New clinical trials and published research are giving us information on how to improve health in elderly patients. Here are some brief points from the Cleveland Journal of Medicine that were surprising to me:
– Each year 30 percent of people age 65 or older fall and sustain serious injuries so preventing falls and fractures is important. Vitamin D prevents both falls and fractures, but mega doses of Vitamin D (50,000 mg) might cause more falls. A better dose is 1,000mg a day in people who consume a low-calcium diet.
– Exercise boosts the effect of influenza vaccine.
– The benefits of dialysis in older patients is uncertain, as it does not improve function in people over age 80. We don’t even know if it improves survival. Older patients who receive dialysis for kidney failure had a decline in function (eating, bed mobility, ambulation, toileting, hygiene, and dressing) after starting treatment.
– Colinesterase inhibitors (Aricept, Razadyne and Exelon) are commonly used to treat Alzheimer disease, but they all can have serious side effects. Syncope (fainting), hip fractures, slow heart rate, and the need for permanent pacemaker insertion were more frequent in people taking these drugs. The benefits of these drugs on cognition is modest.
– A new drug called Pradaxa (dabigatran) will likely prove to be safer than Coumadin (warfarin). Over two million adults have atrial fibrillation and the median age is 75. The blood thinner warfarin is critical for prevention of strokes but it caries a high risk of bleeding and drug levels have to be monitored frequently. Dabigatran will probably replace warfarin, but it will probably also be a lot more expensive.
As I often say, medicine and science are constantly changing and evolving. As new evidence comes forth, physicians and patients need to re-evaluate they way we do things.
*This blog post was originally published at EverythingHealth*
Back in the 1970s, Kansas passed a law that could prevent people with mental illness from voting. The law was never used, but advocates were successful in getting an amendment passed that revoked that law.
This law was passed at a time when stigma against mental illness was much higher than now. I’m guessing it was presumed that folks with a mental illness could not reason enough to exercise an informed vote, which is not true, of course. If 1outta5 have a psychiatric illness, including anxiety, depression, and substance abuse, then there could have been a huge swath of disenfranchised voters.
And there already exists, to a degree, a basic cognitive test for voting: Navigating the whole ballot process. In Maryland, ours was electronic and no harder to use than an iPad, but I could still imaging some with severe dementia unable to navigate the system. But there should never be a cognitive bar one must pass to vote. The challenge would be where to draw the line.
*This blog post was originally published at Shrink Rap*
An article in [last] week’s New York Times entitled Feeding Demented Patients with Dignity suggests that hand feeding dementia patients may be a better option than tube feeding them.
My God, are we really putting feeding tubes in the elderly demented? When did this happen?
During college, I worked as a nurses aide in a nursing home outside Philadelphia. For 20 hours a week (40 hours in the summer) for two years, I cared for patients in all stages of dementia, from the walking confused through to the end stage, stiffened victims confined to wheelchairs or beds. But in all that time, I never, ever saw anyone with a feeding tube. Read more »
*This blog post was originally published at The Blog that Ate Manhattan*
It’s time to ask patients whether they text and drive. An important perspective piece from the New England Journal of Medicine urges doctors to include that question during preventive health exams. The data surrounding texting and driving is grim:
Although there are many possible distractions for drivers, more than 275 million Americans own cell phones, and 81% of them talk on those phones while driving. The adverse consequences have reached epidemic proportions. Current data suggest that each year, at least 1.6 million traffic accidents (28% of all crashes) in the United States are caused by drivers talking on cell phones or texting. Talking on the phone causes many more accidents than texting, simply because millions more drivers talk than text; moreover, using a hands-free device does not make talking on the phone any safer.
The author of the piece, Amy Ship from Boston’s Beth Israel Deaconess Hospital, says that doctors should update traditional preventive questions to keep up with the times. The simple question, “Do you text while you drive?” is a way to start this important conversation. Read more »
*This blog post was originally published at KevinMD.com*
Scientists at Arizona State University have developed a new method of non-surgical brain stimulation using pulsed ultrasound that enhances cognitive function in mice, and may one day be used to non-invasively treat patients with mental retardation, Alzheimer’s disease and other central nervous system (CNS) dysfunctions.
In intact motor cortex in mice, ultrasound was found to stimulate action potentials and elicit motor responses comparable to those only previously achieved with implanted electrodes and related techniques. It also activates meaningful brain wave patterns and the production of brain-derived neurotrophic factor (BDNF) in the hippocampus — one of the most potent regulators of brain plasticity. Read more »
*This blog post was originally published at Medgadget*