Health and Disability

Peters took Coumadin at his Marshalltown, Iowa, nursing home because he had an abnormal heart rhythm, which increases the risk of stroke. It’s a common precaution, but the drug must be carefully calibrated: too much, and you can bleed uncontrollably; too little, and you can develop life-threatening clots.

When nursing homes fail to maintain this delicate balance, it puts patients in danger. From 2011 to 2014, at least 165 nursing home residents were hospitalized or died after errors involving Coumadin or its generic version, warfarin, a ProPublica analysis of government inspection reports shows. Studies suggest there are thousands more injuries every year that are never investigated by the government.

the dangers of the widely used Coumadin have drawn relatively little scrutiny, perhaps because the drug has clear benefits. Still, improper use has caused some patients incalculable suffering and, in some cases, greatly hastened deaths.

Dolores Huss, an 89-year-old grandmother of eight, died from internal bleeding after a San Diego facility gave her an antibiotic that multiplies the effects of Coumadin then didn’t alert her physician that she needed additional blood tests to measure how long it was taking her blood to clot.

Shirley Reim, recovering from hip surgery, was hospitalized with blood clots in her legs after a Minnesota nursing home failed to give her Coumadin for 50 days in a row and also didn’t perform the blood test ordered by her doctor. She suffered permanent damage. Details of the cases come from government inspection reports and lawsuits filed by the patients’ families, which were settled confidentially.

Conducted by researchers at the Birla Institute of Technology and Sciences in India, the study found that "even crude extracts of [garlic] showed good activity against multidrug resistant strains where antibiotic therapy had limited or no effect. This provides hope for developing alternative drugs which may be of help in fighting the menace of growing antibacterial resistance," the team states.

Urinary tract infection is the second most common infectious disease encountered in community practice. Worldwide, about 150 million people are diagnosed each year with UTI, at a total treatment cost in the billions of dollars. Although UTI is usually treated with antibiotics, "emerging antimicrobial resistance compels us to look back into traditional medicines or herbal products, which may provide appropriate/acceptable alternative solutions," the authors argue.

In this study, the team found that 56% of 166 bacteria strains isolated from the urine of people with UTI showed a high degree of resistance to antibiotics. However, about 82% of the antibiotic resistant bacteria were susceptible to a crude aqueous extract of Allium sativum. According to the researchers, "ours is the first study to report the antibacterial activity of aqueous garlic extract against multidrug resistant bacterial isolates from infected urine samples leading to UTI."In this study, the team found that 56% of 166 bacteria strains isolated from the urine of people with UTI showed a high degree of resistance to antibiotics. However, about 82% of the antibiotic resistant bacteria were susceptible to a crude aqueous extract of Allium sativum. According to the researchers, "ours is the first study to report the antibacterial activity of aqueous garlic extract against multidrug resistant bacterial isolates from infected urine samples leading to UTI."

When I did this I started to think of my mother as deeply forgetful, not as an Alzheimer’s patient. So I embarked on a mission to help my mother remember how to do things. For example, in her normal everyday life my mother would wake up, read the newspaper, and then do the crossword puzzle. So we started each and every day by doing just that. I would discuss the front page with her, look at the recipe page and ask her to read the ingredients of a recipe to me, and then eventually put the crossword puzzle in front of her if she didn’t do it herself. As a result, Dotty never forgot how to read.

Difficult, but necessary....

“It is always a shock when someone dies,” as Shirley Roberts writes in her great book, Doris Inc. “None of us is ever truly ready to lose our parents or our spouse.”

Published in the journal Health and Place, the study -Therapeutic landscapes and wellbeing in later life: Impacts of blue and green spaces for older adults--demonstrates that by incorporating smaller features, such as a koi pond or a bench with a view of flowers, public health and urban development strategies can optimize nature as a health resource for older adults. Throughout the research, green and blue spaces promoted feelings of renewal, restoration, and spiritual connectedness. They also provided places for multi-generational social interactions and engagement, including planned activities with friends and families, and impromptu gatherings with neighbors.

"We zoomed in to everyday life for seniors between the ages of 65 and 86. We discovered how a relatively mundane experience, such as hearing the sound of water or a bee buzzing among flowers, can have a tremendous impact on overall health," says Jessica Finlay, a former research assistant on the project and lead author of the paper. Finlay is now a doctoral candidate in geography and gerontology at the University of Minnesota, where she continues to investigate influences of the built environment on health and well-being in later life. "Accessibility to everyday green and blue spaces encourages seniors to simply get out the door. This in turn motivates them to be active physically, spiritually and socially, which can offset chronic illness, disability and isolation."

The researchers found a high correlation between panic disorder, bipolar disorder, and physical illness, with significantly higher prevalence of certain physical illnesses among patients with panic disorder when compared to the general population.

"Panic disorder itself may be a predictor for a number of physical conditions previously considered unrelated to mental conditions, and for which there may be no or few biological markers," explains Dr. Coplan.

In the study, published in the Journal of Neuropsychiatry and Clinical Neurosciences, the researchers proposed the existence of a spectrum syndrome comprising a core anxiety disorder and four related domains, for which they have coined the term ALPIM:

• A = Anxiety disorder (mostly panic disorder);
• L = Ligamentous laxity (joint hypermobility syndrome, scoliosis, double-jointedness, mitral valve prolapse, easy bruising);
• P = Pain (fibromyalgia, migraine and chronic daily headache, irritable bowel syndrome, prostatitis/cystitis);
• I = Immune disorders (hypothyroidism, asthma, nasal allergies, chronic fatigue syndrome); and
• M = Mood disorders (major depression, Bipolar II and Bipolar III disorder, tachyphylaxis. Two thirds of patients in the study with mood disorder had diagnosable bipolar disorder and most of those patients had lost response to antidepressants).

Dr. Coplan notes that the proposal of ALPIM as a syndrome is not entirely new, in that it contains significant elements of previously described spectrum disorders. ALPIM's primary contribution is to add novel elements and groupings, and to shed light on how these groupings overlap.

But what about those living in the nursing home who aren’t prescribed these medications, is there a risk to them even if they aren’t the ones getting the antibiotic? A recent study that came out in JAMA IM showed that not only is antibiotic use highly variable across nursing homes, but their was an association with greater harms if you happen to live in a nursing home that used a lot of antibiotics, even if you didn't get an antibiotic yourself. 

Antibiotic-related adverse events were more common (13.3%) in residents of high-use homes than that of medium-use (12.4%) or low-use homes (11.4%) (P< .001). And here is the kicker, this assoication remained true even for residents who didn't get antibiotics. 

The Take Home Point 

Inappropriate antibiotic use for the treatment of things like asymptomatic bacturia not only affects the patient, putting them at risk for adverse outcomes, but also puts at risk the entire community of residents living in a nursing home.  So next time you are asked to check a urine culture for cloudy urine, just say no to secondhand antibiotic exposure.

Washington State University researchers have found that people can manage chronic pain and reduce their reliance on opioids through an Internet-based program that teaches non-medical alternatives like increased physical activity, thinking more positively and dealing with emotions.

Marian Wilson, an assistant professor in the College of Nursing, tracked 43 people with chronic non-cancer pain as they went through an eight-week course of online tools to manage psychological, social and health issues associated with chronic pain. Compared to a similar-sized control group, the participants reported that they adopted more practices to change negative thinking patterns and use relaxation techniques to help control pain.

"With negative emotions, you often have that physical response of tension," said Wilson. "So we really want people with pain to learn they have control and mastery over some of those physical symptoms. Meditation and relaxation can help with that."

Such techniques are hard for patients to get in traditional care settings but can go a long way to make them more confident about managing their pain, she said. Several studies have found that such confidence, called "self-efficacy," is linked to a higher quality of life, the ability to return to work and higher levels of activity, she said.

"Maybe that pain is never going to go away but you can divert your attention from it," said Wilson. "You can focus on more positive things and you can absolutely get that thought on a back burner rather than fixating on it."

She found that four out of five online program participants made progress toward goals to reduce or eliminate pain or other unspecified medications, as opposed to roughly half the control group.