On April 27, 2010, as mentioned in Oliver’s piece, AstraZeneca LP and AstraZeneca Pharmaceuticals LP was ordered to pay $520 million to resolve allegations that it illegally marketed the anti-psychotic drug Seroquel (quetiapine) for uses not approved as safe and effective by the United States Food and Drug Administration.
Specifically, it marketed the drug for uses that were not FDA improved including aggression, Alzheimer’s disease, anger management, anxiety, attention deficit hyperactivity disorder, bipolar maintenance, dementia, depression, mood disorder, post-traumatic stress disorder, and sleeplessness.
According to the settlement agreement:
“AstraZeneca targeted its illegal marketing of the anti-psychotic Seroquel towards doctors who do not typically treat schizophrenia or bipolar disorder [for which the drug had FDA approval], such as physicians who treat the elderly, primary care physicians, pediatric and adolescent physicians, and in long-term care facilities and prisons.” (Italics mine.)
In April 2014, a joint CBC/Canadian Press report revealed the widespread inappropriate use of quetiapineas a “sleeping aid” for female inmates in the Canadian prison system. When I read it, I was struck by the parallels between subduing women in prison and sedating vulnerable elderly people with dementia using quetiapine.
With 20 million people now enrolled for health care coverage under the Patient Protection and Affordable Care Act, the need for primary care providers is swelling. The minimal increase in medical school graduates entering primary care does not address the prediction by the National Center for Health Workforce Analysis of shortages as high as 20,400 physicians by 2020.
Large increases in NP graduates each year are the good news in the midst of the inadequate numbers of physicians entering primary care. The challenge remains, though, to maximize the practice potential of physicians and NPs so that they both are practicing to the fullest extent of their education and training. Only then will the nation reap the full benefit of expanded access to quality primary care services and a reduction in unnecessary costs to the health care system.
The American Cancer Society study found the highest rate among men in Arkansas, where 40 percent of cancer deaths were linked to cigarette smoking. Kentucky had the highest rate among women — 29 percent.
The lowest rates were in Utah, where 22 percent of cancer deaths in men and 11 percent in women were linked with smoking.
While US smoking rates have been falling, 40 million US adults are cigarette smokers and smoking is the top cause of preventable deaths, according to the federal Centers for Disease Control and Prevention.
The study found that at least 167,000 cancer deaths in 2014 — about 29 percent of all US cancer deaths — were attributable to smoking.
Most of the 10 states with the highest rates of smoking-attributable cancer deaths were in the South, while most of the 10 states with the lowest rates were in the North or West.
The researchers say 9 of 14 states with the least comprehensive smoke-free indoor air policies are in the South. The average cigarette excise tax in major tobacco states, mostly in the South, is 49 cents, compared with $1.80 elsewhere. The tobacco industry heavily influences these policies and most of the US tobacco crop is grown in the South, the researchers said. The region also has relatively high levels of poverty, which is also linked with smoking.
Doctors have long urged people to exercise throughout their lives, pointing out that physical fitness can reduce the risk of dementia and other illnesses.
But the new research suggests physical activity can actually reverse the progress of the disease once it has taken hold.
The findings, published in the Neurology medical journal, bolster growing evidence that exercise can be used to treat cognitive problems, rather than simply being used to lower the risk many years in advance.
A clinical trial on elderly people, with an average age of 74, found those who exercise programme for an hour, three times a week, saw an improvement in overall thinking skills.
The participants’ blood pressure also improved and they were able to walk further.
But the results suggested that the benefit only lasted as long as people continued with an exercise plan.
Delirium (or “sudden-onset confusion”) has it’s own unique features, and it affects people in different ways. It is one of those conditions that doesn’t have a specific laboratory test, and takes at least 24-hours of observation to detect.
I have interviewed three women (Mary, Donna and Emma) and I will share their stories of delirium and their older family members. I hope it will help you if you or a loved one happens to be in a similar situation (I have changed all the names to protect privacy).
Delirium is a confused mental state that causes problems with thinking and speaking. A hallmark of the condition is “inattentiveness” with a fluctuating course. The cause of delirium can usually be determined (not always), and it is often medication side effects, infection or some other medical illness that causes a disruption in normal thinking patterns. It usually comes on quite suddenly. It often leaves suddenly as well. In some older people it is harder to detect, especially if the person already has an underlying cognitive impairment such as Alzheimer’s or another related dementia.
“The Confusion Assessment Method (CAM) is a quick way to determine if the person in question may or may not be experiencing delirium:
Ask these questions, and answer to the best of your ability (scoring information below):
People are usually bombarded with sensory stimulation all day long to one extent or another; at home, on the street, when cooking or dancing and in many other aspects of daily living. This however is not always the case for elderly people living in long term care facilities, especially for those living with Alzheimer’s Disease. Often their overwhelming sense of fear, isolation and confusion will prevent them from experiencing sensory stimulation in their everyday lives.
This is the most recent in a series of studies that shows the effectiveness of placebos when you know they are placebos. One of these days I'm going to post on why the medical profession insists that self-delusion is necessary for placebos to work......
Conventional medical wisdom has long held that placebo effects depend on patients’ belief they are getting pharmacologically active medication. A paper published online today in the journal Pain is the first to demonstrate that patients who knowingly took a placebo in conjunction with traditional treatment for lower back pain saw more improvement than those given traditional treatment alone.
“These findings turn our understanding of the placebo effect on its head,” said joint senior author Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School. “This new research demonstrates that the placebo effect is not necessarily elicited by patients’ conscious expectation that they are getting an active medicine, as long thought. Taking a pill in the context of a patient-clinician relationship – even if you know it’s a placebo – is a ritual that changes symptoms and probably activates regions of the brain that modulate symptoms.”
So take a look at the checklist below – it might be easier than you think to get them back on their feet.
Skin on your feet becomes more fragile as you age and more prone to
- Bunions, (a bump, usually on the outside of your big toe, which can become red and inflamed)
- Corns and calluses
- Hammer toe (a toe becomes permanently curled)
- Toenail problems (ingrown toenails, fungal infections and abnormally thick nails)
If the person you’re caring for has developed any of the above conditions. Their feet could be very sore – large bunions can cause balance problems too – so it’s no wonder they’ve gone off walking.
A chiropodist or podiatrist (they’re both the same, but most prefer being called podiatrists now) might be able to treat the troubling conditions above and ease pain considerably. Many people with dementia find they can get these services on the NHS so it’s worth checking with your GP before paying.