One Solution to Face the Dilemma of Social Isolation
Rates of social isolation are only increasing — not only because of an inherently Western attidude being adapted in so many cultures where individualism is favored over family — but because of new techniques, paradigms, and interventions of health that directly have been improving the global age of survival. Without the ability to counterbalance this increasing age due to a lack of technology to keep our neurons from diminishing over time, for example, or the lack of decreasing the rates of non-communicable, age-related diseases, it remains for us thus as a major obstacle in attaining the state of “living in balance,” as the world-renown statistician Hans Rosling once so eloquently put it in a Global Health lecture at Karolinska Institutet, year 2011. If we are to make no further progress to keep our foundation in supporting the elderly, we will inevitably crumble and shall once again be “dying in balance” as our ancient ancestors have done with leaping infant mortality rates. In our situation, it may be waves of elderly who will be at the brunt end of the sword. It appears to be so that in the near future, when our fertility rate will balance itself, our situation is reversing. Not enough children already now in high income countries will not be able to support or give attention to the growing needs of their elders.
One solution to help diminish this problem is the introduction of elderly-friendly pets. While a large motivation for them may be food and a home, pets are able to give unconditional attention to their owners. They are just as capable of banishing social isolation.
Several pet-elderly-friendly foundations, for example, exist in Pennsylvania within the United States, such as The Philadelphia Animal Welfare Society (PAWS) and Hope for the Animals. Organizations such as these promote the well-being of pets and seniors, and ultimately try to create a win-win situation. While this animal-elderly strategy may seem to be overly simplified, there certainly is nothing wrong in the logic. In fact, the simplicity of such a strategy as giving pets to seniors to banish isolation may also be its brilliance: this initiative can reach far, and across countless homes. If the elder would like a pet, there is nothing to lose aside from allergies, but then you can always find yourself a breed not privy to causing such a reaction.
References
http://phillypetsandseniors.wordpress.com/pet-resources/pets-and-the-elderly/
Smoking is the Foot that steps in the Cinderella Slipper
HLA-DR molecules can be altered genetically in such a sense to lead to the pathway of the so called “Cinderella Slipper” coined by the work of researchers Peter K. Gregerson of the Feinstein Institute of Medical Research, Lars Klareskog of the Karolinska Institute, and Robert J. Winchester of Columbia University. They have discovered that having one HLA risk gene coupled with being a smoker will quintuple the risk of developing the autoimmune disease, Rheumatoid Arthritis – so called the “Foot” that fits into the Cinderella Slipper. Having two HLA risk genes together with being a smoker makes that risk ten times higher in developing Rheumatoid Arthritis when compared to having one risk gene.
For their work, these three researchers have been awarded the 2013 Crafoord prize in polyarthritis research. Watch the video here:
http://www.crafoordprize.se/
This means that particularly for middle-income countries with high and rising rates of smoking, high population, and high rates of aging, Rheumatoid Arthritis will pose a truly serious problem in the coming future unless preventative mechanisms will come into play concerning smoking, i.e. education campaigns, warning labels, and increased taxation.
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References
http://cmm.ki.se/en/Global-navigation/News/Lars-Klareskog-rewarded-The-Crafoord-Prize-20131/
Elders: Live independently without too much room for pride
The New York Times’ Personal Health blog included an article written by Jane Brody: “Staying Independent in Old Age, With a Little Help.” Here, the writer mentions how the majority of American elderly prefer to stay in their homes as long as possible. A barrier remains, however, as the homes they stay in are outdated relevant to the modernization of our people and the rate at which aging is increasing. Therefore, solutions are mentioned here — both on the house level and the community level — that may allow for elderly to live as independently as long as possible. House level solutions include the installment of grab bars, curbless showers, and the removal of steps. Community level changes include the provision of cluster housing in walkable communities within the vicinity of stores and public transportation.
While these solutions will help prevent social isolation and improve human elderly factors, one must also be aware of the signs of when one should consider moving an elder to a more supportive environment. These signs have been mentioned by Paula Spencer Scott, senior editor at Caring.com. Accidents, falls, diminishing health, slow recovery, inability to leave the house, not picking up the mail, not checking food expiration dates, fluctuating behavior, and increased loneliness are one of few signs to tell when the time may be right. Not only these, but if it takes considerable time and effort to care for this person and you are becoming affected if you yourself are the care provider, it is probably the right time to let him or her come to a place where he or she can be helped with a more constant environment of support. The question remains if these facilities will remain available in the coming future with enough staff. This will of course remain a concern and, to boldly say, should be a target addressed in all coming worldly or national health meetings of any kind.
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References
http://well.blogs.nytimes.com/2012/12/24/staying-independent-in-old-age-with-a-little-help/
Live as a liver with a living liver!
If your body was a mobile phone, your liver would be the SIM card
- Businessweek
Although this post is not particularly tailored to the stereotype of Irish men who not only fashionably drink some ale at the Green Dragon tavern (rather, quite more than a hobby), naturally, it would be important for this group of individuals — and of course those who follow that bandwagon, namely, the particular binge-drinking bandwagon — to read this!
It is so that with a healthy liver you are a liver.
While being a liver — one who lives — you can live when there is an organ that clears toxins from your body, converts food into energy, regulates the levels of cholesterol; among several others. Of course, that is why this organ is called a liver! You can’t live without it.
Henceforth, as once a liver takes a considerable amount of time to restore itself after being diseased or taking a large amount of damage, one should consider as one ages that this organ must be kept healthy. Not to sole out this from any other vital organs — of course general health is directly related to holistic wellness — but let us take some time to appreciate what our liver does for us.
Therefore, my liver, I liver you!
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References
If your body was a mobile phone, your liver would be the SIM card:
The Rheumatic Crash of the Silver Wave
Rheumatoid Arthritis (RA) is a chronic condition that affects between 0,5-1% of the general population. It is considered an autoimmune disorder as the inflammatory system attacks joint locations of the body — typically in the hands but also other areas such as the feet.
Enough damage will considerably lower or possibly prevent the individual’s ability to perform motor activity.
Whether the inflammatory arthritides, including RA, have a distinct presentation and course in older as compared to younger subjects as first postulated in 1941 remains unsettled. The issue has gained significant importance as the proportion of the population who are over the age of 60 continues to grow in developed nations. As multiple newer treatment strategies emerge for RA, the efficacy and safety of these in elderly populations need to be evaluated as a distinct clinical issue.
– Aviva Hopkins, MD, and Carlos J. Lozada, MD
Traditionally, treatments known as Disease-Modifying Antirheumatic Drugs (DMARDs) have been used to treat RA in order to slow the progression of the condition — with methotrexate being the gold standard. In cases of heavy or severe inflammation and/or when DMARDs fail, glucocorticoids (corticosteroids) are also used in tablet or IV form. When used over time, these drugs cause considerable damage to the body. Immunosuppressives such as cyclophosphamide are also used in cases of strong inflammation and these drugs bear considerable toxicity — including the risk of developing infertility (which is vital to understand, especially considering the majority of cases are female; 3:1 in younger-onset RA). With these factors in mind, several new treatments have been made available and the most notable are called biologic drugs. These drugs are created from a biological process rather than being chemically synthesized; most often involving recombinant DNA technology to create, for example, monoclonal antibodies and fusion proteins. An example of a monoclonal antibody used in RA is rituximab, which was created as an “antibody” to specifically target B cells — which are a vital part of the immune response. Where a healthy immune system equates to a healthy person, in the case of an autoimmune patient the inflammatory response goes out of control and must be suppressed. Taking these drugs of course can lead to a rise in the rate of infections as they very effectively do what they were made for — lowering the immune response. However, a search on PubMed or any other medical database reveals a very positive force for the usage of biologic drugs; as they are also considered safer than some traditional DMARDs. Biologics have existed for approximately 20 years, but despite evidence showing them to be significantly more effective than DMARDs, they are quite costly. Therefore, biologics are typically reserved for those patients who do not respond well to DMARDs.
If there would be a way to make these biologic drugs more cost effective, these drugs are an important milestone for an answer to worldly health with the rising rates of elderly who may potentially develop RA. Novel drugs which may be considered similar to biologics have just been introduced within the past few years and these are known as protein kinase inhibitors. More research will show if these drugs will prove to be more cost effective than the competitive biologics.
References
http://www.cdc.gov/arthritis/basics/rheumatoid.htm
Diabetes and Canada: Don’t Forget the Youth!
According to the Public Health Agency of Canada, there are primary risk factors for obtaining a chronic disease. While the following are quite typical to hear, we must be reminded of them: tobacco use, harmful use of alcohol, raised blood pressure (or hypertension), physical inactivity, raised cholesterol, overweight/obesity, an unhealthy diet, and raised blood glucose. The Canadian Best Practices Portal has on their news line a report about diabetes in Canada from the Public Health Agency and mentions some preventative solutions.
According to the Public Health Agency report, there are several factors previously mentioned here that can promulgate the development of type 2 diabetes: namely, obesity, physical inactivity, the risk of an unhealthy diet (less than five servings of vegetables and fruit a day), and smoking. Most of these factors attribute to nearly all of the risks — where others include socio-demographic, environmental, or genetic factors.
With the risk factors in mind, it is notable to say nowadays that a highly at-risk population for obtaining type 2 diabetes is young people — with rates of physical inactivity and consumption of high-fat foods being on the rise. Interventions suggested by the Public Health Agency thus include increasing the time for physical activity in school curricula, instituting educational campaigns (which include the understanding of food labels and to teach youth how to cook nutritious, low-fat foods), providing access to community recreational facilities, networking for improving nutrition and physical activity, providing training to staff and volunteers for the skills required to promote population health, and mandating a local health service (i.e. a diabetes education center) . Notably, they stress a “holistic approach” that encompasses social, economic, environmental, genetic and lifestyle factors associated with type 2 diabetes.
“Type 1 diabetes remains the main form of the disease in this population [children and youth], but type 2 diabetes, historically viewed as an adult disease, has been on the rise globally in children and youth for the last decades.”
Why is the health of the young so important when we should be focusing on the rapid aging rate?
This is a notable question to consider, and my answer is that with the continuous drain of services for elderly due to the widespread aging process, fewer and fewer staff will be able to take care of them. What indeed could we do if the next generations of our world could not even take care of the old because they are not healthy themselves? It is an insight that we all must realize — that although there still remains a lack of focus on the rising aging population, we most certainly shouldn’t turn our heads away from the young.
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Public Health Agency of Canada. http://www.phac-aspc.gc.ca/index-eng.php
Canadian Best Practices Portal. http://cbpp-pcpe.phac-aspc.gc.ca/
Diabetes in Canada (PHA). http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php
Innovation in Transportation for Seniors: The Elements
The Community Transportation Association (CTAA) and the Beverly Foundation of the United States brought forth a quote in their report from rural America: “Many of our innovations are by necessity, not by design.” Being driven by necessity is, unfortunately, a hard and cold fact for innovations in general. Only at the brink of when we are about to run out of a resource are our major leaders interested in bringing something new forward. Concerning transportation — and particularly in rural areas — it is indeed a necessity to consider the elderly population.
A summary of CTAA’s and Beverly Foundation’s findings [1]:
(1) The out-migration of the younger population,
and the in-migration and aging-in-place of the older
population, has resulted in an increase in the
population that is less mobile and less able to drive
or navigate transportation services.(2) Many seniors, especially those who are frail and
in need of assistance, depend on community
transportation services to get to both life sustaining
and life enriching activities.(3) Transportation services face numerous
operational and financial challenges in meeting the
transportation needs of seniors.(4) Transportation services generally address
everyday challenges such as scheduling with everyday
solutions such as technology.(5) In addition to everyday solutions, many
transportation services successfully introduce new
or novel changes from the standard way of doing
things. Such changes generally are described as
innovations.
According to this source, the Keys to Innovation (beyond leadership) include A Point of Origin (i.e. Why is this innovation needed? In this case, transportation may be forced to shut down if nothing is done due to a financial crisis with driver salaries, etc.), An Idea Factory (i.e. Where innovations are created. For example, a volunteer driving program), People Markers (i.e. The people define the innovation. For example, riders recruit drivers and drivers recruit riders), and last but not least, a Receptive Culture (i.e. The status of the society’s willingness for change.)
As the decline of infrastructure was apparent in rural America — and the rate with which the elderly population rose higher than when compared to urban America (also considering the differential between the youth leaving vs. the older staying) — the elderly in these areas have been having a challenge. Limitations include the lack of novel treatments and care, destination travel (with the factor of time — especially for long medical trips), and social isolation. But despite these enormous challenges, the Beverly Foundation and CTAA claimed that rural America is “doing a lot with a little,” so to speak.
References
1. http://www.ctaa.org/webmodules/webarticles/articlefiles/Senior_Rural_Innovations.pdf
The challenge of rational medicine’s journey from patient- to pathogen-specific
Recently, the New England Journal of Medicine (NEJM) released their 200th anniversary article titled, “Therapeutic Evolution and the Challenge of Rational Medicine,” by Greene et al. [1]. This article gives us a walkthrough of how medicine has evolved in the past 200 years: specifically, from patient-centered in approximately the first century and a half, to pathogen-centered in the last fifty or so years. Traditionally, western doctors had an in-depth knowledge of herbs — and a wide range of (often bizarre) treatments, ranging from the application of the “Devil’s dung” plant to the practice of bloodletting, i.e. “breathing a vein,” to assist in the curing of a disease. While some of these treatments are arguably questionable, specifically the well-versed knowledge of traditional western doctors focused more on the human perspective, and, as a result, may have been a vital ingredient to the overall well-being of the patient. This component appears lost today — where our healers are efficaciously oriented toward targeting a specific pathogen, with very specific aims. This compartmentalization of focus (generating doctors with specific knowledge about specific subjects) leaves patients with any other possible ailments or concerns to hang in the dark. While the light of the brilliant doctor who shines in his specific field of focus may isolate and treat the primary cause of a disease, the flashlight he is shining with on the patient may just as well blind the patient to any other factors just as important that could improve general well-being. The flashlight will of course cast shadows of its own. As the article in NEJM subtly points out, there can be no medicine without both therapeutic enthusiasm and therapeutic skepticism, and skepticism has flourished in the rationale of science ever since the chilling specter emerged from medicines such as thalidomide, Diethylstilbestrol, Vioxx, and Avandia [ibid]. These drugs were developed for specific purposes, i.e. to prevent morning tiredness, to act as an antidiabetic, etc., and while the focus of developing these drugs may have been done through well intention, the outcomes clearly revealed something menacing lurking in the shadows.
“As the locus of disease has narrowed from the afflicted person to the molecular mechanism, and the target of magic bullets has followed suit, physicians have faced regular reminders of the limits of the reductionist approach.” [1]
As we have been endlessly discovering smaller and smaller particles; and smaller and smaller actions that lead to larger reactions, one might wonder if this approach is the best to solely focus on. What may be an additional approach more fitting for our new century? The Shanghai Center for Systems Biomedicine has released an interesting article titled, “Toward new drugs for the human and non-human cells in people,” by Zhao et al. [2]. This explores the realization that the human body is only sparsely comprised of actual “human” cells. There is in fact a multitude of lifeforms that live within us and work in synergy with our body. For example, our metabolism is aided by lifeforms such as veillonella, bifidobacteria, and lactobacilli. Zhao et al. explain that humans are “superorganisms” due to the fact that we are 10% human cells and 90% microbes (primarily in the intestines).
“‘Super’” in that sense means ‘above and beyond.’ Scientists thus are viewing people as vast ecosystems in which human, bacterial, fungal and other cells interact with each another.” [2]
Therefore, when microbes significantly affect our genetic actions and reactions through gene regulation; i.e. on and off switching, this directly affects our immune response — and thus affects how diseases or disorders manifest. Due to this complexity, scientists realize how the reductionist approach can certainly fail — as all individuals will have a different response to treatment. We are complex beings and thus require complex interventions, and that certainly does not mean we should delve further to find even smaller particles or specialize ourselves even more. We should, on the contrary, seek a more holistic approach. For example, our own nutrition, diets, medications, mental state and physical activity (or lack thereof) completely affect the manifestation of our microbe populations within our bodies — and thus completely affect which genes are expressed and which are not. There is nature just as much as there is nurture. The so called “functional metagenomics” proposed by Zhao et al. [2] for developing new medicines that affect our microbes (and I say “our” for simplicity, because these organisms work together with us) are showing promise through traditional Chinese medicine (TCM) — an archaic yet thriving art of medicine that continues to prosper and grow in popularity even among the general scientific community as time passes. In the case of gene-environment reactions, most chronic conditions are involved. Here, Zhao et al. claim the gut microbiome is vital and TCM is tailored to target both the host as well as the synergistic microbes — thus being a holistic medicine, as treatments are not specifically tailored such as the conventional drug approach, which targets in an isolated fashion typical receptors within the “druggable genome.”
It appears that for the next age — moving on from an efficacious, isolated approach in primary care — we are not going back to a patient-centered approach which began in traditional western rational science, but rather a “super organismic” track that attempts to integrate as many human and non-human factors as possible.
References
1. Jeremy A. Greene, M.D., Ph.D., David S. Jones, M.D., Ph.D., and Scott H. Podolsky. M.D. Therapeutic Evolution and the Challenge of Rational Medicine. N Engl J Med 2012; 367:1077-1082. September 20, 2012. DOI: 10.1056/NEJMp1113570
2. Zhao L, Nicholson JK, Lu A, Wang Z, Tang H, Holmes E, Shen J, Zhang X, Li JV, Lindon JC. Targeting the human genome-microbiome axis for drug discovery: inspirations from global systems biology and traditional Chinese medicine. J Proteome Res. 2012 Jul 6;11(7):3509-19. Epub 2012 Jun 5.
Chronic disease prevention or care: Few of the several benefits of massage
The benefits of complementary and alternative medicine (CAM) (including massage) are readily apparent and have been shown, for
example, through a systematic review to be safe, efficacious vs. placebo, and cost-effective [1].
Massage is a treatment which has been shown to be efficacious when used on the practitioners themselves [2].
Regarding chronic care, pain was reduced and mood improved for nursing home residents with cancer [3]. Massage is recommended to
be integrated in physical therapy for elderly; especially nowadays with the rising elderly population requiring prevention or treatment of
arthritic conditions [4]. And among a large proportion of veterans experiencing non-cancerous chronic pain, CAM appears to have a
broad appeal after responses indicated that almost all in the study had a willingness to try CAM; with massage being the most preferred
option [5].
Massage thus appears to have a benefit for both practitioners (they need care too!) and patients and is promising for chronic and elderly care. Due to its obvious cost-effectiveness (if you want to scratch out any expensive oils and just consider the most important tool: hands); ability to reduce pain and stress; and even the possibility of preventing or treating inflammation, blockages or arthritic manifestation, massage should be an essential component in general health and should be considered for incorporation into all forms physical therapy wherever possible.
References
1: Furlan AD, Yazdi F, Tsertsvadze A, Gross A, Van Tulder M, Santaguida L, Gagnier J, Ammendolia C, Dryden T, Doucette S, Skidmore B, Daniel R, Ostermann T, Tsouros S. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine forneck and low-back pain. Evid Based Complement Alternat Med. 2012;2012:953139. 2: Jensen AM, Ramasamy A, Hotek J, Roel B, Riffe D. The Benefits of Giving a Massage on the Mental State of Massage Therapists: A Randomized, ControlledTrial. J Altern Complement Med. 2012 Sep 4. 3: Hodgson NA, Lafferty D. Reflexology versus Swedish Massage to Reduce Physiologic Stress and Pain and Improve Mood in Nursing Home Residents with Cancer: A Pilot Trial. Evid Based Complement Alternat Med. 2012;2012:456897. Epub 2012 Jul 24. 4: Hardt R. [Special features of physical therapy for elderly rheumatic patients]. Z Rheumatol. 2012 Jul;71(5):396-402. German. 5: Denneson LM, Corson K, Dobscha SK. Complementary and alternative medicine use among veterans with chronic noncancer pain. J Rehabil Res Dev. 2011;48(9):1119-28.
Innovations in Personal Transportation Vehicles: Challenge or Opportunity?
Dean Kamen’s Segway® Personal Transporter (PT) unleashed waves of enthusiasm with its release in 2001 quite frankly as a vehicle for the new age. The self-balancing gyrometers — with their fascinating ability to sustain an upright position — posited a truly bizarre realization for our populace: that times are changing and we need to be ready for it.
This realization certainly does not exclude the elderly population, whom have gone perhaps through the most changes humanity have ever faced in history; with such a dramatic recombination of technology in this past century.
If you browse through search engines and correlate the Segway with the elderly, you won’t find many innovations concerning our aged population. You will find concerns on how the elderly view such devices as the Segway — particularly the operator not being able to control it safely enough in order to prevent collisions with said elders. Forums may reveal that Segways are user-friendly for the elderly if they wish to operate them for themselves, however, safety and bug issues are always notable. It is difficult to find information, if any, regarding devices such as these specifically tailored for those in our population who require more care in their designs for mobility.
Personal Transportation Vehicles such as the Segway have brought a hallmark of inventive changes for the general population. Now, however, with a global, dramatically aging population, focus needs to be directed on the safety and effectiveness of such devices for those with more frail or limited mobility.
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References
http://www.segway.com/about-segway/index.php
http://www.ehow.com/list_6884791_segway-safety-issues.html
http://www.caregivershome.com/news/article.cfm?UID=1097
Willpower: A tool for elders to reinvent themselves
Today gives rise to a new state of mind for the baby boomers. As our elderly are expected to retire during ages 60-65; start playing golf, cleaning the garage and priming up the garden, it brings forth question: Do they want to do this for the rest of their years?
According to Global Action on Aging (GAA) of New York, the elderly appear to have a strong incentive to contribute to society by having a will to stay in the workforce. Trends have shown that working men between ages 62 and 74 in the past decade have risen by about 40%, whereas working women in these ages and in this same time period have risen by 60%. A large proportion of elderly in the States report low amounts of savings, and though while financial reasons are a large contributor to the elderly staying in the workforce, apparently it is not the only one. “All the research we’ve done shows that, even when the money issue is put aside, people don’t want to do nothing.” - Tammy Erickson, author of “Retire Retirement: Career Strategies for the Boomer Generation” (Harvard Business School Press, 2008)
“Call it a second phase, an encore, a reinvention. Just don’t call it retirement. More people are entering their mid-60s — stuck, perhaps, with dismayingly skimpy savings accounts, but blessed with sound health and many years ahead of them — and deciding that retirement doesn’t top their agenda.” - Katy Read, The Courier-Journal
“My speculation is that the more mature the individual, the more self-reflective or self-aware they are, the more likely to recognize that they need to retool, to kind of reinvent themselves.” – Jeff Hudson, program director for continuing education and customized training at Normandale Community College in Bloomington, Minnesota
Perhaps the wave of baby boomers caused a silver evolution and revolution in and of itself; consciously, or unconsciously, as a self-protective mechanism by our elders themselves, to help contribute to the aging world. If it be conscious, however — striven with willpower — it will probably make the outcome much more successful. Willpower is the tool needed to reinvent yourself for a reinventing future, whether is it re-educating yourself, taking on a new initiative, or quite simply charting out a new path to meet your dreams.
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References
GAA
http://www.globalaging.org/about_gaa/mission.htm
People Don’t Want to Retire: Many Seniors Prefer Reinventing Themselves
http://www.globalaging.org/elderrights/us/2012/Reinvention.html
Former Seattlites are Reinventing Themselves in the Hills of San Miguel
http://www.globalaging.org/elderrights/us/2008/SanMiguel.htm
What do you want to be when you grow old?
Do you remember back in the day with vague glimpses of memory when your teachers would ask you, “What do you want to be when you grow up?” Naturally, it would be normal to think about all kinds of professions swimming in your mind.
How different would it be, however, if we ask the question, “What do you want to be when you grow old?”
It may be quite hard to imagine an answer like, “I want to be a monster truck rally daredevil,” as most might imagine themselves lounging in bed, nearly a century old, ponderously trying to recall in the noon what they had for breakfast a mere few hours ago. This is probably why our teachers never bothered to ask the question.
Unfortunately, if you wish to have it revealed how many minds pondered over this question by briefly swimming in the external consciousness of mankind, i.e. surfing the internet, you may not find much more than Adam Sandler’s “I Wanna Grow Old With You.”
How would our world view that question if our elders are given voices? What is life like for them, and is it really all that bad? Did they want to end up where they are now, or had they wished they thought of it? These types of questions with their answers could, for example, help prevent waves of mid-life crises. Perhaps when we think about questions such as these, more waves of innovative technology, paradigms and solutions may arrive to address fields concerning the elderly.
“What do you want to be when you grow old?” I want to be a wise man; healthy, and full of spirit; reading several books a week and even playing chess and tennis regularly. Lastly, I would wish to pass on whatever knowledge I have to my children so that they, one day, could do the same.
It is right to ask the question, is it not? We will all get to that destination in one way or another. I daresay that – for me – it will be fascinating to experience how it all will turn out.
So then, now it’s your turn. What do you want to be when you grow old?
Music Therapy: A Chronic Care Paradigm
Could music therapy be used for treatment of chronic conditions? Could it even prevent them from arising? Let us explore.
The biological effects of music therapy through clinical research have been explored before the turn of the century by GR Watkins of University of Illinois at Chicago, USA. In 1997, he both reviewed and confirmed the usefulness of the effects of music therapy on anxiety, blood pressure and heart rate.
Taking into consideration the death tolls from cardiovascular disease — the largest worldly contributor to chronic disease deaths — we need to find ways to maintain a healthy heart. We definitely can – for example – reduce our trans-fatty acids intake, but there are several pieces to the puzzle. Let us see if anything more recent has discovered similar phenomena as was discovered by Watkins.
A meta-analysis in year 2012, conducted by RS Loomba et al., apparently discovered the same phenomena as Watson’s findings, but here they report major effects. They mention the purported effects of music therapy on relieving anxiety and statistically reveal significant decreases both in systolic and diastolic blood pressure as well as heart rate. With these findings, further studies should triangulate these effects of music therapy after being incorporated into chronic disease prevention and chronic care management programs. Finally, allopathic facilities should aim for integrative care initiatives and involve music therapy as part of holistic treatment — particularly for those who seek complementary or alternative modes of treatment.
References
1: Watkins GR. Music therapy: proposed physiological mechanisms and clinical implications. Clin Nurse Spec. 1997 Mar;11(2):43-50. Review. PubMed PMID: 9233140. 2: Loomba RS, Arora R, Shah PH, Chandrasekar S, Molnar J. Effects of music on systolic blood pressure, diastolic blood pressure, and heart rate: a meta-analysis. Indian Heart J. 2012 May-Jun;64(3):309-13. PubMed PMID: 22664817.
The effects of ginkgo extract on dementia
More than half of the elderly with dementia are over age 80 in high-income countries. Alzheimer’s — a purportedly incurable disease starting with mild memory loss and ending with severe brain damage and death – is the most common form of dementia. Indeed, progress for treating such conditions has not had much haste. Perhaps something is hiding within the alternatives — some formula or combination that may change a dreary caterpillar into a fluttering butterfly. Antioxidants, Asian ginseng, cat’s claw, ginkgo, and grape seed extract have all been proposed as alternatives for treating Alzheimers and dementia. Let us, for example, focus on the extract from the ginkgo biloba leaf from the ginkgo tree — a unique plant species widely known and particularly respected both for its use in traditional medicine and for its symbolism in China, Korea, and Japan.
In addition to its explored potential effects such as improved blood flow, prevention of oxidative cell damage from free radicals (i.e. “aging”), and prevention of platelet aggregation and blood clotting, ginkgo has been purported to act with nootropic, or memory enhancing, properties. A double-blind, randomized, placebo-controlled study conducted by the National Institute on Aging and the National Center for Complementary and Alternative Medicine (NCCAM), of the National Institutes of Health, USA, found some promising results for ginkgo extract as treatment for dementia. Ginkgo biloba extract in this study was able to show an indication of reduced risk of progression of dementia and a smaller decline in memory when compared to the placebo group. It followed 118 volunteers age 85 or older who used 80 mg of ginkgo extract three times per day over a time period of 42 months.
To conclude, ginkgo extract has large potential for treating dementia, but an evidence base just as large is required. Broad clinical trials must commence to address the effectiveness of this treatment.
References
NCCAM (2012) Alzheimer’s disease and CAM. Retrieved May 9th, 2012, from: http://nccam.nih.gov/health/providers/digest/alzheimers.htm
NCCAM (2012) Pilot study provides new insight on effect of ginkgo extract on dementia in the elderly. Retrieved May 9th, 2012, from: http://nccam.nih.gov/research/results/spotlight/022608.htm
Involving eHealth: How health care leaders may envelop chronic care management strategies with health information exchange directives
As chronic diseases are becoming a rapidly growing problem in the world, methods to manage and present medical information both to care providers and patients require several avenues of thought. Janet Marchibroda, MBA is the chief executive officer of the eHealth Initiative and its Foundation — both independent, national non-profit organizations based in Washington, D.C., whose missions are to improve the quality, safety, and efficiency of health care through information and information technology.
Janet Marchibroda has devised three plans to bring together chronic care management strategies with health information exchange directives: 1) Leveraging Health Information Exchange Efforts for New Chronic Care Management Programs, 2) Augmenting Existing Chronic Care Management Strategies with New Data Sets and Services from the Health Information Exchange, and 3) Extending the Ability to Communicate with Care Providers and Patients. To summarize these three strategies, the first implies by asking those involved in chronic care management what tools are already existent or lacking, e.g. ongoing health information exchange initiatives, if any; types of data being exchanged and to whom, and so forth. In other words, a system must be put in place to set a helping “leverage” in managing chronic diseases. Secondly, the next paradigm focuses on improving an already existing chronic disease management initiative. Missing data elements may be included here, as well as methods to improve the measurement of quality of care and cost effectiveness. Thirdly, the final theme emphasizes an active patient-practitioner relationship, and methods should be identified for the patients themselves to be actively involved with the regimen of treating their diagnoses and preventing the onset of worsening or secondary conditions.
With this in mind, there are also some recommendations that may improve chronic disease management. Databases of eHealth ought to have a storage of health indicators, determinants, and conditions. Certain conditions could each have a specific variable (with a proper categorization, i.e. what type of condition is it, e.g. autoimmune, etc.) assigned to them and a constantly updated list of symptoms (entered and updated by the care providers). The database could draw data of symptoms from each patient with a specific condition, and this should be accessible to health care providers to give them more clues for an accurate diagnosis and for the prevention of misdiagnosis. Finally, each of these specific conditions assigned with a variable should have a list of viable treatments and its strengths and weaknesses. These treatments could be taken from studies done in medical databases, i.e. PubMed, The Lancet, and contain and explore as many treatments as possible — both conventional and unconventional. The care provider informs the patient and/or family of the patient not only with the type of treatment they deem the most effective, but also viable alternatives. These methods of managing of eHealth may lead to effective treatment and prevention of chronic diseases.
References
Marchibroda JM (2008) The Impact of Health Information Technology on Collaborative Chronic Care Management. Journal of Managed Care Pharmacy 14:2, s3-10. Retrieved Apr 27 from: http://www.amcp.org/data/jmcp/JMCPSupp_March%2008.pdf
Architectural Human Factors and Re-engineering in Elderly Care
(Image retrieved from The Lancet Neurology)
A topic not actively discussed includes the potential therapeutic effect of architecture as well as horticulture to produce an innovative effect in preventing or slowing the development of chronic disease. Could architecture regarding the application of human factors and re-engineering serve as a significant treatment for the elderly?
The Medical Architectural Research Unit (MARU) of London South Bank University evaluated some European cases of architecture that specifically targeted the elderly, as cited in the World Health Design organization’s website. Field visits from 2005-2008 included Finland, Spain, and France.
Various facilities that focus on dementia care were visited by MARU and offer innovative architectural experiences with holistic approaches that appear to influence the elderly. The Viola-koti of Tampere and Kamppi Service Centre of Helsinki facilities are highlights of Finland, and include human factors-oriented recreational facilities with special exercise activities and workshops; multi-level saunas; and buildings with bi-folding windows that give elderly a wonderful view of the on-goings of the world even in the times of cold, dreary winter months. Next, in Spain, the Madrid Alzheimer Centre has been engineered to conduct bio-mechanistic studies on the probable causes of Alzheimer’s, while at the same time influencing those staying at the clinic with units of residence all independent of each other in design – each topped with well-protected, inspiring courtyard gardens. By understanding ways to incorporate a whole spectrum of care, a central garden even is integrated as being part of a horticultural therapy program. Finally, in Paris, France, the Residence de l’Abbaye allows the elderly in a secure environment simulated as a ‘salon’ on a ‘street of activities’ to learn and discuss about the matters of modern politics and societal issues, keeping their worldly lore active and up-to-date.
This process of course is up to the human experience and how we each individually perceive phenomena. Therefore, architectural human factors and re-engineering would have – like any method of therapy – different effects on different individuals. Yet, the truth remains: an often under looked yet obviously significant stimulus is there, right before our eyes, influencing how we move, perceive, and experience our world. What would our world be like, after all, if our city squares were circles, and our buildings ovals instead of rectangles?
References
World Health Design (2012) Elderly Care: Active Ageing. WorldHealthDesign.com. Retrieved April 19th, 2012 from: http://www.worldhealthdesign.com/Elderly-Care-Active-Ageing.aspx
Discoveries of the effects of Tibetan monk practices: Can meditation be useful in addressing psychological stress and physiological well-being?
(Image retrieved from the Harvard Gazette Archives, April 18 2002 Issue)
Life adaptation – particularly to a brave new world of ever-new gadgets and gizmos – is particularly relevant for the aging population, requiring fundamental mechanisms apparently implicit in the human mind in order to prevent and treat the potential dangers to mental and physical well-being as caused by psychological stress and the fight-or-flight response.
Author William Cromie of the Harvard Gazette in the April 18, 2002 issue revealed one such implicit mechanism to counteract stress, accessible within the human mind. This article, titled, Meditation changes temperatures: Mind controls body in extreme experiments, revealed the works of Dr. Herbert Benson, Associate Professor of Harvard Medical School. Beginning in the 1980’s, with support from His Holiness Dalai Lama, Dr. Benson has been conducting metabolism experiments on Tibetan monks practicing g Tum-mo meditation from Buddhist monasteries in remote areas of northern India. Obstacles due to low funding proved difficult for continued research – including the lack of electricity in the Himalayan areas – until the turn of the century, where g Tum-mo monks were brought to a Guinness estate in Normandy, France, to be involved with another temperature experiment.
Studies which commenced in the 1980’s and on have shown that these monks could lower their metabolism by 64 percent and reduce oxygen consumption by 17 percent just by simple meditation. This may lead to less free radicals in the body, thus less oxidation, and thus less “aging.” The g Tum-mo technique is known for its by-product of producing large amounts of body heat still unexplainable today. Through g Tum-mo meditation, Dr. Benson recorded that monks could raise the temperatures of their bodies to breathtaking amounts of heat – with increases as much as 8.3°C in their hands and toes. Large, chilled, wet towels placed on these monks’ bodies which would normally produce a shivering response did not produce noticeable shivers, and proved to be dry within an hour. Techniques such as g Tum-mo could prove priceless to preventing the onset of illnesses for the elderly – whom are more susceptible to the cold, thus leading to a weaker immune system, which may lead to considerable conditions, i.e. pneumonia.
Dr. Benson – inspired by meditation – has developed the renowned “relaxation response,” published as a book over 40 years ago but used widely today. This technique counters the stressful state of mind and targets physiological equilibrium. The components involve choosing a word, sound, prayer, or phrase, relaxing the body, and letting any thoughts that come to mind simply pass by while continuing to repeat the chosen saying. It is regularly recommended in treating patients suffering from heart conditions, high blood pressure, chronic pain, insomnia, and many other physical conditions. Requiring only minutes to learn and just between ten to twenty minutes of practice twice a day, it can bring cost-effectiveness in all forms of public health ranging from general health clinics to those focusing on elderly care. Although g Tum-mo meditation – a well-guarded secret by the Tibetan monks who meditate hourly per day – may require years to learn and cannot be easily performed by the layman who would meditate 10-20 minutes twice a day, it is shown that simple meditation such as the relaxation response is all that is required to produce physiological, DNA-affecting changes in the body to alleviate the stressful fight-or-flight response and balance the body by putting it into homeostasis. To summarize, there is an indication from the trends of experiments that study some forms of meditation as practiced in Tibet that there may quite be something to the expression, “mind over matter.”
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Dr. Benson’s experiments with Tibetan monks
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ABCNEWS.COM – Simple relaxation techniques to help after a hectic day
via Easy Ways to Take the Edge Off.
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References
Cromie, William J. 2002. Meditation changes temperatures: Mind controls body in extreme experiments. Harvard Gazette. April 18 2002 Issue. Retrieved April 12th, 2012 from http://news.harvard.edu/gazette/2002/04.18/09-tummo.html
Country case for chronic disease: Japan and its staggeringly low cardiovascular death rates
(Yoshikazu Tsuno/AFP/Getty Images)
“Noncommunicable diseases (NCDs), primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, are responsible for 63% of all deaths worldwide (36 million out of 57 million global deaths)” – World Health Organization, 2011
Noncommunicable diseases – also referred to as chronic diseases – remain the number one global cause of deaths worldwide and cardiovascular disease (CVD) or heart disease remains at the top of the pedestal. Chronic diseases significantly concern the elderly, as 75% of 36 million global deaths attributable to chronic disease occurred beyond age 60 in 2011. In this report, we must highlight Japan – the country with the highest average elderly age yet the lowest cases of heart disease.
As early as 1981, Professor Geoffrey Rose of Epidemiology wrote an article in the British Medical Journal about taking the action of preventing CVD. He showed staggeringly low numbers of how Japan in 1968 had just over 100 deaths per 100,000 population attributable to coronary heart disease (CHD), whereas before the United States was able to drop their rates considerably over time, in 1968 they had the highest number – with over 800 deaths per 100,000 population. Sweden was around the middle, with approximately 450 deaths per 100,000 population. Further, Rose adds, “The Japanese owe their low rates not to their genes but to their way of life: when they move to America they rather quickly acquire American rates.” In addition to affirming Japan’s low death ratio, the United States and Australia had shown drops of 25% till year 1977, indicating that therapeutic advancements and prevention strategies can considerably reduce the deaths from CHD – which represent approximately half of CVD deaths (Iso, 2008). Japan has been able to keep their low CHD death ratio similar with a slight drop till 1977 (Rose, 1981) and has considerably dropped further – with over a 50% drop from this time frame to year 2000, having now around 37 deaths per 100,000 population (Iso, 2008). Dr. Hiroyasu Iso of Social and Environmental Medicine wrote in the Journal of the American Heart Association that Japan still has the lowest CHD ratio of high-income countries – between one-third and one-fifth that of the United States.
The decline of CHD deaths in Japan is attributable to the decline of mean systolic blood pressure levels and the prevalence of smoking. However, an issue is arising with a high prevalence of western fast-food diets increasing the mean serum total cholesterol and triglyceride levels (Iso, 2008). It is curious as to how Japan started with such a low ratio of deaths from CHD, and as we have heard from Professor Rose, it is due to their lifestyle. Is this lifestyle perhaps significantly affected by the practice of Complementary and Alternative Medicine (CAM) or Traditional Medicine (TM) involving the use of exercise, herbs, or other techniques? In order to explain a counterbalance for a high-fat-intake diet, I recommend collaboration with a national research organization such as the Japan Society of Oriental Medicine to investigate how the effects of Japanese Traditional Medicine, i.e. Kampo, derived from Chinese Traditional Medicine might be attributable to the low incidence of CHD deaths in Japan.
According to Dr. Johan von Schreeb of Karolinska Institute’s Public Health Sciences, approximately 1/3rd of Japan’s population is over age 60 and the country has the highest average aged population in the world – leading with 84 as the mean age of life expectancy. Prevention of chronic diseases is on the forefront of today’s world, with so many medical advances leading not only high-income countries but countries all over the world to jolt up in life expectancy. And as life expectancy rises, so does the demand for prevention of chronic disease. Is there a golden formula somewhere out in the Far East that could face this issue? As the country with the leading population of elders, perhaps there really is something about Japan that the world could need.
References
The Epoch Times. Image Retrieved April 4th, 2012: http://www.theepochtimes.com/n2/world/40000-japanese-aged-100-over-survey-says-22351.html
World Health Organization. 10 FACTS ON NONCOMMUNICABLE DISEASES. September 2011. Retrieved March 29th, 2012: http://www.who.int/features/factfiles/noncommunicable_diseases/facts/en/index.html
Schreeb, Johan von. Lecture on Disasters & Relief. January, 2012. Karolinska Institutet, Solna, Stockholm. IHCAR Department of Public Health Sciences.
Hiroyasu, Iso. 2008. Changesin Coronary Heart Disease Risk Among Japanese. Journal of the American Heart Association 118:2725-2729.
Rose, Geoffrey. 1981. Strategy of prevention: lessons from cardiovascular disease. British Medical Journal 282:1847-1851.
Time to spin the wheel: A call for integrative medicine initiatives
With the push of Dr. Andrew Weil of the US – establisher of the field of integrative medicine (IM) — we need to move from a system of mere disease management to one that keeps people healthy, and, importantly, to have them stay that way. Deterioration of health only implies more work for those whom are part of care. If the elderly, for example, are able to take better care of themselves in this coming age, exhaustive effort will not be required for the dwindling amount of elderly care providers in contrast to the rising elderly population. There may quite be something to be found from a holistic perspective. One can, for example, take an antibiotic that rids away a pathogen, but it can very well come back again with a biological system somehow suppressed. What problem caused the initial unbalance from homeostasis? Was it the pathogen that was the primary problem, or rather, did it take advantage of a weakened system hindered by a certain state of psychology, mental/physical stress, and/or inadequate nutrition?
The path to finding the answer is a complex one. However, as IM uses so many perspectives and does not centralize treatment, this scientific, holistic process aims for both treating a condition and preventing it from arising again. This includes not only treating individuals by getting as deep as the bones of their body — in other words, physically — but to affect the whole core of their consciousness and unconsciousness — mentally and, arguably, spiritually. As several unconventional modes of treatment are spiritual, the very thought of integrating them into science brings up a vast dilemma. To even utter the word “spiritual” in the common scientific community is to be met as a black sheep, and thus, blunt skepticism has always been the barrier to the emergence of IM. The importance behind this is to understand the science behind the spirituality and to translate that language into what may be more “proper” to say. What an energy medicine practitioner might call the person’s “aura” may very well be the same thing as that person’s electro-photonic vibration response or “energy field,” present in all life forms. Methods to see this bio-electric field have been present now for over three-quarters of a century, starting with the Russian inventor, Kirlian; with more reliable adaptations present through Dr. Korotkov. It has been purportedly discovered in the late 90′s (see here, page 7) — not of course revealed through conventional science — that this bio-field appears to express our condition of health and went even so far as to diagnose patients based on their bio-field expression as based on the color and shape of the phenomena. This has also been purported by Dr. Ignatov of Bulgaria, whom has revealed highly controversial results regarding the bio-field phenomena of energy medicine practitioners.
With such a deep delving down into the rabbit hole and due to the way health care can be radically changed as a result, it can be understandable why IM has not been explored conventionally. However, this borders on ignorance, and the hindrance in exploring the mysteries of “those other treatments” is truly, at heart, unscientific. It is the heart of science to constantly explore the unknown; to challenge, test, or alter existing theories, and to aim for the discovery of those more universal. There is surely a lack of this regarding IM. For example, the National Institute of Complementary Medicine in Australia states,
Notwithstanding these factors, there is no current profile on integrated care initiatives; compendiums of examples and their benefits or information collected on a regularised and agreed basis to enable trends to be monitored and comparisions of health and cost benefits to be made. Yet this information is required to inform future research choices and priorities as well as clinical practice.
Henceforth, with already-present tools available to quantify holistic treatment, a call should be sent forth to researchers and policy- and decision-makers in healthcare to create initiatives for researching and promulgating an evidence base to evaluate the effectiveness of integrative care.
References
Integrative medicine
http://www.relaxedpolitics.com/2009/08/integrative-or-holistic-medicine-the-future-of-health-care-a-debate/
Kirlian photography (Korotkov)
http://kirlianresearch.com/
More advanced stages of Kirlian photography and discoveries (Korotkov)
http://thiaoouba.com/choice.pdf
More discoveries from Kirlian photography (Ignatov)
http://www.reikiprofessionals.com/uploads/First_results.pdf
National Institute of Complementary Medicine
http://www.nicm.edu.au/content/view/59/57/
Massage and Acupuncture: Application of the Science of Touch
Hands can make tools, and hands can be tools themselves.
When one really takes time to think about it, hands are incredible. The science of touch is a rarely discussed topic, primarily due to the sensitivity the topic entails when taking some cultural and social norms into consideration. But the fact is, without touch, we would not be here. It is proven that babies do not develop properly if they do not have skin contact. Apparently, touch is required as a triggering mechanism for promulgation of brain activity, emotional response, as well as the immune system.The touch of a newborn baby’s hand forms tears in the eyes, and the touch of an elder’s hand cannot help but make one think of the wisdom one can learn of the world. The touch of hands have incredible potential. Just as they have let us discover fire, craft tools, and even use smartphones, they have been used in treatment for as long as history can recall.
Two such forms of the application of hands for treatment include massage and acupuncture. While massage involves direct skin contact through the hands, guided by fluid movements, acupuncture involves the intuition of the hands to gently guide needle tools serving as extensions of the hands — affecting meridians of the body that are stimulated through touch. Without the needle tools, this is known as acupressure.
According to the American News Report, studies have shown that, for massage, treatment is effective for treating pain regarding inflammation after exercise (reducing inflammation of acutely damaged skeletal muscle), osteoarthritis knee pain (pain reduction), chronic low back pain (significant pain reduction), and fibromyalgia (pain reduction and improved quality of life). Exhaustive amounts of studies exist for acupuncture, and publications from the China Academy of Chinese Medical Sciences revealed, for example, the potential of acupuncture treatment for depression as well as chronic fatigue syndrome (CFS). Regarding CFS, acupuncture has shown to significantly improve quality of life.
These are just two methods of the science of touch, but this is an almost endless avenue to explore. Ready for an adventure? The skies are the limits… but not for the hands. Hands built space programs.
Hands are incredible.
References
Greenville Hospital System. The Magic Hour. Retrieved May 24th, 2012 from: http://www.ghswomens.org/the-magic-hour.php
American News Report. Studies Show Massage Relieves Chronic Pain. Retrieved May 24th, 2012 from:
http://americannewsreport.com/studies-show-massage-relieves-chronic-pain-8814326.html
PubMed. Development of studies on on neurochemical mechanism of acupuncture underlying improvement of depression. Retrieved May 24th, 2012 from: http://www.ncbi.nlm.nih.gov/pubmed/22073894
PubMed. A meta analysis on randomized controlled trials of acupuncture treatment of chronic fatigue syndrome. Retrieved May 24th, 2012 from: http://www.ncbi.nlm.nih.gov/pubmed/20209981
PubMed. Randomized controlled study on influence of acupuncture for life quality of patients with chronic fatigue syndrome. Retrieved May 24th, 2012 from: http://www.ncbi.nlm.nih.gov/pubmed/19873911
