Archive | March 2012

How fast you walk in middle age may predict dementia risk

Today, 36 million people worldwide have dementia and that number is forecasted to increase to more than 115 million people by 2050 because of the aging of the population. A recent study, conducted at the Boston Medical Center shows that it is possible to determine how likely you are to develop dementia or stroke by measuring your walking speed and the strength of your grip. A general practitioner or a primary care physician could easily conduct these tests that can provide insight into the risk of dementia.

Lead researcher Dr. Erica Camargo and her colleagues have examined 2410 people with an average age of 62, over a time period of 11 years. Their brains have been scanned and their walking speed and strength of grip has been measured. 34 of the participants developed dementia and 79 had a stroke. It was found that middle-aged people who walk slowly were one-and-a-half times more likely to develop dementia at over 65 compared with people who walked faster. People with a strong grip had a 42 percent lower risk of stroke or a mini-stroke in later life.

Dr. Erica Camargo said “While frailty and lower physical performance in elderly people have been associated with an increased risk of dementia, we weren’t sure until now how it impacted people of middle age.”

The study has not yet been published in a peer-reviewed journal but the results will be presented at the American Academy of Neurology annual meeting in April this year.

Sources: World Alzheimer Report 2011 (http://www.alz.co.uk/research/WorldAlzheimerReport2011.pdf)

http://www.dailymail.co.uk/health/article-2101736/Dementia-Fast-walking-speed-strong-grip-middle-age-help-predict-risk.html

Image source: http://www.thirdage.com/news/dementia-stroke-risk-tied-to-walking-speed-grip-strength_02-16-2012

 

 

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/

Dance for Parkinson’s

So, this is a not an entirely new phenomenon, but it is new to me.

Every Friday I have clinic at a community clinic in Berkeley, California and last week we were visited by a local organzation, PD Active, a group that does advocacy and programs for people with Parkinson’s disease (PD).  If you don’t know much about it, PD is a brain disorder that causes difficulty with movement and usually affects older people (Michael J. Fox is unusual in that he developed PD very young).  It is characterized by slow movements that get worse–  hand and arm tremors, trouble buttoning a blouse, walking very slowly, talking slowly and losing the ability to make facial expressions.  As the disease progresses, people can suffer from frequent falling and ultimately dementia.

Needless to say, thinking of people with PD dancing is an incredible thought as they are often thought of as stiff and slow, even unbalanced.  Our visitor explained the incredible things PD Active does for people in the area– yoga classes, dance classes, support groups and advocacy events.  I am sure I will be recommending it to some of my patients with PD.  However, one thing he mentioned really caught my attention.  When he started to do Dance for Parkinson’s (a registered trademark), which was originally developed in Brooklyn at the Mark Morris Dance Group, he felt “graceful”.

Looking at their website and videos, I was incredibly moved.  Not only does it seem to get people to use their bodies in ways they did not think they could, it improves their mobility and safety.  Music and dance open up their brains and ability to move more.  See if you can bring it to your city!

Sources:

PD Active in Berkeley, CA: http://pdactive.wordpress.com/

Picture from Dance for PD (R) website: http://danceforparkinsons.org/

Another Role for Aging Stars

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As American baby-boomers start retiring, new career opportunities are appearing for the stars they grew up with. Actors such as Sally Field and Alex Trebek (Jeopardy host, aged 71) have started advertising products including hearing aids and joint pain medication. These advertising campaigns reflect several realities facing the American and other global populations: the desire for spokespeople that represent this important consumer group and the possibility for continuing your career past retirement age, even in a sector that is as age-conscious as Hollywood.

Marketing researchers suggest that advertisements using older, familiar faces give customers an added confidence in the product being sold because they imagine that these people do not need the money and would not be endorsing products or services they did not believe in.

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As with most successful marketing campaigns, the companies started by identifying their target audience and then researching what kind of spokesperson they would respond to. Interestingly, they found that women of the baby-boom generation were, despite having lived through the sexual revolution, more likely to trust a male spokesperson. They also found that these women were more responsive to someone older than them, thus leading to the decision to hire actors such as Robert Wagner (aged 82) and Pat Boone (aged 77). Focus groups also showed that people may rank a celebrity highly when asked if they would like to have them over as dinner guests, but at the same time rank them as untrustworthy – ranking entirely others as very trustworthy.

It seems celebrities are responding to the confidence placed in them, with Fred Thompson of Law and Order fame acknowledging that he did his research before endorsing the American Advisers Group and that his 91-year-old mother is now one of their customers. Sally Field has been advertising bone-loss drug Boniva since 2006 and has stated that she is happy to talk about a drug she uses and benefits from.

It seems so far the focus groups have been fairly accurate, and that the celebrities endorsing these very important products and services feel a responsibility not only towards the companies but especially towards the customers, who are very much like themselves!

Source:

http://www.nytimes.com/2012/03/08/business/retirementspecial/new-career-for-aging-celebrities-tv-pitchman.html?_r=1&ref=elderly

Zelda Kaplan – Fashionista at any age

I recently came across this fascinating story about a 95 year old fashionista whose recent passing was mourned in the whole fashion world of New York. Unfortunately I didn’t get a chance to hear about her, or less meet her in person out and about, when living in New York myself a couple of years ago, but even though she’s no longer walking this earth, I still believe her story is worth telling.

Zelda Kaplan (already there, Zelda, the coolest name) was namely no ordinary 95 year-old, as you might have guessed. (Then again, what is an ordinary 95-year old? I’d say they’re all pretty extraordinary. Either way, Zelda was extraordinary in her very own way.) Quite alone representing her age group she had a habit of raising the middle age of New Yorks night clubs on a regular basis and usually stayed out until the early morning hour. She also frequented fashion shows, gallery openings and art shows and was quickly recognizable by her trademark the big round glasses, the colourful patterns and the ever-matching hat.

She passed away, as it suited such a personality, by fainting just before the start of a fashion show during fashion week in New York in February, and simply not waking up again.

I include a couple of memorable quotes of hers as chosen by the Time magazine (from a New York Times coverage), that I certainly believe to have made her, as they put it: “New York’s oldest and most beloved night owl”.

“I’m a curious person […] I want to keep learning until it’s over. And when it’s over, it’s over.”—New York Times, 2003

“I wish more people would have [clothes] made for them. But so many Americans want to look like everybody else […] I hate to wear what everybody else is wearing […] I don’t think people should be happy to be a clone.” –New York Post, 2010

“I want to be an example for young people so they aren’t afraid of growing old and a lesson to old people that you can be productive. You don’t have to sit around and wait for death.” – New York Times, 2003

“Many people turn a certain age and “check out,” but that is not me. In my 90s, I am not able to travel as much, so I must read everything I can at home to remain aware of global change, which provides me great knowledge to empower people through daily conversations, and through my charitable efforts.” –  New York, 2010

“I think one of the things that keeps me healthy is that I’m not introspective at all. The secret is being interested in things outside of oneself.” – New York, 2003

Zelda Kaplan – Rest in peace.

Source: Daily Mail article, Time Magazine

Image source: http://glamreporter.blogspot.com/2012/02/tragic.html

The Call for Patient-Centered Care

Some wonderful concepts in patient-centered care were the topic of several pieces in this week’s New England Journal of Medicine (March 1, 2012).  Overall, they discuss its critical role in the future of US health care reform.  One key article was co-authored by two of the US’s most prominent geriatricians, Dr. David B. Reuben, Chief of Geriatrics at University of California, Los Angeles, and Dr. Mary E. Tinetti, Professor of Geriatrics at Yale University.

In this article, “Goal-Oriented Patient Care—An Alternative Health Outcomes Paradigm”, Drs. Reuben and Tinetti discuss the movement in US health care to make patients’ values guide clinical care in a more meaningful way.  This is now an explicit aim of our ever-powerful Center for Medicare and Medicaid (see a prior post re Medicare, the US’s largest insurer).  Yes, patients’ values should guide decision making, but they begin to answer why and how it can be achieved.

As someone training in geriatrics, it did not surprise me that geriatricians wrote this succinct and timely article.  In our field, we frequently care for patients whose medical complexity makes it difficult to pursue the “standard of care” for many conditions. (Which looks bad on many traditional quality measures.  For example, the measure of average blood sugar considered optimal for diabetics is not helpful for older adults in whom it is dangerous to keep at such low levels, but many quality measurements do not take this into account.)

One example might be a patient who is older, not very healthy, and who has a newly discovered kidney cancer that may take longer to grow and cause a problem than she is likely to live.  Should she choose surgery to remove it when she may take months to recover and never get back to her prior state of health?  The decision of what to do must be a carefully considered one between the patient and her doctors.  The right answer lies in the complex mix of what the medical problem is, what is realistic, and what the patient wants based on understanding the medical options and her preferences.  But how do you measure this?  Should we even try?

Drs. Reuben and Tinetti suggest we should work with patients to understand their goals, and document this.  We should then measure whether or not the patient’s goals were achieved with such techniques as “goal-attainment scaling,” or other measures of how well a patient’s goals were met.  This should be part of how we look at quality in health care in a rigorous way.

The future is understanding that meeting patients’ goals are absolutely a critical part of how our health care system can be considered to be high quality.  And the future is finding ways to measure how well we actually meet patient’s goals so we can value those physicians and systems of care that do it well.  It will be very interesting to see how effective we are at doing this, and if indeed our paradigm shifts.

Source:

Reuben DB, Tinetti ME.  Goal-Oriented Patient Care– An Alternative Health Outcomes Paradigm.  N Engl J Med 2012; 366:777-779.

Image: http://healthcarecommunication.wordpress.com/2010/10/25/stop-devaluing-your-patients-the-illusion-of-patient-centered-care/