Clinical Guidelines May Not Suit Older Adults With Several Illnesses
So-called current clinical practice guidelines could have a negative impact on older adults struggling with several illnesses, a new study suggests.
The study noted that most clinical practice guidelines (CPGs), which are based on clinical evidence and expert consensus to help doctors deal with health problems, address single diseases. However, doctors treating older patients with several diseases must find a balance between CPGs and an individual patient's circumstances.
In this study, researchers at the Center on Aging and Health at Johns Hopkins University in Baltimore examined what happened when single-disease CPGs were applied to a hypothetical 79-year-old woman with five common chronic diseases -- type 2 diabetes, chronic obstructive pulmonary disease, osteoporosis, hypertension and osteoarthritis.
The study found that, if the relevant CPGs were followed in this case, the patient would be prescribed 12 medications (costing $406 a month) and could experience adverse interactions between drugs and diseases.
The study appears in the Aug. 10 issue of the Journal of the American Medical Association.
"For the present, widely used CPGs offer little guidance to clinicians caring for older patients with several chronic diseases. The use of CPGs as the basis for pay-for-performance initiatives that focus on specific treatments for single diseases may be particularly unsuited to the care of older individuals with multiple chronic diseases," the study authors wrote.
"Quality improvement and pay-for-performance initiatives within the Medicare system should be designed to improve the quality of care for older patients with multiple chronic diseases; a critical first step is research to define measures of the quality of care needed by this population, including care coordination, education, empowerment for self-management, and shared decision making based on the individual circumstances of older patients," the authors wrote.
Good Health Habits at 60 and Beyond
Do you feel as good now as you did at 40 years of age? At 50?
If the answer is no, read on. You might be able to feel as good as you used to—or even better—by picking up 1 or 2 new good health habits. It may seem like more trouble than it's worth to start doing something new. However, even small changes can improve your health. One small change you can make is to add some activity to your daily life. Another is to eat more fiber.
What if I've never been very active? Will starting now really make a difference?
Yes! Physical activity is good for people at any age. Among older adults, falls are a common cause of injury and disability. Physical activity makes your bones and muscles stronger. When your muscles are strong, you're less likely to fall. If you do fall, strong bones are less likely to break.
Regular physical activity is good for your brain too. Recent studies have shown that people who do simple exercises (for example, walking briskly) on a regular basis are better able to make decisions than people who aren't physically active.
I haven't been physically active in a long time. I'm afraid I'll get hurt when I start.
From diabetes to heart disease, many chronic (ongoing) health problems are improved by even moderate amounts of physical activity. For people who have these conditions, not exercising is a bigger risk than exercise-related injury.
Talk with your doctor about your plans before you get started. Your muscles will very likely be sore when you first increase your physical activity, but don't consider that a reason to stop. Mild soreness will go away in a few days as you become more used to the physical activity.
What's the best way to get physically active now?
For most people, walking is one of the easiest activities to do. Experts recommend at least 30 minutes of physical activity on most days of the week, but you don't have to do all 30 minutes at once. Try walking for 15 minutes twice each day or for 10 minutes 3 times each day.
People who have started being physically active later in life say that exercising with a partner is the best motivation to stick with it. Some suggest starting or joining a walking group with friends or neighbors. Others suggest getting a dog that needs to be walked.
If walking isn't your idea of a good time, try gardening or dancing. Go fishing or swimming. The activity can be enjoyable and good for you.
What about strength training?
When your muscles are strong, activities like getting out of a chair or holding a door open are much easier. If you decide to lift weights, start with a 1-pound or 5-pound weight. If you don't have weights, you can use a can of soup, a book or a full water bottle. Keep your weights in the same room as your television and do a few exercises while you watch.
Another way to build muscle is to use a resistance band (also called an exercise band). Resistance bands are flexible and come in different lengths. They are commonly used to strengthen upper arm and leg muscles.
Why should I eat more fiber?
Fiber can improve your health in 3 ways:
1. It helps your colon work better;
2. It reduces the risk of heart disease and cancer; and
3. It is associated with lower cholesterol levels.
Men over 50 years of age should get 30 grams of fiber per day; women over 50 should get 21 grams per day.
I don't want to start eating health food. How can I get more fiber without changing my diet completely?
You don't have to change your diet all at once. Try making 1 small change at a time. For example, if you eat 2 slices of white toast for breakfast, replace 1 of them with a slice of whole grain bread. If you drink orange juice every day, eat an orange instead for 3 days of the week. If you prefer salty snacks, try low-fat popcorn instead of potato chips.
Some people find it helpful to focus on adding a single high-fiber food at each meal or snack time.
Foods rich in fiber
Unprocessed wheat bran
Unrefined breakfast cereals
Whole wheat and rye flours
Grainy breads, such as whole wheat, rye or pumpernickel
Fresh fruits, such as apples and berries
Dried fruits, such as prunes, apricots and figs
Vegetables, such as broccoli and carrots
Legumes, such as chickpeas, baked beans and lima beans
I often have a hard time sticking with something, even when I know it's a good thing to do.
How active you are and what you eat are habits. Picking up healthy habits can be tough. But by starting small and rewarding yourself for each step you take, you can make a difference in how good you feel. You may find it easier to be more physically active and eat more fiber if you think of every day and every meal as a chance to do something good for yourself.
Doctor Trust Helps Patients Stick with Meds
Depression and trust in their doctors are important factors influencing whether patients take their prescription medicines, and this may be especially true when medication costs are high, researchers report.
The study of 912 patients with diabetes found that patients who trust their doctors are more likely to take their prescription drugs, even if they have high out-of-pocket costs. Patients who don't trust their doctors or who have depression-like symptoms are much more likely to forego doses or refills if they're faced with high drug costs.
The findings, by researchers at the VA Ann Arbor Healthcare Center and the University of Michigan (U-M), show how important the doctor-patient relationship can be when patients have to cope with high drug costs. The researchers said their study shows that doctors need to talk with patients beyond just telling patients how a medicine will help them. Doctors also need to talk to patients about their ability to pay for drugs and the availability of cheaper drugs.
"Our findings suggest that a trusting patient-physician relationship can significantly influence whether a person sticks to prescriptions when that patient faces pressures from their medication costs," study author Dr. John Piette, a member of the VA Ann Arbor Center for Practice Management and Outcomes Research and an associate professor in the U-M Medical School's general medicine division, said in a prepared statement.
Doctors need to recognize the multiple benefits from reaching out to establish trust with their patients, making an effort to form a strong bond, and asking patients how they're being affected by drug costs. The report, published in the August issue of the Archives of Internal Medicine, also offers guidance for patients.
"It's important to be open and honest with your doctor regarding worries about how you're going to pay for your medicines, as well as other things such as side effects and lifestyle issues that might keep you from taking your medications, and any depression-like symptoms such as prolonged sadness or sleep and appetite changes," Piette said.
Your Medicine: Play It Safe
You can learn more about how to take medicines safely by reading this guide. It answers common questions about getting and taking medicines and has many handy forms that will help you keep track of information. Keep this guide with your medicines in case you have any questions, concerns, or worries.
This guide was developed by the Agency for Healthcare Research and Quality (AHRQ) and the National Council on Patient Information and Education (NCPIE).
Click here to view/download file in .pdf format.
Food Fact:
Super nova
Eating one meal of salmon a week can spawn a much healthier you. Salmon and other fatty fish like mackerel or bluefish contain omega-3 fatty acids, which are linked to a lower risk of heart attacks. As little as one weekly serving of fish can cut a middle-aged adult's chances of a fatal heart attack by as much as 50%. More good news: Eating fish rich in omega-3s helps reduce diabetes risk, in part by lowering blood triglycerides. Conversely, diets low in omega-3 fatty acids may contribute to insulin resistance, a risk for developing diabetes. Salmon also bolsters your body's ability to process serotonin, which can help relieve a tendency toward depression. Poach it. Grill it. Pan-sear it. Bake it. Just eat it.
Fitness Tip of the day:
Get in-line.
Step into a pair of skates for a head-turning pair of legs and a killer derriere. In-line skating is a strength-training and cardio workout all in one. Studies find in-line skating to be more aerobic than cycling, easier on your joints than running, and a great way to shape and tone muscles. Get rolling and you can burn 570 - 900 calories an hour!
FAQ of the day:
Why is fat so fattening?
Fat has more calories than carbohydrate, in part because it has a different balance of oxygen and carbon atoms; a gram of fat has 9 calories, while a gram of carbohydrates has 4. Also, carbohydrate-rich foods absorb water while fat does not, which makes a big difference in calories. Apple slices, which are mostly carbohydrates and water, have 65 calories per cup. Lard, which is nearly pure fat, contains 1,850 calories in a cup.
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