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Corner Clinic: Our Experts Answer Your Health Questions

This month we talk about aspirin, fall prevention and emotional eating

By UC San Diego Health Experts   |   August 27, 2014
  1. Should I take a “baby” aspirin daily to reduce my risk of heart attack or stroke?
  2. How do I help my elderly parents avoid falling?
  3. What is emotional eating?

Should I take a “baby” aspirin daily to reduce my risk of heart attack or stroke?

Steven Li

Steven T. Li, MD, primary care physician

Aspirin is highly effective at decreasing one's risk of complications from two leading causes of death in the U.S.: heart attack and stroke. If you have an underlying vascular or heart condition, such as a history of heart attack, stroke, angina, diabetes or peripheral vascular disease, taking an 81-milligram “baby” aspirin daily is a top recommendation. For women, aspirin’s main benefit is in reducing the risk of stroke; for men, it’s in reducing the risk of heart disease.

If you don’t have a history of heart or circulatory issues, the role of aspirin in disease prevention is more complex for both men and women. Although aspirin has been proven to reduce vascular complications by more than 20 percent, aspirin also increases the risk of bleeding. Your physician should help you weigh the pros and cons of taking a daily low-dose aspirin.

Primary risk factors for heart and vascular complications are: being a male between the ages of 45 and 79; being a female between the ages of 55 and 79; high total cholesterol; low HDL (“good cholesterol”); high blood pressure or on medications to control it; smoking, and diabetes. Our risk of bleeding rises as we age into our 80’s and aspirin is not recommended for primary prevention among this elderly demographic.

If you have two or more of these key risk factors, be sure to talk with your physician about aspirin and whether it is worth taking. Reassess your risk every five years. We have methods to mitigate cholesterol, blood pressure and diabetes. If you smoke, please be sure to review this with your physician at your next visit. It is the single most modifiable risk factor that negatively impacts your health.

How do I help my elderly parents avoid falling?

Robyn Stuhr

Robyn M. Stuhr, ACSM-RCEP, program director, UC San Diego Health Sports Medicine, Department of Orthopedic Surgery

Many factors increase an older person’s risk of falling, including lack of regular physical activity, certain prescription medications, age-associated changes in vision, poor footwear, tripping hazards in the home or community and medical conditions such as Parkinson’s disease, arthritis, osteoporosis and having had a stroke.

The first thing you can do for elderly parents is to help them go through their home and eliminate unsecured floor rugs and clutter on the floor. Make sure all areas are well-lit since collisions in the dark are a common cause of falls. Also, consider installing grab bars in the shower and near the toilet. Uneven sidewalks and sloping driveways may present a hazard when simply walking to the mailbox. Depending on your parents’ mobility and balance, the use of an assistive device such as a cane or walker may also be helpful.

Another great idea: Encourage your parents to begin an exercise program to improve strength, balance and endurance. A referral to a physical therapist or clinical exercise physiologist for an evaluation and personalized exercise program is a good place to start. There are also senior exercise programs in the community, television shows and DVDs that offer appropriately paced workouts. If your parents prefer to exercise at home, a personal trainer who specializes in senior fitness can provide supervision. If your parents work out on their own, make sure they exercise in a clear area with something stable nearby – like a sturdy coffee table – for balance.

Maintaining a sense of balance is critical as we age. One simple balance progression: stand near a kitchen counter or other sturdy structure with both feet together, then stand so that the toes on the right foot touch the heel of the left foot, then stand on just one foot. Hold each position for 30 seconds and repeat on the other side. Hands should hover above the counter as a safety measure. Try it with eyes closed for added difficulty.

There are lots of other fun balance exercises using different surfaces, movement patterns and balance devices. Exercise guidance from a qualified professional will help your parents safely get stronger, more mobile and more stable.

What is emotional eating?

Eduardo Grunvald

Eduardo Grunvald, MD, primary care physician and program director, UC San Diego Weight Management Program

Emotional eating refers to an eating behavior in which an individual consumes food in a maladaptive manner in response to negative psychological or emotional triggers, most commonly stress, anxiety or depression. For some, the short-term positive reward of food deflects negative emotions. Individuals who exhibit emotional eating usually consume either too much food, foods that are high in calories or “comfort foods,” which tend to produce strong reward responses in the brain. This, of course, has negative consequences for weight management and can lead to obesity. Emotional eaters are also at higher risk for other eating disorders, such as binge eating disorder or bulimia nervosa.

People who struggle with their weight know how difficult it can be to manage weight loss long-term by changing only one behavior. Excess weight is usually a result of biological, genetic, environmental (lifestyle) and psychological factors. As such, management of emotional eating should be viewed as one of many strategies for successful weight control. For some individuals, treatment of a significant underlying psychological concern is necessary as a first step. For most people with emotional eating tendencies, however, the foundation of treatment involves some form of behavior therapy. Behavior therapy refers to using a set of skills for coping, planning and managing maladaptive eating behaviors, under the direction of a trained therapist. Usually, this is a psychologist trained in eating disorders or weight management, a trained dietician or a bariatric physician. Some people can manage these issues through a weight management program, and some may need weight loss medications as an additional tool. However one chooses to approach the problem, it must be tackled with the intent of long-term treatment to prevent relapse. Weight management is a lot like learning to play a musical instrument or a sport. One needs to practice the skills over and over before the behaviors become second nature.