DR. ELLIE CANNON: Is walking good for my mom if she falls so often?

My mother is 75, very small and frail, and falls frequently. But she seems obsessed with going everywhere to exercise, which she says will make her stronger. I’m afraid the more she walks, the more likely she is to fall. Am I right, or is the exercise good for her?

Exercise, especially walking, is good for a 75-year-old. It strengthens bones and muscles and has other benefits such as preventing heart disease and helping you stop feeling lonely.

But falls are a serious problem, especially for elderly, frail people – and the cause of thousands of hospitalizations and even deaths each year.

So this is a classic case of risk-benefit analysis.

The GP should be able to refer anyone who falls regularly to a falls clinic. An assessment will look for any possible causes – such as side effects of medication or heart problems – and develop strategies to reduce them, including much safer types of exercise than walking.

The Royal Osteoporosis Society (theros.org.uk) has excellent fact sheets and videos on exercises to help maintain balance and strength. On the website home page, click on the “Information and Support” tab and then select “Exercise and Physical Activity for Osteoporosis” from the drop-down menu. Scroll down until you see the “Stay Steady” subheading, then click the link below and you’re in the right place. Age UK also offers training courses in some areas.

Well-fitting, supportive shoes and slippers can also help, as can regular eye exams. At home, loose carpets, clutter and dim lighting should be avoided.

Last year my doctor told me to stop taking citalopram, the antidepressant I’ve been taking for years, because it doesn’t work in people over 65. I was given mirtazapine and again felt very anxious and depressed. I recently read in your column about a 72-year-old man who was told by his doctor to take citalopram. Was my GP wrong?

Citalopram belongs to a family of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. It is one of about eight medications commonly prescribed for a variety of conditions, including depression, anxiety, obsessive-compulsive disorder, eating disorders, and pain. Some are specific, such as B. Escitalopram for anxiety.

Practice by different GPs may vary based on experience, but generally we all follow the National Institute for Health and Care Excellence (NICE) guidelines or specialist psychiatric records such as the Maudsley Prescribing Guidelines.

Geriatric psychiatry is a specialty in itself because the way mental health problems manifest themselves changes with age. Other problems play a role, such as memory loss. When a patient takes many medications, we must be careful that they do not interact – and for these reasons, we often use lower doses of antidepressants in the elderly.

Sertraline, citalopram and escitalopram are recognized as SSRIs to be used in geriatric psychiatry. Your medication may have been stopped for other reasons, such as B. due to possible side effects, intestinal bleeding, glaucoma or heart disease.

For example, if someone regularly takes anti-inflammatory drugs or the blood thinner warfarin, we do not recommend taking an SSRI because of the risk of bleeding if taken at the same time. Mirtazapine would be a good alternative.

Switching from antidepressants is not an easy task for a patient as it can cause side effects while the new drug stabilizes, although these things work out after a while. However, this should also be considered part of the process.

For the past few months, my urine has an unpleasant smell and looks quite dark. It is similar to a urinary tract infection, but I have no burning or pain when I go to the bathroom. I increased my fluid intake and switched to decaffeinated coffee, but nothing changed. I take the antacid omeprazole and naproxen for my sore knees. can you help

A prolonged change in the urine must be clarified by the doctor. The best thing to do first is to ask if you can provide a sample for testing and get a phone consultation with the results. Urinary tract problems are a big reason for people of all ages to see a doctor.

The most common change in urine odor is caused by infection, especially in women.

This can be accompanied by a burning sensation, pain and a frequent urge to urinate small amounts frequently. However, symptoms may be milder, with only a change in smell or cloudiness.

A prolonged change in the urine must be clarified by the doctor. The best thing to do first is to ask if you can provide a sample for testing and get a phone consultation with the results

It can be diagnosed with a urine test strip and a urine culture in the laboratory, which takes about two days.

One change in urine that is important to monitor is blood. This can also be seen in the dipstick test. Although we would all recognize a clear amount of blood in the urine, there can also be small amounts that are not obvious. It may appear dark rather than red. Blood in the urine can usually be from an infection or kidney stones, but it can also indicate bladder cancer or serious kidney problems.

Naproxen is a nonsteroidal anti-inflammatory drug, or NSAID, used to treat joint pain or swelling and is also known to carry a long-term risk of kidney problems.

Changes in the smell and color of urine can also, less commonly, be a sign of type 2 diabetes or liver problems.

This ‘soft’ Covid is still a threat

There is a lot of Covid going on at the moment and last week it got me! I was intrigued that my virus followed the same pattern I’d seen friends do recently – it felt like a common cold that lasted a few days. I had a mild cough that strangely went away as soon as my test came back positive. Everyone I talk to who has contracted Covid in the past month or so seems to have had the same experience, without the old warning signs like an elevated temperature or a change in taste or smell.

This suggests that three years later, Covid-19 is a very different virus than when it started. Despite this, extremely vulnerable people such as blood cancer patients or patients waiting for a transplant should be careful.

It is estimated that around 1 in 25 people currently have the virus, so one of us is likely to contract it.

The “superpower” Paris is nothing to envy

Reality TV star Paris Hilton was interviewed last week to promote her memoir and talk about growing up with attention deficit hyperactivity disorder (ADHD).

I know there are some who believe ADHD does not exist, but I am not one of them.

Symptoms include inattention and impulsivity, which can drastically affect patients’ time at school, at work and in their relationships. Diagnosis and treatment, whether in childhood or as an adult, can be of great benefit.

The 42-year-old property heir, who was diagnosed with the disease as a child, takes medication and now considers it her “superpower”. I’m all for that kind of positive approach.

But I cringe when I hear people say, “I’m a little ADHD,” or that they’ve self-diagnosed using an online questionnaire, even though they’ve never seen a doctor. This is a serious condition and it is important that we do not downplay it.

Reality TV star Paris Hilton was interviewed last week to promote her memoir and talk about growing up with attention deficit hyperactivity disorder (ADHD).