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Researchers Compile Surprising List Of Most Risky Drugs For Older Americans

Some medications are well known for being risky, especially for older people. Certain antihistamines, barbiturates, muscle relaxants—take too much of them, or take them with certain other medications, and you can wind up in serious trouble (and possibly in the back of ambulance).

But researchers from the federal Centers for Disease Control and Prevention (CDC) and Emory University reported in this week’s New England Journal of Medicine that those high-risk medications are not the ones that most commonly put older Americans (ages 65 and older) in the hospital.

Warfarin is #1

Instead, they found that warfarin is the most common culprit. Warfarin (the brand-name version is called Coumadin) reduces the blood’s tendency to clot. Many older people take it to lower their risk of getting a stroke.

After warfarin, different Read more »

*This blog post was originally published at Harvard Health Blog*

Study Contradicts Belief That Whole-Body Vibration Halts Osteoporosis

Good vibrations may work for dancing on the beach or for romance, but they don’t seem to do much to strengthen bones.

Results of a clinical trial published in the Annals of Internal Medicine showed that older women who stood on a vibrating platform for 20 minutes a day experienced just as much bone loss over the course of the year-long trial as women who didn’t use the platform.

The results are a disappointment for older women and men looking to strengthen their bones without exercising, not to mention to the companies that have sprung up to sell whole-body vibration platforms as an easy way to halt osteoporosis, the age-related loss of bone.

The idea behind whole-body vibration makes sense. Like walking, running, and other weight-bearing physical activities, whole-body vibration Read more »

*This blog post was originally published at Harvard Health Blog*

Understanding Hospital Delirium And Some Tips To Prevent It

No matter how sick my grandmother got or what her doctors said, she refused to go to the hospital because she thought it was a dangerous place. To some degree, she was right. Although hospitals can be places of healing, hospital stays can have serious downsides, too.

One that has been getting a lot of attention lately is the development of delirium in people who are hospitalized. Delirium is a sudden change in mental status characterized by confusion, disorientation, altered states of consciousness (from hyperalert to unrousable), an inability to focus, and sometimes hallucinations. It’s the most common complication of hospitalization among older people.

We wrote about treating and preventing hospital delirium earlier this year in the Harvard Women’s Health Watch. In the New York Times “The New Old Age” blog, author Susan Seliger vividly describes her 85-year-old mother’s rapid descent into hospital delirium, and tips for preventing it.

Although delirium often recedes, it may have long-lasting aftereffects. Read more »

*This blog post was originally published at Harvard Health Blog*

Should Medicare Focus On Long-Term Care?

“HERE is the dirty little secret of health care in America for the elderly, the one group we all assume has universal coverage thanks to the 1965 Medicare law: what Medicare paid for then is no longer what recipients need or want today.”

So argues New York Times reporter Jane Gross in a provocative op-ed in last Sunday’s New York Times. She makes the case that too much of Medicare is going to medical treatments and drugs of little value to the elderly, and nearly nothing on long-term care, citing the case of her own family’s experience:

“In the case of my mother, who died at 88 in 2003, room and board in various assisted living communities, at $2,000 to $3,500 a month for seven years, was not paid for by Medicare. Yet neurosurgery, I later learned was not expected to be effective in her case, was fully reimbursed, along with two weeks of in-patient care. Her stay of two years at a nursing home, at $14,000 a month (yes, $14,000) was also not paid for by Medicare. Nor were Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Measuring GNH (“Gross National Happiness”)

This evening, when I fin­ished clean­ing up the kitchen after our fam­ily din­ner, I glanced at the cur­rent issue of the Econ­o­mist. The cover fea­tures this head­line: the Joy of Grow­ing Old (or why life begins at 46). It’s a light read, as this so-influential mag­a­zine goes, but nice to con­tem­plate if you’re, say, 50 years old and won­der­ing about the future.

The article’s the­sis is this: Although as peo­ple move towards old age they lose things they treasure — vitality, men­tal sharp­ness and looks — they also gain what peo­ple spend their lives pur­su­ing: Happiness.

Fig. 1 (above): “A snap­shot of the age dis­tri­b­u­tion of psy­cho­log­i­cal well-being in the United States,” Stone, et al: PNAS, May 2010 (y-axis: “WB” stands for well-being.)

Young adults are gen­er­ally cheer­ful, accord­ing to the Econ­o­mist’s mys­te­ri­ous author or authors. Things go down­hill until midlife, and then they pick up again. There’s a long dis­cus­sion in the arti­cle on pos­si­ble rea­sons for the U-shaped curve of self-reported well-being. Most plau­si­ble among the expla­na­tions offered, which might be kind of sad except that in real­ity (as opposed to ideals) I think it’s gen­er­ally a good thing, is the “death of ambi­tion, birth of accep­tance.” The con­cept is explained: “Maybe peo­ple come to accept their strengths and weak­nesses, give up hop­ing to become chief exec­u­tive or have a pic­ture shown in the royal Acad­emy…” And this yields contentedness. Read more »

*This blog post was originally published at Medical Lessons*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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