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 is1,000mg 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.
It was a straightforward phone message (names changed): “Hey Dr. S., this is Bobbie Jones, April Dixon’s granddaughter. I was calling to inform you that April passed away today at City Hospital. They said she was bleeding in her stomach or something. I’m not quite what sure what happened, but she got real sick. But she’s gone, so, thanks so much. You’ve been a real neat doctor, and it’s been good working with you through the years taking care of my grandmother. Take care. Bye.”
Bobbie Jones is a saint. Pure and simple. She took care of her 88-year-old grandmother with tender, loving care. I am certain if left to the vagaries of the “healthcare system” that her grandmother would have died at least three years ago, maybe earlier.
Ms. Jones will get no recognition. No income. No honors, save this blog post which she’ll never see. She will get a letter from me, expressing my condolences and appreciation for the love and care that she provided her grandma. She singlehandedly advocated for an octogenarian with advanced dementia and probable cancer (we were never able to get a definitive diagnosis of it) and gave her a quality of life that I would want were I in her grandma’s shoes. Read more »
*This blog post was originally published at ACP Internist*
Did you know that physical activity can reduce your risk for memory loss and dementia? I had the chance to speak to ABC’s Let’s Talk Live team about important lifestyle choices that can keep the mind healthy and active. The good news is that you really can teach an old dog new tricks, and those new tricks can stimulate growth of new brain cells. Watch the video and check out the Alzheimer’s Association website for more information about dementia prevention:
Data presented at the International Conference on Alzheimer’s Disease in Honolulu this week indicated that exercise and adequate vitamin D levels could help reduce risk for the disorder. Framingham Heart Study researchers found that risk for dementia was halved in “moderate to heavy exercisers” compared with more sedentary people, while researchers on a separate study found that vitamin D deficiency can greatly increase risk for mental impairment.
Another study found that injecting the compound florbetapir into the brain of patients with dementia and then performing a PET scan could help pinpoint the size and location of plaques.
Researchers also reported that tea consumption was linked to a slower rate of cognitive decline in older adults without cognitive impairment, but there was no dose response and more studies will need to be done to determine a definitive link. (CBS News, Wall Street Journal, Medscape)
*This blog post was originally published at ACP Internist*
Mark Hyman, a proponent of so-called “functional medicine” promoting himself over at the Huffington Post (an online news source that essentially allows dubious medical infomercials to pass as news) has posted a particularly egregious article on personalized medicine for dementia.
In the article Hyman distorts the modern practice of medicine, the current state of genetic science, and the very notion of “disease.” It is, as usual, a fine piece of medical propaganda sure to confuse many a reader. Hyman starts with some standard epidemiology of dementia –- it’s a common and growing disorder –- but then descends quickly into distortion and pseudoscience. Read more »
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