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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.
Advanced cancer patients who regularly received massages averaging 14 minutes or more by a partner or family member declined in stress scores over four weeks, according to results of a study reported at the 7th annual conference of the American Psychosocial Oncology Society.
In the study, sponsored by the National Cancer Institute, 97 care partners followed the instruction of a DVD program to provide massage to patients at home. The multi-ethnic sample represented 21 types of cancer (nearly half with breast cancer), over half with either stage III or IV cancer.
The study looked at the effects of massage by a care partner (spouse or family member) over four weeks. According to the principal investigator, William Collinge, PhD, president of Collinge and Associates, "The number of massages averaged about four per week across all patients, but the duration of massages was particularly important for stage IV patients. At four-week follow-up, 78% of those who averaged over 13.75 minutes per massage had reduced stress scores, while only 15% of those receiving briefer massages did, a significant difference. It appears that 14 minutes is some kind of a 'tipping point' where the effects of massages by family members accumulate and reduce stress in these patients over time."
The study also looked at the immediate effects of massages by care partners and found significant reductions in stress/anxiety (44% reduction), (34%), fatigue (32%), depression (31%), and nausea (29%). These reductions are on a par with what might be expected from a professional massage therapist, Collinge said, and bode well for improved quality of life in cancer patients.
According to Collinge, "It appears that care partners receiving video instruction can achieve some of the same results as professional practitioners. This has important implications for patient quality of life, but also for caregiver satisfaction. Caregivers are at risk of distress themselves - they can feel helpless and frustrated at not feeling able to help. This gives a way to help the patient feel better and increase their own effectiveness and satisfaction as a caregiver. It also appears to strengthen the relationship bond, which is important to both."
The DVD program is available to the public as "Touch, Caring and Cancer: Simple Instruction for Family and Friends" in English, Spanish and Chinese versions. Information and video trailers are available at http://www.partnersinhealing.net.
SOURCE: Collinge and Associates, February 26, 2010
Virtual reality game technology using Wii™ may help recovering stroke patients improve their motor function, according to research presented as a late breaking poster at the American Stroke Association's International Stroke Conference 2010.
The study found the virtual reality gaming system was safe and feasible strategy to improve motor function after stroke.
"This is the first randomized clinical study showing that virtual reality using Wii™ gaming technology is feasible and safe and is potentially effective in enhancing motor function following a stroke, but our study results need to be confirmed in a major clinical trial," said Gustavo Saposnik, M.D., M.Sc., director of the Stroke Outcomes Research Unit at the Li Ka Shing Institute, St. Michael's Hospital and lead investigator of the study carried out at the Toronto Rehabilitation Institute at the University of Toronto, Canada.
The pilot study focused on movements with survivors' impaired arms to help both fine (small muscle) and gross (large muscle) motor function.
Twenty survivors (average age 61) of mild to moderate ischemic or hemorrhagic strokes were randomized to playing recreational games (cards or Jenga, a block stacking and balancing game) or Wii™ tennis and Wii™ Cooking Mama, which uses movements that simulate cutting a potato, peeling an onion, slicing meat and shredding cheese.
Both groups received an intensive program of eight sessions, about 60 minutes each over two weeks, initiated about two months following a stroke.
The study found no adverse effects in the Wii™ group, reflecting safety. There was only one reported side effect in the recreational therapy group: nausea or dizziness. The Wii™ group used the technology for about 364 minutes in total session time, reflecting its feasibility. The recreational therapy group's total time was 388 minutes.
"The beauty of virtual reality is that it applies the concept of repetitive tasks, high-intensity tasks and task-specific activities, that activates special neurons (called 'mirror neuron system') involved in mechanisms of cortical reorganization (brain plasticity)," Saposnik said. "Effective rehabilitation calls for applying these principles."
Researchers found significant motor improvement in speed and extent of recovery with the Wii™ technology.
"Basically, we found that patients in the Wii™ group achieved a better motor function, both fine and gross, manifested by improvement in speed and grip strength," Saposnik said. "But it is too early to recommend this approach generally. A larger, randomized study is needed and is underway."
Wii™ is a virtual reality video gaming system using wireless controllers that interact with the user. A motion detection system allows patients their actions on a television screen with nearly real time sensory feedback.
Co-authors are Mark Bayley, M.D.; Muhammad Mamdani, Pharm.D.; Donna Cheung, O.T.; Kevin Thorpe, Mmath; Judith Hall, M.;Sc.; William McIlroy, Ph.D.; Jacqueline Willems; Robert Teasell, M.D.; and Leonardo G. Cohen, M.D.; for the Stroke Outcome Research Canada (SORCan) Working Group. Author disclosures are on the abstract.
The Effectiveness of Virtual Reality Using Wii Gaming Technology in Stroke Rehabilitation (EVREST) Study was funded by a grant from the Heart and Stroke Foundation (HSFO) and the Ontario Stroke System (OSS) in Canada.
SOURCE: American Heart Association, February 26, 2010
Elderly people with visual disorders that are left untreated are significantly more likely to develop Alzheimer's disease -- the most common form of dementia, according to a University of Michigan Health System study.
The study used Medicare data and shows that those with poor vision who visited an ophthalmologist at least once for an examination were 64 percent less likely to develop dementia.
The study appears online ahead of print in the American Journal of Epidemiology and may draw a new picture of poor vision as predictor of dementia rather than as a symptom after the diagnosis.
"Visual problems can have serious consequences and are very common among the elderly, but many of them are not seeking treatment," says lead author Mary A.M. Rogers, Ph.D, research assistant professor of internal medicine at the U-M Medical School and research director of the Patient Safety Enhancement Program at the U-M Health System and the Ann Arbor VA Medical Center.
For the study, Rogers and her colleague Kenneth M. Langa, M.D., Ph.D., professor of internal medicine at U-M Medical School, analyzed data from the nationally representative Health and Retirement Study and records from Centers for Medicare and Medicaid Services.
"Our results indicate that it is important for elderly individuals with visual problems to seek medical attention so that the causes of the problems can be identified and treated," Rogers says.
The types of vision treatment that were helpful in lowering the risk of dementia were surgery to correct cataracts and treatments for glaucoma, retinal disorders and other eye-related problems.
Proper vision is a requirement for many of the activities that previously have been found to lower the risk of Alzheimer's disease. These include reading, playing board games, other mentally stimulating activities, social networking, as well as physical activity such as walking and routine exercising. A visual disorder may interfere with normal mobility and may also hinder a person's ability to participate in such activities.
"Many elderly Americans do not have adequate health coverage for vision, and Medicare does not cover preventative vision screenings for most beneficiaries," Rogers says. "So it's not unusual that the elderly receive vision treatment only after a problem is severe enough to warrant a visit to the doctor when the problem is more advanced."
According to a survey conducted by the National Eye Health Education Program, less than 11 percent of respondents understood that there are no early warning signs for eye problems such as glaucoma and diabetic retinopathy.
However, vision problems and blindness are among the top 10 disabilities among adults and can result in a greater tendency to experience other health conditions or even to die prematurely.
"While heart disease and cancer death rates are continuing to decline, mortality rates for Alzheimer's disease are on the rise," says Rogers. "So if we can delay the onset of dementia, we can save individuals and their families from the stress, cost and burden that are associated with Alzheimer's disease."
The study was based on the surveys and medical information from 625 people compiled from 1992-2005. Only 10 percent of Medicare beneficiaries who developed dementia had excellent vision at the beginning of the study, while 30 percent of those who maintained normal cognition had excellent vision at the onset of the study.
One in five Americans who are over age 50 report experiencing a visual impairment, according to the U.S. Centers for Disease Control and Prevention. Approximately 5 million Americans have Alzheimer's disease and the number has doubled since 1980. It is expected to be as high as 13 million by 2050.
Additional author: Kenneth M. Langa, M.D., Ph.D., is also a researcher at the Veterans Affairs Center for Practice Management and Outcomes Research and Institute for Social Research Reference: American Journal of Epidemiology, 2010 Feb. 11; doi:10.1093
SOURCE: University of Michigan Health System, February 19, 2010
Electromagnetic pulses significantly decrease pain and inflammation associated with osteoarthritis of the knee, according to Henry Ford Hospital researchers.
In the double-blind, randomized placebo-controlled study, 34 patients used a portable battery-operated device that emits a low-intensity pulsating electromagnetic frequency and experienced more than 40 percent pain relief on their first day.
"Our results show pulsed electromagnetic fields caused a significant decrease in pain" says Fred Nelson, M.D., associate program director for research and director of the Osteoarthritis Center, Department of Orthopaedics, Henry Ford Hospital.
Dr. Nelson will present the results this week at the Orthopaedic Research Society's annual meeting in New Orleans.
Dr. Nelson explains that in the laboratory, electromagnetic signals have been shown to decrease calcium in cartilage cells. This sets off a series of chemical events that can lead to reduced inflammation. Previously, the electromagnetic fields have been used to control pain related to cosmetic surgery.
"We are really fine-tuning what we are doing to the cell environment with a very specific pulse sequence and frequency," says Dr. Nelson.
Patients strapped the small, ring-shaped plastic device around their knees for 15 minutes, twice daily for six weeks. The device was lightweight and patients could position the device directly over clothing. All participants were given a device with a coil that appeared to work but some were assigned active coils and others were given non-active coils. The electromagnetic device was developed by Ivivi Health Sciences of Montvale, New Jersey.
Osteoarthritis of the knee is a leading cause of disability and loss of independence. It is a slow, progressively degenerative disease in which the joint cartilage gradually wears away due to trauma, aging or infection. As the cartilage thins, the surrounding bone thickens and often bones rub against one another, causing additional wear. Normal activity becomes painful and difficult.
Current treatments include drug therapies like anti-inflammatory medication or pain relievers; physical therapy; support devices; health and behavioral modifications such as weight loss; surgery and joint replacement.
Dr. Nelson explains that medications often have variable success and can produce considerable side effects such as changes in kidney and liver function, a reduction in the ability of blood to clot as well as abdominal pain, nausea and indigestion.
"The exciting thing about this new approach is that it has been found to have no side effects, it is relatively low-cost in the long-run and the onset of pain relief is immediate," says Dr. Nelson. "We look at electromagnetic pulses as a potential way to improve quality of life and independence for those who suffer from osteoarthritis of the knee."
Dr. Nelson says researchers will continue to look at the consistency of the relief, how long the pain relief lasts and if electromagnetic pulses might affect other joints.
SOURCE: Henry Ford Health System, March 8, 2010
Adults who have both diabetes and major depression are more than twice as likely to develop dementia, compared to adults with diabetes only, according to a study published in the recent Journal of General Internal Medicine.
Dementia is the progressive decline of thinking and reasoning abilities. These can include memory loss, difficulty with basic math, wandering, living in the past, personality changes, and not recognizing familiar people.
"Diabetes alone has shown to be a risk factor for dementia, as has major depression by itself," noted the lead author of the study, Dr. Wayne Katon, University of Washington (UW) professor of psychiatry and behavioral sciences. Also on the study team were researchers from the Group Health Research Institute in Seattle and the Veterans Affairs (VA) Puget Sound Health Care System, as well as UW researchers in medicine and in epidemiology.
Various other population studies, Katon and the other authors noted, have shown that the risk of Alzheimer's disease, vascular dementia, and other types of dementia is from 40 percent to 100 percent higher in people with diabetes, compared to people without diabetes. A history of depression more than doubles the subsequent risk of Alzheimer's disease and other forms of dementia in the general population.
"We wanted to determine the effects of both conditions - diabetes and major depression - occurring together," Katon said. "Our analysis suggests that major depression more than doubles the risk of dementia in adults with diabetes."
The research team on this project, which is part of the Pathways Epidemiological Follow-Up Study, tracked the outcomes of adults from the Group Health Cooperative's diabetes registry who agreed to participate. They were patients from nine Puget Sound area primary-care clinics in western Washington state. The clinics were chosen for their socioeconomic and racial/ethnic diversity and were demographically similar to the area's population. Initial enrollment of patients took place between 2000 and 2002, and the patients were studied for five years. Patients already diagnosed with dementia were excluded from the study.
Over the five-year period, 36 of 455, or 7.9 percent, of the diabetes patients with major depression were diagnosed with dementia. Among the 3,382 patients with diabetes alone, 163 or 4.8 percent developed dementia.
The researchers calculated that major depression with diabetes was associated with a 2.7-fold increase of dementia, compared to diabetes alone. Because the onset of dementia can sometimes be marked by depression, the researchers also adjusted their hazard model to exclude patients who developed dementia in the first two years after their depression diagnosis.
The team's previous findings from earlier studies showed that depression increases the mortality rate among people with diabetes, as well as the rate of complications such as heart, blood vessel, kidney and vision problems.
The exact manner in which diabetes and depression interact to result in poorer outcomes is not certain. Some studies suggest that a genetic marker for dementia is associated with a faster cognitive decline. Depression may also raise the risk of dementia, the authors noted, because of biological abnormalities linked to this affective illness, including high levels of the stress hormone cortisol, poor regulation in the hypothalamus-pituitary system, or autonomic nervous system problems that can affect heart rate, blood clotting, and inflammatory responses.
Depression, they added, might also raise the risk of dementia because of behaviors common in the condition, such as smoking, over-eating, lack of exercise, and difficulty in adhering to medication and treatment regimens. In the current study, patients with both diabetes and major depression were more likely to be female, single, smokers, physically inactive, and treated with insulin. They also had more diabetes complications and a higher body mass index, a ratio calculated from height and weight. However, these differences were controlled for in the analysis and depression remained an important risk factor.
Diabetes, the authors noted, is a risk factor for dementia because of blood vessel problems and also may accelerate the decline of Alzheimer's disease. Many factors linked to diabetes might also increase the odds of developing dementia, including tissue damage from high blood sugar levels, episodes of low blood sugar and insulin resistance.
Depression is common among people who have diabetes. Until more research is available on the exact mechanisms behind the links between depression, diabetes, and dementia, the researchers say, "It seems prudent for clinicians to add effective screening and treatment for depression to other preventive measures such as exercise, weight control, and blood sugar control to protect against the development of cognitive deficits in patients with diabetes."
In addition to Katon, members of the research team were Elizabeth H.B. Lin, Evette Ludman, Carolyn Rutter, Malia Oliver and Michael Von Korff, all from the Group Health Research Institute; Lisa Williams from the UW Department of Medicine and the Epidemiologic Research and Information Center at the VA Puget Sound Health Care System; Paul Ciechanowski from the UW Department of Psychiatry and Behavioral Sciences; Susan R. Heckbert, from the Department of Epidemiology in the UW School of Public Health; and Paul K. Krane from the UW Department of Medicine.
Grants from the National Institute of Mental Health, National Institutes of Health, supported the study.
SOURCE: University of Washington, March 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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