road safely with those big cars and trucks you've been in all winter.

Your brain is your best asset
Even a low-speed fall on a bicycle path can cause brain injury. Bicycle helmets can reduce the risk of injury from a bicycle crash by 85%. Seventy to eighty percent of the 1000 deaths each year from bicycle crashes are the result of head injury. Bicycles are the second leading cause of childhood injuries, after automobiles. Doesn't it make sense to protect your (and your child's) head?

Helmet fit: A bicycle helmet should be level on your head, touch all around, be comfortably snug, and not move more than an inch in any direction.

Helmet color: The brighter, the better

Keep it simple: Thin straps, complicated adjustments, aerodynamic designs, visors, and excessive vents are generally less safe and less user friendly than the plainer alternatives.

Helmet resources: All helmets made for U.S. sale after March 10, 1999 must meet the US Consumer Product Safety Commission standard -- look for the sticker. Review helmet specifications and warranties.

Don't wait to replace your helmet: Even if there's no visible damage after a crash, replace your helmet. Also, most manufacturers recommend replacing your helmet every five years.

Blood Pressure - Why Should You Care and Are You Getting the Treatment You Need? (January 2000)

See Related Hypertension Article

One of the first things a good health provider will do when you go for an office visit is take your blood pressure. Blood pressure measures the pressure of the blood within your arteries. Taking a blood pressure reading is the primary means of identifying risk for hypertension; many people with hypertension do not have symptoms.

Approximately 50 million Americans, including 30 percent of the adult population, has high blood pressure according to the National Health and Nutrition Examination Survey. Complications from uncontrolled hypertension include:

• Coronary artery disease
  
• Congestive heart failure
  
• Stroke
  
• Kidney disease
  
• Eye disease

  Management techniques to control blood pressure to at least 140/90 mm Hg can include:
  

• Medications
  
• Weight loss
  
• Increased exercise
  
• Decreased intake of saturated fat, alcohol and sodium

Do not become alarmed if your blood pressure is high when it's first read. The only way health providers can reliably measure hypertension is through three elevated blood pressure readings. The important question is - is your doctor monitoring your blood pressure and working with you to keep it low, a criterion of the National Center for Quality Assurance (NCQA).