Stimulating mental activity in the elderly

Stimulating mental activity in the elderly

Edwin Flatto

Q: Can you recommend an exercise to stimulate mental activity in an elderly person?

A: In study done at the neuropsychology laboratory at the Veterans Administration Medical Center in Salt Lake City, Robert Dustman, Director, found that aerobic exercise benefits mental flexibility, reaction time, and memory in elderly persons.

Forty-three subjects over a four month period were assigned to one of three groups: an aerobic exercise group who maintained a heart rate of 80% of maximum, another group who emphasized strength and flexibility, and a sedentary control group. All subjects had memory and mental flexibility tests before and after the study period.

The aerobic control group demonstrated a 27% increase in maximal oxygen intake and a significant improvement in short-term memory mental flexibility, and reaction time; the exercise control group showed only a 9% increase in oxygen intake and only a modest improvement in memory and mental flexibility; and the sedentary control group remained the same.

Q: My husband has recently started taking Prozac for mild depression. His sexual activity has changed. Is the drug capable of causing uncontrolled climaxes?

A: Several studies have demonstrated that some antidepressants, such as Prozac, are effective in treating premature ejaculation. For example, a research study in Italy involving 25 men aged 18 to 46 who complained of premature ejaculation were given 20 mg. of fluoxetine (Prozac) once a day for two months. The dosage was then reduced to 20 mg. every other day for two months. The dosage was then reduced to 20 mg. every other day for 30 days, followed by 20 mg. every two days for another 30 days.

Eighty percent of the men reported delayed ejaculation within the first week of treatment. At the end of the two-month study, however, five of the men who had previously reported significant improvement reported a return of original symptoms. An increase in anxiety was also reported in six of the men by the study’s author, Alessandra Graziottin, M.D.

Prozac has been shown to reduce libido, which could pose a problem. “You have to balance one thing against the other,” commented Perry W. Nadig, M.D., a urologist in San Antonio, Texas.

Q: Are there any clues to an elderly person’s seeming loss of interest in living and contemplation of suicide?

A: Although people over age 60 constitute only about 12% of the United States population, the account for 25% of suicides nationwide. In one Arizona study (Gerontology 1978; 18:488-495), almost 76% of geriatric suicidal patients visited a physician within one month of death, which indicates that illness may be a leading factor in suicide.

Bereavement is another leading cause of suicide. A bereaved spouse is at highest risk in the first 48-hour period following a loved one’s death; this figure remains high for about a year.

Elderly white males have the highest suicide rate of any group, averaging 19.2 per 100,000 for those age 60 and older compared with the national average of 12.8 per 100,000. For all age groups, males commit suicide three times as often as females, but as they age, the spread widens so that at age 85, there are 12 male suicides for each female suicide. Fifty to 70 percent of suicides in older people are caused by severe depression. This is often characterized by being excessively pessimistic or despondent most of the day for weeks at a time. One of the first signs of what can be a serious mental illness is this: a loss of interest. Usually, a well-adjusted person is interested in others, in sharing with others, in being with others, in oneself, and in interacting with others. Sexual dysfunction and alcoholism are other factors that may contribute to suicide in the elderly.

There are also verbal clues, such as, “I am going to kill myself,” “I want to end it all,” “You would be better off without me.” A person may also claim to feel suicidal when receiving a diagnosis of terminal illness or when suffering extreme pain.

Other clues to watch for are unusual patterns of behavior, such as purchasing a gun, stockpiling drugs, or putting one’s affairs in order, such as expressing a wish to donate bodily organs and giving away money.

Q: My elderly parents have increasing difficulty in controlling their bladder functions. Is this normal aging?

A. Urinary incontinence is extremely high among the elderly. About 30% of elderly people living at home and about 60% of nursing home residents are incontinent. A number of risk factors may cause this condition, such as urinary tract infection, genitourinary surgery, lack of postpartum exercise, an enlarged prostate, and certain drugs.

Kegel exercises, developed by Dr. Arnold Kegel, concentrate on the pelvic floor muscles known as the (pubococcygeus muscle) and may help in some cases. These same exercises can also increase a woman’s potential to reach orgasm. It has been estimated the pubococcygeus muscle, located about 1 1/2 inches inside the body, functions inadequately in perhaps two thirds of American women.

Here are some steps to follow:

1. Try urinating a teaspoonful at a time, stopping and starting the urinary stream and concentrating on the muscles used, until the bladder is completely empty. Practice every time you urinate.

2. Practice using these muscles throughout the day when you are not urinating. For example, while you are waiting for a bus or subway, watching television, or even reading this column!

Your physician may suggest other treatments. The most important thing to keep in mind is that urinary incontinence is a treatable problem.

COPYRIGHT 1995 Vegetus Publications

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