Health and Disability

U.S. Senators Dean Heller (R-Nev.) and Ben Cardin (D-Md.) have partnered on The Medicare Home Health Flexibility Act of 2015 (S. 2364), a bipartisan bill meant to guarantee that Medicare beneficiaries receive timely access to essential home health therapy services.

The bill would permit occupational therapists to conduct the initial home health assessment in instances where occupational therapy is ordered by a doctor, along with physical therapy services and/or speech language pathology, and skilled nursing care is not needed.

“In states like Nevada with many rural communities, Medicare beneficiaries depend on in-home occupational therapy. Unfortunately, there are barriers prohibiting them from receiving needed treatment,” Sen. Heller said in a prepared statement. “The Medicare Home Health Flexibility Act is a simple fix that eliminates barriers, increases access, and reduces costs for those dependent on in-home health services.”

Right now, about 40 million Americans, like you and me, are assisting older parents, spouses, partners, children with disabilities, other family members and friends, helping them remain in their own homes and communities - where they want to be.

These family caregivers are the meal-givers, the medicine-givers, the respect-givers. Every day they give of themselves to help their loved ones in a variety of ways, from bathing and dressing, making meals, providing transportation, to assisting with finances, managing medications, and much more. Some provide care a few hours a week, others are responsible 24/7 -- and often they can't even take a break.

Yes, caregiving is a deeply personal issue and a family issue, but now it is rising quickly as a legislative issue in communities, state legislatures across the country, and here in Washington, D.C.

State legislatures are already stepping up. This year alone, 30 states have passed legislation to help almost 27 million family caregivers get needed training, more flexibility in the workplace, and the opportunity take a hard-earned break every now and then.

Capitol Hill has also taken notice, and more importantly, taken action. Just this week, the U.S. Senate passed the bipartisan Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act. The common-sense legislation was introduced by Senators Susan Collins (R-ME) and Tammy Baldwin (D-WI) and would require the development of a national strategy to recognize and support family caregivers.

Passage of this bipartisan legislation is an important step forward. 

A new epidemiologic study showed that patients with early stage dementia, who had been referred to a specialist, have twice the risk of institutionalization compared to those who are not, according to a research study published in the Journal of Alzheimer's Disease this month. The research suggested the influence of early specialist referral for dementia patients on institutionalization risk and demonstrated that the benefits of early dementia diagnosis may lead to challenging issues.

There has been a decades long debate about the advantages and effectiveness of early dementia diagnosis. Many experts have argued that although no anti-dementia drug to date has had any significant clinical effectiveness, early diagnosis of dementia could be relevant to implement tailored strategies and thus improve individuals' prognoses. Others worried about the ramifications of labelling such debilitating symptoms.

In this way, a coffee mug serves as a personal “traffic advisory” sign, which is why the Google mug image has struck such a nerve among patient activists. From the angry patient perspective, the physicians getting a chuckle out of this mug are essentially giving an invisible middle finger to patients who hope to manage their own health, control personal medical care costs, and live well. To me, the joke is less about Google search results than it is some doctors’ perceptions about patientbehavior. What a hoot that patients would spend time and energy online researching our symptoms rather than go to the experts and do what we’re told, right?

The flood of comments on Facebook generated by the TheEmergencyMedicineDoctor post, as well as those on e-Patients.net and elsewhere, have covered vital reasons why empowered patients have it right, and the docs got it wrong this time. But we patients should acknowledge hubris is a dangerous dance. I’ve listened to doctors tell me “it’s nothing” after I experienced alarming symptoms and then I nearly died of a heart attack. Yet, I’ve thought my son had MRSA when he merely experienced an allergic reaction to new soap.

Maybe the whole collaborative, mutually empowering doctor-patient relationship movement would go better if we acknowledge that no one likes authority shoved in his or her face.

In the first known study to examine the prevalence and treatment of psoriasis in older Americans, experts from the Perelman School of Medicine at the University of Pennsylvania have found that black patients receiving Medicare are less likely to receive biologic therapies -medications derived from human or animal cells or tissues - for the treatment of moderate to severe psoriasis than white patients. Additional results show that psoriasis patients who do not have low income subsidy (LIS) - additional coverage provided for prescription drugs, also known as Medicare Extra Help - as part of their Medicare prescription drug coverage (Part D) plan are less likely to receive biologics than Medicare recipients with full low income subsidy benefit. The findings, presented in the December issue of the Journal of Investigative Dermatology, are the first to suggest the presence of economic and racial barriers that impact the treatment of moderate to severe psoriasis

Migraines can be triggered by a variety of factors, including stress, sleep disruption, noise, odors, and diet. The findings of a new Headache review indicate that many of these factors converge on a common pathway involving oxidative stress.

When Dr. Jonathan Borkum at the University of Maine examined studies on migraine triggers published between 1990 and 2014, he found that nearly all traditional triggers had a propensity to generate oxidative stress, an imbalance between the production of free radicals and the ability of the body to counteract their harmful effects. The findings suggest that antioxidants might help prevent or preempt migraines.

"These data hint that an acute migraine attack may be an attempt by the brain to protect itself, and possibly - when you look at certain chemicals released during an attack - to heal itself," said Dr. Borkum. "Understanding migraines may ultimately teach us how we, too, can protect the brain."

The pressure to cut costs brings with it the possibility of overlooking the less tangible benefits when seeking alternative models in the provision of a public service.

Nutrition service providers are no exception, and the new study - conducted as a randomized, controlled trial - shows that home-delivered meals do more than nourish physical well-being; they also have a positive emotional effect in the lives of older people who are stuck at home.

It appears that the regular knock on the door, with the opportunity to exchange some friendly words with the person delivering the meal, goes a long way to reducing feelings of loneliness in older people in need.

A major source of this growth was the introduction of Sovaldi in December 2013, and Harvoni in October 2014. Both are very expensive breakthrough drugs for the treatment of hepatitis C (a disease of the liver, affecting approximately 3 million Americans). The new hepatitis C drugs have had a significant impact on growth rates in spending on prescription drugs and on national health spending.

I conclude with speculation about the future using rough estimates that I believe nonetheless provide some useful information. U.S. sales of hepatitis C drugs seem to have stabilized at about $14 billion per year, which equates to about 150,000 persons treated per year (at a rate of $90,000 per person treated).

The number of new cases per year is about 30,000 so our current rate of spending should be sufficient to reduce prevalence by about 120,000 per year. There are about 3 million people with hepatitis C in the U.S., so our current rate of spending could continue for many years before we run out of cases to treat. (Because hepatitis C is spread by those already infected, the number of new cases should dwindle toward zero as the overall prevalence falls toward zero.)

The study also tested the levels of cognitive impairment (brain function) and found that this was not related to the resident's assessment of their activity participation.

"It is particularly interesting that cognitive impairment was not found to be related to the residents' activity score whereas staff and family members' rating of a resident's activity level was highly negatively related to their cognitive impairment, such that those with more severe impairment were seen as having lower activity levels," says Professor Moyle.

"There appears to be a wrongly held assumption by staff and family that people with severe or late stage dementia are not capable of leisure activity or that they do not require the stimulation of activities.

"However we can see that although these people see themselves as having low ability, they have the capacity for a lot more.

Scientists have recently found evidence that professional football players are susceptible to a progressive degenerative disease, chronic traumatic encephalopathy (CTE), which is caused by repetitive brain trauma. Now, researchers on Mayo Clinic's Florida campus have discovered a significant and surprising amount of CTE in males who had participated in amateur contact sports in their youth.

About one-third of these men whose brains had been donated to the Mayo Clinic Brain Bank had evidence of CTE pathology. CTE only can be diagnosed posthumously.

The Mayo study, published in the December issue of Acta Neuropathologica, links amateur contact sports - football, boxing, wrestling, rugby, basketball, baseball and others played while in school - with the development of CTE, which when severe can affect mood, behavior and cognition.

"The 32 percent of CTE we found in our brain bank is surprisingly high for the frequency of neurodegenerative pathology within the general population," says the study's lead author, Kevin Bieniek, a predoctoral student in Mayo Graduate School's Neurobiology of Disease program.

"If 1 in 3 individuals who participate in a contact sport goes on to develop CTE pathology, this could present a real challenge down the road," Bieniek says. It remains to be determined if the brain changes produce any observable effects on behavior or cognition of the former athletes.