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

The stroke care paradox: Close-knit social networks increase delays in hospital arrival

Newly developed treatment strategies can minimize the size of a patient’s stroke and, in many cases, change what would have been a life-altering cerebrovascular event into a minor one with the prospect of excellent recovery. But these therapies are time sensitive — delays in seeking care can put them out of reach. Each year in the U.S., 795,000 patients will have a stroke and approximately 70 percent of them will arrive at the hospital more than six hours after the onset of symptoms. Investigators from Brigham and Women’s Hospital examined how social networks may influence delays in arrival times for patients experiencing the symptoms of a stroke. Paradoxically, they found that patients with closer-knit social networks, including family members and spouses, were more likely to delay seeking hospital care whereas those with a more dispersed network of acquaintances were more likely to seek care faster. The team’s analysis is published in Nature Communications.

“Closed networks are like echo chambers in which there is a tendency for everyone to agree to watch and wait,” said corresponding author Amar Dhand, MD, DPhil, of the Department of Neurology at the Brigham. “A major problem in stroke care is patients’ delayed arrival to the hospital, and we show that this problem is related to the influence of patients’ social networks.”

Full story at Science Daily

Generic weight-loss drug may be safe and effective for long-term treatment

An inexpensive weight-loss drug approved 60 years ago for only short-term use also may be safe and effective for longer-term treatment, according to a study conducted by researchers at Wake Forest Baptist Health and the Patient Outcomes Research to Advance Learning (PORTAL) network. The study is published in today’s issue of the journal Obesity.

The drug, phentermine, is currently FDA-approved for use of up to three months.

“Although diet and exercise are critical components of any weight-loss program, up to half of patients don’t have long-term success with lifestyle changes alone,” said first author Kristina H. Lewis, M.D., assistant professor of epidemiology and prevention, at Wake Forest Baptist.

“In those cases, medications or surgery can help. Generic phentermine is an effective and affordable option, but now that we view obesity as a chronic disease, it’s important to have medications that can be used indefinitely. Most new weight-loss drugs are approved for long-term use, but unfortunately the newer drugs can be expensive if they are not covered by insurance.”

Full story at Science Daily

Issue Brief: Socially Vulnerable Older Adults & Medical-Legal Partnerships

A new issue brief  from the National Center for Medical-Legal Partnerships at the George Washington University’s Milken Institute School of Public Health describes the pressing legal needs facing older adults, and ways that partnerships between clinical settings and legal assistance providers can address social determinants of health, preserve independence, and improve their care.

In a medical-legal partnership (MLP), lawyers become an important part of the health care team, taking referrals and providing consultations. “As the U.S. population ages,
MLP is a promising approach to support older adults and their families in navigating fragmented and confusing systems of care, optimize choice and self-determination, and protect and promote health and well-being,” the brief concludes.

Full story at acl.gov

Tighter Blood Pressure Control May Prevent Brain Lesions

Reducing high blood pressure in the elderly appears to lower their odds of developing brain lesions, a new study finds.

“I think it’s an important clinical finding, and a very hopeful one for elderly people who have vascular disease of the brain and [high blood pressure],” said study co-principal investigator Dr. William White. He’s a professor of medicine at the University of Connecticut School of Medicine.

Over time, high systolic blood pressure (top number in a reading) can damage small arteries deep in the brain. Reduced blood flow to the brain can lead to areas of damaged nerve cells (lesions) in the brain’s white matter.

Full story at US News