An effective treatment is ketoconazole shampoo, e.g. Sebizole or Nizoral. A second lather must be used and this kept on the scalp for 3–5 minutes (with care to protect the eyes). This presents a challenge with the elderly showering themselves or a carer assisting.
The most effective drops are carbonide peroxide, e.g. ‘Ear Clear®’. These may be used twice daily or even hourly during waking hours and with the resultant wax dissolution, syringing can be avoided.
Patients with dementia often do not tolerate ear syringing, but sometimes they don’t tolerate ear drops every hour either.
Up to 80% of hearing aids become expensive chest-of-drawers ornaments!
Some considerations: If you can converse easily one to one, a hearing aid should not be necessary. If a hearing aid is to be used, it should be worn in the ear with the better hearing. When in a crowded room, attempt to stand or sit next to a wall for greater sound concentration. If an audiogram demonstrates R and L hearing disparity, a CT scan should be performed.
Clear rhinorrhoea in the elderly may be related to lactose intolerance since a dairy-free diet is known to relieve symptoms in 4 weeks. Lactose-free milk, now readily available, and yoghurt may be used as alternatives.
Long-term, intermittent oxymetazoline nasal drops or spray, e.g. Drixine® can be effective but the preferred treatment is lubrication of the nasal passages with an oil-based preparation such as natural sesame seed oil spray, e.g. Nozoil®.
Exclude underlying causes of sleep disturbance. Avoid hypnotics if possible and in particular avoid combining them with alcohol. Ideally, the use of benzodiazepines as hypnotics should be short term only.
Sleep hygiene issues need to be discussed, consider caffeine cessation from lunch time onwards and the avoidance of electronic stimulation right up to bed time.
This is isolated paranoia in the elderly and a sign of early dementia. It can cause havoc with family, neighbours and police, with accusations of theft or property trespass. Auditory hallucinations may also be present.
Risperidone or olanzapine are very effective medications for this problem. Keep in mind that risperidone can aggravate Lewy body dementia.
A useful approach is to use macrogol 3350 (Movicol®), up to eight sachets in 6 hours on successive days with subsequent daily Movicol® maintenance.
This presents as pain in the affected thigh, laterally, and may radiate to the lateral knee and even into the foot. Localised tenderness over the trochanteric bursa site is confirmatory and an ultrasound may add further evidence. An injection of local anaesthetic with corticosteroid is very effective in the short term. During this procedure, a gritty end-point may be detected with the needle tip.
Benign senescent forgetfulness
This popular term is also referred to as ‘aged related memory loss’ or ‘delayed recall of ageing’ or ‘mild cognitive impairment of ageing’.
This is a common sign of ageing and may be an early symptom of dementia, which certainly develops in at least 10% of cases.
Dementia prevention strategies
This program is based on the research work of Dr Michael Valenzuela, as found in his book Maintain Your Brain (HarperCollins, Sydney, 2001).3
Healthy blood pressure—‘a healthy heart means a healthy brain’—the strongest evidence for dementia prevention.
The three keys:
physical: walking 30–60 minutes 3 to 4 times a week, plus strength exercises, balance and stretching exercises—reportedly known to enhance brain cell growth, brain cell interconnections and angiogenesis
mentally stimulating activities
social activities in company that are both fun and rewarding.
Alcohol control: avoid binge drinking and always promote a safe intake, i.e. 1 to 2 standard drinks with a meal for 3 days a week.
Diet—Mediterranean in style, oily fish 2 to 3 times a week (consider Chia seed), 2 fruits and 5 vegetables daily.