CONVENIENTLY SICK

Over the past several years, while Washington has been busy telling us the ‘why’s and wherefores’ of U.S. healthcare and its costs …  threatening to cut Medicare services, and medical provider pay… while allowing medical insurance rates to skyrocket for  everyone… The healthcare industry has been busy learning how to improve their sagging profits by delivering care the way smart retailers deliver clothes, TVs and grocery items.   HOW?  Offer fast, convenient, competitively priced services in multiple locations with business hours that are aligned with consumer need.

No more calling the doctor after 3 days of coughing through your work day, only to be told that you cannot be worked in until next week at 12 noon… and be prepared to wait!  Today’s consumer-patient wants to see their doctor when the symptoms are in play…NOT in a week when the illness is beginning to fade (or a lung falls out!).  They also want to avoid missing work if at all possible, since today’s workplace is not always forgiving of that mid-week, mid-afternoon doctor appointment.

The growth of the new healthcare locations… often called “Urgent Care”, “After Hours Care”, “Medi-centers” or the like, may be satellite locations of hospitals or physician groups, or part of the pharmacy areas of major retail stores like Walgreens, CVS, Wal-Mart or Costco. They may also be independently owned franchise operations.  Most of them offer physician or nurse practitioner services, and many offer lab work, x-rays, ultra-sounds, etc..

These facilities are set up so patients don’t have to wait any longer than necessary; with walk-in service OR appointments via phone or internet…  and some even electronically update your primary care physician with details of the appointment.

Since many of these locations take insurances AND self-pay patients, they give the patient who doesn’t need to go through a hospital emergency room a place to get care, without the price tag of an ER visit…  which will eventually reduce the emergency room crowds down to the real emergencies.

Keep your eyes peeled for new healthcare locations in your area, and ask your doctor for a recommendation.  You never know when that inconvenient flu bug will bite!

 

Keep moving!

Mike

www.nofallszone.com

When Do You STOP Taking Your Meds?

Once you start blood pressure medicine, (or cholesterol, blood thinners, beta blocker meds and many more) you will take it for the rest of your life.  Right?   Well… Over the years, we have made some basic assumptions regarding some of our medicines….and it turns out that we’re not simply wrong… but we may be doing more harm than good.

In a 3-13-2013 Reuters article by Debra Sherman titled: Too many drug types are compromising heart health …physicians raised the following observations:

About 80 million Americans suffer from heart disease, the nation’s No. 1 killer, and most are on multiple drugs.  Some cardiologists think prescribing has gotten out of hand.

The criticism was voiced by a number of leading heart doctors who attended the annual scientific sessions of the American College of Cardiology, held on March 9-11 in San Francisco. They said eliminating certain drugs could potentially improve care without compromising treatment. Evidence is growing that some medications are not effective.

‘EAGER TO ADD, RELUCTANT TO TAKE AWAY’

A person who has had a heart attack typically leaves the hospital on a beta-blocker to slow the heart, an ACE inhibitor to reduce blood pressure, clopidogrel and aspirin to thin the blood and prevent clots, and a statin to reduce cholesterol, said Dr. Micah Eimer, a cardiologist with Northwestern Medicine in suburban Chicago.

“That’s a minimum of five medications, and each one has a proven mortality benefit. It’s practically malpractice if you don’t prescribe those,” Eimer said. “But we have no data on when it’s advantageous to take (patients) off.”

Many patients are on many more drugs, according to research by Dr. Harlan Krumholz, a Yale University professor of cardiology and public health. Using Medicare data, he found that heart failure patients, those whose hearts are too weak to pump blood sufficiently, were prescribed an average of 12 drugs; some were on 30.

“We are eager to add medicines and reluctant to take them away,” said Krumholz.

BLOCK THAT BLOCKER?

Beta-blockers are absolutely necessary for some patients, said Dr. Sripal Bangalore, a cardiologist at New York University, but are probably prescribed too widely and for too long a period of time. Examining three distinct patient groups from a data registry of 44,000 patients, he said the drug did not reduce the risk of heart attack, stroke or death after 3.5 years.

Dr. Richard Stein, a professor of medicine at New York University and spokesperson for the AHA, estimated the average patient with heart disease truly needs to take from seven to nine pills each day in order to control the various risk factors, including cholesterol, high blood pressure and diabetes. Beyond that, he said, it makes sense to be restrictive.

 

Talk with your doctor about “de-prescribing” …it may be one of the best visits you’ve had.

Keep moving!

Mike

A PARENT’S DECLINE…

A few years ago, while one of our nurses and I were talking dizziness, balance and falls among seniors at a local health fair…a lady stopped by to tell us that she had just returned from a skydiving vacation.  She explained that her husband had died a couple of years earlier…and at age 71…she decided that she needed to recapture some of what they loved most in life…which was travel and adventure.

Her two children were very concerned about her plans to visit Machu Picchu and other South American locations. They lovingly offered advice on how she should be more careful…what if she got sick or hurt in a foreign country…or why not plan a trip to Wisconsin Dells with the Grandkids!?!

Having none of it…she explained to her children that she did not intend to sit around waiting to die.  It seems that her husband was ill for several years before his death…and they were forced to give up their travels.  Now, it was time to get back to life…so she joined a gym.  She said that the years of bedside care had provided the perfect venue for extra weight to accumulate.  She added that she and her husband had climbed pyramids…and she wanted to get stronger for the climb up the terraces of Machu Picchu.

O.K….pyramids may not be on the itinerary for most of us…but that 71 year old lady demonstrates that….Like any other time in our lives, struggle and challenge are often more beneficial to our well-being than being helped or waited on.

We’ve all heard of the USE IT OR LOSE IT paradigm…where loss of ability is credited to lack of use. Emotional and psychological well-being can also be a casualty of age related lack of activity.  So when Mom and Dad reduce or stop their pursuit of a daily life…their physical activity is reduced and their emotional well-being is held hostage by lack of human interaction…lack of involvement…and just plain boredom.

Start small, like a walk around the block…and trying to increase your speed every couple of weeks.  Maybe it’s time to learn to swim or Take a ballroom dancing class…Or learn a new language!  Medical Science has shown us time and time again how people with disabilities and illnesses maintain control over their lives with constant challenges to do more and do better.  The achievements are wonderful!

Keep moving!

Mike

5 Things We Almost Always Get Wrong About Aging

Brian Alexander TODAY

Dec. 10, 2014 at 3:15 PM ET

Aging happens. Eventually it catches up with all of us. How soon it does can depend on genes, social life, economics, and a dozen other factors.

But there are plenty of things we get wrong about aging: that we are doomed to becoming crotchety, grumpy, sexless incompetents. Science has dispelled a number of these, including the biggest myth of all: that we have no say in how well we age.

  1. We turn into spindly weaklings.

Studies show that even women in their 90s can build new muscle, making exercise, especially weight lifting, the closest thing there is to an anti-aging elixir.

All sorts of problems, like falls, accumulation of fat, broken bones, overall frailty can be delayed or prevented by fighting sarcopenia, the wasting away of our muscle mass. You do that by eating more protein, fewer carbs, and lifting weights.

Last April, a multi-national group of experts, writing in the journal Clinical Nutrition, concluded that older, healthy people should get at least 1.0 to 1.2 grams of protein per kilogram of body weight each day. If you’re lifting seriously, you may need more. And older people usually need more recovery between training sessions, too.

  1. Old people are sexless.

Don’t tell that to Joan Price, a 71-year-old sex educator and author who has made it her mission in life to help older people get it on.

It’s true that as levels of our sex hormones decline, and many of us spend years living with one sexual partner, our libidos decline, too. We want sex less often.

But good health and fitness are key to maximizing sex lives at any age, and Price points out that if all the parts are still working, we don’t have to wait for desire. We can kick start it by stimulating ourselves through foreplay or self-touching. The lust will come.

A big advocate for sex toys for older people, Price prefers to call them “tools.” “Just as we put moisturizer on our face, or wear a knee brace if we want to go dancing, why not use one or more tools for good sex?”

Less desire, and less frequent sex, doesn’t mean we don’t want sex at all, or that we find our sex lives less satisfying.

A study published in 2009, in the Journal of Gerontology: Social Sciences, used a large sampling of Americans ages 57-85 from the National Social Life, Health and Aging Project and found that 41.4 percent of those ages 75-85 who had a sexual partner had sex during the last year. Of those, 54 percent had it 2-3 times per month or more. Over a third of them had oral sex. Overall, older people in relationships seemed pretty satisfied with their intimate lives.

  1. We will never find our keys again.

Aging leads to cognitive decline. But just like muscles, our brains respond to exercise and fitness.

Just last month, in the journal Frontiers in Aging Neuroscience, a French team of scientists reported a study suggesting that “higher levels of aerobic fitness in older women are related to…better cognitive performance.” The same goes for men.

Cardiovascular exercise helps keep our blood vessels supple, improving blood flow to our whole body, including our brains.

  1. We’ll become very grumpy.

Wrong. In fact, as a group, older people become more satisfied with life. There’s even a name for this phenomenon: the paradox of well-being.

Of course, it easier to happier and a nicer person if you’re healthy and there’s strong evidence linking health and happiness in old people. Those who exercise tend to be happier. Being social, having friends, helps, too.

  1. We will be very, very slow.

Look, old people do slow down. A study of runners from the University of New Hampshire in 2011 showed that older runners (over 60) were slower than younger ones because they had less flexibility, power, and upper body strength.

Here’s the thing, though: Older runners were just as efficient, meaning their strides were just as economical, as younger runners. So while they might not win a marathon, they can keep going and going. In fact, statistics show that older runners have a greater chance of finishing marathons than younger ones, sort of like the tortoise and hare.

Brian Alexander is a frequent contributor to NBC News and a co-author

Anxiety Therapy for Elderly

Hurray for more research!  As the boomers have highlighted the need for increased geriatric (older adult) medical research, we continue to discover how ineffective or harmful some treatments can be…even though the same treatment on younger people works well.  Now, we have some evidence that the same holds true for dealing with anxiety in seniors…opting toward counseling rather than medication.  In a recently published article by Kerry Grens:

NEW YORK (Reuters Health) Feb 03, 2015 – Cognitive behavioral therapy appears to help older adults battle anxiety disorders slightly better than other approaches, but not as well as in younger adults, according to a new meta-analysis.

“Cognitive behavioral therapy is the mainstay for treating anxiety disorders in younger adults. Its lower effect in older adults in this study is concerning,” said Dr. Eric Lenze, a professor at Washington University School of Medicine, who was not involved in this research.

In a paper online January 27 in the Journal of the American Geriatrics Society, the researchers said three to 14 out of every 100 older adults has an anxiety disorder. While earlier studies have shown that cognitive behavioral therapy works well for younger and middle-aged adults, there has not been as much research into the treatment for seniors.

Among people who have fallen and sustained some injury, depression and anxiety (based on the fear of falling again) is a very common health issue among older adults.  In fact, the mental state of the older adult will often predict the likelihood of falls.

Many of the patients who come to our clinics express their fears, but also state that they are not seeking active mental health help.  This is an issue that all of us can change…simply by making the suggestion to those we care about, that having a chat with their primary care physician, a licensed clinical social worker, or religious leader  may provide long lasting health benefits that no pill can match.

The aging of America has plenty of associated social issues…but I’m happy to see that older Americans are demanding more from their lives.

Mike

Tufts University:Seniors Get Healthy in 48 Minutes

Emily Mongan, McKnight’s Staff Writer

Seniors who get an additional 48 minutes of exercise per week can significantly boost their physical function and reduce their risk of immobility, recent research shows.

The findings come from Tufts University researchers who set out to gauge the impact of physical activity on seniors over 70 who had low physical function and engaged in less than 20 minutes of physical activity each week.

The study assigned half of the seniors to a program of walking and walking-based strength and balance training, while the other half received health education workshops.

The researchers originally aimed to have participants engage in 150 minutes of activity per week, but they noticed improvements in gait speed, mobility and physical performance after just 48 minutes of activity per week.

Those results are “encouraging” and show that “small increases can have big impacts,” lead researcher Roger Fielding, Ph.D.

“We wanted the physical activity sessions to include exercise that participants could do outside of the study, and we hope that learning of these results might motivate others to try to make safe, incremental changes to their activity levels,” Fielding said. “Reducing muscle loss, functional decline and loss of independence are important to anyone, at any age, and at any physical ability.”

The study appears in PLOS One  http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0182155

BE A HOLIDAY VOYEUR

O.K.  …maybe voyeur isn’t quite the right word… you can be the judge.

Holidays are the perfect time when friends and families get together with some frequency. It is also the perfect time to “watch and take note” of how everyone is doing.  You know what I mean…it’s the short observations that you make to your spouse AFTER everyone is headed home.  Like, “Boy, Uncle Jim seems to be losing a little weight since he started walking.”   OR  “Aunt Linda seemed a little down…do you think she’s feeling alright?”  OR “Dad looked pretty good, but Mom seemed to be hovering over him more than usual.”

If you are in your late 40s to early 50s I hope you get to spend time with your parents over the holidays.  When you’re together, try to take notice of their physical and emotional being.  Pay attention to how they maneuver around the dining room table and chairs… How easy is it for them to get up off the chair?… Does their movement show signs of instability?… Do they seem to be extra cautious when moving around?… Do they seem like they are present but not really participating like usual.

If your folks are in their 60s and 70s, you may notice the increasing number of missteps; or they seem startled as they turn around and nearly bump into someone… and it is happening more often. Then there is the number of times they scold themselves OR their spouse for not paying attention.

If they are in their late 70s and 80s… you’ll want to note whether they seem somewhat disconnected from the rest of the group.  Do they pick a chair and stay there for the whole time? Do they express a fear of falling?

As a holiday voyeur, your observations can give you some insight into the health and well-being of those closest to you… and might also provide the basis for good dialogue and gentle urging about visiting the doctor.

Falls injury is the number 1 cause of injury and death for those over aged 70…and the number 1 cause of injury for people aged 65 and above.  If the subtle signs of instability and fear of falling are there,  take action for next year’s holidays!

Keep moving!

Mike

ATTACK OF THE WALKERS

Over the past few years, it seems like more and more older adults have purchased walkers.  These things have evolved from the erector set look of the 60’s and 70’s, to a range of styles and colors that evoke space-age design and function. (Now if they could just figure out how to make those tennis ball feet more hip!)

You can buy them with lights, flip seats, saddle bags, horns, and hand brakes… ( can a 10 speed walker be far behind?).  Candy apple red, and those metallic racing car colors are very cool!  Walk into any retirement community and listen…you’ll hear folks talking about their walkers…”Gladys just got a NEW tri-wheeled model…the show-off! She trades them in every other year like clockwork…who’s she trying to impress!”

Until the 1980s, most folks were prescribed their walker by a physician…and then you’d pick up the assistive device at a local pharmacy or medical supply store. Nowadays, walkers are still available at pharmacies (strategically located on every 5th street corner), large grocery stores, and nearly any kind of general merchandise store. A supremely successful example of capitalism and marketing… The problem?                                            Walkers are contributing to falls among older adults.

It’s true!  This phenomenon happens daily…in homes and retirement communities across the country.  Uncle Joe decides that he needs a walker…( he’s been eyeing a sweet steel blue number for a couple of months)…and with a little urging from the family, he buys it.  Now the envy of his community, Uncle Joe goes everywhere with his new accoutrement …sometimes he carries it…and often gets up and forgets it.

The fact is, Uncle Joe would do better to talk with his physician about his fear of falling BEFORE buying anything.  Hopefully, the physician would recommend a Fall Risks Assessment (covered by Medicare) before deciding on a course of action.  Because balance and fear of falling are health issues that can usually be addressed over just a few weeks…Uncle Joe might not need a walker…and might be safer without it.

Before buying a walker or a cane…check with your physician…get a Fall Risk Assessment…and be safe.

 

Keep moving!

Mike

THE SWEET SMELL OF SUCCESS

(This was posted 3 years ago, but is still one of my favorites!)

Earlier this week, I had the pleasure to speak at a local AARP chapter meeting.  Since I represent Fall Prevention Clinics of America™, the topics are focused on falls, falls injury among seniors, and discussion on the medical interventions that are available now compared to years past.  After 30 minutes of expected interaction….how balance works; how it changes as we age; steps we should take to keep our balance function active…etc…a lady raised her hand.  “My knee aches and sometimes gives out on me, so I can’t count on it.  I’ve also fallen a couple of times… should I make an appointment with your physicians?” she said.

When I asked her how long she had the issues with her knee, she simply said that it had bothered her for a few years.  After that response, I paused slightly…not knowing how to approach my next thought…like…What in the world are you waiting for?  Luckily, one of the group took the words out of my mouth, and asked his fellow AARP friend what her doctor said about the offending joint.  (This led to a non-scripted, therapeutic exchange that I could have never seen coming.)

As the lady reacted to others in the group…it became obvious that she was trying to avoid talking to the doctor about her knee.  She does see her doctor…working with him for high cholesterol, blood pressure and weight management…and she has Medicare and a supplemental insurance. Why had she avoided talking about her knee?  She didn’t want to face the idea of a possible knee surgery, recovery and therapy in a rehab facility (she lives alone), and pain.  Fear kept her from getting the help she needed.

At this point I became more a facilitator than a guest speaker…as I called on raised hands who offered support, like…”I had my knee done 2 years ago and it hurt for about 2 weeks before the pain was under control…but I could walk without the knee giving out”  or, “ If you need surgery, I’ll come by to help you with your chores”, and my favorite (because we had previously discussed how traumatic head injury is a leading cause of death among senior fallers)….”I’m sure we’d rather see you gimp around for a few months after a knee surgery than to see you slip away in a hospital because you hit your head after your knee gave out.”

After another 20 minutes of support coming from her comrades, I asked if she had her original question answered.  With moistened eyes she shook her head with a “Yes”…I thanked the group for their participation…and received a resounding round of applause as people got up from their seats to approach the knee lady.

AHHHHHHHH…the sweet smell of success!  And I didn’t do anything!  I love this job!

Keep moving!

Mike

Getting Rid of the Rug Won’t Save Grandpa !

For decades, we have been taught that when family members become unstable around the house…we should begin senior-proofing (as opposed to child-proofing) their environment.  Often, the whole project involves installation of grab-bars or handrails, pitching the throw rugs and floor mats, trying to get Dad to replace that 25 watt bedside lamp bulb with 40 watts of improved visibility; and cajoling them into recycling old accumulated stacks of magazines, newspapers and other “valuable papers”.

The worry, frustration, depressing and often patronizing nature of this exercise is based on the premise that senior-proofing will keep Mom or Dad from falling and breaking a hip…or worse.  Unfortunately, the premise was based on common sense rules that are not directly applicable to falls avoidance.  Truthfully, any household should be “senior-proofed”…since statistics tell us that people of all age groups fall in their homes…and we all can benefit from clutter reduction, throw rug patrol, grab-bars and handrails.

Medical research studies took people at risk for falling and put them in a cluttered environment and a non-cluttered environment. The result?  People in both environments still fell.  The studies then took high risk fallers and provided interventions to remediate or mitigate their individual fall risks.  These folks were placed into the cluttered and uncluttered environments.  Results?  These folks either did not fall, or fell fewer times than those who had received no intervention.  These amazing results clearly show us that working with the individual’s fall risk provides a benefit that transcends their environment.

What’s it mean?  If you want to help Mom, Dad, Grandma and Grandpa…do the work around their home, but don’t forget to help them understand that they can actually retrain themselves to become more stable…and safer…around the house.  Fall Risk Assessments and activities to retrain the eyes, ears, brain, and muscles &joints are a key component of any older adult healthcare initiative.

Bottom line…Keep moving!

 

Mike

References:

Osteoporosis Int (1996) 6:249-255 © 1996 European Foundation for Osteoporosis; British Geriatrics Society-Age and Ageing 2006; 35-S2: ii55–ii59; Journal of Nursing Research Vol. 13, No. 1, 2005