Should I Get Involved in Helping a Neighbor With Dementia?

I live in a large co-op apartment building in Manhattan. Our staff is lovely and caring. A staff member told me that a resident is getting very forgetful and that she likes to spend her time in the lobby. I asked if she had family and was told she had only one brother in Japan. I was probably chosen as a confidante because I cared for my husband who had Alzheimer’s at home. Despite that experience, I was at a loss to give advice.

One day, I got on the elevator with this lovely, forgetful neighbor. She could not remember the number of the floor on which she lived. I offered to accompany her downstairs to learn her apartment number. She thanked me but was naturally embarrassed at the need for help and declined. She acknowledged that she was getting forgetful, and I told her my husband had the same problem and I understood.

I now find myself very worried about what will happen to this nice lady who has no one to help her. The thought has also crossed my mind that she may be a danger not only to herself but also to others living in the building. I am aware of the right of an individual to age in place versus the need for assistance, but this can’t be a unique problem. Is there a protocol for managing agents of buildings to follow? Linda, New York

Full story at The New York Times

Hospitals Chafe Under A Medicare Rule That Reduces Payments To Far-Flung Clinics

Eric Lewis’ plans of expanding his community hospital’s reach have been derailed.

As CEO of Olympic Medical Center, he oversees efforts to provide care to roughly 75,000 people in Clallam County, in the isolated, rural northwestern corner of Washington state.

Last year, Lewis planned to build a primary care clinic in Sequim, a town about 17 miles from the medical center’s main campus of a hospital and clinics in Port Angeles.

But those plans were put aside, Lewis says, because of a change in federal reimbursements this year. Medicare has opted to pay hospitals that have outpatient facilities “off campus” a lower rate — equivalent to what it pays independent doctors for clinic visits.

Full story at npr.org

Older patients resist talking with doctors about their life expectancy, study finds

Nancy Schoenborn, a geriatrician at Johns Hopkins University’s School of Medicine, noticed that doctors increasingly are being told by their professional organizations to treat patients in the last decade or so of life differently. Less aggressive control of blood sugar and blood pressure makes sense for people with fewer years to go, the guidelines suggest. Screening tests for certain cancers probably won’t be beneficial if a patient is unlikely to live at least an additional 10 years.

The emphasis on life span rather than age stems from the recognition that health varies widely in the last chapters of life, and age alone is a poor predictor of how a patient is doing. A sick 65-year-old and a healthy 80-year-old might each have nine years left.

These new rules, though, present doctors like Schoenborn with a problem. How exactly is she supposed to explain her treatment decisions to patients?

This question led her to start asking older Americans how they want to talk about mortality with their doctors. Her recent survey, published in Annals of Family Medicine, revealed some surprising results.

Full story at philly.com

Advances in deep brain stimulation could lead to new treatments

A new paper published in Nature Reviews Neurology suggests that recent advances in deep brain stimulation (DBS) for Parkinson disease could lead to treatments for conditions such as obsessive-compulsive disorder (OCD), Gilles de la Tourette syndrome and depression. The authors of the paper, from the Geneva University Hospitals (HUG), University of Geneva, University of Tübingen and the Wyss Center for Bio and Neuroengineering, argue that bi-directional electrodes which can both stimulate and record from deep brain structures — known as closed-loop DBS — could have applications beyond Parkinson disease.

Other bi-directional brain-computer interfaces (BCIs) have been in development in recent years, notably for the real-time signal processing of neuronal activity to allow control of a robotic arm directly from the brain in people with paralysis.

Professor John Donoghue, Director of the Wyss Center: “Interestingly the fields of brain-computer interfaces for movement restoration and deep brain stimulation for Parkinson disease have developed largely independently. Deep brain stimulation researchers tend to be neurologists or neurosurgeons while brain-computer interface researchers are often neuroscientists, roboticists and engineers. By working together and sharing information we can learn from each other and potentially expand the reach of this technology so that it can help more people.”

Full story at Science Daily

Why Do Older Heart Attack Patients Get Worse Care?

If you’re over 65 and have a heart attack, your care may be compromised, a new study finds.

In fact, you’re less apt than younger patients to receive a timely angioplasty to open blocked arteries. You’re also likely to have more complications and a greater risk of dying, researchers say.

“Seniors were less likely to undergo [angioplasty] for a heart attack and if they do receive the procedure it’s not within the optimal time for the best possible outcome,” said lead researcher Dr. Wojciech Rzechorzek, a resident at Mount Sinai St. Luke’s and Mount Sinai West Hospital in New York City.

“Their prognosis is worse than for younger patients with the same conditions, and this lack of treatment or delay in treatment could be a factor,” he noted.

But a New Jersey heart specialist said the delays in care are not neglect, but necessary.

Full story at Health Day

Caring for an older adult with cancer comes with emotional challenges for caregivers, too

The number of informal caregivers who look after older adults with cancer is on the rise. Caregivers could be relatives, partners, or even friends who provide assistance to people in order to help them function.

Most older people with cancer live at home and are dependent on informal caregivers for support with their cancer treatment, symptom management, and daily activities. Caregiving itself can also take a toll on a caregiver’s own physical and emotional well-being, which makes it important to ensure the proper supports are in place.

Until now, no large study has evaluated whether or not caring for older adults with advanced cancer is linked to caregivers’ emotional health or to their quality of life. Recently, researchers studied a group of adults aged 70 or older who had advanced cancer (as well as other challenges). This study used information from older patients with advanced cancer and their caregivers from local oncology practices enrolled in the “Improving Communication in Older Cancer Patients and Their Caregivers” study conducted through the University of Rochester National Cancer Institute Community Oncology Research Program Research Base between October 2014 and April 2017. Results from the study were published in the Journal of the American Geriatrics Society.

Full story at Science Daily

Where There’s Rarely a Doctor in the House: Assisted Living

The patient moved into a large assisted living facility in Raleigh, N.C., in 2003. She was younger than most residents, just 73, but her daughter thought it a safer option than remaining in her own home.

The woman had been falling so frequently that “she was ending up in the emergency room almost every month,” said Dr. Shohreh Taavoni, the internist who became her primary care physician.

“She didn’t know why she was falling. She didn’t feel dizzy — she’d just find herself on the floor.” At least in a facility, her daughter told Dr. Taavoni, people would be around to help.

Full story at the New York Times

Move More, Live Longer

If you’re a couch potato, get moving. Your life could depend on it.

Researchers say replacing 30 minutes a day of sitting with physical activity could cut your risk of premature death by nearly half.

They examined 14 years of data on inactivity and activity with more than 92,500 people in an American Cancer Society study.

Among those participants who were least active (less than 17 minutes a day of moderate to vigorous physical activity), replacing 30 minutes of sitting with light activity was associated with a 14 percent reduced risk of premature death.

Full story at US News

Signature’s PDPM Playbook: Data, Specialization, and 600 More Nurses

Therapy has taken center stage in the run-up to the new Medicare payment model for skilled nursing facilities, but a growing chorus has begun to frame the change as a return to the primacy of nurses in nursing homes — with a leading provider planning on adding 600 of them to meet the new priorities and expected demand.

As Signature HealthCARE’s senior vice president of data informatics and management information systems, Vinnie Barry and his team have taken the lead on preparing the provider for the Patient-Driven Payment Model (PDPM), set to take effect October 1. And as the Louisville, Ky.-based provider has crunched the numbers, a few clear trends have emerged: Moving forward, Signature plans to focus on honing its clinical capabilities and changing the way it markets its services to hospital partners in key regions.

While Barry expects Signature to see overall reimbursement gains as a result of the new incentives, he emphasized that the company is willing and ready to take a short-term earnings hit in order to properly staff up its facilities to eventually capture that new revenue.

Full story at Skilled Nursing News

The key to brain health: Light but frequent exercise

Researchers are finding new evidence that exercise — even low-intensity, casual physical activity — can boost brain health in the short- and long-term.

Evidence that exercise can benefit the brain and help maintain cognitive function — including memory — is accumulating.

One study, for instance, suggests that engaging even in low-level phyisical activities, such as doing household chores, can help reduce the risk of cognitive impairment in older adults.

Now, a team led by Michelle Voss — from the University of Iowa in Iowa City — has found evidence in support of the notion that the benefits of just one workout can predict the benefits of frequent physical activity in the long run.

Full story at Medical News Today