Idea #290 for December 5th, 2009: Unintended Consequences or Rethinking Dialysis In Elderly Patients

From a quality of life standpoint, dialysis for elderly patients in nursing homes might not make sense. New research suggests that kidney dialysis in those populations does not improve quality of life nor does it extend life. Aspects of daily including eating, dressing, and using the bathroom were assessed before and after dialysis, and more patients showed declines in those abilities than improvement. Also, more than half the patients died within a year of beginning dialysis.

Dialysis involves going to treatment centers once every few days and undergoing a lengthy procedure, which is especially stressful among older patients. At least a quarter of elderly nursing home patients who begin dialysis treatment end up terminating the treatment because of these kinds of problems. Families, patients, and healthcare workers should be aware of these issues when assessing the need for dialysis.

See more about this issue here.

Idea #282 for November 27th, 2009: Warning Signs or Chronic Pain Increases Falling Risk in Elderly Patients

Experiencing chronic pain is a part of life for a lot of aging people, but its effects may reach beyond just discomfort. For elderly patients, chronic pain may lead to a higher rate of falls, a new study says. Falls are a major problem for elderly populations, and tens of thousands become severely injured or are killed in falls each year.

An 18 month study involving 700 elderly patients looked at their chronic joint pain and incidence of falling. Patients who reported having pain in more than one joint were 50% more likely to fall than others. Beyond chronic pain, there was also a link between acute pain and falls. Patients who had severe pain for a month were 77% more likely to fall in the next month than those with no pain. These findings are important because it could tell doctors that their elderly patients who experience pain should take extra precautions against falls. That could entail using an occupational therapist or adapting their living area to remove potential hazards and make it easier to navigate.

Read about this study here.

Idea #263 for November 8th, 2009: Beating The Clock or Time Is Crucial For Stroke Victims

For people exhibiting symptoms of stroke, getting emergency care as fast as possible could mean the difference between life and death. Yet 40% of stroke patients use private transportation to get to ERs instead of dialing 911, says a new CDC report. Timing is crucial because the drug used to treat a stroke, tissue plasminogen activator, has to be given within three hours of the first symptoms. Patients cannot afford to wait for travel arrangements.

The important thing here is that people have to be well aware of the typical symptoms of stroke so that they can identify their condition rapidly and seek emergency help. A vital part of that process is making sure people who are at high risk of stroke — smokers, people with hypertension or obesity, etc. — know what the beginning of a stroke feels like. The symptoms include: vision problems, weakness on one side of the body, and rapid onset of dizziness or headache. It’s in the best interest of elderly patients and other people in a high risk category to memorize the symptoms of a stroke so that if the worst happens, they can react promptly.

Read more about this issue here.

 

Idea #248 for October 24th, 2009: Going Under or Damaging Effects of General Anesthesia on Young Brains

We can all agree that the advent of general anesthesia was one of the greatest steps forward in medicine. There’s growing evidence, though, that its use in young children can have some serious effects on their developing neurological systems. It’s thought that the calcium-blocking effects of general anesthetics can kill off neurons in the brains of children under two, affecting their cognitive abilities. Young children in that age range have brains undergoing neurological changes that make them especially susceptible to that side-effect of anesthesia. At the same time, elderly populations appear to be more likely to suffer symptoms of dementia following general anesthesia.

This news certainly doesn’t mean that children should forgo general anesthesia during operations. It does reinforce the idea, however, that general anesthesia should only be used when necessary with young kids, but you can pretty much be sure that’s what is happening now anyway. Evidence shows that undergoing surgery without anesthesia is not only painful, but actually quite dangerous because of stress responses to pain in the body. So the solution to this problem might mean developing new anesthetics in the future that do not disrupt calcium in brain cells. Until then, we will have to live with the potentially damaging side-effects that these very necessary drugs come with.

Read more about this in Time Magazine.

 

Idea #244 for October 20th, 2009: Online Brain Fitness or Getting Seniors Online to Increase Brain Function

A key to keeping minds sharp through the later years might entail getting the elderly population online. In a study of 24 people with an average age of 66, researchers found that engaging in Internet searches, along with other online activity, was associated with increased brain function. Before and after the experiment, the subjects’ brains were scanned with fMRI, which shows blood flow and can be used to assess the activity of areas of the brain.

Half of the study group had little or no experience using the Internet, but with just two weeks practice, their brains were already showing increased activity in the frontal gyrus regions. Those areas are important in decision-making and memory. After the two-week period, the brain scans of the previously inexperienced users were similar to those of the control group, whose subjects were Internet savvy. The findings hold promise that one way to preserve brain function in elderly populations is through something as simple as casual web browsing. Pending more research, it would be a low-cost way of keeping aging minds healthy.

Read more about the study here.

 

Idea #238 for October 14th, 2009: Working Past 65 or Post-Retirement Work Makes For Healthier Lives

Seniors who keep at least a part-time job during their retirement age will not only have better financial standing, but also tend to have fewer health problems. In a study of over 12,000 people nearing retirement age, researchers found that people who maintained a part-time role during their transition into retirement had fewer diseases and better mental health than those who were totally retired.

Researchers speculate that the reason continued employment makes for healthier lives is related to the ongoing physical and mental tasks that the jobs demand. The constant social contact and activities associated with work help keep minds sharp, they believe. The one caveat is that people who worked part-time after retirement, but in a different job than they had previously worked, did not enjoy the same health benefits as those who maintained the same or similar job. The stress of switching jobs and learning the ropes may be responsible. Regardless, it makes sense financially and health-wise for people nearing retirement to consider a transition phase in which they reduce their workload before diving into full-fledged retirement.

Read about this study here.

Idea #228 for October 4th, 2009: Closing Time or Nursing Homes Face Closures Amid Recession

Between shrinking state budgets and a new Medicare rate adjustment, many nursing homes in this country are nearing financial crisis. Twenty-four states so far this year have cut nursing home spending and a CMS adjustment will cut $16 billion from nursing home funding over the next decade.  Over the next ten years, President Obama aims to cut an additional $300+ billion from CMS, which may impact nursing home budgets further. With the retirement of the baby boomers looming, something will need to be done to prevent catastrophe.

Amid the financial woes, the rate of nursing home closures is rising while the number of patients in nursing home care also increases. Part of this year’s stimulus bill included $87 billion in funding for state Medicaid programs, however some states have diverted that money towards other, non-health related budget gaps. Last year, nursing homes got shorted over $4 billion in un-reimbursed costs under Medicaid. In the immediate term, we should at least disallow the practice of states misspending federal money earmarked for Medicaid funding. In the long term, we have to think about ways to dedicate more, rather than less, funding to nursing homes, which will see a steep increase in patients in coming years.

Read about this issue in the news here.

Idea #218 for September 24th: Supporting Seniors or Preventing Falls Among The Elderly

Each year, a third of those 65 and older will have an accident where they fall down, and for those over 80, it happens to about half the population. Patients aged 75 with high blood pressure are just as likely to die or get seriously injured falling as they are from a stroke. Falling should not be an inevitable byproduct of growing old, though. Mary Tinetti, a professor from Yale, recently won a MacArthur genius award for her work uncovering the reasons behind falls in the senior population.

Factors like multiple medications, muscle weakness, vision problems, and changes in blood pressure all contribute to falls. Whereas in the past most of the reasons for elderly falls were considered unavoidable, Dr. Tinetti believes the factors should be controllable and can be reduced by 30% if new protocols are implemented. Proper screening for risk factors, she contends, is key to preventing elderly falls. The risk factors are sometimes overlooked because providers may focus on more pressing health matters. Methods like lowering medications, teaching balance, and arranging living spaces to make movement easier can all help prevent falls, and should be considered in elderly patient care.

Read more about this issue in the Wall St Journal and Washington Post.

Idea #179 for August 16th, 2009: Educating Seniors on Stroke Risks

Receiving timely medical attention is key to treating strokes in elderly patients. Recognizing signs of strokes, and knowing the risk factors that contribute to them, can ensure that patients will react promptly and correctly to the onset of a stroke. However, seniors are often not well-enough informed on these issues, surveys find.

A study found that less than half of elderly patients surveyed were aware that dizziness, numbness, weakness, and headaches are warning signs of a stroke. The majority were able to correctly identify high blood pressure as a risk factor for stroke, but less than half knew that high cholesterol and smoking were also factors. Further, only 10% of the respondents were aware that diabetes and alcohol consumption are other stroke risk factors.

If patients have a better grasp of the symptoms associated with the onset of stroke, their chances of receiving rapid treatment and recovery can be greatly improved. Additionally, having a clear understanding of the risk factors involved can encourage people to adjust their lifestyles in order to lessen their chances of having a stroke. Primary care physicians can help educate seniors on stroke symptoms, especially ones who are at a higher risk of developing them. Additionally, an education campaign targeting that population can also help spread the message.

Read more about this issue in the news here.

Idea #178 for August 15th, 2009: Driving While Medicated or Making Senior Citizen Drivers Aware of Medications’ Dangers

Many elderly Americans are on multiple medications, but are not always aware of the effects that those drugs have on their driving abilities. A study found that 78% of people over 55 were on at least one medication, but that only 28% of those were aware that driving while on medications could be dangerous. The older the people in the study, the more likely they were to be taking multiple medications, and the less likely they were to be aware of the driving dangers associated with them.

As of now, it is difficult to know how much of a role medications have in elderly traffic accidents, as drug tests are rarely conducted after crashes. However, it is known that elderly drivers have the highest accident rate per mile driven. What’s more, the number of elderly drivers is expected to increase by 50% by 2030. Next year, the AAA Foundation for Traffic Safety will release a web-based tool that will serve to inform elderly drivers of the dangers associated with specific medications. One has to wonder, though, if reaching out to the elderly population through the Internet is the best way to connect with that population. It makes more sense for prescribers to educate their patients on the matter, and to make sure that the drivers are aware of any interactions that may affect their ability to control a vehicle.

Read more about this study in the NY Times and USA Today.