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www.planetree-sv.org 
October 2021


DIRECTOR'S NOTE

We’ve all been living in heightened states of anxiety for the last 18 months. Sometimes less, sometimes more, but pandemic anxiety has been running constantly in the background for quite awhile. It’s wearying, exhausting at times. Yet ironically, one of the healthy ways to cope with constant anxiety is to actively plan for emergency situations, thinking through “what can I do if…?”.


PlaneTree Health Library’s online collections offer many resources to help you strategize for emergencies, both large and minor. From practicing creative ways to get back up after an awkward fall, and home safety checklists, to making a list of current medications; looking at organizational tools for caregivers, creating an emergency contacts list, to signing up for emergency alerts on your phone -  there are so many relatively easy, straightforward steps to take. If it helps to think through what to do in a medical emergency, see our new resources about when to call 911 and how to be ready for that next visit to the ER.

For those who want to go deeper, our online collections on later life planning and caregiving will help you tackle those concerns. And our newest online collection focuses entirely on emergency planning and your health, with information on many levels for how to prepare for a climate crisis.

Planning ahead can be reassuring, comforting, and autumn might be the perfect time to do this. (Perhaps we’re not that different from squirrels after all!) Make a plan, create some lists, take a deep breath knowing that you’re that much closer to being prepared -- and relax as that weight lifts from your spirit.

SHOULD I...?

… try a new method of birth control? 

No singular method of birth control is perfect, but there are types that work better than others as well as optimal combinations that provide extra protection. To prevent pregnancy, the birth control implant (AKA Nexplanon) and IUDs (Intrauterine Device) are the most effective (as well as convenient) method to use. Condoms, while one of the most common options, is not the most effective by itself. Layering a condom with another type of birth control, however, has been hailed by many professionals as one of the most successful defenses against both unplanned pregnancies as well as STDs.  

... take up yoga to improve my balance?

Improved flexibility and balance are among the many benefits of yoga to people of all ages. Some poses are especially useful for better balance (search the phrase: yoga for balance to find examples, instructions, and videos). Some people with vestibular disease find specific poses improve their dizziness and ability to focus.

Injuries from yoga are on the rise in the U.S., especially among older adults, however; choose classes and teachers wisely to avoid problems. Poses may need to be modified for people with joint or muscular problems; head-down poses can cause problems for people with cardiovascular diseases even though they are touted as beneficial for the heart in healthy people.

T’ai chi and qi gong can also be very helpful to improve balance, and there are exercises that even mobility-challenged people can do - see our resource guide for more details.

 … ask his doctor to prescribe Aduhelm (aducanumab) for my husband’s dementia?

Many people with dementia, and their families / loved ones, excitedly followed news reports last summer of a new drug getting FDA approval for mild cases of Alzheimer’s dementia. Since then, however, the FDA put limits on who could receive the drug, and has deferred considering it for full U.S. approval until 2030. (It was not approved for use in other types of dementia in the U.S., or for use at all in Canada.) Until full FDA approval, it may be very costly. 

If you think this drug might be appropriate, talk with the healthcare team - but also consider and discuss with them the many other possible factors that could be affecting memory loss or other dementia behaviors.

… take extra measures to protect against poor air quality if I have COPD?

Do you suffer from a chronic lung disease that puts you at higher risk from bad air quality? The American Lung Association outlines steps you can take to protect yourself from harmful air pollution. The CDC also provides tips to protect yourself from air pollution during physical activities. You can start by monitoring your local Air Quality Index levels at AirNow, and check out other ways to decrease exposure from the above sources. For more in-depth information about how to track and understand air quality, visit the PlaneTree Health Library webpage for more information.

… use a probiotic toothpaste for healthy gums?

Probiotics have not (yet) proven to be effective against plaque, gingivitis, or periodontal diseases. Here’s what has been clinically proven to make a difference: cleaning our teeth with a toothbrush, water pick, or interdental brush; and rinsing with mouthwashes with either essential oils (like Listerine), chlorhexidine gluconate (CHX), or cetylpyridinium chloride (CPC).

… take St. John’s Wort or vitamins for the wintertime blues? 

Probably not - research studies don’t show clinical effectiveness for these.

Fewer hours of daylight can bring on Seasonal Affective Disorder, a.k.a. Winter depression, in many. Among the various attempted treatments to improve mood during darker months, evidence shows that the most effective methods are: antidepressant drugs, cognitive-behavioral psychotherapy, or light therapy. (While people with SAD often have low levels of vitamin D, it’s not clear whether it helps to take it in pill form.)

COVID-19 CORNER

Earlier this month Gov. Newsom announced that starting in 2022, once it is approved and available for children 5-11, “COVID-19 vaccine will be required for in-person school attendance — just like vaccines for measles, mumps, rubella and more.” Vaccination mandates are already in place for school staff.

Until such time as children in that age group can be vaccinated, it’s important to note that masking has been proven to lower COVID-19 infections in school settings.

 

Additional doses of the Pfizer / BioNtech vaccine were approved by the FDA & CDC for people who are immunocompromised, for people 65 and older, and for younger people with certain chronic diseases. Specifically, this means “a third dose of vaccine from Pfizer-BioNTech” (or, once these are approved, a third dose of the Moderna or a second dose of the Johnson & Johnson vaccines). Some immunocompromised people have few antibodies even after a full vaccine dose, which is why they’re eligible for a third dose. But as with many vaccines, our antibodies may grow fewer over time, which is why a booster dose is recommended for those people who are more at-risk. Other immunocompromised people have no (or almost no) antibodies at all despite vaccination so have to rely on higher rates of vaccination among those who can get it. (Another argument in favor of vaccination mandates, which have been proven to raise vaccination rates.)

IN DEPTH
When to Ask for Help

People don’t come with a user manual, and it is often really difficult to decide “when it’s time” to step in with assistance, support, medical intervention, etc. For those of us who are caring for an older adult, red flags to watch for are changes in:

  • Mobility (walking, bending, reaching), balance, and especially tripping or falling;
  • Sleep patterns;
  • Speech and hearing;
  • Vision;
  • Activities of daily living (dressing, hygiene, housekeeping, meals, etc.)
  • Frequent infections (bronchitis, UTIs, etc.); and
  • Memory.

In some cases, a medical emergency is the “wake-up call” that someone needs more help, but more often these changes are gradual. If you’re concerned, there are ways to assess if someone needs assistance.  This recent article lists ways to evaluate how well someone is functioning, and suggests what to do if a problem surfaces. If memory is a concern, this factsheet can also help. As for mobility, the various tools listed under “Assess Your Home Environment” in our resource guide page for Caring at Home will help you check home safety and suggest tools for aging in place. And don’t forget the other materials in our online collections for caregivers!

IN DEPTH
Approving New Drugs in the U.S.: The FDA, CDER, CDC, and ACIP

The recent pandemic, as well as news reports on various drugs being authorized / unauthorized or approved / unapproved, highlight the details of drug approval processes in the U.S.

Before a new drug like Aduhelm / aducanumab can be sold or prescribed in the U.S., it must pass review by the Food & Drug Administration’s Center for Drug Evaluation and Research (CDER). In particular, the CDER performs an analysis of background information - “the condition or illness for which the drug is intended, and ... the current treatment landscape, which provide the context for weighing the drug’s risks and benefits.” The CDER examines results from research and clinical trials, paying careful attention to benefits and risks of the new treatment, and weighs the strategies for managing its risks. 

The process is slightly different for approving vaccines, in that the Centers for Disease Control (CDC) is also involved in the early development stages (research and clinical trials). Once a vaccine has successfully passed clinical trials with a large number of people, then it passes like any drug to the CDER for evaluation. If approved, the CDER passes it to a group within the CDC, the Advisory Committee on Immunization Practices (ACIP), which sets vaccination protocols (who is eligible to be vaccinated, when, whether boosters will be necessary, etc.). And the CDC continues to be involved after approval, in formal effectiveness studies, manufacturing and quality control. 

Approval of a new drug or vaccine can be accelerated when it offers the promise of having a big impact on “a serious or life-threatening condition and [to] provide therapeutic benefit over available therapies.” If that promise ultimately isn’t confirmed, the FDA can retract approval, or postpone it as in the case of Aduhelm / aducanumab. 

Accelerated process is used for drugs or vaccines where the more usual clinical trials would take a long time to prove effectiveness. It looks to prove clinically-relevant results for a “surrogate endpoint” that’s used to stand in for that far-off effective endpoint. (This process was set up, in part, as response to the AIDS crisis, when so many people died awaiting the results of slow-moving clinical trials.) “This approval pathway is especially useful when the drug is meant to treat a disease whose course is long [like Alzheimer’s disease], and an extended period of time is needed to measure its effect. After the drug enters the market, the drug maker is required to conduct post-marketing clinical trials to verify and describe the drug’s benefit. If further trials fail to verify the predicted clinical benefit, FDA may withdraw approval.” 

An Emergency Use Authorization (EUA) is different from an accelerated approval. While this, too, comes from the FDA, it is given in response to a public health emergency declared by the department of Health and Human Services. In addition to drugs and vaccines, EUAs can be for “unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions … when certain criteria are met, including there are no adequate, approved, and available alternatives.” At present there are EUAs to treat COVID-19 for medical devices, therapies, and protective equipment (PPE) as well as the Moderna and Johnson & Johnson vaccines. (The Pfizer/BioNTech vaccine is the only one so far that has been fully approved by the FDA.)

This background information may make it easier to understand the players involved behind-the-scenes to the approvals and advice described in our resource guide on Coronavirus and COVID-19 in the Bay Area.

 

Looking for more community events?

 
The list of free, public, health-related events in the South Bay that used to be included in PlaneTalk has moved online, as have the events themselves. 

We’ve created an expanded Community Events Calendar on our webpages at: https://www.planetree-sv.org/calendar/

There are many more events on health and other topics of interest to seniors, their caregivers, and anyone interested in healthy aging on this calendar - and since they’re online, you don’t have to worry about travel time or parking!

 
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