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Macular Degeneration

Image by F Delventhal - Creative Commons

There is something mystical about sight. Vision is so mechanically complex that we all take our eyesight for granted until something goes wrong. As we age there are numerous ways that our eyesight can be compromised. Many of us are familiar with cataracts and understand what they do to blur vision. Cataracts are one of many possible vision problems as we age. Lately, my attention has been drawn to a number of my friends at Sierra View Homes and family members who have been diagnosed with macular degeneration. I realized I did not know much about the disease and became interested in understanding macular degeneration better. 

In a healthy eye, the eye receives and processes light. The retina takes the light and turns it into signals that the brain interprets as visual images. The macula is part of the retina where the detailed central vision happens. Peripheral vision is the side vision and is the less acute vision and is not affected by macular degeneration. 

People 50 years and older can be affected by Adult Related Macular Degeneration (AMD). AMD happens when the macula part of the retina is slowly destroyed, and represents the leading cause of vision loss in older adults. People who have macular degeneration talk about how blurred the central part of their vision is. AMD affects the central vision of one or both eyes by causing blurred vision and shadows that create blind spots. This causes problems with activities such as driving, sewing and reading. b            

There are two forms of AMD: wet and dry. Either version can cause severe vision loss. The dry form is the most common. It has three stages, early, intermediate and advanced. The dry AMD increases slowly as the light-sensitive cells in the macula gradually break down causing the central vision to blur. There are few symptoms in the early stages so you may not be aware things are changing.  AMD is not painful and if you are not getting regular eye exams you may miss the early symptoms. In the later stages, the blurred vision is the most common symptom. AMD usually does not affect both eyes equally. You can have it in one eye, or it can be in both eyes but in different stages. 

The wet AMD is the advanced form of AMD. People who have the dry AMD are at risk of the disease progressing to the wet AMD. Wet AMD happens when new blood vessels under the macula leak blood and fluid causing the macula to break down quickly. Blood and fluid can cause the macula to swell damaging the retina and create scarring of the retina. Wet AMD causes the central vision to become distorted. Straight lines look wavy and blurred. It can also cause a blind spot that is in the center of your vision. The good news for people with wet AMD is that eye care professionals can delay or even stop the progression of the disease. There are several therapies that could be done. None of them are a cure for AMD. It is important that you work closely with an eye care professional to determine what  is the best therapy for you. 

AMD affects older adults. People who are 50 and older should get regular testing done.  As we age our chances of AMD increases. Caucasians are more likely to get AMD than people of other nationalities. If you smoke you double your chances of AMD and if your grandparents or your parents had AMD you are at higher risk. 

Research is telling us to avoid smoking, exercise, maintain normal blood pressure and cholesterol levels, and eat a healthy diet with an abundance of green leafy vegetables and fish to reduce the impact of AMD. Have regular eye exams and follow your eye care professional’s advice to slow down or stop the progression of the disease. 

In my discussions with people with macular degeneration, I sense the frustration of not being able to do the things that once were so easy. It becomes difficult to sing out of the hymnal in church because the eyes can’t focus to read the print of the song. Using the computer becomes more frustrating because there is not enough contrast to see clear enough to work the different functions. Driving becomes difficult when you need to look all directions and have a spot you can’t see through. The central part of our vision is necessary for so many tasks. It would be easy to become depressed. If someone you know has AMD, it is important to stay supportive and to help the person as they work on rearranging their life style to accommodate the vision changes. There is no cure for AMD but with support those affected by AMD can lead a happy healthy lifestyle.

What is Assisted Living?

Question:  I see advertisements in the newspaper for assisted living facilities, and it is difficult to understand what is offered there in comparison to other care services, such as skilled nursing. Can you explain the differences? –  K.A. Reedley CA.

 Answer: Great question! The term “assisted living” became popular in the 1980’s. At that time, it was a new level of care that allowed retirement communities to provide personal care programs. Before retirement communities provided assisted living, personal care was mostly handled by small board and care facilities or nursing homes.

Assisted living facilities provide help for seniors who struggle with daily chores but do not need 24-hour medical care. One room apartments with a bathroom, meals and snacks, activities of various interests, medication observation, and some assistance with personal care are provided. The goal of assisted living is to help seniors remain as independent as they can be for as long as possible — delaying the need to live in a skilled nursing facility.

Skilled nursing care is generally utilized for people with severe disability and/or a resident who needs rehabilitation therapy. Skilled nursing is ‘total care,’ offering 24-hour staffing with licensed nursing and registered therapists to allow patients to recover or at least maintain the functions they have.

The decision to move into an assisted living facility can be a difficult one. It often means moving out of a house full of memories and downsizing, leaving precious belongings. It means allowing someone to assist you with your medications and possibly having some hands-on personal care.

When is it time to consider Assisted Living? Some simple questions will help you decide.

Fortunately, there are two very reputable retirement communities right here in Reedley that offer assisted living, as well as several small board and care facilities in the greater Reedley area. Not all facilities are alike. Just as there are different levels of care, the costs can also vary widely. Some facilities charge a basic fee and then charge separately for additional services while others have an all-inclusive rate. Assisted living can run between $2,000 to $5,000 per month, while the cost of a skilled nursing facility can be $6000 to $7000 per month.  

The best way to make a decision is to visit the facility, talk to staff and residents, and ask questions regarding care and services. As with all planning decisions, it is best done well in advance, with time to make comparisons and have all your questions answered before making such an important decision.

Not all Assisted Living communities are alike. Here are some factors to consider as you help your loved one choose.

Retirement Communities and Eating Habits

Could moving to a retirement community improve my eating habits and help me eat a healthier diet?   
– D. Mc. of Reedley, California

Yes! Living in a retirement community does encourage better eating habits. Very often, socialization during meals results in an increase in appetite.

Having a healthy diet with proper nutrition has benefits, such as increased mental ability, better mood stability, a strong immune system, more energy and faster recuperation times.

As we age there are factors that cause our eating habits to change, such as the loss of a spouse, a limited budget, metabolism starts to slow down around age 40. Activity levels change due to medical or physical problems. Our sense of taste and smell diminish and various factors can cause appetite changes, such as medication, depression, or an acute or chronic medical condition.

In the aging process we need to continue to exercise.  Statistics show weight more than age determines how much energy we have.  Eating food with fiber keeps the digestive system working well. Taking calcium walking and getting 15 minutes of sunlight daily, helps keep bones strong. Drinking plenty of water promotes regularity, helps our joints, keeps us feeling energetic and much more.  Avoiding foods with high sugar content is important; sugar can suppress the immune system, weaken eye sight, and contribute to obesity, diabetes and other chronic health issues.

Retirement living facilities offer help with maintaining good eating habits. Some independent living facilities have meal plans that can be purchased by the people who live there. There are facilities that offer one meal a day; others offer 2 or more. Some have the meal plan built right into the rental price. There are also assisted living and skilled facilities that serve 3 meals a day.

It should be noted that retirement communities create menu cycles based on the direction of a registered dietitian. For example, SVH has John Varin, RD who verifies diets for proper nutrient content and gives direction to the kitchen supervisor in coordinating food preparation and modified diets. . Retirement communities offer nourishing meals and the socialization encourages better nutrition by continuing to wet the resident’s appetite.

If living in a retirement facility is not an option then try having a potluck frequently with friends. Go to the community center either in Dinuba or Reedley for a noon meal M-F.

Both programs are serving meals very reasonably priced and offer other activities with possibilities to meet new friends and have things to do.

The life span for the average American is increasing. A healthy diet and regular exercise can help us live those extra years with energy, and enjoyment.

This article was co-written with John Varin, R.D. He is the consultant dietician for Sierra Kings Hospital and a number of long term care facilities in the Reedley area.