Mental Acuity and Function Preservation Archives

Anticholinergic medications may be linked to increased dementia risk

“Avoiding anticholinergic medications over the counter is a smart choice with this information. The list of common anticholinergic drugs is listed here in Wikipedia. https://en.wikipedia.org/wiki/Anticholinergic . It surprised me.” Bill Chesnut, MD

To go back to New Health News: http://billchesnutmd.com/new-health-news

Anticholinergic medications may be linked to increased dementia risk

ABC World News Tonight (4/18, story 10, 0:20, Muir) reported that “certain medications may increase the risk of dementia,” a new study warns. Medicines, “including tablets for cold and flu, allergies and heartburn,” appear to be linked to “memory problems.”

According to CNN (4/18, Tinker), the study “offers the most definite proof yet of what scientists have known for at least a decade: that anticholinergic” medications are associated with “cognitive impairment and an increased risk of dementia.” Such medicines “are sold over the counter and by prescription as sleep aids and for chronic diseases including hypertension, cardiovascular disease and chronic obstructive pulmonary disease.”

TIME (4/18, Oaklander) points out that researchers “analyzed already existing data from 451 people around ages 70-75 who had normal brains,” then “examined the results of memory tests, MRI brain scans and other neuroimaging data – all while paying particular attention to people who said they took anticholinergic” medications. Seniors “who regularly took at least one anticholinergic drug showed poorer cognition, lower brain volumes and less glucose metabolism in the whole brain and the temporal lobe” than seniors who did not. The study was published online in JAMA Neurology.

Anti-smoking medications may not increase risk of mental health disorders

“This finding of no connection between Wellbutrin and its cousin Chantix and new mental health issues makes sense. Wellbutrin has been used a long time with fewer side effects than originally expected. It is available as a generic a lower costs. If you know a smoker, pass the good word along.” Bill Chesnut, MD

To go back to New Health News: http://billchesnutmd.com/new-health-news

Anti-smoking medications may not increase risk of mental health disorders

The AP (4/23, Johnson) reported, “Seven years after US regulators slapped their strictest warning on two popular smoking-cessation medicines citing risks of suicidal behavior, a large international study found no such risk.”

According to HealthDay (4/23, Preidt), a new, FDA-requested, 8,000-participant study published online April 22 in The Lancet suggests anti-smoking medications Chantix (varenicline) and Wellbutrin (bupropion) “don’t appear to raise the risk of serious mental health disorders such as depression, anxiety and suicidal thoughts.” An accompanying editorial observed the study shows “neuropsychiatric adverse events occurring during smoking cessation are independent of the medication used.”

AMA news _4.25.16

Immediate release opioids for pain control are a poorer choice than extended release

“I want to share my understanding of better ways to control pain with opioids. My comment here is not putting the post below in perspective, but a chance to share what I learned controlling acute and chronic pain by prescribing opioid medications. My comments are not research, just experience.

Immediate release (IR) opioids for pain control are the poorer choice when extended release (ER) forms of the same medication exist. The extended release drugs have a lower and slower rise in maximum blood level, do not have a trough of inadequate dose level and do not have frequency and severity of personality impairments seen with immediate-release medications. The lack of personality changes is with ER medications prescribed at drug levels controlling the pain adequately. The same degree of pain control with an IR drug can have personality changes. The personality side effects are especially concerning in co-morbidities such as depression. Ten percent of Americans studied have depression, often don’t get treatment, and are at risk for depressive exacerbations on pain control medication.

Examples of ER medications that have been approved and used extensively are tramadol, both IR and ER, hydrocodone, both IR and ER, oxycodone IR and ER. The costs of the ER form is higher than IR of the same drug. Buprenorphine, Butrans, is available in an extended release patch that lasts a week.

There are two factors that have delayed the more common use of ER opioids. First is the first formulations of ER drugs could be altered and injected by drug abusers. The new ER formulations are much harder to inject. They cannot be crushed by common methods using. They don’t dissolve to inject the drug intravenously and similar. The second factor is that the prescriber must create and submit a “prior authorization” form before you can get the ER medication. There are free software that makes obtaining the “prior auth” a matter of only a few keyboard clicks, if your provider uses them. I find using the software for prior authorizations and the software to look up your insurance drug formulary is efficient. It’s more work and time to get the ER form of an opioid than prescribing the IR form of the same drug.“ Bill Chesnut, MD.

To go back to New Health News: http://billchesnutmd.com/new-health-news

Leading the News AMA Morning Rounds 3.23.2016. FDA to update warning for immediate-release opioids

The Washington Post (3/22, Bernstein) reports in “To Your Health” that the Food and Drug Administration announced that “it will require new warnings about the risk of addiction, abuse, overdose and death for short-acting opioid pain medications.” The boxed warning for immediate-release opioids “also will warn of the danger that chronic use of the drugs by pregnant women can result in…Neonatal Opioid Withdrawal Syndrome” in newborns. The new warnings “will emphasize that immediate-release opioids should be a last resort for severe pain.”

The New York Times (3/22, A13, Tavernise, Subscription Publication) reports that “the new labels also include ‘clearer instructions’ for directions like initial drug dose and dose changes during therapy.”

Exercise may slow mental decline by ten years.

“The Journal of the American Academy of Neurology reports a wonderful piece of news from the University of Miami. This long-term study of 876 participants found exercise can slow cognitive decline in older people by ten years. Keeping better brain function for years by exercising is a great cost/benefits ratio. In the eyes of an orthopedic surgeon, this finding is true and those who exercise have fewer painful bone fractures in the last decade. Major fractures in the elderly commonly prevent the injured to cover to the pre-injury quality of life. “ Bill Chesnut, MD

Study: Exercise may slow mental decline by ten years. MIAMI, March 25 (UPI) –.

Exercise can slow cognitive decline in older people by ten years, researchers at the University of Miami found in a recent study. People who reported little to no physical activity in the study saw a greater decline in brain aging than those who were active, the researchers report in the new study, published in the Journal of the American Academy of Neurology. A study released earlier this year by Boston University found increased blood flow resulting from physical activity protected brain volume, which also protects its ability to function properly. Physical activity is an attractive option to reduce the burden of cognitive impairment in public health because it is low cost and doesn’t interfere with medications, Dr. Clinton Wright, an associate professor of neurology at the University of Miami, said in a press release. For the study, researchers recruited 876 participants with an average age of 71, assessing their cognition in the Northern Manhattan Study based on processing speed, semantic memory, episodic memory and executive function, with 90 percent of participants reporting light exercise, and 10 percent reporting moderate to heavy levels of exercise. The participants were then assessed seven years later with the same tests, and again five years after that. Overall, the researchers report people without signs of cognitive impairment who exercised the least when the study started showed a more significant decline in brain function equivalent to about 10 years of aging. The number of people over the age of 65 in the United States is on the rise, meaning the public health burden of thinking and memory problems will likely grow, Wright said. Our study showed that for older people, getting regular exercise may be protective, helping them keep their cognitive abilities longer. .

Lifting Weights As You Age Cuts Your Risk Of Death By 46%

“Lifting weights is essential for bone health. Lifting weights have been shown to be at least as effective as taking Fosamax. From menopause to age 65 women without hormone replacement lose 25 percent of their bone mass. I lift every day, and you should do. (Do I sound like your mother?).” Bill Chesnut, MD.

To go back to New Health News: http://billchesnutmd.com/new-health-news

Lifting Weights As You Age Cuts Your Risk Of Death By 46%. Discover the science of how strength training keeps you young. Men’s Health by ALI EAVESWednesday, March 23, 2016.

The secret to a longer life may be a barbell: Strength training as you age reduces your risk of death, according to a new study from Penn State College of Medicine.

Researchers surveyed people age 65 or older about their exercise habits and then tracked them for 15 years. Nearly a third of the study participants died during that period.

Less than 10 percent of the subjects strength is trained, but those select few were 46 percent less likely to die during the study than everyone else.

Sure, you could say that older folks who lift must be in better health to begin with. But even after adjusting for BMI, chronic conditions like diabetes and hypertension, and habits like total physical activity, drinking, and smoking, lifting was linked to a 19 percent reduced risk of death.

Strength training can keep you active and independent in your golden years, says study author Jennifer Kraschnewski, M.D. Not only does it strengthen your muscles, resulting in better stamina and balance, but it also increases your bone density.

Surgery, Anesthesia Not Linked to Long-Term Cognitive Impairment in Older Adults

“Postoperative confusion does not mean there is long-term dementia because of the operation. The result is a significant finding. Many patients and providers discourage surgery in the elderly based on old data. Our techniques are now so improved that this study of 8,500 operated cases with general anesthesia found are no increased incidence of cognitive impairment in the Denmark. Research of this type from the Scandanavian countries has extra validly with me because they can track their patients more carefully. Patients return for follow-up care as directed better than in American” Bill Chesnut, MD

AAOS Now online edition _March 1, 2016 __SOURCE: American Society of Anesthesiologists

CHICAGO — March 1, 2016 — New research suggests that older patients should not feel reluctant to have quality of life enhancing surgeries due to concerns that undergoing anaesthesia may boost their risk of developing cognitive issues.

In a study of more than 8,500 middle-aged and elderly Danish twins published in Anesthesiology, researchers found no clinically significant association between major surgery and general anaesthesia with long-term cognitive decline.

“Our use of twins in the study provides a powerful approach to detect subtle effects of surgery and anaesthesia on cognitive functioning by minimising the risk that the true effects of surgery and anaesthesia are mixed-up with other environmental and genetic factors,” said lead author Unni Dokkedal, MD, University of Southern Denmark, Odense, Denmark. “We found no significant cognitive effects related to surgery and anaesthesia in these patients, suggesting that other factors, such as preoperative cognitive levels and underlying diseases, are more important to cognitive functioning in aging patients following surgery.”

The researchers examined the association between exposure to surgery and level of cognitive functioning in a sample of 4,299 middle-aged twins aged younger than 70 years and 4,204 elderly twins aged 70 years or older.

Results from cognitive tests of twins who had either major, minor, hip, and knee replacement or other surgery within 18 to 24 years before cognitive examination were compared with the cognitive results of a reference group, comprised of twins who had no surgical procedures. Test results were also compared in an intra-pair analysis of twins, one of whom was exposed to surgery while the other was not, to assess genetic and shared environmental confounding.

Twins who had undergone major surgery had slightly lower cognitive scores, compared with the reference group, but when compared to their twin, when genetic and shared environmental factors were adjusted, no association was observed.

Interestingly, twins who had undergone hip and knee replacement surgery had slightly higher cognitive scores, but the difference was not statistically significant.

No differences were found in the minor or other surgery group when compared with the reference group.

The authors also analysed data for patients who had undergone surgery from 3 months to 2 years before cognitive examination and found no effect of the short time interval between surgery and cognitive examination on cognitive function.

The results suggest preoperative cognitive functioning and underlying diseases are more important for cognitive functioning in mid- and late life than surgery and anaesthesia.

“It is important to know whether surgery and anaesthesia have any negative effects, especially with regard to preoperative counselling of the patient,” said Dr. Dokkedal. “This research has the potential to become a key piece of this very complex research puzzle.”

In an accompanying editorial, Michael S. Avidan, MD, and Alex S. Evers, MD, Washington University School of Medicine, St. Louis, Missouri, wrote: “On the basis of a growing body of evidence, of which the study by Dokkedal et al is symbolic, older patients should today be reassured that surgery and anaesthesia are unlikely to be implicated in causing persistent cognitive decline or incident dementia. The large number of patients and the use of rigorous longitudinal cognitive testing in the study increased the reliability of the findings.”

Warnings about concurrent use of opioids, benzodiazepines.

“This is an important health fact that is not broadly known. This is not research. It is a petition asking for warning labels. A combination of benzodiazepines and opioid pain medications is common. Benzodiazepines are a class of psychoactive drugs used to treat anxiety, insomnia, and a range of other conditions. They are one of the most widely prescribed medications in the U.S., particularly among elderly patients. Benzodiazepines possess sedative, hypnotic, anti-anxiety, anticonvulsant, and muscle relaxant properties.” Bill Chesnut, MD.

Public health officials petition FDA to add boxed warnings about concurrent use of opioids, benzodiazepines.

The Washington Post (2/22, Dennis) reports in “To Your Health” that “dozens of public health officials and academics across the country are pushing the Food and Drug Administration to warn people about the potential dangers of taking” opioid pain medications along with benzodiazepines. In a petition, officials from 41 state and municipal health departments, as well as some universities, “urged the agency” to add boxed warnings to both medications, “given evidence that using them together increases the chance of deadly overdoses.”

Bright light therapy may benefit depression

“I include this article for emphasis that this type of treatment is not used enough. Also the Cleveland Clinic describes the details of the type to use and for how long.” Bill Chesnut, MD

Let there be light! Bright light therapy may benefit depression — and not just the seasonal variety. Cleveland Clinic Wellness newsletter February 24, 2016
There’s a relationship, it seems, between outer light and inner light. Step outside on a sunny day, and you can practically feel your mood meter rising a few points. And while depression doesn’t lift so easily, it may respond to light. Light therapy with specialized lamps is standard treatment for seasonal depression (a.k.a. seasonal affective disorder). A new study shows that it may help chronic, year-round depression, too, possibly by affecting the mood-regulating hormone serotonin. In one study, combining light therapy with antidepressant medication was shown to be more effective than either treatment alone. If you have depression, talk with your mental health professional about adding light therapy to your treatment plan. ADVISORY: If you have been diagnosed with bipolar depression, you must be sure to check with your doctor before you use a light box. You’ll want to look for a light box that offers 10,000 lux and then schedule a time to sit nearby for about 30 minutes a day, ideally at sunrise. Be sure you’re getting regular exercise, which has also been shown to ease depression. The more mood boosters, the merrier…literally!

The Health Benefits of Friendship

“This article was first published in 2010. The Cleveland Clinic Wellness newsletter published in again this month. This is more than listing health benefits; it discusses how to make friends. Be deliberate and see out relationships.” Bill Chesnut, MD

The Health Benefits of Friendship By Victoria Moran Cleveland Clinic Wellness newsletter_Published 6/29/2010

No doubt you’ve heard the good-health prescription: Eat a colorful, natural diet; exercise regularly; manage your stress with relaxation, recreation and meditation; get enough sleep; and have the proper checkups and screenings for your age and history. Recently, a host of research has added another, perhaps surprising, to-do to that list: Make friends, and keep those friendships in good repair.

”Researchers have found that having even one close friend that you confide in can extend your life by as much as 10 years,” says sociologist and relationship coach Jan Yager, PhD, author of Friendshifts.“Numerous studies also show that recovery from a major health challenge, such as a heart attack or cancer, is enhanced because of friendship.”

The Friendship Advantage

A landmark UCLA study in 2000 showed that, for women, having a circle of friends actually provides an alternative to the traditional fight-or-flight response to stress. The researchers called this response “tend-and-befriend” and showed that when women gather with other women (and with children), they release more oxytocin, the mother-love hormone associated with breast-feeding, which has a marked calming effect.

But women aren’t alone in attaining measurable health benefits from friendship. The Australian Longitudinal Study of Aging looked at nearly 1,500 seniors — women and men — for a full decade. Among their findings was that having good friends is more likely to increase longevity than even close relationships with adult children and other family members. The study subjects with the largest number of close friends outlived those with the fewest by 22 percent. Even major life changes such as the death of a spouse could not erode the “friendship advantage.” What makes these findings exciting — and practically applicable — is that while anyone’s number of family members is limited, we can expand our network of friends for as long as we live.

Friends may also add to the quality of those extra years by helping us maintain brain function. A Harvard School of Public Health study that looked at older adults across the country provides evidence that social integration — through marriage, volunteer work or frequent contact with children and neighbors — delays memory loss in elderly Americans.

While it’s clear that having friends is a healthy habit, the verdict is still out on the precise reasons why this is so. The Australian researchers speculate that, in addition to the emotional support friends provide one another during difficult times, positive peer pressure may also play a role — encouraging the adaptation of healthy lifestyle practices, such as joining a gym or a smoking cessation program together — as well as the stress-reduction benefits that derive from feeling connected to other people.

Friends in Health

Stress management is, in fact, one of the great gifts of friendship. One 2009 study found that clients with the fewest friendship connections were those most likely to be dealing with depression, anxiety and heart disease. Stress is known to encourage a host of maladies, from the common cold to the arterial inflammation that contributes to cardiovascular disease.

That might explain the results of a two-year study that looked at 500 women with suspected coronary artery disease. Those with a strong support system were not only more likely to be alive after two years, but their rates of hypertension and diabetes were lower, and they were less likely to have an excess of abdominal fat.

The Friend-Weight Dilemma

It is in the area of excess fat, however, that a single dark cloud may lurk in the bright sky of friendship and health. A study reported in 2007 in the New England Journal of Medicine suggests that there could be a connection between the rise of obesity and our social interactions. In other words, obesity may “spread” through a network of friends as members of that network become more tolerant of obesity and the behaviors that lead to it.

Reflecting on this study, Michelle P. Gallant, MS, RD, of Harvard University Health Services, says, “Because we want to fit in with our peers, we might go along with their way of eating. If we’re out with people having appetizers, drinks and desserts, the brain is stimulated by that, and it can trigger us to eat more than we’re really hungry for.”

Curiously, it’s our same-gender friends that appear to be the culprits here. The New England Journal report suggests that we’re influenced more by those who “resemble us.” Even spouses, who presumably share a kitchen and routinely dine together, may not affect each other’s weight gain as much as mutual friends do.

These same friends can also exert another kind of unhelpful peer pressure, especially among young women, when they overemphasize and idealize thinness. “I see the damage friends can cause each other about body image,” says Gallant. “Too much ‘diet talk’ can cause women to be preoccupied with body size in a negative way.”

The secret seems to be choosing well-balanced, health-conscious friends and engaging together in health-promoting activities. Good habits, as well as bad, may be “contagious” when we’re in the company of people we care about and whose company we genuinely enjoy. A University of Pennsylvania study reported in the Archives of Internal Medicine looked at 344 African-American women and men, and found that exercising with a family member or friend led to more weight loss than going solo, but only if the buddy-cisers enrolled together. Being assigned an exercise partner who wasn’t a “real friend” had a negligible effect.

Making Friends 101

As positive friendships vie with dark, leafy greens as the good-health superstars, how do we get more of them, especially if we’re not the life-of-the-party type? Some ideas:

Make the first move: According to Dr. Yager, showing an interest in another person is the first step on the road to friendship.

Branch out: “Since having shared interests is an obvious way to begin a relationship that might become a friendship, get active in sports or cultural activities where you’ll meet people. If someone seems interesting, suggest getting a cup of coffee before or after the next session.”

Be interested: Once a nascent friendship is underway, be genuinely interested in learning about this person. Keep things light and allow for humor. Although strong friendships can develop in support groups and other places where people go for help, more often the person who’ll be there for you when things get rough entered your life through shared good times.

Show your appreciation: Finally, cherish the friends you already have. It’s no easy matter to stay in touch these days, especially if you’ve lived in seven cities, had a dozen jobs and your face-to-face friends are in competition with a hundred Facebook friends you may not have seen since childhood (if you’ve ever met at all). While it can be fun to “know” a lot of people, acquaintances aren’t the same as friends. Stay close to the tried-and-true by getting together in person when you can, sharing a phone call every so often and making e-mail contact or even sending a real note — on paper with a stamp! Handwritten notes were always special, but now that they’re so rare, they’re worth their weight in friendship gold.

Finally, be there for the people you care about when they could use a friend. Most of us will never save a life by running into a burning building or jumping into a churning sea, but science now tells us that we just might extend someone’s life simply by being a part of it.

Knitting and other crafting activities have also been linked with a reduced risk of cognitive impairment.

“This is true science. Using your mind to concentrate on a pleasurable task reduced the risk of cognitive impairment. You feel better, have less stress and less stress mean better health.” Bill Chesnut, MD

Crafters, take note: To help keep your brain sharp, hang up your “just gone knitting” sign.Cleveland Clinic Wellness newsletter_February 25, 2016

Knit one, pearl two, brain power, we love you! Sudoku and other paper puzzles aren’t the only activities that can help keep your neurons firing as you age. Knitting and other crafting activities have also been linked with a reduced risk of cognitive impairment. The calming, meditative effects of knitting have been shown to reduce stress, but there may be additional benefits as well. Knitting and other creative crafting activities also require the use of multiple parts of the brain, which may help keep you sharp. And don’t think it’s ever too late to learn or re-learn. Pshaw! Until relatively recently, conventional medical “wisdom” held that we couldn’t generate new brain cells, but we now know better. Research has shown that our nervous systems have endless “neuroplasticity,” meaning that they continue to form new connections and patterns throughout our entire lives. Find a knitting class or a friend who’s willing to teach you. If you’re an old hand at knitting or crocheting, challenge yourself with new patterns and skills. And with every click of your needles, imagine your brain cells doing a little happy dance.

Outsmart Alzheimer’s_grow a Brain Forest to

“This article in 2010 is worth reading again. Think of growing a brain forest.” Bill Chesnut, MD

Grow a Brain Forest to Outsmart Alzheimer’s

By Dana Sullivan Cleveland Clinic Wellness newsletter_Published 6/29/2010

We’ll just get the bad news out of the way first: “There is no way to prevent Alzheimer’s disease,” says Nancy Udelson, the executive director of the Alzheimer’s Association’s Cleveland Area Chapter. Before you toss in the towel (and stop reading), here’s the good news: There is plenty of evidence that if you stay active, eat a healthy diet with plenty of antioxidants and “good” fats and exercise regularly, you won’t develop the symptoms. “We do autopsies on brains that definitely have Alzheimer’s, but the person never manifested the symptoms,” explains Paul Nussbaum, PhD, a clinical neuropsychologist and the chairman of the Alzheimer’s Prevention Advisory Council for the Alzheimer’s Foundation of America. By way of explanation, he compares a healthy, active brain to a thickly forested jungle. If your brain resembles the Amazon, should Alzheimer’s cut down a few of the “trees” — aka brain cells — the symptoms may go unnoticed. On the other hand, if poor lifestyle habits have led your brain to look like a desert island, with a palm tree here and there, losing a single tree is going to make a bigdifference.

“It’s possible to build up brain reserves in childhood and early adulthood so that later in life you have that ‘rain forest’ of a brain,” adds Mark Mapstone, PhD, of the University of Rochester Medical Center, who is a spokeman for the Alzheimer’s Foundation of America. If you’re well past either life stage, there’s still a good way to build up reserves: Go back to school. The more education a person has, and the more mentally challenging his or her work, the lower the risk of developing the symptoms of Alzheimer’s, Dr. Mapstone states.

Among the other ways you can add new trees to your brain forest to keep it lush and vibrant:

Get Your Game On

Scrabble, crossword puzzles, card games and chess are all brain builders. You’ve got to hold information in your mind to solve problems that arise during such games, and intellectually stimulating activities such as these spur the brain to produce new neurons and connections between brain cells. In fact, a recent study of adults 75 or older found that those who played cards and board games, did crossword puzzles and read also lowered their risk of dementia. Play with other people and you cut your risk even more: Researchers in Sweden found that older adults who participated in social activities reduced their risk of dementia by nearly half.

Just Sit There

“Americans have a hard time sitting quietly,” says Dr. Nussbaum. We fill every moment — too many moments, actually — with passive activities such as watching television and playing video games. He says that taking 30 minutes a day to just sit (with the TV off!) and think, pray or meditate ultimately helps boosts brain power. People who meditate strengthen the left prefrontal cortex of the brain, the part that is responsible for memory.

Home in on a Hobby

Learn French, Spanish, Russian or even sign language, pick up knitting, master the classical guitar or write your memoirs (you don’t even have to let anyone read them). The benefit comes from “engaging in something novel,” says Dr. Nussbaum. If you don’t want to give up the hobbies that you love, and that you’re already good at, just look for ways to make your favorite pastimes more challenging. If you repeat the same activity, you’re operating on autopilot and not building new pathways (or planting new trees, to use Dr. Nussbaum’s brain forest metaphor) in your brain. Here, some ideas to spur your creativity:

Is knitting a favorite activity? Try to learn a new stitch every once in a while, and don’t just knit the same scarf for every person on your Christmas list. Challenge yourself with a sweater!
Like to build birdhouses? Sketch out different designs.
Crazy for quilting? Experiment with a variety of patterns.
Love jigsaw puzzles? Try doing an occasional puzzle facedown, which forces you to fit the pieces together using just the shapes.

Long-term hospice care driving up costs for Medicare

“Hospice care is another shining testament to our society caring for the dying. Hospice is a wonderful service of exceptional providers with one of the most difficult tasks in medicine. The hospice program must be protected from misuse that endangers its ability to continue its mission. This type of transparent accounting is necessary.” Bill Chesnut, MD

Long-term hospice care driving up costs for Medicare_____AMA NEWS 2.19.16

The Wall Street Journal (2/19, A1, Weaver, Mathews, McGinty, Subscription Publication) reports on its front page that while Medicare’s hospice program is supposed to cover only patients who physicians certify are likely to die within six months, a Wall Street Journal analysis of billing records shows about 107,000 beneficiaries between 2005 and 2013 received hospice care for an average of nearly 1,000 days, driving up costs for the program.

US military fails to provide adequate therapy for soldiers with PTSD

“This post is of the largest independent examination of mental health treatment in the military. It shows that we fail attempting to provide even the minimum of treatment visits for these veterans in PTSD.” Bill Chesnut, MD

US military fails to provide adequate therapy for soldiers with PTSD, depression, study finds

USA Today (2/18, Zoroya) reports that a study released Feb. 18 by the RAND Corp. suggests that the US military is “struggling to provide adequate therapy sessions for thousands of active-duty troops suffering from post-traumatic stress disorder and depression.” http://www.rand.org/pubs/research_reports/RR978.html

According to the study, only a third of troops suffering from PTSD and fewer than a quarter of those suffering from clinical depression receive the minimum number of therapy sessions once they have been diagnosed. RAND “described the study as the largest independent examination of mental health treatment in the military.”

AMA News Febrary 21, 2016.

Happy news for happy hour: A glass of wine a day might keep the doctor away.

“This information is known. Other reports are that the good health effect is only with red wine. I posted this today because it states the current definition of over-drinking, which can be devastating.” Bill Chesnut, MD

Happy news for happy hour: A glass of wine a day might keep the doctor away. Cleveland Clinic Wellness newsletter_February 11, 2016

A toast is in order! Recent research shows moderate alcohol consumption — defined as up to one drink a day for women and up to two for men — may improve immune system function and help us fight off infection. Based on previous research, we already know that moderate drinking can protect against cardiovascular disease, type 2 diabetes, and gallstones. It’s important to keep in mind that the key is moderation. In the U.S., one drink means 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor, such as gin or whiskey. And you can’t save up either, so use it or lose it! Higher levels of drinking (more than seven drinks a week for women and 14 for men) may cause your efforts to backfire, harming the immune system, increasing blood pressure, and damaging heart muscle. It’s also has been linked with several cancers. So keep your quantity moderate as you enjoy your special beverage. Cheers!

Concussion may increase long-term suicide risk in adults

“This brief notice links to a significant research report in Canada. It is titled Risk of suicide after a concussion. Their interpretation of their findings is “Adults with a diagnosis of concussion had an increased long-term risk of suicide, particularly after concussions on weekends. Greater attention to the long-term care of patients after a concussion in the community might save lives because deaths from suicide can be prevented.” Bill Chesnut, MD.

Concussion may increase long-term suicide risk in adults. AMA Wire_2.9.16.

http://www.cmaj.ca/content/early/2016/02/08/cmaj.150790

Reuters (2/8, Doyle) reports that adults suffering a concussion may have a threefold increase in the long-term suicide risk, according to the findings of a 235,000-participant study published online Feb. 8 in the Canadian Medical Association Journal suggest.

According to AFP (2/8), “the likelihood of suicide was even greater among those whose head injury was incurred on the weekend, suggesting they had hurt themselves during a recreational activity.” Overall, whether concussions were incurred on the job or during recreation, “the average time from concussion to subsequent suicide was nearly six years.”

The ABC News (2/8, Hawkins) website reports that because “each additional concussion is associated with a further increase” in the risk for suicide, the study’s lead researcher, Donald Redelmeier, MD, “said the findings emphasize that it’s important for medical” professionals “to be aware of a patient’s concussion history.”

Growing number of Americans taking prescription medications

“This unintended consequence of losing control of physical health is so important. It cannot be understated easily. The amount of orthopedic surgery that might be avoided by maintaining optimal physical condition can’t be estimated. This study uses prescribing data from Medicare Part D, making it an excellent source for conclusions. A life lost to constant poor quality from years of obesity is a tragedy. We should feel empathy for those trapped and double our efforts to find an effective treatment.” Bill Chesnut, MD

Growing number of Americans taking prescription medications

The Washington Post (11/4, Dennis) reports that research published in the Journal of the American Medical Association indicates that “nearly three in five American adults take a prescription” medication. That number “is up markedly since 2000 because of much higher use of almost every type of medication, from antidepressants to treatments for high cholesterol and diabetes.”

The Los Angeles Times (11/4, Kaplan) reports that “the graying of America and the advent of Medicare Part D contributed to the increase, but the nation’s obesity crisis was probably a bigger factor…wrote” the researchers. They found that “among the 10 drugs that were most widely used in 2011 and 2012, eight are prescribed to treat diabetes, high cholesterol,” hypertension, “or other conditions often related to being overweight or obese.”

NBC News (11/4, Fox) reports on its website that “more people are also taking antidepressants and proton pump inhibitors.”

The Milwaukee Journal Sentinel (11/4, Fauber) reports, however, that “some drug classes saw a decline in use including sex hormones for women…and antibiotics.”

Meanwhile, the NPR (11/4, Kodjak) “Shots” blog reports that the research “also shows a rising number of people are taking multiple meds.” The data indicated that “the share of people who took more than five prescription drugs in a month nearly doubled to 15 percent.”

AMA News, Wednesday, November 4, 2015

Children conceived using infertility treatment at no greater risk of developmental problems

“This is happy news to broadcast. Wanting children and considering infertility treatment causes concerns that, maybe, are not really a concern. Yeah for babies and for the parents who want them desperately. My heart goes out to them each and every one.” Bill Chesnut, MD

Children conceived using infertility treatment at no greater risk of developmental problems, study suggests

Reuters (1/5, Doyle) reports that a new study conducted at the Eunice Kennedy Shriver National Institute of Child Health and Human Development suggests that “children conceived with assisted reproductive technology have similar early childhood development as other children.” However, researchers found that those conceived using fertility treatments were more often born as twins or multiple births prompting lead author Edwina H. Yeung to encourage fertility specialist to use techniques that decrease the risk of multiple births.

HealthDay (1/5, Norton) reports that for the study, Yeung’s team “followed over 5,800 children born in New York state between 2008 and 2010,” including 1,830 children conceived using fertility treatments. Overall, the researchers found that those conceived using reproductive technology “were no more likely to show developmental delays at the age of 3 than their peers whose parents conceived naturally.” The findings were published in JAMA Pediatrics.

AMA Wire newsletter, January 2015.

3 simple ways to help prevent falls among older patients.

“This is important information for any families with older members. Balance declines at age 65. Field sobriety tests are different for drivers >65 years of age I heard on the radio.” Bill Chesnut, MD

Three simple ways to help prevent falls among older patients AMA newswire_9/22/2015, 3:30 PM

Fall-related injuries among older Americans are rising as the people age 65 and older become a larger percentage of the population. In 2013, 2.5 million older Americans were treated in emergency departments for injuries from falls, resulting in $34 billion in direct medical costs. Fortunately, several opportunities are available to help physicians prevent falls among their patients.

With National Falls Prevention Awareness Day Wednesday, sponsored by the National Council on Aging, it’s a good time to work with your patients to minimize their risk of falling. Here are three things you can do:

1.Screen patients by asking if they have fallen in the past year, feel unsteady or worry about falling.
Review patients’ medications and stop, switch or reduce the dose of drugs that increase the risk for falls.
Recommend daily Vitamin D with calcium. (The American Academy of Orthopedic Surgeons recommends that everyone > 65 years or who had a fracture falling from standing height have a bone density test and blood tests for hypovitaminosis D. Bill Chesnut, MD)

Resources to help

The Centers for Disease Control and Prevention (CDC) recently launched its STEADI (Stopping Elderly Accidents, Deaths and Injuries) initiative for health care professionals in association with the 2015 White House Conference on Aging. Rooted in established clinical guidelines and scientifically tested interventions, STEADI helps physicians address fall risk, identify modifiable risk factors and provide effective interventions for patients.