Doctors Ordering Unnecessary Imaging Studies

The Journal of the American College of Radiology reports that too many primary care doctors are making inappropriate patients referrals for CT and MRI scans.

A review of 459 elective outpatient CT and MRI examinations conducted at Harborview Medical Center in Seattle showed that 74 percent were considered appropriate and 26 percent were considered inappropriate. Fifty-eight percent of the appropriate studies were positive and affected subsequent management, while only 24 percent of inappropriate studies were positive, affecting management.

Inappropriate exams included brain CT for chronic headache, lumbar spine MRI for acute back pain, and knee or shoulder MRI in patients with osteoarthritis.

Study authors suggested a need for tools to help primary care physicians improve the quality of their imaging decision requests.

Two things that struck me. First it is not unusual in this litigious society that doctors order more tests to cover their you know whats. But tell the 24 percent of people who had inappropriate studies whose results were positive that indeed those studies were inappropriate. They would probably disagree.

I am not a physician but I am a patient occasionally and my rule is to always question. Question your physicians not only the need for tests but what they are intended to accomplish. Be an educated consumer. And work with your doctor to determine the best course for your health care plan.

When Seniors Tutor Kids They Sharpen Their Own Mind

Here is an interesting article from Health Day worth a read. It backs what we have been saying regarding not only the need to stay active and lifelong learning but also the value and importance of inter-generational programs.

104 Year Old Still Drives and Lives Independently

OATESVILLE, Pa. - May 24, 2010 (WPVI) -- She's about to turn 104-years-old, yet she lives alone and still drives!

So what's her secret?

"A lot of it is mental, a lot of people give in to something and they wait for the graveyard. It's going to come anyhow whether you wait or not, so why wait for it. Keep on doing what you been doing."

As I told a group at the Environmental Protection Agency yesterday, one of the eight secrets to life I have learned from hanging around seniors is your positive attitude.

This video speaks for itself.

Happiness is Good for Your Heart

From Health Day News - Researchers from Columbia University report that people who are enthusiastic and content are less likely to develop heart disease. Researchers concluded that if everyone did more of the things that made them happy, they could significantly reduce their risk of heart attack and angina.

"We were excited to discover in a large population-based sample of adults that the tendency to express positive emotion predicted fewer heart attacks across a period of 10 years," said lead researcher Karina Davidson, director of Columbia's Center for Behavioral Cardiovascular Health.

She speculated that several factors may combine to producing this effect. Happier people tend to sleep better and to practice more heart-healthy behaviors for example.

These people tend to have less stress in their lives and handle the stress they do have better than less happy people.

For every point on a five-point scale that measured positive affect, the risk of heart disease dropped 22 percent. However, unhappy people had a 22 percent increased risk of having a heart attack or chronic chest pain, compared with those who were somewhat happy. These somewhat happy people also had a 22 percent increased risk for heart problems compared with people who were moderately happy.

Previous studies, have suggested that positive affect is associated with lower risk of disease and improved clinical outcomes.

One researcher noted that while maintaining a positive affect may be one factor associated with a lower risk of cardiovascular disease, regular exercise, not smoking, a healthy diet and maintaining optimal blood pressure, cholesterol levels and body weight are well-established and essential.

I agree with that. But I also know this happiness study to be inherently true as well. I have spent thousands of hours with older folks who have lived long, happy, quality lives. In fact I turned their secrets of life into a keynote called The Meaning of Life. Not surprisingly a great attitude is one key to a quality life. Having a sense of humor and being able to laugh (and therefore reduce stress is another). So there is validity here. Want to know the eight secrets I talk about? Email me at cirillo@4wardfast.com.

I'm Healthy You're Not! At least that's what the survey says.

This from Health Day - Despite rising rates of obesity and diabetes, a survey has found that a majority of Americans believe their health is just fine - it's everyone else who has the problem. More than 50 percent of respondents said that other people's health "was going in the wrong direction." In contrast, only 17 percent said their own health was going in the wrong direction. Furthermore, Americans seem to think they are in much better shape than their doctors believe they are.

This is quite typical of behaviors I have witnessed and of other studies I have read. We may be in a bit of denial. Read more here.

CMS Issues Donut Hole Discount Guidelines for 2011

The Centers for Medicare & Medicaid Services (CMS) issued new guidance to Part D plan sponsors to guarantee that Medicare beneficiaries enrolled in Part D prescription drug plans will see 50 percent savings on their brand name and some authorized generic drugs when they enter the coverage gap, or donut hole, during 2011.

Drug manufacturers will have to sign an agreement to participate in the discount program. Discounts will apply when the beneficiary reaches the coverage gap. Eligible beneficiaries will see the discount when they buy their drugs at their local pharmacy counter.

CMS will host a public meeting on June 1 to discuss and collect public feedback about the draft manufacturer agreement, and to gather feedback about the final Part D guidance released today. As part of the June 1 meeting, CMS is encouraging drug manufacturers, Part D plan sponsors, and representatives from the beneficiary advocacy community to provide input and comments. All stakeholders can register online.

“The documents we are releasing today facilitate the implementation of the Affordable Care Act’s provisions to help Medicare beneficiaries with the high costs of their prescription medicines,” said CMS Deputy Administrator and Director of the Center for Medicare Jonathan Blum.

Fear of Falling Can Lead to Falling

An elderly person's fear of falling can actually exacerbate underlying physical conditions, creating a “vicious circle,” which could lead to a greater risk of falling, according to a new report.

Difficulty walking as a result of old age often have many causes. These can include visual defects, degeneration of motor skills, taking medication or drinking alcohol, and anxiety over falls. Elderly individuals who are afraid of falling typically restrict their own movements, inadvertently worsening the physical conditions they may have, and contributing to a greater risk of falls.

When treating the elderly for gait disturbances of any kind, it is important to correctly identify the underlying cause of the disturbance and tailor any therapies to that cause, researchers say. Their paper, “Gait Disturbances in Old Age: Classification, Diagnosis, and Treatment From a Neurological Perspective,” outlines diagnostic and treatment techniques, and is available online in the current issue of Deutsches Ärzteblatt International.

I can say firsthand that this is certainly the case with my mom. She is in constant fear of falling. And some of it is justifiable for sure. I'm not sure how you lessen the anxiety. One way perhaps and something I tell my clients to offer is training in balance techniques. A few years ago my wife and I had the good fortune to go to Canyon Ranch in Arizona. We took a balance class. It was interesting. They encouraged us to get a simple 2x4 at home and perhaps during television commercials practice standing and balancing on it. Of course we didn't but I can see how over time this will demonstratively help people. Keeping your balance is one step in preventing falls. And maybe a class like that will also reduce the anxiety people have as well.

Caffeine Can Slow Progression of Alzheimer's and Parkinson's Diseases

From McKnight's -

Caffeine helps us stay alert. Research suggests it also could slow the progression of Alzheimer's and Parkinson's diseases.

In a new collection of studies from around the world on the effects of caffeine on cognitive decline, a number of researchers present evidence of the drug's ability to slow the progression of these two diseases, as well as a number of other benefits. Here are some of the findings from the 22 new studies: Moderate caffeine intake could provide therapeutic potential for humans, caffeine was associated with lower cognitive decline in women than in men, and caffeine helps reduce the production of amyloid-beta, which is associated with Alzheimer's. Many of the studies used animal models in the tests.

The studies appear in a special supplement to the recent edition of the Journal of Alzheimer's Disease, "Therapeutic Opportunities for Caffeine in Alzheimer's Disease and Other Neurodegenerative Diseases."

I prefer Dunkin. How about you?

Alzheimer's Disease: Success In Caregiving

The following is a guest post by Jeff Beaty, chief development officer for Signature HealthCARE. His company's recent research on Alzheimer's shows that increasing the knowledge of the caregiver can improve the clinical application of care to the resident with dementia.

Energize your relationship with those who have Alzheimer's disease by entering into their reality. It is possible provided you find the "right" door.

Alzheimer’s disease (AD) is a devastating condition as it gradually destroys a person’s memory, ability to learn, reason, make judgments, communicate, and carry out daily activities. As Alzheimer’s progresses, individuals may also experience changes in personality and behavior, such as anxiety, suspiciousness or agitation, as well as hallucinations and delusions. This impairs their quality of life.

Today, every 70 seconds someone in the United States develops Alzheimer’s disease. By mid-century, someone will develop Alzheimer’s every 33 seconds (Alzheimer's Association, 2009).

The importance of caregiving for older people has been identified for many years.

In order to improve the quality of life of nursing home residents with Alzheimer’s disease, it is recommended that new and innovative approaches to quality of life be examined and that all caregivers be trained in dementia care. The researchers examined a facilitated quality of life improvement education program to enhance knowledge related to this disease among residents in a long term care facility.

The primary study hypothesis, stating that caregiver education to disease process would moderate an improvement on resident QoL was supported. Further, caregiver scores on the educational component were found to be significant. The data revealed a positive relationship between caregiver training and quality of life for the resident with Alzheimer’s disease (331.0). This investigation further indicated that that individuals can rate their own life quality well into the progression of Alzheimer's disease.

Women Often Miss Signs of Stroke

(HealthDay News) -- A new online survey of U.S. women finds only about one in four women aged 25 to 75 can name more than two primary symptoms of stroke.

The survey also found that women think that breast cancer is five times more common than stroke (women are actually twice as likely to die of stroke than breast cancer), and 40 percent of women surveyed weren't very concerned about experiencing a stroke.

In general, women surveyed weren't aware that women suffer more strokes than men, and one-quarter said they didn't believe stroke could happen at any age.

The researchers also found that black and Hispanic women knew fewer facts about stroke than white women in some specific areas of knowledge.

The main symptoms of stroke are:

• Sudden difficulty speaking, understanding speech, or confusion
• Sudden numbness or weakness in the limbs, particularly on one side
• Sudden facial drooping or numbness and weakness on one side of the face
• Sudden balance problems, dizziness or trouble walking
• Sudden difficulty seeing with one or both eyes
• Sudden severe headache

The online-only survey included 2,000 women in the United States, and was undertaken on behalf of HealthyWomen in conjunction with the American College of Emergency Physicians and National Stroke Association. It was funded by the Genentech, a biotech company that develops medications.

More information

For more on preventing stroke, visit the U.S. National Institute of Neurological Disorders and Stroke.

Aspirin May Increase Breast Cancer Survival Rate

A study in the Journal of Clinical Oncology shows that aspirin may increase breast cancer survival rates. It reports that aspirin and other non-steroidal anti-inflammatory drugs inhibit production of prostaglandins and cyclo-oxygenase. Studies have shown that breast cancers produce prostaglandins in greater amounts than normal breast cells and that aspirin can inhibit growth and decrease the invasiveness of breast cancer cells, reduce cytokines involved in bony metastasis, and stimulate immune responsiveness.

We already know the benefits of aspirin for our heart. Who new this little wonder drug had so many purposes. Ask your doctor about this study. Find the pdf here.

What the Animals Can Teach Us About Leadership

A recent trip to the Serengeti in Africa can shed some light on leadership through the eyes of the majestic animals we had the pleasure to see.

Going Down - How Elevators Harm the Elderly

According to Health Day, over 2,600 senior citizens suffer serious elevator-related injuries each year in the United States according to the first large-scale study of these events.

Slips, trips and falls accounted for more than half of the injuries, and about one-third were caused by elevator doors closing on a person. The third most common cause of injuries were those related to the wedging of walkers in elevator door openings, the researchers reported in the Journal of Trauma Injury, Infection and Critical Care. Half of the injuries were injuries such as sprains and bruises.

Greg Steele, associate professor of epidemiology in the department of public health at the Indiana University School of Medicine, said this: "Elevator open buttons should be made twice the size of the other elevator buttons so they are not hard to find by passengers who want to stop the door from closing on an approaching individual. This would be very inexpensive to change because electronics don't have to be altered, just the button. Certainly all newly installed or updated elevators should have such buttons."

Heck, it's not just the elderly who get jammed by closing doors. We have all experienced that at one point or another. There has got to be a better way to open the doors than putting your arm out to stop them.

Those Caring for a Spouse with Dementia More Likely to Develop Dementia Themselves

I have spoken about the affects of care giving on caregivers, the medical and emotional toll and even the fact that many caregivers die before the one they are taking care of dies. So now comes this study from Utah State University that shows that people who care for a spouse with dementia are six times more likely to develop dementia themselves than spouses of people without dementia.

Researchers followed 1,221 married couples for 12 years to determine the effects of dementia on a spousal caregiver. During the study, 125 husbands, 70 wives and 30 couples developed dementia. After making some statistical adjustments, researchers determined that men are 11.9 times more likely to develop dementia while caring for a wife with dementia. Women are 3.7 times more likely to develop dementia when caring for their spouse. Having a spouse with dementia is associated with a sixfold risk for dementia.

The study will appear in the May edition of the Journal of The American Geriatrics Society.

Health Reform, Steve Jobs and Owning More of the Aging Service Pie

Read our guest blog in McKnight's.

PACE a Great Resource as We Celebrate Older Americans Month

May is Older Americans Month and a great time to talk to your aging loved ones just how important it is to plan for their long term care needs. The celebration of Older Americans Month can provide the opportunity to have the difficult discussion with elderly family members and friends about their plans for their future.

One source you might consider is PACE (Programs of All-inclusive Care for the Elderly). It is rapidly growing as an innovative model of care that provides older Americans with the care services and supports that enables them to live in their own homes and age with dignity.

When the time comes to make these difficult decisions many people are unaware that PACE programs exist as an option that will allow a loved one in need of nursing home care to remain at home.

Visit www.PACE4You.org, an easy-to-understand Web site that provides background on the program. You can view a PACE video that tells the stories of PACE participants and their families, read testimonials and access a PACE Program Finder that helps people find a PACE program in their community.

PACE operates 73 programs in 30 states. At the core of PACE is a team of caregivers that forms a medical home for each participant to ensure all aspects of their medical, social, and therapeutic needs are met. PACE programs’ documented results in preserving wellness, supporting healthy outcomes, and promoting quality of life help reduce hospital visits and avoid nursing home admissions.

PACE has been using the medical home concept well before it received recognition in the health care reform debate. This has enabled their organization to not only provide quality care at a lower price in the best setting but in doing so it brings person-centered care to the forefront. And putting our loved ones front and center is what it is all about.