Health and Disability

At an academic medical institution in Baltimore, several doctors examined a teenager. They were mystified by his rapid weight loss, an unusual and alarming condition for an otherwise healthy young man. As the boy shivered on the exam table, his doctors mulled which blood tests to order, metabolic tests to run, and potential diagnoses. A volunteer member of the primary care clinic’s extended care team wondered aloud, “Do you think he’s hungry?” One of the doctors replied, “He’s never said anything like that, but you can ask him if you want.” It turned out that the teen had recently moved out of his home, often didn’t have enough money to buy food, and simply went without.

Variations of this story play out across the country hundreds of times every day. Unmet social needs represent a disastrously overlooked, or ignored, underpinning of poor health, disability, and even death.

Doctors use the term comorbidity to describe the simultaneous presence of two or more chronic diseases or conditions in a patient. They readily include in this category high blood pressure, diabetes, obesity, depression, and others. It’s high time to include in the definition things like the inability to get enough food, not being able to refrigerate insulin because the electricity got shut off, not having safe and secure housing, and the like.

Technology that connects seniors to their families, friends, healthcare providers, and the world around them is increasingly important to successful aging in place.

For many seniors, that technology will be the same smartphones, tablets and computers used by younger generations.

Others, though, have needs best met by devices that are safe, secure, and straightforward to use. They may not have tech-savvy friends or family near them, so their devices need to work without regular “tech support” to be useful and used.

But is there such a device?

We didn’t think so before we saw grandPad at CES. What we saw impressed us enough to want to share it with you in this episode of the Senior Care Corner® Show.

grandPad for Seniors

The feature segment of this episode is a conversation with Dr. Kerry Burnight, grandPad’s Chief Gerontologist, who has seen firsthand how her patients have benefited from being reconnected with family and friends via grandPad.

Chronic fatigue has many causes, including illnesses such as anemia and multiple sclerosis as well as depression and other psychiatric disorders. But it’s also often a side effect of drugs previously prescribed for other conditions. (I’m not talking here of the complicated disorder known as chronic fatigue syndrome, whose cause is unknown. This condition is characterized by extreme fatigue that can’t be explained by any underlying medical condition.)

Could one or more of the medications you’re taking be making you feel listless or lethargic? Read below to learn about the major classes of drugs that can cause chronic fatigue. If you suspect that your symptoms might be linked to a medication you’re taking, talk to your doctor or health care provider right away. It’s important that you do not discontinue them on your own.

Broadband Gaps in America.  According to the most recentBroadband Progress Report, 34 million Americans still lack access to broadband benchmark speeds. This baseline map visualizes broadband access at the county level and identifies connectivity gaps — the lighter the color, the lower the percentage of households with broadband access. Toggle the map between state and county levels to see regional patterns and potential challenges in accessing broadband-enabled health tools. View state, county, and ruralbroadband maps.

Generic biologic drugs are similarly effective to brand-name counterparts in treating rheumatoid arthritis, inflammatory bowel disease and psoriasis, a new study says.

Biologics are medications made from living cells. They are complicated to manufacturer and companies that make brand-name versions say cheaper generic versions aren't interchangeable with their products.

The patents of many brand-name biologics are expiring and the use of generic versions (called biosimilars) could save patients and the healthcare system significant amounts of money, the Johns Hopkins University researchers noted.

"The billion-dollar question has been whether these 'generic biologics' are the same as the brand-name versions," study leader Dr. G. Caleb Alexander, said in a university news release.

"The same debate occurred with the advent of less complicated generic drugs and now it's being hashed out all over again with much more at stake -- more room for error and more potential for cost savings to the health system," he explained.

"But based on the available evidence, we conclude that the products we studied appear comparable, and they will definitely be cheaper," Alexander said. He's an associate professor in the department of Epidemiology at the Bloomberg School of Public Health, and co-director of the Johns Hopkins Center for Drug Safety and Effectiveness in Baltimore.

Providing person-centered care (PCC) to older adults with dual diagnosis, co-occurring serious mental illness (SMI), and substance misuse is complex and requires an interprofessional team. Older adults, who qualify for both Medicaid and Medicare (i.e., dual-eligibles) are overrepresented in the population of older adults with SMI and substance misuse. Programs of All-Inclusive Care for the Elderly (PACE) exist to support community living needs of nursing home–eligible older adults and are increasingly in a position to serve older adults with SMI and substance misuse issues. PACE programs provide integrated person-centered mental health care to address the serious medical, social, and emotional complications posed by having SMI and substance misuse disorders. The case study presented illustrates PCC provided to a dual-diagnosis PACE participant, illustrating the impact of recent and past trauma on current psychopathology and substance misuse. Finally, recommendations for addressing PCC of dual diagnosis within the PACE model are provided. [Journal of Gerontological Nursing, 42(5), 11–17.]

While we continue to wait for new regulations for the websites of state and local governments, federal agencies and public accommodations, two new regulations from the Department of Health and Human Services (HHS) strongly suggest that health care provider websites must conform to the Web Content Accessibility Guidelines (WCAG) 2.0 AA to meet their non-discrimination obligations.

Effective July 18, 2016, a new “Meaningful Access” rule interpreting the Affordable Care Act’s (ACA) Section 1557 Anti-Discrimination requirements will require providers of health care programs and services that receive federal financial assistance comply with new requirements for effective communication (EIT) (including accessible electronic information technology), and physical accessibility.  Because most health care providers do receive federal funds through Medicare reimbursements, this rule has broad coverage.  Effective July 1, 2017, new Medicaid rules will require managed care programs to have (EIT) that complies with “modern accessibility standards,” and impose other effective-communication requirements such as large print and other alternative formats.

Previous large population studies examining pain in older people have been limited to data related to frequency of pain, and/or the reported pain intensity. The study is unique in that it recognises that the impact of pain may vary considerably, and is a subjective experience. It also takes into consideration the degree to which pain affects a person's ability to participate in home or occupational activities, how widespread the pain is, as well as the use of analgesic medications. The study highlights the benefit of considering a greater range of variables in pain profiling to improve management, and reduce excessive medical investigations and treatment.

The study also finds that pain profiling can be used to predict health care utilisation by older people. Identifying people with multi-site pain, or those with single-site pain which affects daily activities and requires medication, could prove a significant independent predictor of the utilisation of GP care and hospital outpatient visits. Access to such data could prove to be of enormous benefit from a health planning perspective.

Functional magnetic resonance imaging (fMRI) has repeatedly shown that a significant minority of patients diagnosed as in the vegetative state are actually aware, but unable to show it reliably with their behaviour.

The new research findings, published in Annals of Neurology, suggest a correspondence between a patient’s ability to generate an EEG marker of attention to tactile stimulation, and their ability to produce the critical clinical marker of awareness by following verbal commands.

Crucially, this relationship existed for patients who could only follow commands with the more expensive methods of fMRI.

The mental demands of the EEG task are lower than the demands of the fMRI tasks. Furthermore, EEG is entirely portable, inexpensive, and available in the majority of hospitals.

The researchers state that this more simple EEG assessment may be capable of diagnosing a patient’s level of awareness without the need for expensive and challenging fMRI scans, thereby increasing the number of patients who may benefit from a more accurate diagnosis.