Call
or email now to discuss your needs
AAA Warman Home Care’s E-Update is intended to bring to you timely and useful articles and information at the click of the mouse. It is sent monthly in an effort to keep you apprised of what is happening across the healthcare continuum of care effecting hospital, hospice and rehabilitation social workers and case managers, as well as Assisted Living, Independent Living and Skilled Nursing facility executives. Warman understands that time is limited and has undertaken to share with you important industry information without your having to search for it.
Motorcycle riders across the country are growing older, and the impact of this trend is evident in emergency rooms daily. Doctors are finding that these aging road warriors are more likely to be injured or die as a result of a motorcycle mishap compared to their younger counterparts.
While the typical injured motorcyclist has long been thought of as a young, otherwise healthy victim of sudden injury, a study from the University of Rochester Medical Center suggests otherwise. Between 1996 and 2005, researchers found the average age of motorcyclists involved in crashes increased from approximately 34 to 39 years, and the proportion of injured riders above the age of 40 increased from around 28 percent to close to 50 percent. Of all injured riders included in the study, 50- to 59-year-olds represented the fastest growing group, while 20- to 29-year-olds were the most rapidly declining.
"We made the clinical observation that older patients - people in their 50's, 60's and even 70's - were being injured on motorcycles with increasing frequency," said Mark Gestring, M.D., director of the trauma program at the University of Rochester Medical Center. "We wanted to see if this observation was true on a national level and we found that it was."
For riders above the age of 40, injury severity, length of stay in the hospital or intensive care unit, and mortality were higher compared to riders below the age of 40. The risk of dying was one-and-a-half to two times more likely in riders over 40, based on the severity of the original injury. The study also found that older riders are more likely to die from less severe injuries than younger riders, to spend at least 24 hours in the intensive care unit, and to have more pre-existing co-morbidities and complications, such as heart attack and infections, that contribute to longer hospital stays.
"Treating a 60-year-old who has been in a motorcycle accident is very different from treating a 21-year-old who has been in a similar accident - 60-year-olds bring a lot more medical baggage with them, and this can adversely impact outcomes following injury," said Gestring. "As people start to dust off their motorcycles this spring, older riders should take an extra measure of caution; if an accident happens they'll often pay a higher price than younger riders."
The increase in injury severity for older riders may be related to the reduced capacity to withstand injury as the body ages. Age-related changes, such as decreases in bone strength and brain size, may make older riders more susceptible to injury. Other factors associated with aging, such as impaired vision, delayed reaction time, and altered balance contribute to motorcycle crashes in this population, explaining in part the researchers' finding that older riders crashed more often as a result of loss of control than younger riders.
In the study, which was published in the March issue of the American Surgeon, researchers using the National Trauma Databank reviewed the records of 61,689 motorcyclists aged 17 to 89 years involved in a motorcycle crash between 1996 and 2005. The average age of motorcyclists involved in crashes steadily increased over the study period, which is consistent with published statistics from the Motorcycle Industry Council which report that the average age of motorcycle ownership rose from 33 years in 1998 to 40 years in 2003.
Injury patterns remained stable over the study period, with extremity fractures, such as broken arms and legs, being the most common injuries, occurring in approximately 25 to 40 percent of motorcyclists studied. The majority of severe injuries were chest and head injuries, and researchers found significantly higher proportions of older riders sustained these types of injuries compared to younger riders.
The younger and older riders did have two things in common: helmet use and alcohol use. Overall helmet use was around 73 percent for both groups, and alcohol use was seen in approximately one third of injured motorcyclists, with no significant difference between the older and younger riders.
Alcohol use and helmet use have been linked in prior reports, with intoxicated drivers less likely to be wearing a helmet and therefore at greater risk for injury and death. It is not surprising that the researchers at the University of Rochester found that riders who tested positive for alcohol use were two-and-a-half times more likely to not be wearing a helmet at the time of injury. Despite abundant evidence that helmets reduce mortality, brain injury, length of hospital stay and economic burden, only 20 states have universal helmet laws.
Motorcycle crashes are a significant cause of injury and death on our nation's roadways, despite the fact that motorcycles are responsible for only a small fraction of the total miles traveled annually in the United States. The authors say that the study provides justification for expanding the scope of motorcycle safety research, education and training initiatives to specifically target the older motorcyclist.
"At the University of Rochester, we are looking at the development of prevention programs targeting motorcycle safety for older individuals, possibly in partnership with local motorcycle clubs and other interested groups," said Gestring.
In addition to Gestring, Joshua B. Brown, Paul E. Bankey, M.D., Ph.D., John T. Gorczyca, M.D., Julius D. Cheng, M.D., and Nicole A. Stassen, M.D., from the departments of Surgery and Orthopaedics and the Strong Regional Trauma Center at the University of Rochester Medical Center also contributed to the study.
SOURCE: University of Rochester Medical Center, April 6, 2010
A self-administered test to screen for early dementia could help speed the diagnosis and subsequent treatment of memory disorders, including Alzheimer's disease. It could also provide health care providers and caregivers an earlier indication of life-changing events that could lie ahead.
The handwritten self-assessment, which can take less than 15 minutes to complete, is a reliable tool for evaluating cognitive abilities. Findings confirming the validity of the tool are reported in the current issue of the journal Alzheimer Disease and Associated Disorders.
Douglas Scharre, a neurologist at the Ohio State University Medical Center, developed the Self-Administered Gerocognitive Examination (SAGE) to help identify individuals with mild thinking and memory impairments at an early stage. The research shows four out of five people (80 percent) with mild thinking and memory (cognitive) issues will be detected by this test, and 95% of people who are normal thinking will have normal SAGE scores.
Scharre, who specializes in treating Alzheimer's disease, said treatments for Alzheimer's and dementia are more effective when they are introduced in the earliest stage of the disease. Unfortunately, he said he often sees patients more than three to four years after the first symptoms of a cognitive impairment began to appear.
"It's a recurring problem," said Scharre. "People don't come in early enough for a diagnosis, or families generally resist making the appointment because they don't want confirmation of their worst fears. Whatever the reason, it's unfortunate because the drugs we're using now work better the earlier they are started."
Many of the assessment tools for cognitive disorders being used today, while accurate, have aspects that deter their use. "Seldom are physicians reimbursed for the time and effort it takes to give such tests, or they tie up personnel to physically administer the test," said Scharre, who advocates the use of routine screening for cognitive disorders in the primary care setting. Other diagnostic tests require the patient to use a computer, which can add heightened anxiety to some older adults who may be infrequent users of technology.
The SAGE self-assessment is a practical tool for a busy primary care office," added Scharre, who makes the tests available free of charge to healthcare personnel at http://www.sagetest.osu.edu. It only takes a paper, pen and a few minutes to take the test and because it's self-administered, it doesn't necessarily take time away from the appointment. "They can take the test in the waiting room while waiting for the doctor," said Scharre.
Missing six or more points on the 22-point SAGE test usually warrants additional follow-up by the physician. Abnormal results can also prompt an early search for reversible and treatable conditions that may be causing the patient's thinking and memory impairment. Many conditions besides Alzheimer's disease, such as strokes and some thyroid conditions, can also impact memory, according to Scharre.
Scharre said there are potential cost savings to using the tests in a primary care setting. He reasons that a person who fares poorly on the self-exam will likely be less compliant taking medications on time, taking them in the proper dosages or following other recommendations such as maintaining healthy diets.
"Abnormal test results can serve as an early warning to the patient's family," added Scharre. "The results can be a signal that caregivers may need to begin closer monitoring of the patient to ensure their safety and good health is not compromised and that they are protected from financial predators."
Results of the new test compare favorably with current standard cognitive assessments that are not self-administered. To validate the exam's findings and accuracy, Scharre and other researchers at Ohio State evaluated study participants using SAGE, and then evaluated the same subjects with a battery of other established and well-documented assessment tools.
The study involved 254 study participants, 59 years of age or older, who took the SAGE self-assessment. Sixty-three (63) individuals were randomly selected to have a one-day clinical evaluation utilizing a battery of physical, neurological and cognitive tests.
SAGE scores compared favorably with the mini-mental state examination (MMSE), a brief questionnaire test that is commonly used in medicine to screen for cognitive impairments and dementia.
Both tests were able to differentiate clinically defined normal and mild cognitive improvement from subjects with dementia. However, SAGE, but not MMSE, was also able to distinguish between clinically defined normal from the mild cognitive improvement group.
SOURCE: Ohio State University, April 1, 2010
Essential oils could be a cheap and effective alternative to antibiotics and potentially used to combat drug-resistant hospital superbugs, according to research presented at the Society for General Microbiology's spring meeting in Edinburgh this week.
Professor Yiannis Samaras and Dr Effimia Eriotou, from the Technological Educational Institute of Ionian Islands, in Greece, who led the research, tested the antimicrobial activity of eight plant essential oils. They found that thyme essential oil was the most effective and was able to almost completely eliminate bacteria within 60 minutes.
The essential oils of thyme and cinnamon were found to be particularly efficient antibacterial agents against a range of Staphylococcus species. Strains of these bacteria are common inhabitants of the skin and some may cause infection in immunocompromised individuals. Drug-resistant strains, such as meticillin-resistant Staphylococcus aureus (MRSA) are extremely difficult to treat. "Not only are essential oils a cheap and effective treatment option for antibiotic-resistant strains, but decreased use of antibiotics will help minimise the risk of new strains of antibiotic resistant micro-organisms emerging," said Professor Samaras.
Essential oils have been recognised for hundreds of years for their therapeutic properties, although very little is still known about how they exert their antimicrobial effects in humans. Australian aborigines used Tea tree oil to treat colds, sore throats, skin infections and insect bites and the remedy was sold commercially as a medicinal antiseptic from the early 20th century. Various scientific studies have demonstrated that essential oils are not only well tolerated, but are effective against a range of bacterial and fungal species. Their therapeutic value has been shown for the treatment of a variety of conditions, including acne, dandruff, head lice and oral infections.
The Greek team believes essential oils could have diverse medical and industrial applications. "The oils - or their active ingredients - could be easily incorporated into antimicrobial creams or gels for external application. In the food industry the impregnation of food packaging with essential oils has already been successfully trialled. They could also be included in food stuffs to replace synthetic chemicals that act as preservatives," they said.
SOURCE: Society for General Microbiology, March 31, 2010
Researchers from Mount Sinai School of Medicine have found that patients admitted to hospice care who have an implantable cardioverter defibrillator (ICD) are rarely having their ICDs deactivated and are receiving electrical shocks from these devices near the end of life. This first-of-its-kind study of hospice patients with ICDs is published in the March 2, 2010 issue of the Annals of Internal Medicine.
Mount Sinai researchers surveyed 900 hospices, 414 of which responded. Ninety-seven percent of the responding hospices admitted patients with ICDs. On average, nearly 60 percent of patients did not have the shocking function of the ICD deactivated. Only 20 percent of hospices had a question on their intake forms to identify patients with ICDs, and just 10 percent reported having a policy in place to discuss deactivation with patients and their families.
An ICD is a device programmed to detect cardiac arrhythmias and shock the heart back into normal rhythm. ICDs are effective in preventing sudden cardiac death in patients with recurrent arrhythmias, but for patients in hospice care they may cause unnecessary pain, and significant stress and anxiety for their family members who feel helpless in watching their loved one suffer.
"Hospices are the foremost experts at dealing with the complex communication issues surrounding end-of-life discussions with patients and their families," said Nathan Goldstein, MD, assistant professor, Hertzberg Palliative Care Institute, Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine. "The fact that so few organizations have a policy about deactivation shows how complicated these conversations are. Having a policy in place can improve communication and provide better quality of care for patients and their families."
ICD shocks may cause physical and psychological distress for patients and their caregivers. Patients report that receiving shocks from an ICD is comparable to being "kicked or punched" in the chest. Receiving ICD shocks has been associated with the development of adjustment disorders, depression, post-traumatic stress disorder, and panic disorder. Family caregivers who observe patients being shocked report feelings of fear, worry, and helplessness, and have been shown to have increased rates of depression and anxiety. For patients with advanced disease, an ICD may no longer prolong a life of acceptable quality, and cause needless discomfort.
"These data indicate that developing a policy to address concerns surrounding ICDs can be highly beneficial in reducing emotional and physical discomfort for hospice patients and their families," said Dr. Goldstein, whose team developed a model policy for ICDs in hospices based on feedback they received from several facilities. The policy includes the necessity for staff to be educated on how ICDs work, identification of patients with ICDs at the time of evaluation and admission, an informed consent discussion with the patient and family about the benefits and burdens of the device, and how to handle the device in an emergency situation.
"Many patients have had these devices for years and see them as a sign of stability. It's important to address this issue and emphasize the importance of the patient's comfort at end of life," Dr Goldstein explained.
The researchers received a list of 3,750 hospices from the National Hospice and Palliative Care Organization. From this list, the researchers generated a geographically weighted random sample of 100 hospices from each of the nine U.S. census regions. Survey response rate was 50 percent.
SOURCE: The Mount Sinai Medical Center, March 2, 2010
What do obesity, heart disease, depression, diabetes, and fibromyalgia have in common? The answer is vitamin D deficiency. More than 200 million Americans lack this essential vitamin and as a result suffer from a host of daily annoyances, chronic conditions, and even life-threatening illnesses. In the landmark book THE VITAMIN D SOLUTION: A 3-Step Strategy to Cure Our Most Common Health Problem (Penguin/Hudson Street Press; April 1, 2010) Dr. Michael F. Holick identifies the causes of vitamin D deficiency, outlines why it is essential to our health, and provides a 3-step program to attain optimal levels of Vitamin D in our bodies.
The leading expert worldwide, Dr. Holick has studied Vitamin D for more than 30 years. Through his research, we now know that every body cell has a receptor for vitamin D and it goes much further beyond bone health. Increasing levels of vitamin D can treat, prevent, and even reverse a remarkable number of daily ailments, from high blood pressure to back pain; lessen the symptoms of chronic conditions such as diabetes and arthritis; and actually prevent infectious diseases, including H1N1 and cancer. Dr. Holick also credits vitamin D with improving infertility, weight control, memory and mood.
Vitamin D is called the "Sunshine Vitamin" for a reason, but surprisingly to many, it is not actually a vitamin but a hormone – unique because it is made in the skin as a result of exposure to sunlight. It is also possible to receive vitamin D from certain foods like milk or mushrooms, the only item in the produce aisle to contain vitamin D. Dr. Holick also recommends supplements to ensure people have optimal levels of this crucial vitamin.
THE VITAMIN D SOLUTION combines cutting-edge research from around the world, an insightful historical perspective, and a simple plan for rebuilding and maintaining an optimal level of vitamin D which combines a sensible amount of sun exposure, supplementation, and foods rich in vitamin D.
Michael F. Holick, M.D., Ph.D., is a professor of medicine, physiology and biophysics at Boston University Medical Center. Additionally a BUMC, Dr. Holick serves as the director of the General Clinical Research Unit, the Bone Health Clinic, and the Heliotherapy Light and Skin Research Center. A recipient of the prestigious Linus Paulding Institute Prize in health research and the DSM Nutrition Award, Dr. Holick has authored more than three hundred peer-reviewed research articles, coedited eleven books in academia, written two books for a general audience, and currently serves on the editorial board for a number of medical publications. Dr. Holick has been featured in numerous popular media, included The New York Times, Forbes, Time Magazine, Newsweek, Men's Health, and Scientific American. He lives in Massachusetts with his family.
SOURCE: Penguin Group, USA, April 6, 2010
AAA Warman Home Care is a family-owned Residential Service Agency which has been providing in-home health care services to thousands of clients for the past twenty years. Warman specializes in providing the highest quality of private duty, non-medical care and companionship for the elderly, those recuperating after hospitalization / rehabilitation, the terminally ill, disabled, alone or at-risk. It is our goal to assist our clients in living the most independent, healthy and comfortable lives in the privacy of their own homes.
If you have written or find any articles that you would like to contribute to the Warman E-Update, please contact Brenda Head at bhead@warmanhomecare.com or by telephone at (877) 694-4264. If any of your colleagues are not receiving the Warman E-Update, please send his or her e-mail address to bhead@warmanhomecare.com for inclusion.
