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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.
Researchers from Iowa State University's gerontology program have helped identify what predicts happiness and long life in centenarians, as well as what causes depression in 80-somethings and above.
In a study of 158 Georgia centenarians, the researchers found that past satisfaction with life — even if it's simply recalling isolated career accomplishments — is the key to happiness in our oldest years.
"The past is the best predictor of the future, so you're not going to turn your life around at 85 or 90," said Peter Martin, director of Iowa State's gerontology program and a professor of human development and family studies (HDFS), who collaborated on both studies. "But it's also good to know that past accomplishments and the happiness that you had — looking back at your past — carries you through these very last years."
For the depression study, researchers added 78 octogenarians (people 80 or older) to the happiness centenarian sample. They found that diminished cognitive problem-solving ability was a significant predictor of depressive symptoms in octogenarians, while living in a nursing home and greater neurotic tendencies increased depression among centenarians.
Both studies were published online in the Jan. 26 issue of the journal Gerontology. Jennifer Margrett, an assistant professor of HDFS, was the lead author on the depression study. Alex Bishop, an assistant professor of human development and family studies at Oklahoma State University (who was a doctoral student at Iowa State), was lead author of the happiness study.
Past life satisfaction pays happiness dividends
In that study, researchers analyzed the subjects' responses to a series of questions that assessed their happiness, perceived health, social provisions, economic security and life satisfaction. While there was no indication that resources affect happiness, past life satisfaction — even individual achievements — was found to have a direct association.
Because of their results, the researchers urge caregivers of the elderly to implement programs — including reminiscence therapy and structured life review sessions — to foster feelings of happiness among very old populations.
"You can be not overly satisfied with your overall current capacity and physical well-being, but you can still be a very happy person because there's a lot you can contribute just by sharing some of the things that nobody knew because it was 80 or 90 years ago," said Martin, who is also in the second year of a three-year study of Iowa centenarians.
In the second other study, researchers measured depressive symptoms, demographics and functional indicators, cognition and personality in the subjects. They then compared the ability of cognition, personality, and demographic and functional indicators in explaining depressive symptoms in the octogenarians and centenarians respectively.
They were surprised to learn that overall cognition was not a stronger predictor of depressive symptoms at either age. Rather, it was the loss of the subject's control — problem-solving in the octogenarians, and choosing where they lived in the centenarians — that tended to depress them.
"In the case of the octogenarians, it's not so much your intellectual ability as it is the ability to come up with a solution to a particular task that you used to be able to solve in your 60s and 70s," Martin said. "And so for the first time, you realize that there may be decline in being able to manage tasks.
"And at 100, it's not so much the surrounding of the nursing home that gets you depressed," he added. "But in a nursing home, two things have changed. First, there's a sign that you cannot take care of yourself anymore. And then there's the sign that you know you only have limited time to live, which is different for an 80-year-old."
Elderly worried about direction country is headed
The research also confirmed that worry and anxiety contribute to depression in centenarians. And one of the things they're worried about, according to Martin, is the direction the country is headed and the world they're leaving for their grandchildren and great-grandchildren.
Martin says these studies have practical applications for elderly care providers.
"When we have professionals who work with elderly in nursing homes, we pay so much attention to the helping condition — make sure they eat, make sure they have their hygiene taken care of, and so forth — but you also have to work on the mood aspect of it," Martin said. "And I know people who work in nursing homes have difficult jobs, but just a brief conversation with a very old person can lighten up their entire day."
The research team also published two related papers in the Jan. 26 issue of Gerontology. One confirms the importance of family history on present-day functioning among centenarians and octogenarians, while the other analyzed the influences on their economic dependency.
SOURCE: Iowa State University, April 12, 2010
Leading physician policy experts are calling for changes in medical education policy at multiple levels to ensure that doctors are prepared to treat the country's aging adult population.
In the May issue of Health Affairs, co-author Steven R. Counsell, M.D., Mary Elizabeth Mitchell Professor and director of geriatrics at the Indiana University School of Medicine and a Regenstrief Institute affiliated scientist, and colleagues Chad Boult, M.D., M.P.H., M.B.A., Rosanne M. Leipzig, M.D., Ph.D., and Robert A. Berenson, M.D. propose several policy solutions to help the United States prepare for the increasing number of geriatric patients.
"The geriatric imperative of the 21st century requires major, rapid changes to our health care system," said Dr. Counsell, who is an IU Center for Aging Research center scientist. "Through educational policy reforms at the state and federal levels, policymakers can catalyze the dramatic workforce changes necessary for delivery of cost-effective chronic care to the rapidly swelling ranks of older Americans."
The article, entitled "The Urgency of Preparing Primary Care Physicians to Care for Older People with Chronic Illnesses," proposes multiple policy-driven solutions. Leading physician policy experts are calling for changes in medical education policy at multiple levels to ensure that physicians are ready to treat the country's growing older adult population.
To ensure a better trained physician workforce as the demand for geriatric care swells and the number of geriatric specialists shrinks, policy options proposed by the authors include:
The authors propose modifying Title VII of the U.S. Public Health Service Act to provide financial support for medical schools and residency programs that adopt the educational innovations needed to care for an aging society.
Similarly, the Medicare program, which provides teaching hospitals with large annual subsidies for graduate medical education, could make continued educational funding contingent on rapid reforms in the training of resident physicians and specialty fellows. To drive swift educational reform, new Medicare policy could link a significant portion of the teaching hospitals' annual direct and indirect medical education payments to the amount of training they provide in primary care, chronic care and geriatrics.
"As Medicare funds are intended to enhance the care of Medicare beneficiaries, the logic of prioritizing training for chronically ill older patients is compelling," said Dr. Berenson, a fellow at the Urban Institute. "Another policy option is to extend Medicare graduate medical education funding to non-hospital clinical training sites, such as nursing homes," added Dr. Leipzig, the Gerald and Mary Ellen Ritter Professor and vice chair of education in the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine.
To support continuous geriatrics training of the many physicians already in practice, the authors propose that state policies could require geriatric continuing education credits for physicians to maintain their licensure, or to practice as Medicaid providers or medical directors of nursing homes.
"With just one geriatrician for every 10,000 adults over 75, primary care physicians are being called on to provide geriatric care for our rapidly aging population," said Dr. Boult, director of the Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health. "But most of today's primary care physicians are not adequately trained to provide the complex care needed by older adults with multiple chronic conditions. In fewer than 20 years, one of every five Americans will be over 65, amounting to more than 70 million people. We need to act now, and act aggressively, to improve the geriatric education of all physicians."
The Institute of Medicine/National Academy of Sciences provided financial support for part of this work.
SOURCE: Indiana University School of Medicine, May 6, 2010
The U.S. Food and Drug Administration is advising consumers not to purchase nor consume Vita Breath, a dietary supplement manufactured by American Herbal Lab Inc. of Rosemead, Calif., and marketed at health fairs and on the Internet, because the product may contain hazardous levels of lead.
The FDA was notified by the New York City Department of Health and Mental Hygiene about a patient with lead poisoning who reported taking Vita Breath and two other herbal products. The department analyzed a sample of Vita Breath and reported it contained 1,100 parts per million of lead. This level is more than 10,000 times higher than FDA's maximum recommended level for lead in candy.
The FDA has collected and is currently analyzing its own samples of Vita Breath.
People with high blood levels of lead may show no symptoms, but the condition may cause damage to the nervous system and internal organs. Acute lead poisoning may cause a wide range of symptoms, including abdominal pain, muscle weakness, nausea, vomiting, diarrhea, weight loss, and bloody or decreased urinary output. Children are particularly vulnerable to lead poisoning. Lead poisoning can be diagnosed through clinical testing, and individuals who have taken Vita Breath should talk to their health care providers about testing.
The FDA is working with state officials in New York and California to further investigate Vita Breath.
SOURCE: Food and Drug Administration, May 4, 2010
Geisinger has exceeded the national benchmark for testing women who are at risk for developing osteoporosis a silent and serious disease.
According to Eric Newman, M.D., Director, Geisinger Department of Rheumatology, the DXA scan is the industry standard for the diagnosis of osteoporosis and the calculation of fracture risk. National recommendations state that all women over age 65 should receive this test as part of their routine health maintenance. Following the implementation of a three-pronged plan to improve testing rates, Geisinger reports that an unprecedented 74 percent of women over the age of 65 cared for at a Geisinger primary care site have received DXA testing, that is more than 19,000 women. The national rate of women having this diagnostic procedure is only 20 to 30 percent.
"Osteoporosis is a very serious disease. Any woman over age 65 should be tested to determine their future risk of breaking a bone. We were very concerned that a large percentage of women have not been scheduling this simple, painless test that can ultimately save their lives," said Dr. Newman. "This concern prompted a multi-team effort to find ways to close the gap for osteoporosis diagnosis and subsequent care."
Geisinger had been well above the national standard for DXA testing with a 44 percent DXA testing rate prior to launching this initiative.
Providers, nurses and technologists from Rheumatology, Endocrinology and community practice sites, in conjunction with Radiology, Laboratory Medicine and Clinical Innovation, developed a series of strategies to reach a larger percentage of at-risk women. Utilizing Geisinger's existing Electronic Health Record (EHR), providers were prompted to schedule DXA testing for patients determined to be at-risk during a routine visit. In addition, EHR records were searched for those women who had not been DXA scanned in the last three years. Letters were sent to this population to schedule an appointment, with follow-up telephone calls if necessary.
"This achievement is a testimony to what we can accomplish with engaged healthcare providers, electronic support systems and organized programs of care delivery. And, this is just the beginning," said Dr. Newman. "In conjunction with our colleagues in Primary Care and Orthopedics, as well as our hospitalists (specialists who provide medical treatment to individuals while they are in the hospital), we have already started exploring ways to ensure that more high-risk patients get on the necessary treatment regimens. In addition, the team is seeking ways to enhance adherence to osteoporosis treatment plans. That is particularly challenging, but given the successes we've already seen, I am confident that those in need of osteoporosis care will get it and we'll prevent many unnecessary and life-threatening fractures."
According to the National Osteoporosis Foundation, osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. Of particular concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain and deformity. About Geisinger Health System
Geisinger is an integrated health services organization widely recognized for its innovative use of the electronic health record, and the development and implementation of innovative care models including advanced medical home and ProvenCare ("warranty") program. The system serves more than 2.6 million residents throughout 42 counties in central and northeastern Pennsylvania.
SOURCE: Geisinger Health System, May 7, 2010
Surviving heart failure calls for lifestyle changes, taking medications and following doctor's orders. Some of the 5 million heart failure patients have trouble adhering to these changes and end up returning to the hospital.
Researchers from Case Western Reserve University, Kent State University, Summa Health System and University Hospitals Case Medical Center will find out if subtle or hidden cognitive impairments cause the adherence problems in heart failure cases.
The research project, "Heart ABC : Adherence, Behavior and Cognition," will contribute important information about which types of cognitive impairments are related to specific problems in self-management. It is supported by a four-year, $2.7 million grant from the National Institutes of Health's National Heart, Lung and Blood Institute.
Treating heart failure costs the healthcare system about $43 billion annually. Recent indicators point out that between 25-50 percent of these patients might have unrecognized cognitive problems that impair their ability to make decisions about their health.
These decisions can range from keeping doctor's appointments to taking medicines at the appropriate times, according to Mary Dolansky, assistant professor of nursing at CWRU's Frances Payne Bolton School of Nursing. She is one of the lead investigators on the study.
This will be one of the first studies to look at the connections between subtle cognitive impairment, particularly on a battery of tests for mental functions, and adhering to a complex medical regimen such as taking their medications, eating a low salt diet and knowing when to call the doctor if their condition worsens.
Dolansky will co-lead the project with Joel Hughes, associate professor of psychology at Kent State University.
They will study 400 patients between the ages of 50 and 85 from Summa Health System and University Hospitals. Other co-investigators are John G. Gunstad, Kent State; Richard Josephson, CWRU School of Medicine; Joseph Redle, Summa Health System; James Fang, University Hospitals; Nahida Gordon and Shirley Moore, Frances Payne Bolton School of Nursing, CWRU.
The team has expertise in nursing, behavioral medicine, neuropsychology, cardiovascular medicine and patient self-management. The strength of the study is the interprofessional team, which will approach the study from these different backgrounds.
"Self-management is complex," Dolansky says. Heart failure patients may be on three to eight medications, have to reduce salt in their diets and cannot gain weight.
Dolansky and Moore are part of a team of researchers in nursing who examine how people manage their illnesses and have advanced knowledge about self-management through research projects at the nursing school's NIH-funded Center Self-Management Advancement through Research and Translation (SMART Center).
A potential hidden cognitive problem among HF patients is the inability to make decisions about what to do if their condition changes. For example, HF patients who have a cognitive problem and who experience sudden weight gain may not think to notify their physician. Over time, their condition will worsen, thus resulting in an unnecessary trip to the emergency room.
The researchers will administer a number of psychological tests that can reveal hidden impairments.
Then the patients will be monitored for how well they adhere to their medications, diet, and weight levels for 21 days. They will have follow-up monitoring at 3, 6, 9 and 12 months.
"Our findings will have important implications for screening heart failure patients and understanding how we can best intervene to help patients self-manage their heart failure," Hughes adds.
New interventions or medications can be designed to help people keep on track with all the different things they have to do to keep healthy and stay out of the hospital.
SOURCE: Case Western Reserve University, May 9, 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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