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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.
To assist physicians in caring for a patient demographic that is rapidly growing in size, JAMA is launching a new series, "Care of the Aging Patient: From Evidence to Action."
"The aging of the global population will be a hallmark of the 21st century, when average lifespan may reach 100 years in some countries, at least for women. Worldwide, the proportion of the population aged 60 years or older is expected to increase from 10 percent worldwide in 2005 to 22 percent in 2050, with the steepest rise in the next 25 years. Individuals aged 85 years or older are the most rapidly increasing segment of many populations," according to an editorial in the December 23/30 issue of JAMA.
C. Seth Landefeld, M.D., of the University of California, San Francisco, and colleagues write that aging will shape the lives of patients and the practice of medicine, and that physicians will spend more time caring for older individuals. "Although physicians are knowledgeable about the pathophysiology, diagnosis, and management of organ-specific diseases such as cataract, coronary artery disease, and pneumonia, many geriatric syndromes are not straightforward and do not fit the conventional paradigm of disease. Are physicians ready for these challenges? How can physicians prepare to meet the needs of patients as they age?"
"The Institute of Medicine's 2008 report Retooling for an Aging America concluded, 'The health care workforce... is not prepared to deliver the best care to older patients.' This new series takes a step to address this problem."
The overall goal of this series will be to help improve clinical practice and inform policy in care of older individuals, especially those who have started to lose their independence or are at risk of doing so. "Using the real stories of patients and interviews with them, the new series will analyze how to put existing evidence into practice to address pressing questions that arise for older patients, their families, and their physicians. By focusing on older patients' specific problems, the articles will explore themes that develop with aging," the authors write.
The first 12 articles will explore the course of aging, from the first hints of frailty through events such as difficulty driving a car to the progressive restriction of activities that results from a steady decline. "The series aims to provide clinicians with pragmatic tools and methods for translating published evidence into daily practice, or if evidence does not exist, recommendations with a rationale and a potential research agenda."
"Care of older patients often brings joy and satisfaction to their physicians. With enhancement of their knowledge and skills, all physicians have the opportunity to share in this meaningful and important work, which will be the main work for many in the aging century. With this new series of articles focused on geriatric issues and their policy implications, JAMA begins to enhance physicians' ability to do so."
In the first article in the series, David Reuben, M.D., of the University of California, Los Angeles, discusses the approach to care of older patients beginning with a consideration of life expectancy and patient goals. Such an approach helps tailor the patient's visit to issues of greatest importance to the patient and interventions to maximize prevention, independence, and quality of life. An accompanying commentary by Christine Cassel, M.D., President of the American Board of Internal Medicine, addresses necessary changes in workforce support for primary care, training requirements, payment reform, research, and systems to improve care of older adults.
SOURCE: Journal of the American Medical Association, January 3, 2010
Millions of Americans with significant or chronic pain associated with their medical problems are being under-treated as physicians increasingly fail to provide comprehensive pain treatment - either due to inadequate training, personal biases or fear of prescription drug abuse.
A pharmaceutical expert in pain management in the College of Pharmacy at Oregon State University says the issue is reaching crisis proportions, and in two new professional publications argues that health consumers must be aware of the problem and in many cases become more informed, persistent advocates for the care they need and deserve.
"We have more sophisticated pain management techniques available now than ever before," said Kathryn Hahn, a pharmacist, affiliate faculty member at OSU and chair of the Oregon Pain Management Commission. "But many doctors are not fully informed about all the options available, and also often turn patients away because they're very concerned about the problems with prescription drug abuse.
"Because of this, many people suffer needlessly with pain that could be treated, and almost 80 percent of visits to community pharmacies involve pain issues," Hahn said. "We're in the middle of a storm here, and have to figure out some way to navigate through it."
Adequate pain treatment has always been a concern, Hahn said, in part because it's not a major part of most physician's medical training. Even though they will often see a stream of patients with pain problems throughout their careers, they may only get a few hours of education on the use of opioids in medical school.
In recent years, the problems have dramatically increased due to concerns about prescription drug abuse, in which drugs such as oxycodone are often stolen from homes or otherwise misused. In a 2006 survey of teenagers, 62 percent said prescription pain relievers were easy to get from their parents' medicine cabinet. One analysis concluded that admissions to federally supported treatment programs for prescription opioid abuse increased 342 percent from 1996 to 2006 — a comprehensive problem that is also estimated to cost insurance companies tens of billions of dollars a year.
Concerns about this within the medical profession are sufficiently high, Hahn said, that many doctors prefer not to even work with patients who have ongoing pain issues. They also fear criticism from other doctors if they have high numbers of pain-related cases or prescribe significant amounts of pain medications, she said.
"I see patients every week who have lost their doctors, don't know what to do and these people are scared," Hahn said. "It's particularly bad with elderly and Medicare patients. Prescription drug abuse is a very real problem, we do have to take necessary steps to address it, but right now the pendulum has swung too far, and legitimate pain problems are not being managed."
Long-term solutions, Hahn said, will take education and responsibility by all parties involved, including consumers, physicians, nurses and pharmacists.
Among the steps that may help:
Hahn outlined some of these issues in two new publications, one in the Journal of Pain and Palliative Care Pharmacotherapy, and the other in The Rx Consultant.
"Surveys show that at least 30 percent of patients with moderate chronic pain and more than 50 percent of those with severe chronic pain fail to achieve adequate pain relief," she wrote in one article. "The economic impact of acute and chronic pain exceeds $100 billion per year in the U.S. alone."
Community pharmacists, she said, are often on the front lines of this issue and constantly see individuals with pain concerns and inadequate pain management by their health care providers. They can often help serve as advocates, improve lines of communication between patients and their doctors, and help patients manage their prescribed drug therapies.
Health insurers also have an important role to play in reducing prescription drug abuse, Hahn said. They can help educate physicians on appropriate use, advocate for universal precautions in use of pain medicines, restrict off-label uses of readily diverted opioids, pay for multidisciplinary pain management programs, and take other steps.
SOURCE: Oregon State University, January 6, 2010
In the early stages of Alzheimer's disease, patients typically suffer a major loss of the brain connections necessary for memory and information processing. Now, a combination of nutrients that was developed at MIT has shown the potential to improve memory in Alzheimer's patients by stimulating growth of new brain connections.
In a clinical trial of 225 Alzheimer's patients, researchers found that a cocktail of three naturally occurring nutrients believed to promote growth of those connections, known as synapses, plus other ingredients (B vitamins, phosopholipids and antioxidants), improved verbal memory in patients with mild Alzheimer's.
"If you can increase the number of synapses by enhancing their production, you might to some extent avoid that loss of cognitive ability," says Richard Wurtman, the Cecil H. Green Distinguished Professor of Brain and Cognitive Sciences, who did the basic research that led to the new experimental treatment. He is an author of a paper describing the new results in the journal Alzheimer's and Dementia.
There is currently no cure for Alzheimer's disease, though some medications can slow the progression of the disease. In particular, many U.S. patients take cholinesterase inhibitors, which increase levels of acetylcholine, a neurotransmitter important for learning and memory.
While those treatments target the symptoms of Alzheimer's, Wurtman hopes to attack what he believes is the root cause of the disease: loss of synapses. The three nutrients in his dietary cocktail - uridine, choline and the omega-3 fatty acid DHA (all normally present in breast milk) - are precursors to the fatty molecules that make up brain cell membranes, which form synapses.
In animal studies, Wurtman has shown that these nutrients boost the number of dendritic spines (small outcroppings of neural membranes). When those spines contact another neuron, a synapse is formed.
Three additional clinical studies in Alzheimer's patients are now underway, one in the United States and two in Europe. Results are expected to be available between 2011 and 2013.
The first clinical study was sponsored by the French company Danone, known in the United States as Dannon; the study was conducted primarily in Europe and was led by Philip Scheltens, director of the Alzheimer Center at Vrije Universiteit Medical Center in Amsterdam. Wurtman and MIT have patented the mixture of nutrients used in the study, and Nutricia Advanced Medical Nutrition, a unit of Danone, holds the exclusive license on the patent.
Patients with mild Alzheimer's drank the cocktail (made in the form of a nutrient drink called Souvenaid, with the collaboration of Danone) or a control beverage daily for 12 weeks. Patients who received the nutrients showed a statistically significant level of improvement compared to control subjects: 40 percent of the treated patients improved performance in a test of verbal memory (memory for words, as opposed to memory of locations or experiences) known as the Wechsler Memory Scale, while 24 percent of patients who received the control drink improved their performance. Among those who received the cocktail, patients with the mildest cases of Alzheimer's showed the most improvement.
The drink appeared to have no effect on patients' performance in another commonly used evaluation for Alzheimer's patients, the ADAS-cog test. Wurtman believes that is because ADAS-cog is a more general assessment that tests for orientation and movement/spatial memory as well as cognition. So in subjects with early Alzheimer's who show principally cognitive changes, more than the 225 subjects in the first study will probably be required to yield significant ADAS-cog changes after Souvenaid. The 500 subjects in the ongoing study in the United States may be sufficient.
John Growdon, a neurologist at Massachusetts General Hospital, says that trying to regrow synapses is an innovative strategy and offers a complementary approach to two other lines of attack in treating Alzheimer's: targeting the amyloid plaques that accumulate in patients' brains, and minimizing the damage done by toxic metabolites that build up in Alzheimer's-affected brains.
"I don't think any one approach has a monopoly, and that's good," Growdon says. "You need to have a lot of different approaches because no one knows what's going to work."
Wurtman believes his approach to Alzheimer's may eventually prove beneficial in treating other diseases. If these nutrients prove to be successful in Alzheimer's patients, "then you can think about other diseases in which there are too few synapses," such as Parkinson's disease, he says. "There are a lot of diseases associated with synapse deficiency."
SOURCE: Massachusetts Institute of Technology, January 8, 2010
A death of a loved one, a job loss, the end of a marriage, an illness or disability. Everyone faces losses and grief, but the toll that grief can take on the mind and body can catch many people by surprise.
The December issue of Mayo Clinic Women's HealthSource provides an overview of grief -- a normal reaction to loss. In years past, grief often was described as following a certain pattern or orderly progression from one feeling to another.
But there is no one way to grieve. People who are grieving experience many different emotions in any number of combinations. They may include denial, sadness, anger, confusion, despair and even guilt. Physical reactions can include sleeping problems, changes in appetite, a drop in energy level, body aches and pain or the development or worsening of an illness.
Time spent grieving varies, too. Some people take months to fully accept or adapt to a loss. For others, the process may take years. To help cope with grief:
SOURCE: The Mayo Clinic, December 31, 2009
A new approach to common cardiac procedures called transradial angiography might lead to reduced patient complications and recovery time and decreased hospital costs.
Cardiologists at the University of Illinois and Jesse Brown VA medical centers are among the first in the Chicago area to offer the approach to heart angiograms and clearing blocked arteries.
In the procedure, a catheter is threaded through the small radial artery in the wrist rather than the larger femoral artery in the groin.
"It's a simple change that has a dramatic impact on the experience and recovery of the patient," said Dr. Adhir Shroff, assistant professor of cardiology at UIC.
Although complications from standard catheterization through the groin are low, occurring in only 2 percent to 9 percent of patients, the transradial approach can reduce bleeding — the most common complication, particularly among women and the elderly — to under 1 percent. It also eliminates much of the discomfort associated with the procedure.
Following a standard angiogram and angioplasty through the femoral artery, the patient needs to lie still on his or her back for four to six hours. This can be very uncomfortable for elderly patients with back problems, Shroff said. Walking can be uncomfortable for days.
In contrast, patients who have the procedure done via the wrist can immediately sit up, eat, and walk without pain, said Shroff.
The transradial procedure has been widely adopted in Europe, where up to 60 percent of procedures are now done this way. In the U.S., only about 2 percent of coronary interventions use the procedure.
"The issue is really just the learning-curve," said Shroff. "The change requires dozens of small changes — everything from redesigning the sterile drape so that the openings are at the wrist rather than the leg and finding smaller needles, wires and catheters to the way the table is set up."
Last month, Shroff, Dr. Mladen Vidovich, UIC assistant professor of cardiology, and Bernadette Speiser, nurse manager in cardiology at the Jesse Brown VA Medical Center, led an all-day workshop at UIC in implementing a transradial approach that drew cardiologists and other catheter lab team members from the Chicago area and around the country. The Jesse Brown VA Medical Center is one of only a handful of VA centers in the country to offer the procedure.
"We've solved dozens of small problems that stand in the way of implementing this kind of program, so that everyone interested in transradial cardiac catheterization doesn't have to re-invent the wheel," said Speiser.
In addition to offering a ready-made approach to the technique, Shroff said the key is enlisting the help and cooperation of everyone involved in the cath lab, from nurses and nurse-managers to the technicians who set up the equipment.
Schroff says there is no downside to using the transradial approach where appropriate.
"And in these times, as everyone tries to think strategically about the delivery of healthcare, the savings in terms of costs and hospital resources offered by transradial catheterization make it especially attractive," he said. "It is my belief that once a patient has their procedure done from the wrist, they will demand that approach in the future, if they require it again."
SOURCE: University of Illinois at Chicago, January 8, 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.
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