Archive by Author | agmiranda

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.

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Design for dementia

My co-blogger Stéphanie Treschow earlier blogged about an inspiring London-based fashion brand for pensioners by a young female fashion school graduate, Fanny Karst, designing clothes for women three times her age. I don’t know if Hampus Rendmar, a recent graduate from Konstfack (University College of Arts, Crafts & Design) in Sweden, had heard about her and gotten inspired or if we might be seeing an emerging trend among art/fashion school graduates, but his recent graduation project had a related audience – people with dementia.

Hampus feels that interior design at today’s nursing homes lags behind in general and says that dementia patients have the same right to trends and design as does everyone else. He means that many dementia patients must have gotten tired of the old and worn traditional furniture that fills residential care homes today. Therefore he has created a series of furniture targeting this audience with a focus on design that gives a sense of calm and safety. ‘Calm’ is also the name of two chairs in the project, made out of beech and steel, that have been painted in mediterranean green, since it is said to have a calming effect. Furthermore the chairs have a rocking effect, something that research has shown can diminish worry and stress.

What is up next for Hampus is yet to be told, but both visitors at the final art graduation projects’ exhibition by Konstfack and he himself noted that his furniture was widely popular among the audience throughout the whole exhibition. Maybe ‘Calm’ is soon to be found in a nursing home near you.

Source (in Swedish):

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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: (in Swedish, including short interview with Dr Sandberg)   (abstract of Dr Sandberg’s research article) (full research article in The Journal of Neuroscience)

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*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)

Happy times a comin’ – majority of to-be pensioners optimistic about their future

Graph description further down.

When my little brother was a kid he used to answer the question of what he wanted to be when he grew up with a firm and certain: ‘a pensioner’. Quite insightful, I must say, for a 5 year-old, but I guess he’d simply realized what so many pensioners-to-be are starting to realize as the day of retirement draws nearer. According to a recent study of the state of the elderly and elderly-to-be in Sweden, the UK and the US, life satisfaction increases steadily from the age of 47 and four out of five in this age group have a positive view of their coming years in ‘life’s third act’. This all the while two thirds of the same respondents fear that the care system for senior citizens will not be able to look after them when their time comes.

The study, presented by Kairos Future in cooperation with a number of Swedish companies and institutions*, is Kairos Future’s fourth in line of studies of attitudes among the baby boom generation. Previous studies being carried out in 1999, 2004 and 2008, they have all followed the same baby boom generation born in 1945-1954. It was first in the third one that the scope was expanded to include also the UK and the US.

Below I share a couple of highlights from the study:

1. Contentedness of life in general increases steadily from the age of 47. Graph above depicting contentedness of life. On the y-axis the scale of contentedness and on the x-axis year of birth of respondent. The arrow points at respondents of 50 years of age. As graph shows contentedness of life increases steadily from just before this point in time (and has a bottom low between age 35-45 (youngest respondents of study were of 30 years of age)).

2. The primary focus of most to-be pensioners is to stay healthy, both physically and mentally. To keep the brain alert and maintain an active lifestyle are top priorities for most baby-boomers. Many also say that they want to keep contributing to society to a larger extent than in earlier studies and statistics also reflect this fact showing that the number of 66-year olds that are still working have increased from 19% (1997) to 36% (2009). This is also reflected in that few of the already retired wish that they would have retired earlier (only 7%), whereas a larger group wish they would have retired later (20%). Which leads me to the last of the interesting findings I have chosen to highlight.

3. Many suspect that society’s elderly care won’t be able to support them, when they reach the later stage of the Third Age. As many as 37% of the baby boomers, and 35% of the 30-55 year-olds doubt this. Kairos Future have created an interesting graph depicting how society’s changing demography in the past century puts a lot more pressure on the working generation in order to sustain those not working, since we both start working later in life, and live longer after retirement today, than 90 years ago. Question is – will society be economically sustainable with people only working one third of their lifetime (as suggested will be the case if the demographic development continues til 2040, without changes to the number of working years)? Or will things have to change, and in that case, how? Is the current debt crisis around the world maybe even an early reflection of society’s debts to its people that is simply running out of hand due to the demographic changes with people living longer and longer? Interesting questions asked by Kairos Future and visualized through the following graph:

Average duration of different periods in life at different points in time (1920-2040). X-axis shows between which ages each period of life approximately runs and the periods (as explained in the top right corner) are, from the top: Childhood, Emancipation, Freedom years, Responsibility years and Old age.

So, to sum it up, an interesting read.

On a final note, I just loved the introduction of the report where they presented a number of the new names that people have started to give to the people living in this new active Third Age: Such as Silver surfers, Passionists, Passioners, SALLIES (Senior Affluent Life Lovers Enjoying a Second Spring), OPALS (Old People Active Lifestyle) and MAPPIES, (Mature Attractive Pioneers). Now that’s some granny! 😉

* For the curious: SEB, SPV, Micasa Fastigheter in Stockholm AB, Apotek Hjärtat, Pensionsmyndigheten and Friskis&Svettis.

Source (where you can also find the report for download (unfortunately only available in Swedish)):

Pain – is it all in the brain?

In a recent book, well-renowned neuroscientist and writer Martin Ingvar and medicine journalist Lotta Eldh, dive deeper into the latest research findings related to the topic of pain. Interestingly, scientists seem to have started to pay more attention to the importance of exercising the brain’s inherent defense mechanisms against pain, particularly in the case of chronic pain. The authors even go as far as saying that strong pain killers, such as opiates, can be counter productive since they will knock out the brain’s natural response of pain relief, and thus inhibit the brain’s learning pattern for its own pain treatment.

Some of the examples discussed of alternative pain relief treatments are; exercise, Acceptance and Commitment Therapy (ACT) and mindfulness. When we exercise the brain releases endorphines which can work as to ease the pain that we sense, either directly from our work-out or from before. ACT is a type of cognitive behavioural therapy that is all about accepting the presence of the pain and learning how to control the feelings that it provokes in order to handle it better, and mindfulness, that is related, also focuses on how to handle everything present while relaxing into the pain. As Ingvar and Eldh point out, pain is something very subjective, and as a matter of fact research has shown that the limbic system (that controls our feelings, memory and behaviours) plays an important role in how we experience pain.

Thus Ingvar and Eldh explain that a good combination of a physical training program together with psychological training can be just as effective in the long run as a traditional medication treatment, when dealing with pain. The authors however ask for patience, since the ‘re-programming’ of the brain’s acquired pain responses can take time. But as they put it, if you just confront your pain and hang in there you get rewarded when you finally get out at the other end of the tunnel.

The authors also dedicate a specific chapter to people not susceptible to psychological treatment, such as patients with dementia or that have suffered a stroke resulting in speech disorders. On many occassions such patients have trouble communicating what they feel, which is why care-givers need to pay extra attention to behaviours that can represent the expression of pain. This e.g. includes banging of one’s hand at the table, scraping with the foot, restless wandering back and forth or cries for mum.

Personally, I’m once again fascinated by what exercise (and psychological will) can do for your body and well-being and will try to keep this in mind next time somebody’s pushing me into that tough exercise or stretch at the gym.

Unfortunately the book is not available in English, but if you’re interested in the topic, you can surely find something interesting to read here.

Source article (unfortunately only available in Swedish):

Babushkimania – Russian grannies to take over Europe’s music scene?

In times when all of Europe (and some of its neighbouring countries) are preparing for the musical get-together of the year, The Eurovision Song Contest (ESC), Russia is generally a country to look out for. With a track record of ending among the top three in five of the past 11 years and a general strong voting base in the former Soviet Union they often bring an important contribution that’s considered an odds-on from the start. (Eurotechno or grand ballads with figure ice-skaters or ballet dancers usually being the winning concepts.) Nothing saying that that would have changed for this year, and many still saying they’re just as much of a favourite this year as other years, but you could definitely say they surprised many when bringing forth this year’s contribution.

Timely enough for the European Year for Active Ageing and Solidarity between Generations (that I blogged about here), they’ve namely selected a group of 8 grand-mothers called the Buranovskiye Babushki (literally ‘Grandmothers from Buranovo’) that with their ethno-pop style out-performed former ESC winners Dima Bilan and T.A.T.u with almost 10 points by the public vote in the Russian national song selection. With most of the group being 70-80 years of age, only 6 out of the 8 grannies will be performing in Baku, Azerbadjzan next week when the competition starts with the semifinals.

However it ends up going for Russia’s new grannie stars, I still think their initiative is admirable and the fact that Russia ended up voting them winners a true mark of Solidarity between Generations, in its very own special way.

See them perform their winning song here:

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

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