As is widely known, the risk of falling increases with age for a number of reasons, such as decrease in bone density and failure to exercise regularly resulting in decreased strength. But another reason, which is not as debated, is all the medication that elderly are prescribed, especially antidepressants that are commonly used when elderly are starting to worry about the future. As falls are the leading cause of death from injury among people 65 or over and the fact that the majority of the lifetime cost of injury for people 65 or over can be attributed to falls, this is an important area of study.
Prior research indicates that there is a connection between medication with anti-depressive drugs and the risk of falling. This inspired scientists at Erasmus University in Rotterdam to investigate whether the connection between antidepressants and injurious falls is dose-dependent. A study involving 248 patients with dementia at a nursing home was conducted. Drug prescription and injurious falls were analysed during a period of two years and the results show a significant higher risk of falling for patients using SSRI, Selective Serotonin Reuptake Inhibitors, (a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders and some personality disorders). The higher the dose, the higher the risk of falling. A low dose (25% of the Defined Daily Dose) resulted in 31% higher risk of falling and a higher dose (100% of the Defined Daily Dose) tripled the risk of falling.
This study, published in the British Journal of Clinical Pharmacology, is the first one to quantify the contribution of SSRI to the risk of falling. The results indicate that even low doses of SSRI are associated with an increased risk of falling for patients suffering from dementia. This leads the scientist to suggest that new treatment protocols should be assumed.
Image source: http://www.arabstoday.net/en/2012011980618
Can’t help but returning to the theme of life’s second chances in my writing. I guess it might be related to being a person with a little too many interests to be able to realize all of them as career choices in one life time (and put to that a general dislike for making choices) and my fascination for seeing people that reinvent themselves at the age of 80 suddenly becomes quite evident.
Next up is the career of a dancer. A profession I hold dearly, since I, myself, earlier pursued a dance career before changing lanes over to the engineering guild.
I don’t know if there are any communities that are as judging when it comes to age as that of the dancing community. If you didn’t start at five, it’s over, if being a prima ballerina is what makes your heart beat. At least that’s what they tell you.
BUT, what if it isn’t true?
Obviously there are a lot of pros with starting early if you want to become a principal or first soloist of the Kirov (Mariinksy) Ballet of St Petersburg, but as a Guardian Theatre Blog post recently pointed out, there is a lot to the stories told in ballets or dance performances that having a little life experience can make more interesting.
And the best part is that there are quite a lot of good examples. Apart from the obvious dance icons of Martha Graham, Merce Cunningham and ballet icon Frederic Franklin, who all continued to give popular performances up in their 70s (90s(!) for Franklin), just adapting movements to the new restrictions of the body, there are also examples of people having started to dance way later than in their 10s or 20s. Such as e.g. Cambridge pensioner John Lowe, who started dancing ballet at the age of 79 and recently at the age of 88 performed on stage in his first ballet at a regional theatre. Specific routines and stretches supported with ropes help him keep up with his arabesques.
So I say, if you want it – just go and get it. Be it a career of dance, music, writing, acting, photography, archeology or whatever you’ve always wanted, but never taken the time to do, or thought you’d have become too old to pursue. Sure, age does affect the body. But apparently less in some cases than our mind makes us believe.
More to come on this very interesting topic…
PS. This post also makes me think about my old ballet teacher. He always used to say that students that had once trained for him didn’t get injured, because they learnt the techniques right from the start. Another one of those prejudices. That ballet will destroy your body. It doesn’t need to, if you are just careful when approaching it. Another important hint for all you senior to be-dancers out there. 🙂 DS.
In my search for innovative systems promoting patient-centred integrated care, I recently came across the company myVitali, which is designed to facilitate for people approaching what Jane Fonda calls “Life’s Third Act”. MyVitali is a system integrated into the own home, consisting of emergency call, vital monitoring, control, information and supply services offering the security of total care. The system is designed to motivate the user to actively and effectively take care of his health. The company has aimed to create an intuitive interaction concept rather thought of as a lifestyle product than a device for telehealth.
The project was born out of a brainstorming session between the developers at Massive Art Multimedia in Austria and CoSi Elektronik in Germany where they produced the idea of bringing together several aspects of the modern computing world and applying them specifically to senior citizens. As Massive Art Multimedia’s Tom Ulmer explains, “The introduction of computing power into the lives of the elderly can offer reminders to take medicines, dietary advice, immediate access to medical professionals and much more. It also reduces the need for visits to a local doctor. Users can take important measurements such as their blood pressure, weight and body fat and have that information directly uploaded to the system. Any healthcare professional they deal with can therefore have immediate access to their recent health records.”
The system is designed assuming very little computer knowledge of their users, without compromising on the inclusion of advanced technology, such as wireless, webcams and touch pads. Users with sight and hearing problems are also taken into consideration. All the information that is gathered belongs to the user and he can limit access at any time. The data is safeguarded using the same technology that banks use for mobile devices.
For a better understanding of how myVitaly works, have a look at the below video which is posted under “Our Goals” on the company’s webpage.
A new tool to help doctors and patients discuss life expectancy.
From my posts, I hope my bias for my home institution is not too burdensome. Unfortunately, I cannot help it if the Geriatrics faculty at the University of California at San Francisco churn out an innovation a week. This week? A major advance in how we can prognosticate for our patients.
Prognosis is an inherently difficult process for doctors. How do we, as a medical community, really know how long a patient has to live? What should we tell her about what we do know? It is often difficult to determine a person’s prognosis if she does not have one specific disease that can guide us. It would be helpful to always be able to say something specific; for example, “We know that women with your stage of lung disease generally live another 6 to 8 months with the treatments we can offer you.”
The difficult place for doctors to prognosticate accurately is when a patient has many diseases, none so severe that one overshadows the others. And sadly, many doctors do not, as a result, discuss life expectancy with their older patients who often have multiple diseases. Despite this, we increasingly have evidence that patients and their families want to know what the future holds so they can plan and make medical decisions accordingly. And that doctors should start these conversations. Drs. Alex Smith, Brie Williams and Bernard Lo made this case quite convincingly in a recent New England Journal of Medicine article.
Now we have a tool to help us and patients discuss prognosis and overall life expectancy. And it’s publically available!
Uniting different research done on larger populations and tools developed from this research, eProgosis.org, is a platform for using 16 different estimators of life expectancy for older adults in different settings—nursing homes, hospital, the community—and it leads you through each calculator. In the end, you get an estimated life expectancy. And anyone can use it.
The media buzz around this tool (see articles listed below) has emphasized what should be understood well by anyone using it—this is not a crystal ball. These are tools based on studies of groups of people, and therefore cannot be exact with an individual. Also, because certain populations are used in the studies to derive the tools, it may not apply to everyone who plugs in his or her information. It is unclear, for example, how this extends to international populations, which were not studied. Therefore, the results should always be discussed with a doctor.
Regardless, ePrognosis is a remarkable leap forward. It is an accessible and useable tool that uses the best information on how to predict life expectancy in complicated older adults. It creates a way for patients and doctors to begin these critical conversations with real information. Explore it, and see what you think!
ePrognosis website: http://www.eprognosis.org/
Blogs and articles mentioning ePrognosis:
3) NY Times, New Old Age Blog: http://newoldage.blogs.nytimes.com/2012/01/10/how-long-until-the-end/?scp=2&sq=eprognosis&st=cse
4) NY Times article on JAMA paper: http://www.nytimes.com/2012/01/11/health/using-interactive-tools-to-assess-the-likelihood-of-death.html?scp=1&sq=eprognosis&st=cse
Recent academic articles on prognostic indices:
1) Yourman LC, Prognostic Indices for Older Adults. Journal of the American Medical Association (JAMA), 2012;307(2):182-192, http://jama.ama-assn.org/content/307/2/182.short
2) Smith AK, Williams BA, Lo B. Discussing Overall Prognosis with the Very Elderly. New England Journal of Medicine (N Engl J Med), 2011; 365: 2149-2151. http://www.nejm.org/doi/full/10.1056/NEJMp1109990
Think AT&T and cellular devices such as iPhones as well as Blackberries would spring to mind.
These days however, the American telecommunications giant is also venturing into telehealth devices and a communication network that could potentially expand its wireless business. A slew of prototype connected health products have already been developed by AT&T’s scientists who are seeking to make everyday household items “part of the network cloud.”
One particular innovation that is still under clinical trials aims to reduce fall rates among the elderly. Statistically in the US, about one third of the elderly over 65 fall each year and 10% of these cases result in serious injury or death. The “smart slippers” designed by AT&T’s scientists may be the solution to this growing problem. With built-in pressure sensors in their soles to record gait, stride, and pace measurements as elderly patients walk, these information will then be transmitted over AT&T’s network to healthcare providers. By noting changes in the elderly patient’s walking pattern, the device will notify a doctor via e-mail or text message of a problem before they take a tumble. This could reduce the chance of a fall and a costly trip to the hospital. In the UK, medical expenditure of fall injuries and deaths by the elderly are already amounting up to a staggering £6m daily and the government is looking to promote music-based exercises to build strength and reduce falls among the elderly.
In addition, the other pilot programme initiated by AT&T covers the aspect of diabetes management while its ‘telehealth solutions’ involve the use of high-definition video and audio conferencing technology to offer patients in underserved regions access to higher quality care. Vitality Glowcaps that run on AT&T’s wireless network is also an interesting feature to aid elderly patients with medication reminders.
With a swelling elderly population nationwide, AT&T is one of the few companies that are working on a technology solution that not only lower costs but enhance medical care at the same time. According to AT&T’s Xavier Williams, “If we do what we think we’re capable of doing, we think we’re able to change healthcare the way ATMs changed banking.”
And with forward-looking innovations such as the “smart slippers,” they are certainly taking the right ‘step’ forward.
(Image source: Business Week)
(Video source: ATTBizSolutions)
Jane Fonda recently held a speech about what she calls “Life’s Third Act” which refers to the ages 60-90 and the fact that we on average today live 34 years longer than our great-grandparents did. Life’s Third Act is a whole second adult lifetime that has been added and Jane Fonda discusses how to make the most out of these years and how you can during this time free yourself from your past in order to become whole. As she approached her 60th birthday she did a life review where she studied the life she had lived in order to realize who she had really been. She also talks about the upward ascension of human spirit and how to avoid what she calls decrepitude.
This is a very inspiring speech by Jane Fonda who herself is more than a decade into her “third act” and has had three extraordinary careers as an Oscar-winning actress, an activist and a best-selling fitness guru. The speech was organized by TED, which holds conferences offering free knowledge and inspiration from the world’s most inspired thinkers.