Health and Disability

We are getting healthier for our age, even as there are more of us.

http://goo.gl/c0dqP

A new study has found that dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, a trend that researchers say is probably occurring across developed countries and that could have major social and economic implications for families and societies.

The incidence of dementia is lower among those better educated, as well as among those who control their blood pressure and cholesterol, possibly because some dementia is caused by ministrokes and other vascular damage. So as populations controlled cardiovascular risk factors better and had more years of schooling, it made sense that the risk of dementia might decrease. A half-dozen previous studies had hinted that the rate was falling, but they had flaws that led some to doubt the conclusions.

http://goo.gl/ZR3dw

To join the resveratrol study, participants were first given a fasting glucose tolerance test to obtain a baseline level, and then retested two hours after eating. During digestion, the blood sugar level increases, but the pancreas produces insulin to lower it. A high sugar level after two hours reveals glucose intolerance (pre-diabetes) or diabetes if the level is very high.

"The number of people with glucose intolerance (pre-diabetes) was much higher than expected," says Turner. "I was surprised by how many people didn't know they were pre-diabetic, and these are individuals who already get the best medical care."

Five (4 percent) of 128 participants had impaired fasting glucose levels while three others (2 percent) had findings consistent with type 2 diabetes mellitus. Of the 125 subjects who completed the two-hour test, 38 (30 percent) demonstrated glucose intolerance while 16 (13 percent) had results consistent with diabetes. Thus, the overall prevalence of impaired glucose tolerance or diabetes at two hours was 43 percent - or almost half of the individuals recruited to the study.

Turner asks, "How does glucose intolerance or diabetes lead to AD? Does the inflammationassociated with AD trigger glucose intolerance? Or do both events create a vicious cycle of Alzheimer's and glucose intolerance?"

http://goo.gl/cVubT

I am sorry I have wasted (and still waste) so much time; I am sorry to be as agonizingly shy at 80 as I was at 20; I am sorry that I speak no languages but my mother tongue and that I have not traveled or experienced other cultures as widely as I should have done.

I feel I should be trying to complete my life, whatever “completing a life” means. Some of my patients in their 90s or 100s say nunc dimittis — “I have had a full life, and now I am ready to go.” For some of them, this means going to heaven — it is always heaven rather than hell, though Samuel Johnson and James Boswell both quaked at the thought of going to hell and got furious with David Hume, who entertained no such beliefs. I have no belief in (or desire for) any post-mortem existence, other than in the memories of friends and the hope that some of my books may still “speak” to people after my death.

http://www.medicalnewstoday.com/releases/263212.php

Specifically, the researchers found:

• About 24 percent of whites aged 50 and older experienced major depressive symptoms at least once during their lifetime, and 9 percent experienced major depression in the previous 12 months.
• About 17 percent of older African-Americans experienced major depression during their lifetime, with 7 percent experiencing major depression in the previous 12 months.
• About 23 percent of older black Caribbeans experienced major depression during their lifetime, and 15 percent experienced major depressive symptoms in the previous 12 months.

Still another example of customized supports eliminating and reducing the need for treatment.

http://goo.gl/gsX9c

At the moment, patients over the age of 70 are treated using a blanket method of aggressively reducing blood glucose levels, but that does little to take their complex needs into account.

Dr David Strain, from the University of Exeter Medical School, who led the study, said: "People over the age of 70 are more likely to have multiple complications, such asheart disease, as well as type 2 diabetes. Yet perversely, these patients have so far been excluded from clinical trials, precisely because of these complications. It means they are generally treated with a 'one-size-fits-all' approach. We found that simply by individualising goals and setting realistic targets, then spending time talking to patients rather than aggressively chasing targets resulted in nearly a quarter of patients achieving better glycaemic control, without the need for medication."

Thanks and a Hat Tip to Tom Mead

http://goo.gl/oooQR

Videos adopt an overwhelmingly positive stance towards CCSVI; many were uploaded by patients and present pre- and/or post-treatment experiences. Patients demonstrate rather than merely describe their symptoms, performing tests on themselves before and after treatment to quantify improvement. Videos combine medical terminology and tests with personal experiences of living with MS.

CONCLUSION:

Social media technologies provide patients with novel opportunities for advocating for particular treatments; generating alternative forms of 'evidence' built on a hybrid of personal experience and medical knowledge.PRACTICE IMPLICATIONS:

Healthcare practitioners need to engage with new digital forms of content, including online social media. Instead of disregarding sources not considered 'evidence-based', practitioners should enhance their understanding of what 'experiential-evidence' is deemed significant to patients, particularly in contested areas of healthcare.

http://goo.gl/3NiF9

The Giraff, which stands just over 3 feet tall, is a motorized robot that can facilitate a two-way video call. It can be controlled remotely with an ordinary computer and allows carers or relatives to interact with the patient from a different location.

The robot is being piloted in remote Scottish islands as part of the European Union project called "RemoDem," which develops and tests various ways of helping people with dementia living in remote rural communities.

http://goo.gl/SKpKI

The monthly occurrence of restricting symptoms was fairly constant from 12 months before death (20.4 percent) until five months before death (27.4 percent) when it increased rapidly and reached 57.2 percent in the month before death, according to the study results.

"Our results highlight the importance of assessing and managing symptoms in older patients, particularly those with multimorbidity," the study concludes.

This is a technically difficult read, but a terribly important issue if integrated care is to work. IDEO is considered by many to be the best design group (for anything, including even appliances) in the US. Their work with Project Synapse brings a level of creativity and breadth of vision to an area (how medical records and services can actually be coordinated) that we must get right if people are to have genuine coordination and the long term benefits of that coordination.

http://goo.gl/FNbeZ

In November 2011, representatives from leading EHR vendors, along with stakeholders such as the US Department of Veterans Affairs, met to explore ways to improve the usability of EHRs, including the development of new prototypes for CCDs.

The workshop had these goals:

1. To understand the unmet needs of patients
2. To learn how human-centered design can be used to create patient-centered CCDs
3. To identify models of collaboration and additional areas for future work together

The following resources were generated at the workshop and are available as Document Downloads.

Workshop Summary: Presents background about the workshop, research findings on patients' needs, insights from participants, and designs for human-centered CCDs. The summary introduces two CCD concepts: "Accordion" and "Collage" approaches.

CCD Concepts: This ZIP download includes PDFs of the Accordion (the Health Card Deck) and Collage examples, as well as the HTML code, JavaScript code, CSS, and graphic files to incorporate some or all of the information display methods into a provider's system as desired.

http://goo.gl/3xxQv

America should have a coherent and comprehensive framework for its LTSS policies, programs, and funding. NCD offers the following recommendations:

• Decouple eligibility for Home- and Community-Based Services (HCBS) under an HCBS waiver from a determination of nursing home eligibility. Remove the institutional bias in the Medicaid program to give Medicaid beneficiaries greater choice in where they live and how financial assistance is provided to cover a range of LTSS.
• Increase support for families and significant others in their role as informal and unpaid caregivers.
• Improve the supply, retention, and performance of direct support workers to meet increasing demand. Funding should be authorized for collaborative demonstration projects between the U.S. Departments of Labor and Health and Human Services that promote collaboration between community colleges and disability-related organizations to develop a high-quality set of competencies to be taught in a new support worker certificate program that expands supplies of quality workers to meet market demand in home- and community-based settings.
• Mandate coordination and collaboration among federal agencies to align public policy and transform infrastructure to be responsive to consumer needs and preferences for a comprehensive system of LTSS.