Health and Disability

The changes are big. The difference between the current estimate for Medicare’s 2019 budget and the estimate for the 2019 budget four years ago is about $95 billion. That sum is greater than the government is expected to spend that year on unemployment insurance, welfare and Amtrak — combined. It’s equal to about one-fifth of the expected Pentagon budget in 2019. Widely discussed policy changes, like raising the estate tax, would generate just a tiny fraction of the budget savings relative to the recent changes in Medicare’s spending estimates.

The risk of complications when implanting deep brain stimulation devices in the brains of people with Parkinson's disease is no greater in older patients than younger ones, a new study shows.

The treatment involves placing electrodes in specific parts of the brain. The new findings should ease concerns about using the devices in patients older than 75, the Duke University researchers said.

They analyzed data from more than 1,750 Parkinson's patients who had the devices implanted between 2000 and 2009. Of those patients, 7.5 percent had at least one complication within 90 days of the surgery. Complications included wound infections, bleeding, pneumonia and pulmonary embolism.

Hip fracture rates increase exponentially with age, so as the US population ages, the incidence of hip fracture is set to increase substantially.

Previous research estimates that, by 2040, the annual incidence of hip fractures will be more than 500,000, which is 200,000 more than the current rates. This increase is expected to place significant financial burden on patients, families, insurers and the government.

In the study, the researchers took into account long-term medical costs, home modifications costs and costs associated with long-term nursing home care. From these factors, they estimated the impact of surgical and nonsurgical treatment in patients aged 65 and older.

The study found that the average per-patient savings for surgery compared with nonsurgical treatment were $65,279 for surgery to correct a displaced intracapsular hip fracture (occurring at the neck or head of the femur) and $67,964 for a displaced extracapsular hip fracture (occurring farther down the bone).

Women with severe disabilities and multiple chronic conditions are screened for breast cancer less often than women with no disabilities or no chronic conditions, a new study has found.

They are also screened less often than women with moderate disabilities or women with only one chronic condition, according to Dr. Sara Guilcher, an affiliate scientist with the Li Ka Shing Knowledge Institute ofSt. Michael’s Hospital.

Dr. Guilcher said women with disabilities often have other measures of social vulnerability, such as low income and low education levels.

My family is very important to me. I am the eldest child in a big Liverpool family and there's also my husband, Graham, and my two children, who are in their 30s. My son is my carer. He goes everywhere with me and hovers – he's very tall! He's very patient and kind, smoothes the way for me.

I have been politically active all my life, in the peace movement and as a steward for the Royal College of Nursing. I'm passionate about equality, making life better. And that's why I'm an advocate for Dementia Friends.

I want to encourage everyone to become a Dementia Friend. It would be a different world if everyone did this. People don't know how to deal with people with dementia and the Dementia Friends awareness session empowers them. It's brilliant. When I did it, I learned things – and I have dementia myself!

Since the 1920s, medical breakthroughs in prevention and treatment have allowed people to live longer and longer every decade. However, in the 1910s and ’20s there were no antibiotics, and no effective treatments for conditions such as high blood pressure, heart disease or cancer. In addition, there was no Social Security, Medicare or Medicaid to help protect elders from the health effects of poverty. Many more elderly parents lived with their children than they do now, but those parents, for the most part, did not linger for years with chronic conditions. Declines were generally swift. Most adult children in their 50s did not have parents who were still alive.

In the 1920s, family members also lived closer together than they do now, and families were larger, so caregiving duties could be shared. As social worker Lisa Kendall points out in a blog post, families of extended generations often had “sick rooms” in the back of their homes where they could work together to care for ill or dying relatives. Certainly, fewer family members found themselves providing hands-on care 24 hours a day all by themselves as they do now.

I’m glad to see that in July Congresswoman Nita M. Lowey (D-Westchester/Rockland) introduced in the House of Representatives what she is calling the “Social Security Caregiver Credit Act.” This Social Security credit would apply to family caregivers who provide unpaid care at least 80 hours a month to a dependent relative who needs supervision or assistance to perform activities of daily living (bathing, dressing, eating, toileting and transferring from a bed or chair). The caregiver would be credited with having earned a certain percentage of the income they would have earned if they had not left their paid work to provide long-term care.

In recent news on gender inequalities regarding health, Medical News Today reported on a study that suggested strong family ties, genetics and gender produces different consequences for men and womenwhen it comes to substance abuse. Specifically, the researchers found that the demands of relationships could be overwhelming for women - not men - with a sensitivity to stress.

And previous research has suggested that women suffer from higher negative consequences linked to caregiving than men. Regarding her latest study, Grigoryeva says the negative side effects of caring for elderly parents could have "potentially intensifying effects on a series of gender inequalities pertaining to health and economic well-being."

"In other words," says Grigoryeva, "daughters spend twice as much time, or almost 7 more hours each month, providing care to elderly parents than sons."

As a supposed measure of last resort, however, restraints are surprisingly common. A 2007 study in the Journal of Nursing Scholarship estimated that 27,000 patients are restrained every day in U.S. hospitals—an average of five patients per hospital per day.

In some situations, restraints may be ineffective and even harmful. Doctors and nurses often employ restraints when a patient is at risk for falling or delirious. However, evidence suggests that restraints do not reduce one’s risk of falling.  Likewise, a study in the Journal of the American Medical Association suggested that restraints increase the risk of delirium in the hospital by 4-fold, possibly by increasing patients’ levels of anxiety and stress due to involuntary immobilization.  Physical restraints and the resulting immobilization they cause are also associated with increased rates of pressure ulcers,respiratory complications—and even death via strangulation and aspiration. Even more disturbingly, a 2006 report by the U.S. Department of Health and Human Services concluded that hospitals failed to report more than 40 percent of deaths related to restraints to The Centers for Medicare and Medicaid Services (CMS).

However, as one of my senior residents confided in me, when caring for the sickest patients in the hospital, restraining a delirious patient might be the only way to devote time to other seriously ill patients.

I assume providers use them because they really are effective money-savers, but it seems to me these agreements are toxic for public relations. And as Malcolm Gladwell fans know, malpractice lawsuits against doctors seem to be linked less to actual poor medical outcomes and more to patients' feelings of being disrespected. Being asked to sign away my right to legal recourse would not lead me to feel very respected in my initial interactions with a long-term care provider.

Of patients age 65 and older, 16 percent were malnourished and 60 percent were either malnourished or at risk for malnutrition. Of the malnourished patients, 77 percent denied have been previously diagnosed with malnutrition. Malnutrition was highest among patients with symptoms of depression (52 percent), those residing in assisted living (50 percent), those with difficulty eating (38 percent) and those reporting difficulty buying groceries (33 percent). Difficulty eating was mostly attributed to denture problems, dental pain or difficulty swallowing.

"Depression and dental problems appear to be important contributors, as is difficulty buying groceries. Given that seniors visit ERs more than 20 million times a year in the U.S., emergency physicians have an opportunity to screen and intervene in ways that may be very helpful without being very costly."