Health and Disability

The use of antipsychotic medication in nearly 100 Massachusetts nursing homes was significantly reduced when staff was trained to recognize challenging behaviors of cognitively impaired residents as communication of their unmet needs, according to a new study led by Jennifer Tjia, MD, MSCE, associate professor of quantitative health sciences. Results of the study were published in JAMA Internal Medicine.

"This is the largest study to show that it is possible to reduce antipsychotic use in the nursing home population," said Dr. Tjia. "This intervention focused on treating the residents as human beings with needs, not as patients with problems. We don't medicate babies when they cry or act out, because we assume that they have a need that we need to address. However, when people with dementia are unable to communicate, the current approach medicates them when they have undesirable behaviors."

The off-label prescription of antipsychotics for nursing home residents with dementia is common, despite numerous studies that have shown it increases risk of stroke and death and is only minimally effective in controlling behavioral symptoms of dementia.

Tjia studied the influence of a communication training program called "OASIS" for nursing home staff on off-label antipsychotic use. The OASIS curriculum and training - launched by the Massachusetts Senior Care Association in collaboration with the Massachusetts Department of Health and developed by Susan Wehry, MD,--equips frontline nursing home staff, such as nursing assistants, nurses, dietary staff and receptionists, with the knowledge, skills and attitudes to meet the needs of residents with dementia using nonpharmacologic approaches rather than medication. Ironically, the program reached very few prescribers, but was still able to significantly reduce antipsychotic use.

"The OASIS program asks nursing staff to create care plans that include what residents can do, shifting away from the model that focuses on what they can't do," Tjia said. "This is a fundamental shift in how to think about caring for persons with dementia and we showed that it is effective."

Across the industry, home health agencies are struggling with high turnover rates among caregivers and dealing with rising labor costs. While boosting caregiver wages can aid in caregiver retention, it isn’t the only mechanism to deal with turnover, according to Caitlin Connolly, home care fair pay campaign coordinator at the National Employment Law Project.

“It is not helpful if only the agencies raise wages,” she said. “Agencies need to take a close look at turnover and how they are working with caregivers in a way that would want them to stay.”

“Depending on which state someone is working in, even if agencies are saying they are paying above minimum wage, it could still be a poverty wage,” she said. “In addition to paying workers above a poverty wage, it’s also about looking at making investments in our home care system.”

One way agencies may be able to give more value to caregiver pay is by providing more than just higher hourly wages, such as categorizing caregivers as full-time workers with W-2 status, rather than on a 1099 contract basis. Full-time workers may be eligible for other optional benefits and have more stability.

“It’s very hard to stay in this field as a caregiver because of the wages, but turnover plagues the entire industry,” she said. “It not only hurts the consumers but also is extremely expensive for agencies. We know that it costs at least $2,500 per person who quits at an agency, and that’s old data. We need to look at benefits like giving caregivers access to consistent schedules, flexibility, and continuing education, as well as consistent pay.”

The public could soon get a look at confidential reports about errors, mishaps and mix-ups in the nation’s hospitals that put patients’ health and safety at risk, under a groundbreaking proposal from federal health officials.

The Centers for Medicare and Medicaid Services wants to require that private health care accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. Nearly nine in 10 hospitals are directly overseen by those accreditors, not the government.

There’s increasing concern among regulators that private accreditors aren’t picking up on serious problems at health facilities. Every year, CMS takes a sample of hospitals and other health care facilities accredited by private organizations and does its own inspections to validate the work of the groups. In a 2016 report, CMS noted that its review found that accrediting organizations often missed serious deficiencies found soon after by state inspectors.

In 2014, for instance, state officials examined 103 acute-care hospitals that had been reviewed by an accreditor in the past 60 days. The state officials found 41 serious deficiencies. Of those, 39 were missed by the accrediting organizations. This disparity “raises serious concerns regarding the [accrediting organizations’] ability to appropriately identify and cite health and safety deficiencies” during inspections, CMS officials wrote when they released draft regulations including the proposed change on Friday.

The move follows steps CMS took several years ago to post government inspection reports online for nursing homes and some hospitals. ProPublica has created a tool, Nursing Home Inspect, to allow people to more easily search through the nursing home deficiency reports; the Association of Health Care Journalists has done the same for hospital violations.

Those government inspection reports do not identify patients or medical staff, but they do offer a description—often detailed—of what went wrong. This includes medication errors, operations on the wrong patient or the wrong body part, and patient abuse.

But private accrediting organizations, the largest of which is The Joint Commission, have not followed suit, creating a patchwork of disclosure in which some inspections are public and others are not. CMS’ proposed rules are designed to fix this.

“We believe it is important to continue to lead the effort to make information regarding a health care facility’s compliance with health and safety requirements” publicly available, CMS officials wrote.

Unfortunately, many of these in-home care aides and even visiting nurses are currently unable to get adequate care for themselves. In an industry that can’t offer its workers consistent hours, many home care providers are unable to find more than 30 hours of work each week and, as a result, may not qualify for employer-provided health insurance coverage.

“But because of the low wages and the hourly structure of this industry — which analysts estimate is worth nearly $100 billion annually and projected to grow rapidly — workers like Thompson often don’t have health insurance. Many home health agencies, 80 percent of which are for-profit, don’t offer coverage, or their employees don’t consistently clock enough hours to be eligible. They generally earn too much to qualify for public aid but too little to afford the cost of premiums.

None of that is a surprise, and in fact, there is a good deal of literature to suggest that the medical environment includes all kinds of harshness, and that much of the rudeness you encounter as a doctor or nurse is likely to come from colleagues and co-workers. An often-cited British study from 2015 called “Sticks and Stones” reported that rude, dismissive and aggressive communication between doctors (inevitably abbreviated, in a medical journal, as RDA communication) affected 31 percent of doctors several times a week or more. The researchers found that rudeness was more common from certain medical specialties: radiology, general surgery, neurosurgery and cardiology. They also established that higher status was somewhat protective; junior doctors and trainees encountered more rudeness.

In the United States, a number of studies have looked at how rudeness affects medical students and medical residents, as part of tracking the different ways in which they are often mistreated.

One article earlier this year in the journal Medical Teacher charted the effect on medical student morale of a variety of experiences, including verbal and nonverbal mistreatment, by everyone from attending physicians to residents to nurses. Mistreatment of medical students, the authors argued, may actually reflect serious problems on the part of their teachers, such as burnout, depression or substance abuse; it’s not enough to classify the “perpetrators” (that is, the rude people) as unprofessional and tell them to stop.

Now, research published Tuesday in the Journal of the American Medical Association offers the latest evidence that spinal manipulation can offer a modestly effective alternative.

Researchers analyzed 26 studies involving more than 1,700 patients with lower back pain. The analysis found spinal manipulation can reduce lower back pain as measured by patients on a pain scale — like this one — from zero to 10.

Spinal manipulation, which is typically done by chiropractors, physical therapists, osteopaths, massage therapists and some other health providers, involves applying pressure and moving joints in the spine.

Patients undergoing spinal manipulation experienced a decline of 1 point in their pain rating, says Dr. Paul Shekelle, an internist with the West Los Angeles Veterans Affairs Medical Center and the Rand Corp. who headed the study.

"So if it had been a 7 it would be a 6, or if it had been a 5 it would be a 4," Shekelle says. That's about the same amount of pain relief as from NSAIDs, over-the-counter nonsteroidal anti-inflammatory medication, such as ibuprofen.

The study also found spinal manipulation modestly improved function. On average, patients reported greater ease and comfort engaging in two day-to-day activities — such as finding they could walk more quickly, were having less difficulty turning over in bed or were sleeping more soundly.

Marie Leblanc, an artist from Winnipeg who is living with MCS/ES herself, is compiling information and statements to put into an MCS awareness project. There are two ideas  to contribute to.

The easier one is to share shorter personal statements about your life with MCS/ES and related environmentally linked health conditions,  which will be projected onto walls in a way similar to the photo below.

The other project involves answering 6 questions:

1. Have you been officially diagnosed?

2. How do your symptoms impact your life?

3. What is a typical day like for you?

4. What would you require for a better quality of life?

5. What have you learned about yourself since living with MCS?

6. How do you keep hope alive and move forward?

NOTE:

You can use Environmental Illness/Multiple Chemical Sensitivities/Chemical Injury/Chronic Inflammatory Response Syndrome/Environmental Hyper-Sensitivity or any other name you have been given for Environmental Sensitivities.

Marie would like permission to include your name or initials, and location (city and or province/state).

If you wish to have your photo included, please send one.

You can contact Marie via the fb post above or by sending an email to her at:
toxicnomad911 @ gmail . com
(please remove the spaces around the @ and the ./dot )

Please be respectful and only use this email for project submissions.

Marie’s 2016 contribution to the Canary in the Coal Mine project at the Martha Street Studio in Winnipeg is mentioned here.

The new research investigates the effect of magnesium on bone fractures, specifically.

"The findings do suggest that avoiding low serum concentrations of magnesium may be a promising though unproven strategy for risk prevention of fractures," says Dr. Kunutsor.

Increasing the intake of magnesium from food and water may not automatically increase the levels of magnesium in the blood, the authors explain, particularly in elderly people who are taking certain medications or who have gastrointestinal disorders. The authors suggest that instead, treating these conditions first and taking supplements may be an effective way of increasing blood levels of magnesium.

Principal investigator Prof. Jari Laukkanen, from the University of Eastern Finland, explains the findings and comments on the potential therapeutic role of magnesium supplementation:

"The overall evidence suggests that increasing serum magnesium concentrations may protect against the future risk of fractures; however, well-designed magnesium supplementation trials are needed to investigate these potential therapeutic implications."

The researchers underscore the impact of their findings on public health and note that most seniors and middle-aged people who are at a higher risk of bone fractures also have low levels of magnesium in their blood. This lack of magnesium is difficult to identify as it does not cause any symptoms and medical professionals do not test for magnesium deficiency as a matter of routine.