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 A barrier remains, however, as the homes they stay in are outdated relevant to the modernization of our people and the rate at which aging is increasing.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.
–
References
http://well.blogs.nytimes.com/2012/12/24/staying-independent-in-old-age-with-a-little-help/
How grandma celebrates Christmas by herself
I came across this article from the UK about elderly people spending their merry Christmas on their own. I found it interesting, depressing, and even discovered a link to health in the whole dilemma.
While for many people Christmas is the only time in the year when they actually meet family and friends, others are not cared for by anybody or do not care for anybody (anymore). Thus, they spend the celebration of love alone, like a quarter of all people in the UK that are older than 75 and live by themselves – even though the majority of them have children.
Experts say that “family breakdown is fuelling an epidemic of loneliness in old age” and that the fact that two in five marriages fail has serious impacts for the elderly. Young people have to divide their time between parents and step-parents. Besides, ‘silver separations’ are also becoming more common, with latest figures showing that more than 11,500 over-60s were granted a divorce in 2009.
In one of the largest surveys of its kind, the think-tank polled 2,000 over-75s to test how isolated the elderly truly are. ‘I’m 88 and I have nobody at all. I’m on my own’, said one, and ‘some days the only person I speak to is the boy in the shop when I pick up my paper.’
Growing isolation and loneliness makes elderly people particularly vulnerable – also in terms of health. Related mental and physical health conditions include a weakened immune system, sleep deprivation, higher blood pressure, a higher risk of dementia and depression. What to do?
In the UK there is an initiative that involves the police, fire officers conducting home safety checks, as well as social workers who see “warning signs” to connect people to local voluntary groups that can provide companionship. But is that a solution of the problem really?
——-
Chapman J (2011): 250,000 elderly people who’ll be spending their Christmas alone. Available: http://www.dailymail.co.uk/news/article-2078261/250-000-elderly-people-ll-spending-Christmas-alone.html#ixzz2FXDlyfWT
Let the cyber knife take away your pain
In 1983, the World Health Organization put cancer as a leading cause of death in South Korea. It has an immense impact with 64,000 people dying every year in Korea due to the disease. Luckily, the latest development in cancer treatment is available in Korea: Cyber Knife Radio Surgery. There are currently some hundred cyber knife systems installed in only few countries in the world. Korea was among the first to implement it and today, it has one of the most numbers of installed systems. Compared to UK and US, a cyber knife treatment costs less in Korea.
Cyber knife systems have been used to treat tumors in upper spine, head and neck since 1999 and in the rest of the body since 2001. John Adler invented the system for cancer treatment. It is made to deliver radiotherapy for malign and benign cancer tumors at all stages in specific parts of the body in a non-invasive way. It uses a real-time image guide to find tumors even if the patient is moving, and to deliver radiation with highest accuracy. It eliminates the need for invasive surgeries.
There are various benefits of the technique, e.g. faster procedures in comparison to other radiation methods, no requirement for hospitalization, no need for anesthesia and almost no post-operative care. Cyber knife surgery can even be used for tumors that have already received the maximum dose of radiation. There are no incisions or cuts, and recovery time is not needed. It can even be used for tumors in the spine, which are hard to treat because they are moving while the patient is breathing. The cyber knife can pinpoint the exact location of the tumor and beam into it without damaging other surrounding tissues. That leads to a shorter treatment period and a quick recovery. Treatment can be finished in less than five days on an outpatient basis, without spending a single night at the hospital.
One hospital in Korea is specialized in treating spine cancer. The oncology experts in Korea are highly trained and have years of experience in radiology and cyber knife cancer treatment. Medical staff in Korean hospitals are English speaking and communication will not be a problem when getting medical treatment there.
Cyber knife surgery abroad:
http://www.medicaltourismco.com/oncology/cyber knife-cancer-radiotherapy-overseas.php
Cyber knife Treatment for Spine Cancer
http://www.medicaltourismco.com/south-korea-hospitals/cyber knife-surgery-korea.php
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
Science fiction medicine from Sweden
Imagine you were able to simply replace one of your organs once you fall sick. You just go to the hospital and quickly come out with a new intestine, kidney, liver or even heart, if an incurable disease was present. This sounds more like an idea from a science fiction movie than a like a feasible therapeutic option, but research on regenerative medicine and the engineering of “artificial” organs is happening to make these options a reality for many patients worldwide in the near future.
Nowadays, chronic diseases are a major health issue in almost every country – they cannot be cured and the patient’s best bet is to prevent those diseases and their complications. We are talking about e.g. diabetes, heart and kidney failure, hepatic disease and hypertension. After treatment has failed the last resort for many patients is organ transplantation. However, as simple as it may sound, there are countless complications involved, as the organ has to be compatible with the patient. The patient will have to remain on medication to lower his immune system response to the minimal for the rest of his life, which can make him more vulnerable to infections.
By the year 2010, over 90,000 people were signed in for the waiting list for a kidney transplant in the US and 3,000 at any given day for a heart transplant. Many patients who have no other choice of treatment wait, and most of the times death arrives faster than the suitable organ.
What if you could build a custom-made organ according to a patient’s need? A group of biomedical researchers at Karolinska Institutet in Sweden have pioneered what can be the first step in the beginning of a science fiction medicine: working with stem cells, which are cells capable of giving rise to any human tissue. They have managed to make a fully artificial trachea from scratch and implant it in a patient with cancer without any immunological reaction. The newly formed organ is built on a PET mold, yes the same used in bottles, which is as anatomically identical to the patient’s actual trachea – not only in shape but also in composition. The mold is filled with stem cells from the patient himself. Giving rise to a new and fully functional organ ready to be replaced.
The patient who went under this treatment is currently under annual checkups while living a normal life without health related restrictions. This is only the first step, but it is a firm step.
Thanks to Antonio Beltrán Rodríguez for sharing this post with our silverevolution-readers. Antonio is a biomedical student at Karolinska Institutet. Contact: antonio.beltran@stud.ki.se
And tomorrow WALL-E is taking care of you
Nowadays, a lot of research is conducted in the area of healthcare robotics, which has the potential to increase the quality of life for our silver population. Imagine!
I would like to tell you about the examples of New Zealand and South Korea – two countries that are combining their knowledge in order to build and develop something groundbreaking. Here, South Korea contributes from the hardware-side, while New Zealand is busy developing the latest software (check out: HealthBots Project, launched in 2008).
Healthcare robots that can take grandma’s heart rate or blood pressure are the outcome of the research. But besides simple medical jobs, robots can also play a tremendous role in monitoring, as they are able to store and manage the patient’s relevant medical data. All this can make elderly care much more cost-effective.
Another idea is that robots can enhance old people’s quality of live by offering entertainment, e.g. through music, films, games and the use of social media as Skype.
——————-
All this sounds futuristic, but the question is if it is a concept that will be feasible: Will decision-makers be willing to invest in healthcare robotics? And will our grandparents (our parents? we? our kids?) enjoy interaction with robots? A lot more studies have to be carried out in order to find out more about cost-effectiveness, but particularly about interaction between human beings and machines – and thus, about the increase (or not) of people’s quality of life.
Healthcare robots could change lives: http://www.msi.govt.nz/update-me/success-stories/research/healthcare-robots-could-change-lives/ (December 2011)
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.
23 and 1/2 hours
There seems to be one single, simple best thing to keep our lives healthy and to prevent especially non-communicable diseases: a small, but regular dose of physical activity. This is especially relevant for elderly people as they often suffer from multi-morbidity, but could potentially stay more healthy by changing their lifestyles just a little bit.
Wouldn’t it be easy to put eating and sleeping in 23 and 1/2 hours and keep 30 minutes for physical activit? It doesn’t even have to be on a daily basis, but e.g. going for a 30 minutes walk three times a week has already proven to reduce the risk for arthritis by 47%, for dementia by 50% and for diabetes by 58%.
So how about prescribing physical activity? If doctors did that for their patients – do you think it would have an impact on people’s health?
Check out this video by Michael Evans and Mercury Films Inc. http://www.youtube.com/watch?v=aUaInS6HIGo. It has also been posted by the Swedish Professional Association for Physical Activity. http://www.yfa.se/
Also check out Michael Evans’ blog: http://www.myfavouritemedicine.com/23-and-a-half-hours/
Council of Labor Affairs in Taiwan is Piloting A Programme That Will Provide The Elderly Accessibility To Foreign Caregivers on An Hourly Basis
Taiwan, like other places in Asia, is experiencing rapid ageing. According to some estimates, by 2025, the population of those over 65 years-of-age will be 20 percent, up from 8 percent in 2008. With a population just over 25 million, this represents a huge increase in a relatively short period of time–a problem further exacerbated with population trends such as increased women in the work-place, increased people living alone –being separated from the elderly, and decreased fertility.
Adequate manpower continues to represent a challenge, in part due to Taiwan’s strict laws on foreign immigration and caregiving but also due to the aforementioned trends, such as low fertility rates. Taiwan typically provides good care to veterans and old people, but little community support is available. Little government support is also provided to those who wish to age at home.
Despite this, most elderly Taiwanese prefer to age at home and, many of them, prefer to stay at home rather than go out and partake in community services. Given this fact, recently, Taiwan is undertaking a series of building projects aimed at building age-friendly environment to keep elderly energetic and age successfully at home.
However the issue still remains–with informal caregiving structures on the decline from more women participating in the work force and more elderly ageing at home, who will be able to care for the elderly as they choose to age at home?
Starting 2013, the Council of Labor Affairs will test out a pilot programme that will allow foreign workers to work part-time by the hour.
Citizens over the age of 80 who score 60 or less on the Bartel Index will be eligible to apply for part-time foreign caregiving services. Currently, due to immigration laws, only the elderly who suffer from 1-10 severe mental or physical disabilities and score lower than 35 on the Bartel Index/require around-the-clock care are eligible to employ a foreign caregiver.
Typically these caregivers are hired full-time and the employer is responsible for providing food and accommodation. With the new pilot, the arrangement will be quite different: rather than making employers responsible for housing and accommodation, part-time foreign workers will be employed by NGOs who will take responsibility for their well-being and care.
While there will be no limits on how many hours foreign caregivers can be hired for, their employment needs to be in-line with Taiwan’s Labor Standards Act. All agreements between caregivers and non-profit organisations are to be covered in a contract, stipulating what is expected on the part of both the employee and the employer.
Reimbursement issues are still to be defined at a later time between two parties: local governments and the non-profit organisations (the prospective employers).
Receiving full-time local home-based caregiving care, is available for those elderly at a much higher income bracket. However, there are also government-supported long-term care services available to the elderly, particularly for the veterans, the poor, and those with disabilities. If the elderly is a veteran, the veteran affairs commission provides homes and long-term care services. The Council for Agriculture provides some assistance for aged farmers. For poor elderly with mild-disabilities, the Ministry of Interior provides long-term care support such as step-down care facilities, home services, dementia day care and care in a community setting, and the Bureau of Nursing and Health provides long-term care services, such as nursing home care and home nursing/home care rehabilitation to the poor and disabled.
The new pilot programme then has the potential to cater to a new market of elderly–to allow elderly who are slightly more affluent but still low to middle, middle class, who may not be in need of full-time caregiving support and who wish to age at home–the ability to receive long-term care services from a foreign caregiver who may not be as costly as a local one and only for when needed. It still remains to be seen how this programme will be operationalised and will ensure that local caregivers are adequately provided for. Also, whether or not foreign caregivers will accept the contractual terms and be willing to be part-time caregivers in Taiwan.
Source: http://focustaiwan.tw/ShowNews/WebNews_Detail.aspx?Type=aSOC&ID=201209090012
U-health in Korea
Our teacher once accused us: “You’re incredible! What you guys don’t find on Wikipedia does not exist in your world – or what?”
Trying to find out more about “u-health”, I remembered that and it made me smile. U-health or u-health care cannot be found on Wikipedia (yet) and on the first sight it does not seem to be on many peoples’ minds in today’s world, but dig a little deeper!
U-health stands for ubiquitous health – omnipresent, universal, ever-present health. Sounds big! And there you go with your online-search… [Small note: I found so many interesting aspects that I don’t know where to start now – so let me just give you a basic idea with this blog post and let’s explore the topic further within the following ones.]
On the Congress on Nursing Informatics 2006 in Korea, u-health did cause lively discussions. The Korean Government had started a project on u-health services for the provision of health care services in the country’s rural areas using the advanced broadband infrastructure (NI 2006).
U-health care is a developing area of technology to monitor and improve a patient’s health status. It uses different environmental and patient sensors to gather data on almost any physiological characteristic to diagnose health problems (Brown et al. 2007). U-health should stand out through availability, transparency, seamlessness, awareness and trustworthiness – anytime and anywhere (Cha 2008).
Many industrialized countries are sitting on a demographic time bomb – facing problems in health care that are related to the growing number of elderly. Their limited resources in health need to be used more efficiently and effectively. So especially these societies could benefit from u-health care and its innovations to reach better diagnosis and treatment. It also has a lot of potential in improving hospital administration and patient management with reduction of medical errors, and in enhancing service quality, communication and collaboration. (Chang) However, at the same time, u-health care confronts ethical issues, e.g. when it comes to trust, privacy and liability, or in combining computer and information ethics with medical ethics (Brown 2007).
Hence, the bottom line is that yes, u-health is and will increasingly be on peoples’ minds (and it will probably soon appear on Wikipedia).
Societies as well as individuals will have to make difficult choices in the future.
1 Korea IT Times offers a variety of more interesting articles by Cha Joo-hak on the topic: http://www.koreaittimes.com/source/cha-joo-hak
2 Brown I and Adams A A 2007. The ethical challenges of ubiquitous healthcare. International Review of Information Ethics Vol. 8. www.i-r-i-e.net/inhalt/008/008_9.pdf
3 Cha J-H (2008). Defining the Perfect Ubiquitous Healthcare Information System. Korea IT Times. http://www.koreaittimes.com/story/56/defining-perfect-ubiquitous-healthcare-information-system
4 Cha J-H (2010)Who Shall Live Better? – Health Care and Socioeconomic Choice. Korea IT Times. http://www.koreaittimes.com/story/8559/who-shall-live-better-health-care-and-socioeconomic-choice
5 Chang B-C ().Ubiquitous-Healthcare Changed paradigm after introduction of EHR. Yonsei University. www.health-informatics.kk.usm.my/resources/2_Chang.pdf
6 NI 2006. The 9th International Congress on Nursing Informatics. Seoul, Korea June 2006. http://differance-engine.net/ni2006blog/?p=22
Sleep and Dementia
We all know how bad our thinking can be when we don’t get a good night’s sleep, but over time poor sleep may put us at higher risk of more profound cognitive problems, like dementia.
Recent studies presented at the Alzheimer’s conference this summer show that sleep disruptions of different kinds– like sleep apnea (abnormal periods of obstructed breathing or stopping breathing), decreased time sleeping, or waking up often– can lead to real cognitive deficits.
Dr. Kristine Yaffe, from Univ of California, San Francisco, directs a clinic that evaluates and treats patients with memory disorders. Her research makes an important contribution because it looks at direct measures of sleep by observing people’s sleep quality and their subsequent development of cognitive problems 5 years later. Many other studies have looked at people’s self-report of how they sleep, which is notoriously inaccurate, and the concurrent presence of memory or cognitive problems. Such an approach does not address the question of which came first, the cogntive problem or the sleep problem, but Dr. Yaffe’s work suggests that in some people sleep problems may come first. Persons with disordered breathing (like sleep apnea) had more than 2 times the risk of dementia later on.
Let’s not all stay up even later worrying that by not getting good sleep we are imperiling our brains. The lesson is yes, get good sleep (that’s an order)! And for us that take care of patients, we should be asking them about their sleep and daytime functioning– daytime sleepiness can be an indicator that someone’s sleep at night is not adequate– and get them tested for sleeping problems. Many sleep problems can be treated, and doing so may save precious brain function.
Other links:
NPR interview with Dr. Yaffe and news story: http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=159983037&m=160095742
Photo credit: http://www.pasunautre.com/2010/11/30/objet-dart-the-sleeping-muse-by-brancusi/
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.
New ideas on how to counter polypharmacy risks
Over- and polymedication among the elderly is a risky business that we have covered earlier, eg. in a blog post by agjessica on Polypharmacy among the elderly. As Jessica recounts studies have shown that the risk of drug interactions (with potential negative consequences) increase from 6% to 50% in patients on 2 or 4-5 medications, respectively. Nevertheless, as the digitalization of healthcare gains grounds there are a couple of really interesting ideas out there on both how to better document the side effects caused by taking various medications at a time as well as on how to use technology to help elders (and others) out with keeping track of when they need to take their medications.
Last week I had the privilege to listen in to parts of a high level summit on the Globalization of the Healthcare Market, namely the Swedish American Life Sciences Summit, where Digital Healthcare was one of the subtopics of the year. As a former Mechatronics student I took a particular liking to two innovative solutions tackling the above challenge.
The first was presented by Nicolaus Henke, McKinsey’s Director of Healthcare Practice in Europe, the Middle East and Africa, as an example of the future potential of the mix of technology and healthcare. Dr Henke explained how Proteus Digital Health (that just got FDA approval to sell their solution as a medical device a little over a month ago) has created a pill that, swallowed, together with the gastric acids of the body gets activated and the energy needed to start analyzing real-time conditions of the body, such as information related to the medication taken. This information is communicated to a wearable patch, that apart from receiving the signal from the edible sensor also records the time that the medication was taken, as well as a number of other factors related to the person’s health, such as heart beat, temperature, physical activity, position (standing, lying down) and rest patterns. The patch further communicates this information to one’s smartphone and a secure server in order to collect and analyze data in order to support medical adherence and effective monitoring of a person’s health. The person being monitored can, in turn, choose who can see this information (physicians, caregivers and/or family members, only him-/herself etc) as well as get feedback via notifications when medications are overdue.
Fascinating piece of solution in my opinion. Proteus Digital Health’s edible sensor can currently ‘only’ monitor the time, characteristics and identity of what you swallow, but the company is working on a solution that can analyze bodily measures on a more advanced scale. Since estimations have shown that as many as a third to half of the world’s patients don’t take their medications properly solutions like these apparently have a large target market. Even though development and research on biomedical telemetry from ingestible electronics has been around since the 60s Proteus D. H. have managed to put the first (and currently only) product on the market within this particular field. Looking forward to follow what the research community on related solutions is planning in the years to come.
The second solution was developed by one of the conference participants, Mr. Robert Pakter, CEO and founder of Pilljogger, a company that has created an app that helps people track their medical intakes and thanks them when they stay on track. Mr. Pakter shared that he and his company are planning on developing a feature where patients will be enabled to report side effects that they experience when taking different medicines. Given that the Pilljogger app already will keep track of the different medications the patient is taking, this will also provide for an opportunity to track different side effects that arise from the combination of different medications in certain patients on a wider scale, providing a unique material that can later be used for further research and conclusions in the field of polypharmacy.
Thus, after my brief and intense opportunity to rub shoulders with some of the Healthcare industry’s finest, I feel reassured that we can expect to see a lot of exciting things in the field of digital health in the year’s to come.
PS. I also wanted to shine a little light on an unrelated topic, namely the Not-For-Profit research organization MEND (Medicine in Need), that I also got the chance to listen in to last week, and that are doing amazing work on the formulation of vaccines, reengineering them in order to make them more easily distributed to the developing world (mainly by taking them out of the cold chain, that is often so much more difficult to maintain in the developing world). Really inspiring work! DS.
Image source: http://spectrum.ieee.org/tech-talk/biomedical/devices/a-medical-sensor-you-can-swallow
Elderly in China
In China, the population over age 60 has reached 180 million. It is predicted that the number will be increasing every year by 5-8 million. Beijing, for example, has the number of elderly people accounting for more than 15% of the city population. In the meantime, due to birth control (one child policy) starting in 1978 – together with the fact that more and more young people are going abroad for work or studies – the number of households with only elderly people is increasing. Senior citizens living alone have become the main characteristic of the aging situation in cities such as Beijing and Shanghai.
The retirement age normally is 50 (for women) or 55 (for men) in China, which is relatively young comparing to the western countries. What do they do after they retire? Most elderly have to provide day care for their grandchildren since maternal leave is only 3-4 months, while kids could only start going to day care at the age of three. In fact, the elderly are taking care of their grandchildren day and night during working days and the kids only stay with their parents during weekends. So when the elderly are enjoying the company of grandchildren, they have to make efforts to take care of them too.
The neighborhood community plays a key role in daily life for the elderly, especially in urban areas. The community center is an ideal place for elderly living in the same neighborhood to gather together and play chess, exercise, etc. Recently, these communities would also be responsible for the day care services (i.e. meal delivery) for the elderly who lose self-care abilities and ensure health checkups of the elderly in the neighborhood.
Transportation is a dilemma, as it is both easy and hard for the elderly. Starting with Shanghai, several other regions such as Sichuan, Lanzhou, Hangzhou, etc. allow elderly people aged above 70 to take public transportation for free. However, if they wish to take a flight, a health certificate is required by most aviation companies.
Monthly pension is normally 1000-2000 CNY (157-315 USD). However, elderly people feel insecure due to low coverage of public medical insurance (from the government). So Chinese people generally save for retirement, meanwhile support from the family is also expected especially when they are sick in the hospital – since usually medical insurance is not enough to cover the costs. Furthermore, nursing service is normally expected from family members due to Chinese tradition and unsatisfying nursing services provided by public hospitals/nursing homes.
Nursing homes are more acceptable by the elderly now than they used to be. In the past, elderly going to nursing homes has been looked down upon, since normally only solitary aged individuals would have to go there and the service from nursing homes was poor. However, due to the trend of an oncoming inverted pyramid within the population – and the improvement of service – going to nursing homes is more acceptable by the elderly nowadays. By interviewing one private nursing home owner, it was observed that compensation on the nursing homes for the elderly requires several criteria. Non-profit nursing homes are either hard to get in or equipped with poor service – with 6-8 beds in one room and one nurse for 15-20 people, while private nursing homes would have rooms with single bed available. There are also newly built public nursing homes these years with better conditions, but it could take the elderly years in the queue system to get a spot. Another issue mentioned by the interviewee was the labor system. Running nursing homes needs employees take night shifts. However, the nursing home labor system doesn’t share the same one as the hospital’s, which has made the management of employees difficult.
The Fifth Social Welfare Institute is one of the best nursing homes in Beijing. It has 230 beds in total and the normal price is 1800 CNY per month per bed. It is equipped with designated medical care (which could be reimbursed), as well as different kinds of activity rooms for dancing, playing pingpong, calligraphy, reading, etc. The reasonable price and complete setting of the nursing home attracts lots of elderly people, however, the waiting time to get in could be years.
In short, after early retirement, the elderly in China rely on pension for the expenses on daily life. While when they get sick or more senior, support from the family will be needed. They enjoy having fun with the people at the same age in the neighborhood or in nursing homes. The number of nursing homes in China is far from enough due to the rapid aging population. Though, the bed occupancy rate might be low in private nursing homes. More affordable nursing homes with upgraded and reimbursable medical services are definitely required for the elderly population in China.
Palliative Care in Singapore
According to the WHO definition of Palliative Care: “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” (WHO Definition of Palliative Care[1]).
In Singapore, palliative care started as a grassroots movement in the mid-1980s to meet the needs of patients dying of cancer at home. The first home care team worked out of a university lecturer’s apartment in Gillman Heights. No doctors were trained in palliative care and there were limitations on the kind of care and setting where care could be provided.
Things changed a few years later. Singapore saw its first doctor trained in palliative care in the late 1980s. The first palliative care home provider – the Hospice Care Group – was formed in 1987. In 1988 Assisi Home and Hospice was established. This was followed by Agape Home and Hospice and the Hospice Care Association in 1989, Dover Park Hospice in 1995, Metta Hospice Care in 2001 and the palliative arm of Bright Vision Hospital in 2002. In 2007, the Lien Centre for Palliative Care was established to promote research and education in palliative care in Singapore and the region. Since 1996, the restructured hospitals have also been building up expertise to support palliative care for their patients.
Palliative care has now advanced to the point that it can help manage and stabilise patients’ symptoms, and reduce their suffering. Due to greater and more structured training opportunities for healthcare professionals (palliative care is a subspecialty of medicine now), and a steady expansion of palliative care services, even treatments such as blood transfusions and intravenous infusion can be provided to patients in hospice care.
Palliative care is primarily provided by hospices (at an inpatient, home, or day-care setting). There are four palliative care providers that offer inpatient hospice care, six providers that offer home hospice care and two that offer day hospice care.
Many restructured hospitals, as well as some community hospitals and nursing homes have also developed palliative care services, including to meet the needs of certain specialty groups, such as children (for example, in KK Women’s and Children’s Hospital). These services have largely evolved to meet the needs of patients admitted; the provision of palliative care services is not the main function of these institutions.
Palliative care is financed primarily by government subsidies and charity dollars. Most home hospice services are free-of-charge for patients. Day hospice services, hospital-based services, and inpatient hospice services are offered at nominal fees, which can also be partly or fully waived depending on the patient’s financial ability.
Palliative care education is provided by a variety of organisations and institutions. For doctors, palliative care is part of the undergraduate medical curriculum. Subspecialty training is also available for some residency programmes. Palliative care is also incorporated in the formal generalist nursing curriculum for nurses and there are options for them to obtain an advance diploma in palliative care at the polytechnics. A number of different training programmes/certificates on palliative medicine/care are also run by different organisations for all health professionals (doctors, nurses, pharmacists, social workers and other health allied workers).
Public awareness and understanding of palliative care is still quite low. Many people still associate palliative care with giving up hope and treatment. The Singapore Hospice Council recently launched a new community outreach program to increase public awareness of inpatient, home and day hospice services available for end-of-life patients here.
Healthcare providers’ willingness to discuss end-of-life care and dying is also low. Research suggests that, even in hospitals, there seems to be some unwillingness of both patients and healthcare staff to talk about the potential of death. Since 2009, health professionals have started utilising Advanced Care Planning (ACP) as a tool to start having open discussions with dying patients and their families. ACP is currently being piloted at a few restructured hospitals, nursing homes and other end-of-life programmes.
These changes as well as some others implemented suggest that although willingness to discuss death still remains low, there has been improvement over the last few years.
In late 2011, MOH commissioned the Lien Centre for Palliative Care at Duke-NUS Graduate Medical School to formulate a National Strategy for Palliative Care in consultation with key stakeholders in the healthcare system. The report reaffirms the important role of palliative care in the health sector as well as the importance of delivering such care in a coordinated and affordable manner. The report lists ten strategic goals and associated recommendations that address the importance of supply-side interventions such as training and ensuring adequate capacity as well as demand-side interventions such as the need for greater awareness and research. It also calls for greater leadership and governance to guide the development of palliative care services in Singapore.[2]
MOH recently accepted the report on the national strategy for palliative care. Presently, the Government has committed to expand the workforce and hospice care services to make end-of-life care more accessible to patients by committing to:
- Incorporate a greater degree of palliative care training into courses offered in universities, polytechnics and Institutes of Technical Education.
- Expand public education drives and awareness of the services to the terminally ill.
- Promote specialised research and improve understanding of palliative care, by learning and adapting models used abroad.
- Set up an implementation taskforce to put the strategies set forth by the Report on the National Strategy for Palliative Care into action in a country-wide coordinated manner.
- Ensure that palliative care remains a key part of each regional health system.
Singapore’s ageing population and the effect it will have on epidemiological trends (increased burden of non-communicable disease, frailty and dementia, etc) and the subsequent needs required of the health system (increased demand for preventive services, long-term and end-of-life care), coupled with trends of increasing affluence, demand for more choices and declines in informal care-giving structures, suggest that the case for a greater role for palliative care, to meet the needs of patients who will face terminal illnesses, is strong.
Thus, a National Strategy for Palliative Care is welcome. To fully develop, palliative care needs more measures to promote the awareness of palliative care options, ensure that there are an adequate number of skilled healthcare professionals in the sector, introduce standards of care
across providers and settings, improve the coordination of care and ensure that there is adequate capacity to meet the demands for its care.
A greater role of palliative care will help increase the options, visibility, medical and social support for people facing end-of-life and enable decision-making based on preferences. It also allows for a more efficient use of resources for the health system.
Sources
HLC 2012. Briefing: Palliative Care in Singapore, July 26, 2012 version. Healthcare Leadership College, MOHH Holdings, Inc., Singapore.
Lien Centre for Palliative Care, Duke-NUH Graduate Medical School “Report on the National Strategy for Palliative Care,” Submitted to the Ministry of Health, Singapore, 4 Oct 2011.
World Health Organization (WHO). WHO Definition of Palliative Care .Accessed April 27 2012
[2] 2011 Report on the National Strategy for Palliative Care http://www.dukenus.edu.sg/sites/default/files/Report_on_National_Strategy_for_Palliative_Care%205Jan2012.pdf
Dementiabots: The movie, Robot & Frank
I went Friday night to see a movie just released here, Robot & Frank. I knew I would love it just based on the premise, but it may just be my favorite movie in the last couple years.
Set in the “near future”, it tells the story of Frank, an older man suffering from early dementia, who is given a robot by his children to help take care of him. The man, bored and isolated in a country town, gradually comes to enjoy the company and stimulation the robot provides. The story gets moving when you learn that before his retirement he was a professional jewelry thief and now, with the encouragement the robot provides to be active, he realizes he can get back in the game and teach the robot to help him steal. It’s a movie, so inevitably they get into trouble.
I am a sucker for movies about dementia because it is complex and a hard topic to do sensitively and well. But Robot & Frank is about more than the vanishing mind. It is about the person Frank was, is and always will be, and how dementia is just a part of that. The movie and the actor, Frank Langella, make him shine as a character. It is also about the stress that an aging and vulnerable parent puts on children, especially in the US, who live far away and have their own families or geographically distant careers. In this way it touches on the way Americans in particular are dealing with dementia.
But it went from good to great because it got how we treat dementia right (Sadly, in the near future we still don’t have better medication to treat dementia it seems). Now we largely treat dementia with lifestyle changes and support via caregivers and adult day programs. The robot is basically a lifestyle manager– he gets Frank on a routine; he makes sure he sleeps enough; he keeps the house clean and orderly; he cooks and serves him well-balanced meals at regular times. He endlessly proposes activites: let’s garden, let’s go for a walk, let’s play a game. He knows that to keep Frank well he needs to keep him as physically and mentally as active as possible and keep a routine. And then when Frank gets upset or angry, naturally he does not take it personally and can continue to work with Frank. He does not get upset or burnt out — an unfortunate reality for many human caregivers. By the end I was intrigued on how robots could be the perfect treatment to help people with dementia have the best functioning possible.
I would even suggest that Frank gets the idea to have the robot help him with burglaries because his brain is working better at this point, after the robot’s interventions have made him sharper. This is not unusual. When someone with dementia starts getting good care, they start doing better in many ways– mentally, socially and physically.
No matter, it’s all a movie anyway and such sophisticated technologies, while present in small ways– eg. alerts installed at home to help family monitor their loved ones from afar, small fuzzy robots to help demented patients with behavior issues (see this prior post)— are a long way from being fully autonomous beings that can live with otherwise independent elders. But I was impressed with how the screenplay and the movie treated the tangled issues of dementia, aging, and family tension and made it fun and funny. Like anyone with dementia, Frank never stops surprising everyone, even the robot, who he reminds that “the human brain, it’s a lovely piece of hardware.” Indeed.
See other reviews:
http://www.kqed.org/arts/movies/article.jsp?essid=106423
http://www.huffingtonpost.com/2012/08/24/frank-langella-robot-and-frank_n_1824927.html
http://nymag.com/movies/reviews/robot-and-frank-edelstein-2012-8/
The Philippine Telegeriatric Pilot Project: How did it Start?
Access Health Philippines promotes innovations for the healthcare delivery system so that “all people wherever they are, have access to quality and affordable healthcare”. In partnership with Asian Institute of Management – Dr. Stephen Zuellig Center for Asian Business Transformation (AIM-ZCABT), a Telemedicine Project was formed with an ultimate goal of filling the gaps of widening problems in health access and shortage in the number of health specialists.
Elderly in the Philippines comprises 6.8% of the total population (NSCB, 2010), which means 1 out of 5 households have senior citizens. Older people have special needs and challenges in accessing healthcare services. The physical and cognitive disabilities limit their capacity to travel and access healthcare. They need specialist care providers for the aged. With the lack of access or difficulty to access health care, distance medication can be of great help to this sector of the society. This brought the telemedicine team to propose a start up project for the elderly population which is known as the “Telegeria”.
A Telemedicine team was formed which composed of members from different sectors which have stakes in providing better healthcare for the elderly. They are the Ayala Technology Business Incubation- ACCESS Health Philippines, AIM SRF/AIM ZCABT, ClickMedix, Total Transcription Solution Inc., Coalition of Services of the Elderly, Inc. (COSE) and Alliance of Young Nurse Leaders & Advocates International Inc. (AYNLA).
The Team initially chose to pilot the project in one of the major cities in Metro Manila. However, with a show of hesitation and delayed response from the involved staff, the Team prompted to look for another entity that was willing to adopt the concept and pilot the Telegeria. This is the Home Health Care (HHC) in Quezon City.
HHC specializes in delivering wellness programs and services to seniors and persons with disability in the comfort of their homes. It has a multidisciplinary expert team of physicians, registered nurses, physical therapists, nutritionists/dieticians, medical technologists and trained caregivers. They have been cited as a community resource providing quality home care for seniors across all settings.
HHC agreed to participate in the project seeing the opportunity for a potential innovation that could improve their management system in providing better and more cost-effective health services towards their clients. A virtual clinic from ClickMedix system was given to HHC for a free trial of one full month. This was applied in their four senior residential facilities.
Check out for the continuation of this project in the coming blogs. This pilot project is being documented by the Program Coordinator and Program Associate of AIM-ZCABT, Davidson Teh and Jayson Soriano, respectively.
LESSONS LEARNED FROM JAPAN–THE PROMOTION OF INTEGRATED, SUSTAINABLE AND LIVEABLE CITIES/COMMUNITIES
Centrally planned communities, “new towns,” have been around in Japan since the 60s. However unlike the 60s many of these “new towns” are increasingly becoming more integrated, age-friendly. They are increasingly also built with the goal of ensuring sustainability and with helping communities successfully manage the rising social challenges, in mind.
An example of one such community is Yukarigaoka. Yukarigaoka was extensively planned back in the 1970s by Yamaman, a private company. It is located in the north-central Chiba city of Sakura. However unlike some other “new towns” that were also built around the 1970s (for example, Tama New Town, which is composed of mostly elderly persons), Yukarigaoka is specifically designed to allow for the elderly to live close to their families and friends in their communities with the hope that such integration will foster opportunities for younger generations to benefit from the old and vice versa (Yukarigaoka has a balanced population aged structure, which means that it provides a living environment for residents at all stages of life).
To date, Yukarigaoka has a total land area of 245 ha. and a population of 17,000. The distance to the nearest train station is no longer than 10 minutes by foot. Doctor’s offices and child care centres are also easily accessible and close to public transport. Electric bus transportation is available for the elderly in residential areas, so the aged have direct access to residential areas and can stop where they want to. Also, Yamaman directly intervenes to help maintain the relatively balanced population structure between the young and the old. Yamaman handles the sale of both new and older housing units in Yukarigaoka so that that the transition to new accommodation can occur seamlessly within the community and the value of property does not change too much.
Kashiwa-no-ha is a new “new town” that builds on this model. It is developed with a view to the future: to pioneer solutions for social challenges. The town has a planned population of 30,000 and is situated between Tokyo and Tsukuba. Similar to Yukarigaoka, Kashiwa-no-ha is a public-private academia partnership that aims to develop a city of health and longevity, a smart city, and a new industry-creating city. The city promotes ageing-in-place, wellness and health promotion in a community setting, and allows for middle-aged residents to benefit from mutual assistance within the community. Age-friendly services provided in communities include the provision of transportation, buildings, libraries, and shopping centres, among other support structures that are specifically catered to meet elderly and youth needs.
Large investments and multiple investors are increasingly common for the development of integrated communities that can address social challenges, such as environmental sustainability and population ageing. That these communities can be sustainable and can grow are important.
Enabling the elderly to successfully age-in-place and for the youth to have connection to the old, goes down to the design of a community in Japan: of creating the appropriate physical and social environments to ensure that the appropriate interconnections exist at the local level: between the service user, informal carer and professional; between various aspects of the healthcare system and across all relevant sectors, even though such coordination may not exist at the national level. Promoting inclusiveness of elderly ensures community sustainability and growth over time. It also enables the elderly to stay in the same communities as their families as they continue to age.
With one of the highest proportions of elderly in the world, Japan undoubtedly has more structures, funding mechanisms and institutions in place to support the aged. The importance of tackling the aged society is recognised at the national level in Japan (even though local communities have their own successful initiatives targeting aged people in highly rural areas). The Ministry of Health Labour and Welfare is the agency responsible for policy making and administration of the workforce, national pension system, national healthcare system, national nursing care insurance system, etc. While most initiatives related to ageing and planning involve and have been initiated by the national government, who has the authority to secure budget and distribute it to each local government, national/state/local governments also pay. The ventures are also open to other partners. Thus, while the Japanese Government seems to take on a large burden of caring for the aged, so do the other stakeholders in Japanese society.
The benefit of multi-stakeholder engagement to create these integrated communities is that the burden of the elderly is shared among a wide variety of stakeholders. Another advantage is that elderly needs can be provided more downstream at the community level, assuming that enough support structures are present in the community and home setting to enable that to occur. This ensures that all people in society can continue to remain productive, socially engaged and age-in-place in urban settings. It also helps ensure that the communities that are built or redesigned can successfully grow to address the rising social challenges facing Japanese society in the years ahead.
Source:
Field diary: Yukarigaoka by catforehead
Notes from AAIF Conference in Singapore, April 2012
Notes from unpublished research brief.
The Old Celebrate the New
Including all generations may be best for some
While I had high hopes for a scientific blog today, I find myself more reflective on a wonderful experience I had this weekend and its impact on the work I do.
I was lucky to attend the wedding of a close friend and his new bride. It was under the relentless but magnificent sun in the scenic foot hills of Mt. Hood, Oregon. We were hot, some of us even burning, but we joyfully celebrated with the graceful couple, twice– once with her family’s religious traditions, and once with his family’s religious traditions (welcome to the US!). Beautiful, inclusive, rowdy and sweet, it was a wonderful series of events over two days.
I noticed, too, that the couple was fortunate to have, along with nephews and nieces and friends and parents, many of their grandparents and older relatives there. I couldn’t help but notice one older gentleman who attended every event. He walked formidable distances to the meals and the ceremonies, but often one or two relatives would help him. He walked slowly but deliberately. And if anyone looked over at him, he smiled from ear to ear. Despite clear difficulty, he was an undeniably positive force and seemed to spread cheer. The groom acknowledged this man, his grandfather, in his wedding speech. He said despite a recent broken bone in back and being 95 years old, he got up every morning and declared, “I’m going.” And he was very grateful that his grandfather had come. And I was amazed that, as far as I could tell, his grandfather stayed later than I did at the party!
As I watched the groom’s grandfather enjoy and take part in the exhaustive events of the weekend, I had a couple thoughts.
- Many of my patients, when faced with difficulties that come with aging– pain, mobility issues, health problems– will talk about what they look forward to as what keeps them going, and it is commonly a grandchild’s graduation or wedding. I thought I understood this, but it was beautiful to see. And many of the other bloggers on this site have written about how having things to look forward to maintains psychological health and well-being. That was clear to me this weekend.
- For so many reasons– physical and cognitive function among the most important– I routinely try to identify and encourage patients to stay as socially engaged as possible. Watching the engagement and joy of the groom’s grandfather, I thought about the recent and influential article by a colleague of mine at University of California, San Francisco, Dr. Carla Perissinotto. She found that feelings of loneliness led to a higher rate of death and functional decline in a cohort of elderly US adults, independent of whether or not these adults actually lived alone. This finding means that for us as geriatricians, knowing that our patients live alone is one thing, but actually asking them if they feel lonely and trying to find ways to help them feel less lonely is just as important.
At this spectacular wedding it was wonderful to see everyone of all ages celebrate and be together, but for one person, the groom’s grandfather, it may have actually prolonged his life.
Life-long love through medication?
Why do people stay together and why don’t they? Why marry or why break up/divorce? Those are common questions for people to ask themselves at some point during their lifetime. While the act of getting married is seeing a boost in eg. Sweden (with the number of new marriages up with 33% in the past 10 years (due to among other things a larger cultural popularity, more kids being born etc – see embedded article (in Swedish))) we also live in a time when many countries have statistics where one out of two marriages end in divorce (Sweden, US, Spain, Germany, Russia, Belarus, Cuba (even more) etc*). Something that might seem strange to the generation of pensioners and grand-parents around today that married in a time when divorces where not as common and the view on marriage was quite different from what it is today. (See an interesting interview on the topic with sociologist Dr Paul Amato, who has conducted extensive research on marital quality and stability, under the paragraph ‘The 1950s and “companionate marriage”‘ in this blog post where he argues that marriages today have more individualistic/psychological/existential reasons (find one’s soul mate, help each other fulfil one another’s lives and grow as persons) as opposed to the more pragmatic/companionate approach of the 50s and 60s.)
While the view on life-long love and marriage as an institution obviously gets a lot of influences from the trends and tides of the society around it, there are those that argue that there are few things that makes us as happy as being in a relationship. Anders Sandberg, philosopher and computational neuroscientist working for Future of Humanity Institute at Oxford University, means that people in a relationship live longer, are less ill and generally feel more content with life than those that don’t. Money or intelligence doesn’t even come close in comparison for the importance for our well-being. Thus, as the human enhancement scientist that he is, Dr Sandberg looks to biology to find ways to increase the likelihood of people forming and staying in relationships. According to Dr Sandberg, even though much of society has changed around us in the past 1000s of years, the same is not true for our psychology. The average life time of a person did for a very long time not pass 35 years, meaning that we seldom would be in relationships for more than 15 years – ironically close to the median duration of marriage today – 11 years. In a recent article co-written with Julian Savulescu and published in the New Scientist, Dr Sandberg argues that in order to increase the chances of people’s well-being caused by being in a relationship, while sparing them the pain break-ups can often inflict, we can look to some recent findings from another research article published in The Journal of Neuroscience with experiments on voles in order to find new ways forward.
The results published in The Journal of Neuroscience show that introducing vasopressin (known as one of the ‘love hormones’ together with eg. oxytocin) by gene modification in polygamous male meadow voles made them more monogamous and similar to their cousin, the prairie vole, that is already monogamous as a species (and that also has more receptors for oxytocin and vasopressin in their brains from a start). Given their other argument that helping humans stay in relationships would generally imply more happiness for them, Sandberg and Savulescu thus argue that it would be ethically correct to develop methods that would make possible the same biological alterations in humans. Of course, Sandberg admits such methods would have to be used with caution not to have people entrapped in bad relationships. One of the authors of the article in The Journal of Neuroscience, Dr Larry Young, along with Dr Hasse Valum at Karolinska Institutet (who in a recent PhD thesis proved that the same correlations between pair bonding and vasopressin (in males) and oxytocin (in females) could be found in humans), however argue that they don’t believe in creating medicinal treatment based on those findings, especially since there are also potential negative side effects by eg. increased vasopressin in males such as that they become more aggressive and defendant of their partner with higher rates of this hormone.
Even though convention, rather than biology, is more likely to be the reason for the lower divorce rates on a macro scale among pensioners and grand-parents back in their day (and maybe, as a result of holding true to that convention, even today) I think it is still interesting to see how we can unlock some of the secrets of the world around us through science. Let’s see what the future holds. (Apart from being love hormones both vasopressin and oxytocin has shown potential of treating both autism, social anxiety disorder, borderline personality disorder and schizophrenia.)
On a final note, when researching for this blog post I came across another very interesting study showing that friends, rather than family, are more important to help people live longer after the age of 70 according to a recent Australian study (in a way contradicting, or at least weakening, Dr Sandberg’s argumentation above). I think I will have to save that topic for my next blog post. 
Sources: http://www.dn.se/nyheter/vetenskap/livslang-romans-med-hjalp-av-medicin (in Swedish, including short interview with Dr Sandberg)
http://www.practicalethics.ox.ac.uk/latest_news/love_machine_engineering_lifelong_romance (abstract of Dr Sandberg’s research article)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768419/ (full research article in The Journal of Neuroscience)
Image source: http://www.flickr.com/photos/aneesprince/7202772588/
*Statistics sources: Sweden: SCB – Central Bureau of Statistics (see above embedded link – in Swedish), US, Spain, Germany (and some other countries): United States Census Bureau – Table 1336 (see above embedded link), Russia, Belarus, Cuba (and many other countries): United Nations Demographic Yearbook 2009-2010 comparing tables 23 and 24 per country (see above embedded link)
