Saturday, April 27, 2019

Life with Chronic Conditions: Long Term Care

Helping a couple, who paid for long term care insurance for the last 19 years, it was tragic to see that when it was needed, between the red tape, exclusions etc., they didn’t receive a dime. A combination of Medicare and supplemental policy covered hospice. At the end of the day, the long-term care policy was useless. Money, that could have improved their lives, was wasted.

Fortunately, the couple was able to remain in their home because of dedicated family as well as strong community support, all of which was unpaid. Now that the husband has died, the widow is faced with the challenges that many women find themselves in. Who will take care of her?

Regardless of income, the combination of longer lives and low saving rates are putting many at risk of depleting resources and becoming entirely dependent on social security at the end of their lives. Is long-term care insurance the answer? Are there ways to reduce the need for long-term care?

Today’s post aims to address both of these questions.

WHAT IS LONG TERM CARE: Long-term care involves a variety of services designed to meet a person's health or personal care needs during a short or long period of time. These services help people live as independently and safely as possible when they can no longer perform everyday activities on their own. Most long-term care is provided at home by unpaid family members and friends. It can also be given in a facility such as a nursing home or in the community, for example, in an adult day care center. National Institute on Aging.

NEED FOR LONG TERM CARE: How much care you need and for how long will vary from one person to the next. Today, someone turning 65 will have about a 70% chance of needing some type of help and support as they age. Women, because of longevity and serving as caregivers of spouses who died before them, tend to need care longer. However, a third of those who are 65 will never need long-term support and for those that do, many rely on unpaid care from family and community. US Administration on Aging

The top ten reasons people need long-term care are:
1. Fractures resulting from a fall.
2. Recovery from an illness, injury or surgery
3. Rehabilitation following a hospital stay
4. Alzheimer’s Disease and dementia
5. Multiple Sclerosis
6. Parkinson’s Disease
7. Heart disease
8. Strokes
9. Head injury, also related to falls
10. Obesity and other chronic or terminal medical conditions.

Approximately 82% of long-term care is delivered in the home. With the baby boomer generation becoming the “silver tsunami,” many communities have become more aggressive in developing programs to help people age in place.

In addition, there are new housing options being developed including senior apartments; continuing care retirement centers (CCRCs),  co-housing and intentional communities .

Some communities have developed a Village-to-Village Network. These are generally grassroots nonprofits that help to coordinate access to affordable services. Not only can you obtain help from such organizations but it also provides an opportunity to volunteer

LONG TERM CARE INSURANCE: Long-term care insurance sounds ideal. As people age, more and more recognize the potential need for home health and possibly nursing home care. However, it’s a field loaded with fraud and deception, with seniors on fixed incomes the biggest targets.

The rising costs of premiums, exclusions, and fewer companies offering such coverage has made long term care insurance less popular. However, there are new trends in the field, such as combining long-term care with life insurance policies, which may make it more feasible for those who can afford the policies in the first place.

While I’m including various articles where you can learn more about trends and policies pertaining to long term care insurance,  if you are already on Medicaid or you know you can’t afford premiums, skip to the next section on ways to reduce the need for long term care.

• Why Long-Term Care Insurance is a Bad Idea: While the majority of Americans will need long-term care later in life, there are ways to save for it that have less risk than long term care insurance.

REDUCING NEED FOR LONG TERM CARE: In looking at the top ten reasons people require long term care, numbers 1 & 9 relate can be significantly reduced by avoiding falls in the first place. Check out I’ve fallen but I can get up to learn how to avoid falls and what to do if you should fall.

• Maintain a healthy diet and life style so that you remain as functional as possible. Check out Healing the Whole Person: Ways to Increase Well-Being

• Know your finances and what you can afford to do not just what you’d like to do. Have realistic expectations of family, close friends and your community. Don’t assume your adult children will drop everything and come take care of you. As the expression goes, prepare for the worst and hope for the best.

• Understand what you might need and identify resources that can help you. Use the Getting What you Need Checklist to help identify the types of things you might need and how to locate them.

• Where you live matters: Your state, community and home all can make a significant difference in how you live and your need for long-term care. Don’t make assumptions about what is available, do your homework so you know about benefits, resources etc.
-       If you don’t think your home is suitable for your changing needs, make a move to a new home/community that is better for you.
-       Your home should be set up so it’s handicap accessible, easy to manage, allows for maximum mobility while reducing the risks of falls. Living on one level, where it is easy to get outside, is going to eliminate a number of potential problems.  Every state has an Independent Living Center, which can help make your home handicap accessible.
-       Choose a community where many of these components are available: Transportation services for medical appointments, shopping etc.; Good emergency response systems; Friendly visitor/companion services are available; medical services are nearby; home delivered meals are available; a nearby senior center where you can socialize and exercise
-       Consider different types of housing such as co-housing; intentional community; senior living facility; continuing care retirement center.
-       Look for communities that have established Village to Village Network or something similar

• Live below your means. If you spend less than what you income is you can build up a nest egg to help when you need it the most.  Check out Recession Proof Your Life.

• Use Assistive Devices: There are all sorts of tools and devices to help make activities of daily living much easier and allow you to maximize your independence. Condition specific support groups will often have items to make things easier. Check out Gadgets to Make Life Easier.

Use a Life Alert System: Whether it’s a fear of falling, a sudden onset of a life-threatening symptom, or a charge that wanders, there are ways to reduce and even eliminate concerns using an appropriate life alert device/system. Such items can make all the difference in being able to live independently. Medic Alert Devices/Systems Increase Independence

Join the local chapter of the condition specific organization you are affected by (e.g. American Lung Association) and become actively involved.  These organizations can help in many different ways including recommendations for housing, providing assistive devices, offering a supportive network of people

• Invest in Social Capital: Your social networks have value and importance. By being an active participant in your community, condition specific organization, family, work and other networks, you have an opportunity to give to those in need and in turn, have community you can reach out to when you need help. Check out The Importance of Social Capital for those Affected by Chronic Conditions

Wednesday, April 24, 2019

Take a Break: Watch Lil Dicky-Earth

In honor of Earth Day (April 22) and part of Earth Week watch Lil Dicky Earth 

Looking for other ways to celebrate earth week, try one of the following:
• Pick up litter in your neighborhood
• If you aren’t composting, attend a workshop and learn how you can do it  or check for local resources where you can take your compost
• Become a “citizen scientist” at Citizen Science for Environmental Protection

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Saturday, April 20, 2019

Journal Watch April 2019

CDC Clarifies Guideline on Opioid Prescribing for Chronic Pain: The U.S. Centers for Disease Control and Prevention has clarified that the new guideline on prescribing opioids for chronic pain is not meant to limit access to appropriate pain management, for any patients who suffer from chronic pain, particularly those undergoing cancer treatment, cancer survivors with chronic pain, and individuals with painful complications of sickle cell disease. Rather, it aims to ensure that clinicians and patients consider all safe and effective treatment options. According to the CDC, the relationship between the clinician and patient should form the basis of clinical decision making, with an understanding of the patient's clinical situation, functioning, and life context as well as careful consideration of the risks and benefits associated with treatment options. Letter issued to the American Society of Clinical Oncology, the American Society of Hematology, and the National Comprehensive Cancer Network.

New IR treatment for 'tennis elbow' reduces pain and inflammation without surgery: Tennis elbow, the painful chronic condition that affects up to 3 percent of the US adult population, can be effectively treated through transcatheter arterial embolization (TAE), an image-guided, non-surgical treatment that decreases abnormal blood flow to the injured area to reduce inflammation and pain, according to new research. ScienceDaily

Acetaminophen Safe as First-Line Analgesic for Most Older Adults: Despite a potential increased risk for stroke in patients with diabetes, acetaminophen is a safe first-line analgesic for most older adults living in nursing homes. Journal of the American Geriatrics Society.

Cannabis Products Used Differ for Cancer, Noncancer Patients: The forms of medical cannabis used vary for patients with and without cancer, according to a study published online March 25 in the Journal of Palliative Medicine. Cancer patients more likely to use sublingual tincture form; noncancer patients often use vaporization form.

Just 20 minutes of contact with nature will lower stress hormone levels: Taking at least 20 minutes out of your day to stroll or sit in a place that makes you feel in contact with nature will significantly lower your stress hormone levels. That's the finding of a study that has established for the first time the most effective dose of an urban nature experience. Healthcare practitioners can use this discovery to prescribe 'nature-pills' in the knowledge that they have a real measurable effect.  Frontiers in Psychology

•Aapproved the first drug specifically developed for severe depression after childbirth, Zulresso, an IV drug given over 2 ½ days.
Permitted marketing of the first medical device to treat attention deficit hyperactivity disorder (ADHD), Monarch external Trigeminal Nerve Stimulation (eTNS) System
• Approved the first generic naloxone hydrochloride nasal spray, commonly known as Narcan, a life-saving medication that can stop or reverse the effects of an opioid overdose.
• Approved Balversa (erdafitinib), a treatment for adult patients with locally advanced or metastatic bladder cancer

• Approved new treatment Evenity (romosozumab-aqqg) for osteoporosis in postmenopausal women at high risk of fracture

Approved Dovato (dolutegravir and lamivudine), as a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults with no antiretroviral treatment history

• Expanded approved use of metastatic breast cancer treatment to include male patients

• Approved Mavenclad (cladribine) tablets to treat relapsing forms of multiple sclerosis (MS) in adults
• Approved Mayzent (siponimod) tablets to treat adults with relapsing forms of multiple sclerosis (MS),
• Approved Cimzia (certolizumab pegol) injection for treatment of adults with a certain type of inflammatory arthritis
• Approved Jatenzo (testosterone undecanoate), an oral testosterone capsule to treat men with certain forms of hypogonadism
Approved the Optimizer Smart system for treating patients with chronic, moderate-to-severe heart failure who are not suited for treatment with other heart failure devices

Exercise is more critical than diet to maintain weight loss: The study showed successful weight-loss maintainers rely on physical activity to remain in energy balance (rather than chronic restriction of dietary intake) to avoid weight regain. Successful weight-loss maintainers are individuals who maintain a reduced body weight of 30 pounds or more for over a year. March issue of Obesity 

One Hour of Activity/Week Helps Maintain Disability-Free Status: For adults with lower-extremity joint symptoms, attaining about one hour of moderate-vigorous activity per week is associated with an increased likelihood of maintaining disability-free status over four years, according to a study published online March 19 in the American Journal of Preventive Medicine.

Common Sleep Myths Compromise Good Sleep & Health: People often say they can get by on five or fewer hours of sleep, that snoring is harmless, and that having a drink helps you to fall asleep. These are, in fact, among the most widely held myths about sleeping that not only shape poor habits, but may also pose a significant public health threat, according to a new study publishing online in Sleep Health on April 16.  Researchers from NYU School of Medicine reviewed more than 8,000 websites to identify the 20 most common assumptions about sleep. With a team of sleep medicine experts, they ranked them based on whether each could be dispelled as a myth or supported by scientific evidence, and on the harm that the myth could cause.

Novel 5-minute workout improves blood pressure, may boost brain function: Five minutes daily of Inspiratory Muscle Strength Training lowers blood pressure, improves vascular health, boosts fitness and sharpens memory, according to preliminary results. Experimental Biology conference

Exercise Helps Prevent Cartilage Damaged Caused by Arthritis: Exercise helps to prevent the degradation of cartilage caused by osteoarthritis, Osteoarthritis and Cartilage

High-intensity interval training increases injuries, research shows. White men aged 20 to 39 were injured most, study finds: People who engage in high-intensity interval training are at greater risk for injury, especially in the knees and shoulders, a new study has found.  Journal of Sports Medicine and Physical Fitness

Ability to lift weights quickly can mean a longer life: Prolong your life by increasing your muscle power. That's the main message of a new study. 'Rising from a chair in old age and kicking a ball depend more on muscle power than muscle strength, yet most weight bearing exercise focuses on the latter,' said a study author. EuroPrevent 2019

People with a sense of oneness experience greater life satisfaction: People who believe in oneness -- the idea that everything in the world is connected and interdependent -- appear to have greater life satisfaction than those who don't, regardless of whether they belong to a religion or don't, according to new research. American Psychology Association


Light, physical activity reduces brain aging: The new 2018 Physical Activity-Guidelines for Americans suggest that some physical activity is better than none, but achieving greater than 150 minutes of moderate-to-vigorous (MV) physical activity per week is recommended for substantial health benefits. Using data from the Framingham Heart Study, the researchers found that for each additional hour spent in light-intensity physical activity was equivalent to approximately 1.1 years less brain aging. JAMA Network Open


Replacing 30 Minutes of Sitting With Activity May Cut Mortality: Replacing half an hour of daily sitting time with even light physical activity is associated with a reduction in mortality risk among less active adults, according to a study published online March 21 in the American Journal of Preventive Medicine.

Nonstick Frying Pans Can Cause Penis Size to Shrink: Teflon has its drawbacks and one of the most unusual and probably the most stunning is that PFCs in nonstick pans might shrink the size of male penises and also worsen semen quality. Journal of Clinical Endocrinology & Metabolism

Low levels of 'bad cholesterol' may actually increase stroke risk: A recent study warns that women with low levels of low-density lipoprotein cholesterol, sometimes called "bad cholesterol," may face an increased risk of bleeding stroke. They identified a similar association in relation to triglyceride levels. Neurology

A nutty solution for improving brain health: Long-term, high nut consumption could be the key to better cognitive health in older people according to new research. In a study of 4822 Chinese adults aged 55+ years, researchers found that eating more than 10 grams of nuts a day was positively associated with better mental functioning, including improved thinking, reasoning and memory. The journal of nutrition, health & aging 

Later Dinner and No Breakfast a Killer Combination: People who skip breakfast and eat dinner near bedtime have worse outcomes after a heart attack. The study found that people with the two eating habits had a four to five times higher likelihood of death, another heart attack, or angina (chest pain) within 30 days after hospital discharge for heart attack. European Journal of Preventive Cardiology

Replacing Red Meat With Nuts And Beans Can Cut Heart Disease Risk: Choose plants over red meat to keep your heart healthy. That is the recommendation of a new study that found diets with high-quality plant protein sources could help reduce cardiovascular disease risk factors, mainly lowering risks of heart attacks. Circulation

Dietary Supplement Use Not Linked to Mortality Benefits: For U.S. adults, dietary supplements are not associated with mortality benefits, according to a study published online April 9 in the Annals of Internal Medicine. Excess calcium intake correlated with elevated cancer death risk.

Vitamin D may help fight colorectal cancer: A new study concludes that high doses of vitamin D may help hinder the growth of advanced colorectal cancer in combination with chemotherapy. JAMA

Hormonal treatment may trigger depression in men with prostate cancer: Men who receive anti-hormonal treatment after having their prostate removed are 80% more likely to suffer from depression than men who don't receive this treatment. This leads researchers to suggest that patients receiving androgen deprivation therapy should be monitored for post-surgical depression. This is presented at the European Association of Urology congress in Barcelona. 

Behavioral therapy generally more effective than pharmacologic therapies for urinary incontinence: Most nonpharmacologic and pharmacologic interventions are more likely than no treatment to improve outcomes for women with either stress or urgency urinary incontinence (UI). Behavioral therapy, alone or in combination with other interventions, was found to be generally more effective than pharmacologic therapies alone. Findings from a systematic evidence review and network meta-analysis of clinical outcomes of nonpharmacologic and pharmacologic interventions for UI are published in Annals of Internal Medicine.

Deep brain stimulation provides sustained relief for severe depression: Patients suffering from severe, treatment-resistant depression can benefit not only acutely but also the long-term from deep brain stimulation. Thin electrodes were used to stimulate a deep seated part of the reward system in the brains of 16 patients. This led to a significant reduction of ratings of depression severity in all patients, it was reduced by half on average. For half of the study participants it was even reduced below the level regarded as the threshold for a depression requiring treatment. Most of the patients experienced those positive stimulation effects within the first week, and they lasted throughout the course of the one-year study. The study was published online in the Nature journal Neuropsychopharmacology on Thursday, 14 March 2019. 

Tilt Training Prevents Fainting: Tilt training effectively prevents fainting, according to research presented today at EHRA 2019, a European Society of Cardiology (ESC) congress.1 The program also improved quality of life, reduced the worry and fear about future fainting and enabled patients to return to work.

Canagliflozin Seems Effective for Patients With T2DM, Kidney Disease: Canagliflozin is associated with a reduced risk for renal and cardiovascular events for patients with type 2 diabetes and kidney disease, according to a study published online April 14 in the New England Journal of Medicine

Normalizing BP in Elderly With Hypertension May Up Mortality: Normalized blood pressure (BP) is associated with an increased risk for all-cause mortality for older adults during hypertension treatment, with increased risk seen in octogenarians and those with previous cardiovascular events, according to a study recently published in the European Heart Journal. Blood pressure values less than 140/90 mm Hg were tied to increased mortality risk for octogenarians.


Over Half of Patients Have Suboptimal Response to Statins: More than half of patients initiating statin therapy have a suboptimal low-density lipoprotein cholesterol (LDL-C) response within 24 months. Suboptimal responders have increased risk for incident cardiovascular disease Heart

Could this brain stimulation technique reverse memory decline? New research suggests that transcranial magnetic stimulation could reverse age-related memory loss. In fact, the technique restored the memory of senior participants to the level of young adults. Neurology

Doctors Unclear on Legal Obligations in Caring for Patients With Disability: Practicing physicians might not understand their legal responsibilities when caring for people with disability, which may contribute to inequalities in their care, according to a study published online April 1 in Health Affairs.

Most Diabetes Phone Apps Lack Education, Support Functions: Most diabetes apps miss opportunities to improve care and health outcomes by not providing real-time decision support or situation-specific education on blood glucose self-management, according to a research letter published in the April 16 issue of JAMA.

Why Do Doctors Over treat? Medical education is built on the assumption that the more procedures or treatments doctors see and do, the more competent they'll be when they're independent. It can feel tempting to do more rather than less. "It's totally natural to think more information is just going to be better." "Eventually it leads to patients feeling less well than they actually are, if you uncover things that are meaningless but abnormal." NPR