Surgical Complications From Falling

General Posted by anthony Date November 1, 2013

(From JAMA)

Surgical complications from falling increase if you have fallen six months prior to surgery, no doubt a result of a weakened physical state.

According to a JAMA article, a history of one or more falls in the six months before a surgery appears to be an indicator of complications, the need to be discharged to a care facility and 30-day readmission after a surgery, according to a study by Teresa S. Jones, M.D., of the University of Colorado School of Medicine, Aurora, and colleagues.

More than one-third of all U.S. inpatient operations are performed on patients 65 years and older, a proportion which will increase during the next several decades. Existing preoperative risk assessment strategies do not quantify the risk that comes from being frail, according to the study background.

Researchers sought to evaluate the relationship between older patients with a history of falls (a measure of frailty) in the preceding six months of a major elective operation and postoperative outcomes. The study included 235 patients (average age 74 years) undergoing elective colorectal and cardiac operations. Thirty-three percent of patients had preoperative falls.

Postoperative complications occurred more frequently in the group with prior falls compared to those patients who had not fallen following both colorectal (59 percent vs. 25 percent) and cardiac (39 percent vs. 15 percent) operations, according to the study findings. The need to be discharged to a care facility also occurred more frequently in the group that had fallen and 30-day readmission was higher.

ÛÏGiven the high volume of surgical care provided for the elderly population, improving preoperative risk assessment for the older adult is becoming increasingly important. Incorporating geriatric-specific variables that reflect physiologic vulnerability of the older adult into large surgical outcomes data sets used to construct preoperative risk calculators has real potential to improve the accuracy of these tools at forecasting risk in older adults Û the study concludes.

Do This: Talk to your physician / surgeon and specifically report any falls and consider postponing surgery if possible until your health improves.

Not That: Do not selectively forget to mention this to your physician. Don’t put yourself at risk by having a surgery whose risks could be complicated by a recent fall.

Your Cholesterol Drug May Prevent Dementia

General Posted by anthony Date October 30, 2013

The U.S. Food and Drug Administration recently ordered that statin labels include a warning about memory problems associated with short-term use.åÊA research team from Johns Hopkins Medicine found no evidence of this, based on their analysis of prior studies. In addition, they found that statin use for longer than one year reduced the risk of dementia by 29%. In short, your cholesterol drug may prevent dementia.

In patients without baseline cognitive dysfunction, the results of the available studies are most compatible with no significant short-term cognitive detriments related to statin therapy, whereas long-term data suggest a beneficial role in the prevention of dementia.åÊ

Researchers noted that at present, patients and physicians can be reassured about concerns related to neurocognitive effects of statin therapy, and the evidence does not support a change to practice guidelines.
ÛÏWe looked at high-quality, randomized controlled trials and prospective studies that included more than 23,000 men and women with no prior history of cognitive problems,Û stated Raoul Manalac, M.D., a co-primary author. ÛÏThe participants in those studies were followed for up to 25 years.Û

The short-term memory issues related to statins could be caused by drug interactions, since many people on statins also take other medications, the researchers surmised. The benefits of statins make sense, they wrote, because these drugs reduce or stabilize plaque in blood vessels, which is associated with dementia.

So if you are on a cholesterol medicine and getting routine blood work and you are fine, be comforted by the fact that these medications may have other benefits.

You Are Indeed Wiser When You Are Older

General Posted by anthony Date October 28, 2013

Older and Wiser

(From ALFA)

A new study has found that although the ability to learn naturally decreases with age, experience accumulated over a lifetime allows most older adults to make better decisions than their younger counterparts. This shows in part that you are indeed wiser when you are older.

Researchers from the University of California, Riverside say the study is the first to measure decision making and intelligence over the lifespan through what they call fluid and crystallized intelligence. The authors describe fluid intelligence as the ability to learn and process information, while crystallized intelligence is a term that refers to experience and accumulated knowledge.

Previous research has found that fluid intelligence decreases with age, but no prior research had been undertaken to discover if this had any effect on decision-making ability.

Test results indicated that the older cohort scored as well or better than the younger participants in four economic decision-making measures.åÊ ÛÏThe findings confirm our hypothesis that experience and acquired knowledge from a lifetime of decision making help offset the declining ability to learn and process new information,Û said Ye Li, assistant professor at UC Riverside and lead author of the study.

With the average American holding off on retirement later than previous generations, these results show that most older adults will be well-equipped to handle important choices related to their finances and health care. However, the older participants in this study were found to have lower fluid intelligence, prompting the researchers to note that older adults can still benefit from aids such as a financial advisor when making important financial decisions.åÊ

Read the full report: Complementary Cognitive Capabilities, Economic Decision-Making, and Aging

Americans Confused About How Long Term Care is Paid For

General Posted by anthony Date October 25, 2013

(From Health Day News / Harris Interactive)

A new Harris Interactive/Health Day poll finds that more than two-thirds of Americans are anxious and uncertain about how they’ll meet nursing home or home care costs should they need them.

Most people were also wrong about how most of these costs are covered under the current

system.åÊ

About half (49 percent) mistakenly thought the bulk of the bill was paid by individuals, while one third guessed Medicare.
Only 19 percent understood that the major funder of long term care is actually Medicaid, the government agency that covers health services for the poor.

One thing most people agreed on: as America ages, the problem of how to pay for seniors’ long-term care will only get worse. Eighty-seven percent called the situation “serious” or “somewhat serious.”

They’re right to be worried, said Howard Gleckman, a fellow at the Urban Institute in

Washington, D.C., who focuses on long-term care issues. “This is a huge and growing problem,” he said. There are currently about 12 million Americans

in some form of long-term care, he noted, and that’s expected to double within the next 20 years. It’s estimated that most Americans, more than two-thirds of those aged 65 and up

will need some type of long -term care, such as a nursing home, home health aide or adult “day care” center.

In the new poll, a similar percentage–68 percent–expressed worry about how to pay for it all. The problem of how to pay for rising costs of senior care was not addressed by the Affordable Care Act, or what some call “Obamacare.” And Gleckman said that policymakers have shown no agreement on where to go from here.

As for the general public, past research proves that few of us even know how long-term care is currently financed, Gleckman noted. And the new poll confirms that.

For example, “very few people understand Medicaid’s role in long-term care,” Gleckman said. The problem for families is that Medicaid coverage only kicks in once people have spent down their assets enough to qualify for assistance.

The other option is for people to plan in advance and buy pricey private insurance that

specifically covers long-term care. The poll found that 64 percent of Americans think “most

people” should buy long-term care insurance.

But thinking that something sounds good, and actually doing it for yourself are two distinct

things, Gleckman pointed out. Based on current statistics, less than 8 percent of U.S. adults have bought long-term care insurance, he noted.

In the new poll, 79 percent said they supported the notion of tax breaks that would help people purchase long-term care insurance, with similar numbers of Republican and Democrat respondents in favor of such a move. Whether any tax perk would actually encourage more Americans to invest in private insurance is the big question, Gleckman said.

With the age of the average voter steadily rising, “how we will pay for long-

term care in the future is likely to become a huge political issue,” added Harris Poll chairman Humphrey Taylor.

“The cost is already well over $200 billion and is almost certain to grow rapidly as many more baby boomers grow older.” Just last week, the federal Long-Term Care Commission–

an expert panel established by Congress — issued recommendations on how to improve the delivery of long-term care.

“Where they couldn’t reach any consensus at all,” Gleckman said, “was how to finance it.”

But in the new poll, he noted, the public showed a surprising amount of agreement on some

financing options. Over two-thirds were in favor of a “new government program” to help out.

Even among Republicans, half liked the idea–which was particularly striking, Gleckman said.

Another expert in long-term care said the poll shows that Americans are becoming more awareof the issue. “Most Americans now will live for some years with an inability to take care of themselves due to the illnesses associated with advanced old age,” said Dr. Joanne Lynn, director of the Center for Elder Care and Advanced Illness at the non-profit Altarum Institute.

“This will be the most expensive part of most of our lives,” Lynn said, “yet insurance does not cover it — at least not until the person has spent down to poverty, when Medicaid will pitch in.”

She added that “very few” Americans can save enough money to pay for long-term care in their final years. “It’s good that most Americans are beginning to recognize the need for some public support,” she said. According to Gleckman, the financing solution does not have to be strictly “private” or “public,” but could involve some mix.

My two cents – I have been preaching about this for years. The elephant in the Obama-care room is this issue. Everyone is concerned with what I call hospital insurance. The bigger issue. is long-term care. And while it may be too late for my boomer colleagues, younger people need to start paying attention to this issue.åÊ

Blinded by the Light – Diagnosed with Melanoma, They > Their Exposure

General Posted by anthony Date October 23, 2013

Too much exposure people.

(From JAMA)

Patients with cutaneous malignant melanoma (CMM) (skin cancer) did not remain cautious about sun exposure in the three years after their diagnoses, according to a study by Luise Winkel Idorn, M.D., Ph.D., of Bispebjerg Hospital and the University of Copenhagen, Denmark, and colleagues.

Exposure to ultraviolet radiation (UVR) from the sun is the primary environmental risk factor for the development of CMM.

The investigators studied 40 participants, including 20 patients with the disease and 20 in a control group.

They measured their exposure to UVR using personal electronic UVR dosimeters and sun exposure diary information.

Study findings indicate that patientsÛª daily UVR dose increased 25 percent from the first to the second summer after diagnosis and 33 percent from the first to the third summer after diagnosis. UVR exposure also increased on holidays and days spent abroad, according to the study.

ÛÏIn conclusion, data from the present study indicate that from the first until the third summer after diagnosis of CMM, patients increase their daily UVR dose in connection with an increase on days with body exposure, holidays and days abroad, whereas controls maintain a stable UVR exposure dose,Û the study concludes.

åÊDo we really need to say more?!