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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.
The numbers are, well, depressing: More than 2 million people age 65 and older suffer from depression, including 50 percent of those living in nursing homes. The suicide rate among white men over 85 is the highest in the country - six times the national rate.
And we're not getting any younger. In the next 35 years, the number of Americans over 65 will double and the number of those over 85 will triple.
So the question becomes, how to help elderly depressed individuals?
Researchers at UCLA turned to a gentle, Westernized version of tai chi chih, a 2,000-year-old Chinese martial art. When they combined a weekly tai chi exercise class with a standard depression treatment for a group of depressed elderly adults, they found greater improvement in the level of depression - along with improved quality of life, better memory and cognition, and more overall energy - than among a different group in which the standard treatment was paired with a weekly health education class.
The results of the study appear in the current online edition of the American Journal of Geriatric Psychiatry.
"This is the first study to demonstrate the benefits of tai chi in the management of late-life depression, and we were encouraged by the results," said first author Dr. Helen Lavretsky, a UCLA professor-in-residence of psychiatry. "We know that nearly two-thirds of elderly patients who seek treatment for their depression fail to achieve relief with a prescribed medication."
In the study, 112 adults age 60 or older with major depression were treated with the drug escitalopram, a standard antidepressant, for approximately four weeks. From among those participants, 73 who showed only partial improvement continued to receive the medication daily but were also randomly assigned to 10 weeks of either a tai chi class for two hours per week or a health education class for two hours per week.
All the participants were evaluated for their levels of depression, anxiety, resilience, health-related quality of life, cognition and immune system inflammation at the beginning of the study and again four months later.
The level of depression among each participant was assessed using a common diagnostic tool known as the Hamilton Rating Scale for Depression, which involves interviewing the individual. The questions are designed to gauge the severity of depression. A cut-off score of 10/11 is generally regarded as appropriate for the diagnosis of depression.
The researchers found that among the tai chi participants, 94 percent achieved a score of less than 10, with 65 percent achieving remission (a score of 6 or less). By comparison, among participants who received health education, 77 percent achieved scores of 10 or less, with 51 percent achieving remission.
While both groups showed improvement in the severity of depression, said Lavretsky, who directs UCLA's Late-Life Depression, Stress and Wellness Research Program, greater reductions were seen among those taking escitalopram and participating in tai chi, a form of exercise that is gentle enough for the elderly.
"Depression can lead to serious consequences, including greater morbidity, disability, mortality and increased cost of care," Lavretsky said. "This study shows that adding a mind-body exercise like tai chi that is widely available in the community can improve the outcomes of treating depression in older adults, who may also have other, co-existing medical conditions, or cognitive impairment.
"With tai chi," she said, "we may be able to treat these conditions without exposing them to additional medications."
SOURCE: University of California - Los Angeles, March 17, 2001
A new study on the use of prostate-specific antigen (PSA)-based prostate cancer screening in the United States found that many elderly men may be undergoing unnecessary prostate cancer screenings. Using data from surveys conducted in 2000 and 2005, researchers report that nearly half of men in their seventies underwent PSA screening in the past year almost double the screening rate of men in their early fifties, who are more likely to benefit from early prostate cancer diagnosis and treatment. Further, men aged 85 and older were screened just as often as men in their early fifties.
Because prostate cancer tends to be slow-growing, data show that many men particularly those in their seventies and older will die of other causes before prostate cancer becomes a problem that requires medical attention. The new findings underscore a long-standing concern that overuse of PSA screening and PSA-based treatment decisions may lead to unnecessary treatment of many older men and potential complications such as incontinence, impotence and bowel dysfunction.
"Our findings show a high rate of elderly and sometimes ill men being inappropriately screened for prostate cancer. We're concerned these screenings may prompt cancer treatment among elderly men who ultimately have a very low likelihood of benefitting the patient and paradoxically can cause more harm than good," said senior author Scott Eggener, MD, assistant professor of surgery at the University of Chicago. "We were also surprised to find that nearly three-quarters of men in their fifties were not screened within the past year. These results emphasize the need for greater physician interaction and conversations about the merits and limitations of prostate cancer screening for men of all ages."
While large declines in prostate cancer metastases and death rates in the last 20 years coincide with widespread use of PSA-based screening, questions remain about its use. Data have been unclear about when men should be considered for PSA screening and when screening should stop, and recent studies have provided conflicting evidence on whether routine PSA screening in the general population of men actually reduces the risk of dying from prostate cancer. Based on these concerns, major organizations such as the American Cancer Society now encourage men who expect to live at least 10 years to talk with their doctor about the risks and benefits of screening, starting at age 50 for men with an average risk or at age 45 for men with a higher risk.
In this study, the researchers examined results from health surveys of randomly selected households conducted in 2000 and 2005 as part of the federal government-sponsored National Health Interview Survey. In addition to reviewing survey data, which included information on age, smoking, mass-body index, underlying medical conditions and other factors, the investigators calculated the estimated five-year life expectancy of each man over 40 who had received a PSA test.
They divided survey results of men age 70 and older into five-year age groups (70 to 74, 75 to 79, 80 to 84, and 85 years and older). In all, 2,623 men ages 70 and older were included in the analysis, while nearly 12,000 men between the ages of 40 and 69 served as controls.
The overall PSA screening rate within the past year for men aged 40 and older was 23.7 percent in 2000 and 26.0 percent in 2005. The PSA screening rate was lowest in the 40 to 44 age group (7.5 percent). Researchers found that the PSA screening rate was 24.0 percent in men ages 50 to 54, increasing with age until a peak of 45.5 percent in ages 70 to 74. Screening rates then declined with age, with 24.6 percent of men 85 or older reporting being screened.
Among men who were 70 or older, the investigators did find that PSA screening was more common in men with a greater estimated five-year life expectancy. For example, approximately 47.3 percent of men who were unlikely to die in five years (an estimated chance of 15 percent or less) were screened, 39.2 percent of men with an intermediate chance (16 to 48 percent probability) of dying received screening, and 30.7 percent of those with the highest probability of death (48 percent or greater) in five years were screened.
Eggener offered some possible explanations for the results, noting that screening rates may reflect how frequently men visit primary care physicians. Older men tend to have more health problems that require doctor visits, and this may in turn result in more frequent PSA testing than younger men, who see their doctors less. The authors suggest that physicians should be more selective in recommending PSA testing for older men, particularly those with a limited life expectancy, and consider more routinely screening younger, healthier men who are most likely to benefit from early prostate cancer diagnosis and related treatment. Men are encouraged to talk with their doctor about their individual risk for prostate cancer, and about the risks and benefits of prostate cancer screening.
SOURCE: American Society of Clinical Oncology, March 29, 2011
Patients who have suffered a "mini stroke" are at twice the risk of heart attack than the general population, according to research reported in Stroke: Journal of the American Heart Association.
These mini-strokes, called transient-ischemic attacks, or TIAs, occur when a blood clot temporarily blocks a blood vessel to the brain. Although the symptoms are similar to a stroke, a TIA is shorter - usually lasting only minutes or a few hours - and does not cause long-term disability. A TIA, also called a "warning stroke," signals a high risk of a subsequent, larger stroke.
In this study, the risk of heart attack among TIA patients was about 1 percent per year, double that of people who had never had a TIA. This increased risk persisted for years and was highest among patients under age 60, who were 15 times more likely than non-TIA patients to have a heart attack.
"Physicians and other healthcare providers should be mindful of the increased risk for heart attack after TIA, just as they are about the increased occurrence of stroke," said Robert D. Brown Jr., M.D., M.P.H., principal investigator and chair of the neurology department at the Mayo Clinic in Rochester, Minn. "In the same way that we evaluate the patient to determine the cause of TIA and implement strategies to reduce the occurrence of stroke after a TIA, we should step back and consider whether a stress test or some other screening study for coronary-artery disease should also be performed after a TIA, in an attempt to lessen the occurrence of heart attack."
In the study, the average length of time between a first TIA and a heart attack was five years. Researchers also found that TIA patients who later had a heart attack were three times more likely than those who did not have a heart attack to die during study follow-up.
Factors that independently increased the risk of heart attack after TIA included:
The study included 456 patients (average age 72, 43 percent men) diagnosed with a TIA between 1985 and 1994. Nearly two-thirds had high blood pressure, more than half smoked, and three-fourths were being treated with medication, such as aspirin, to prevent blood clots. Average follow-up was 10 years.
Investigators used a medical-records database (Rochester Epidemiology Project) to retrospectively identify TIA patients in Rochester, Minn. They then cross-referenced this information with data on heart attacks occurring within this patient group through 2006.
Most heart attacks are caused by coronary-artery disease, which occurs when a blood clot blocks blood and oxygen flow in a blood vessel leading to the heart. Although coronary-artery disease is the primary cause of death among TIA patients, according to the study, limited data exist on the incidence of heart attack after TIA.
"In fact, coronary-artery disease is an even greater cause of death after transient-ischemic attack than stroke is, surprising as that may be," Brown said. "We should use the TIA event not only to provide a warning sign that patients are at heightened risk of stroke, but are also at increased risk of heart attack, an event that will increase their risk of death after the TIA."
Co-authors are Joseph D. Burns, M.D.; Alejandro A. Rabinstein, M.D.; Veronique L. Roger, M.D., M.P.H.; Latha G. Stead, M.D.; Teresa J. H. Christianson, B.S.; and Jill M. Killian, B.S. Author disclosures are on the manuscript.
The Mayo Clinic funded the study.
TIA and stroke warning signs are sudden:
The presence of any of these signs warrants a call to 9-1-1 for immediate medical attention.
SOURCE: American Heart Association, March 25, 2011
As you spring clean your closets, cars, and garages, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) encourages everyone to Be Food Safe and give your kitchen - especially refrigerators and freezers where raw meat, poultry and seafood is stored - a thorough cleaning as well.
This is a good time of year to use or throw out items that are losing their quality or have spoiled, as well as to check for unnoticed spills and remove lingering odors. Cleaning out your freezer requires extra care and can create new messes, so FSIS is providing simple steps to help you spring clean your kitchen, prevent cross contamination, and reduce the risk of foodborne illness.
Clean. Bacteria can be transferred by hands, cutting boards, and knives and quickly spread to all kitchen surfaces. Frequent cleaning can keep that from happening.
Separate. Cross-contamination is the spread of bacteria from one surface to another, and it is especially likely to take place when thawing or preparing raw meat, poultry, and seafood. Any bacteria that may be on frozen meat, poultry, and fish can become active upon thawing and cause illness if food is not handled safely.
Cook. Even for experienced cooks, the improper heating and preparation of food means illness-causing bacteria can survive. Meat, poultry, and seafood should be cooked to a safe internal temperature to be sure bacteria that may be present is destroyed.
Chill. Bacteria grow fastest at temperatures between 40 °F - 140 °F, so chilling food properly is one of the most effective ways to reduce the risk of foodborne illness.
SOURCE: USDA, March 25, 2011
Americans may like their drinks "sickeningly sweet" but a new labeling initiative may discourage us from pouring on the unnecessary calories, said Jessica Bartfield, MD, medical weight-loss specialist at Gottlieb Memorial Hospital.
As of February, the front labels of packaged beverages now include the total number of calories in containers of 20 ounces or less. "Liquid caloric consumption can be quite a significant contribution to weight gain so this is a tremendous effort to educate the public," said Dr. Bartfield, who is part of the Loyola University Health System campus physician-led team of exercise physiologists, nutritionists and psychologists who work together to change the behaviors of those significantly overweight.
"Beverage containers traditionally 'hid' the nutritional content at the back in a small square with small print and cleverly listed just the calorie content per serving," Bartfield said.
"Unbeknownst to those who are happily guzzling their favorite cola or fruit drink, most packaged beverages contain multiple servings, and most Americans fail to do the math on the total calorie count."
Dr. Bartfield's top three "sickeningly sweet" statistics include:
Message In a Bottle
35 year-old Chicagoan, Aaron Villarreal regularly drank about 12 cans of cola every day before joining the Gottlieb Medical Weight Loss Program when his weight spilled over at 350 pounds. "I was stunned when the nutritionist poured white sugar in a measuring cup to show me how much sugar I was drinking in just one day," he said. Villarreal cut the cola from his diet and lost 5 pounds in one week. "Seeing that one small change make such a dramatic difference encouraged me to improve my diet in other ways and to add exercise."
SOURCE: Loyola University Health System, March 17, 2011
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.
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