Sea Crest Health Care Center

806,000 hip and knee implants were performed in the US in 2007 – that’s double the amount done a decade earlier. However, a 2007 study demonstrates that 7% of Medicare patients who underwent a hip replacement required another replacement hip within seven and a half years.  That number, small as it sounds, translates into thousands of patients who eventually need a “do over”. A joint surgery involves risk, pain, convalescence, rehab and medical expenses; no one wants to go through that more than once if necessary.

A National Joint Replacement Registry helps reduce the rate of failed procedures by keeping a database of information that keys in surgeons to problematic implants, and provides insight as to how to avoid mess ups. According to Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn,  “Every country that has developed a registry has been able to reduce failure rates significantly.”  Sweden is one case in point.

The newly formed American Joint Replacement Registry is still in its nascent stage and has started collecting data. Its goal is to improve the quality, outcomes, and cost-effectiveness of total joint replacement (TJR) surgeries through the achievement of four objectives:

1. Establish an infrastructure and a uniform system for the collecting device information and monitoring outcomes of TJR throughout the U.S.;

2. Identify patients who may need follow-up evaluation thereby increasing patient safety;

3. Create real-time survivorship curve in order to detect poorly performing implants;

4. Establish a uniform system that can be used to define the epidemiology of TJR for outcomes research to improve the quality and outcomes of patient care.

Until we have access to solid facts from the U.S. Registry, there are some proactive steps you can take if you are in the market for a new joint.

– Go with a highly experienced surgeon in a busy hospital; don’t look for the best deal. Ask for recommendations. A 2004 study published in The Journal of Bone and Joint Surgery found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

A similar trend was documented with hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

– A joint replacement is not for everyone. Some arthritic problems are better served with medication, and surgery may be too risky for those who have uncontrolled high blood pressure or another serious chronic condition.

– Research the joint implant that your surgeon recommends. Find out how well it has performed in others and if there are known complications. Some implants are somewhat controversial and may cause tissue and bone damage; newer doesn’t necessarily mean better. If the hospital has its own registry, ask to review the data.

– Educate yourself as to what the surgery entails. The American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org is very helpful.

– Prepare your recovery in advance. Arrange for the necessary support upon your return home, and make sure you have all the help you need. It is crucial not to overexert yourself during your initial healing period.

Yup, there’s actually such a title. A recent Wall Street Journal article highlighted the growth of a new genre – upscale, more palatable cuisine now offered in healthcare facilities.

The typical hospital fare such as jello, soggy sandwiches and tasteless chow that we’re all familiar with, seems to be a thing of the past.  Think Machaca Steak with Sauce and Curried Banana Pierogi. Hospitals are now competing with the likes of five-star hotels and restaurants by installing sushi stations, organic salad bars and pizza ovens.

The National Society for Healthcare Foodservice Management recently launched an annual cooking competition. “We want to show the world that health-care food is so much different. It can be creative. It can dazzle,” said Betty Perez, a society board member and a hospital food administrator in New Jersey. “We have chefs that can compete with the best of them.”

However, hospital chefs must play by different rules than their glitzy restaurant counterparts. Their creative offerings must be in tune with doctors orders, as well as nutritionists and cost-sensitive food administrators.

600 calories, 20 grams of fat, and 1,000 milligrams of sodium were the max for each contest dish and the production cost per dish could not exceed $5.

So pass the Green Apple-Jicama Slaw and enjoy your stay.

It starts with neglecting one’s hygiene, nutrition and medications, and can lead to death within the year. According to data compiled by the Chicago Health and Aging Project (CHAP), an older person’s risk of dying within the year increases six-fold when he or she starts to ignore his or her physical and medical needs.

The CHAP?study took place from 1993-2005 in three Chicago neighborhoods and the 9,318 participants were ages 65 or older. Among that population there were 1,544 reported cases of self-neglect (mean age of 73.2 years old) and in the average follow-up within almost a year, there were 927 deaths (47.8%) in that group.

Elder abuse of any kind also generated a greater mortality rate, with a 61.6% death rate within an average of 2.7 years.

By the self neglect cases,  the increased mortality rate wasn’t affected by whether or not the senior’s cognitive or physical functions were impaired. However by confirmed abuse cases there was a significant difference – increased mortality was not associated with elder abuse of high functioning seniors, demonstrating that this group was more likely to recognize abuse and seek help.

As the Baby Boomer generation ages, there is a swelling populaton of people suffering from osteoarthritis. Arthritis pain seems to go hand in hand with insomnia, with joint pain keeping awake 60% of those with osteoarthritis

A new study, reported in the Aug. 15 issue of Journal of Clinical Sleep Medicine, finds that cognitive therapy has a beneficial effect on osteoarthritis patients and insomniacs – assisting them in their quest for a good night’s sleep.

Cognitive behavior therapy for insomnia or CBT-I,was given by an experienced clinical psychologist who taught participants cognitive restructuring techniques that helped change unrealistic beliefs and irrational fears regarding sleep or lack of it.

Handwritten sleep logs kept by participants documented their sleep patterns, and pain level was graded by the Short-Form McGill Pain Questionnaire (MPQ) and the Body Pain Subscale (SF-PAIN) question from the Medical Outcomes Study Short Form-36 Pain.

Results showed that after CBT-I treatement, patients were falling asleep faster than before, and remained sleeping approximately 37 minutes longer. CBT-I seems to be an effective tool for treatment of osteoarthritis in conjunction with other pain management techniques, and may also work well with other chronic pain conditions.

At the recent Alzheimer’s Association 2009 International Conference on Alzheimer’s Disease, an eye opening study demonstrated that spouses who care for a mate suffering from dementia were more likely to develop the same condition, with husband caregivers at a much greater risk than wife caregivers.

Wives who cared for husbands with dementia were nearly four times more likely to develop dementia than wives of men who didn’t have dementia, while husband caregivers in the same circumstances were almost 12 times more likely to develop the disease.

So what exactly is it that causes the risk of developing Alzheimer’s to skyrocket? You can’t catch it, can you? Researchers think the root cause is the stress that comes along with these caregiving situations.

Ralph Nixon, MD, PhD, a psychiatrist and Alzheimer’s disease expert at NYU and vice chairman of the Medical & Scientific Advisory Council at the Alzheimer’s Association feels that “the amount of stress involved in caring for a spouse with dementia is tremendous,and stress is a known risk factor for dementia.”

Healthy diet and exercise are key factors of good brain health, and both of these areas tend to falter when one is stressed out. It is critical that caregivers look after themselves properly, making sure to rest, to visit a doctor regularly and to maintain social ties.

Since men tend to rely on their wives to serve as the impetus for seeing the doctor and keeping up with friends and family, they are more apt than women caregivers to let these things slide when their spouse is cognitively impaired – thereby increasing their risk of high cholesterol, blood pressure and other conditions that can lead to dementia.

The irony is quite delicious:  Scientists believe they have indeed found the Fountain of Youth and it is found right at the entry of our mouths- as long as we seriously restrict our calorie intake while maintaining all essential nutrients?

For the first time, researchers have shown that restricting calories in primates maintains their youth and prevents age-related disease.

According to a  long-running study by  Richard Weindruch, PhD, of the University of Wisconsin Madison, and colleagues running study of rhesus macaques, suggest that a similar effect might occur in humans and open the door to drugs that would mimic so-called caloric restriction, “We now have proof of efficacy of caloric restriction in primates,” Dr. Weindruch said, and  once the mechanisms are understood, it may be possible to develop “mimetics”– drugs that would have the same effect, but without the need for altering human diets.

Our diet controlled monkeys did extraordinarily well on calorie-restricted diets:

None of the animals on caloric restriction — even those with compromised metabolic function at baseline — had impaired glucose homeostasis.

The incidence of neoplasia was reduced by 50% in the animals on caloric restriction, compared with controls.

The incidence of cardiovascular disease was reduced by half in the diet-controlled monkeys, compared with controls.

They had  significantly slower rates of age-associated brain atrophy in some regions than controls.

The researchers also monitored when age-associated diseases appeared and found that caloric restriction reduced disease onset significantly.

Monkeys on the restricted diet appeared and acted biologically younger than their counterparts in the control arm and physically looked considerably better.

“Not only do the animals stay biologically younger longer, they look younger longer,” Dr. Weindruch said.

Dr. Sierra’s institute is sponsoring a study on calorie restriction in humans — the so-called CALORIE study — but he noted that “you have to be a special type of person to subject yourself to this . . . it’s a self-selected group.” Conducting a calorie restriction study in people in general “would be difficult, let’s put it that way,” he said.

You think?

By: Nechama Drillick

Advanced dementia is something that the average healthy person has a hard time imagining unless they are the caregiver of a loved one in that condition. Researchers in Boston recently documented the ravages of this incurable state on video. After showing this heartwrenching movie to adults over age 65, many had the same reaction; if they were faced with such serious loss of cognitive function they would not want their lives aggressively prolonged. The conclusion of researchers (published in the current BMJ journal) – people should make decisions about their future care while they are fully informed and healthy, and have them legally documented.?Otherwise, once one reaches the point of incapacity, other will make those significant decisions for you, regardless of your wishes.

This footage underlines the importance of surrounding one’s self with devoted loved ones, especially in one’s old age. The knowledge that your family will sincerely and patiently see to your comfort, well-being and dignity provides one with the security to face the vulnerability of old age and its possible side effects head on.

VIDEO LINK
http://www.bmj.com/video/care_preferences_dementia.dtl

By: Ruth Folger Weiss

My brother’s early morning email message was cryptic: “Bobbo, see Page 1 of The Wall St. Journal.” Not known for spouting endearments,and having received more than my share of ribbing for the moniker I chose when my children were delivering their’s,  I was curious to see what he was alluding to.

I still couldn’t understand why  friends and family had  seemed enormously tickled  by my creative appellation; winking at my proclivity for the ostensibly hip even when it came to my  morphing into grandparenthood.

So I indulged in what was a frisson of delight reading Anne Zimmerman’s Page 1 feature in the WSJ:
“A Grandma or Grandpa by Any Other Name is Just as Old”,  Boomers Want to Pick What Grandkids Call Them: Meet Glamma and Pap Doc

Here’s the affirmation I  needed that it wasn’t just a marketer’s need to brand myself, but a representative trend of Boomers to attempt to defy the gravitational pull of  aging and to put our imprimatur on everything related to our lives.  We’re deciding what fifty today looks like, and if that means being more physically fit and well-coiffed than anyone else in history, so be it.  We’re grateful and delighted our kids are having some more of the same, and love every moment of interaction with each amazing prodigy that is gifted our way  but we’ve  got to calibrate the perspective…and “Bobbo” is who’ve I’ve chosen to be to these wonderful children who happen to be our wonderful grandchildren.

Experts in the field of aging are not surprised that baby boomers are seeking creative ways to avoid wrinkly sounding labels. “That whole generation is reinventing old age,” says Tom Nelson, chief operating officer of AARP, formerly known as the American Association of Retired Persons.

AARP’s marketing department has had to devise new ways of talking to boomers so as not to alienate them by making them feel old. The association’s magazine was called Modern Maturity for decades and two years ago was renamed AARP The Magazine. “We have put some iconic boomers on the cover, and their take on aging and all the great work they are doing reflects how aging isn’t something that has to be dreaded,” Mr. Nelson says.

So not intentionally wishing to brand myself, this marketing executive was keenly aware that  cognitive association is deeply rooted in the names we choose and the mantles we wear.  Just didn’t realize that this Bobbo  was at the forefront of another revolution!

by Jose Sonik
With aging, comes reduced hormone levels. Does reversing the hormone levels reverse aging?
Not exactly, but it might come close.
Human growth hormone is a hormone that predominantly increases height. While doing so, it also increases muscle mass and bone density. HGH is at its highest levels during childhood and puberty. As we mature, the levels decrease, beginning a sharp decline at around age 30. At around that time, bone density declines, muscle mass reduces, and physical disorders like diabetes increase.
Until now, some of the more desperate aging generation have taken HGH in the hope of reversing aging, but research has not corroborated their theory.
But now, something new is in the air. According to Natalie Angier of the NY Times: “In a clinical trial of 21 healthy men ranging in age from 61 to 81, researchers found that after six months of injections of a genetically engineered version of the natural body hormone, the men emerged with bodies that by many measures were almost 20 years younger than the ones they started with.”
Aging was measured only in the distribution of body weight. The men were found to have increased muscle mass and decreased fat. The scientists hypothesize that some bulk went to internal organs, which shrink with age, but aren’t sure. The men’s skin also increased in thickness and youth, and bone density increased.
Of course, the significance of this improvement is debatable. HGH is known to increase muscles mass and reduce fat, but without really increasing strength. And what’s the point of muscle without strength? Similarly, the change in appearance was not correlated to an increase in performance of organs or body.
And as with all drugs, there were the side effects. HGH can cause swelling in the face, arms, and legs; arthritis; diabetes; hardened arteries, high blood pressure, and heart failure; and abnormal growth of bones and organs, among others.

by Ruth Folger Weiss

Add this to your  “it’s nice to know” file:

Physical warmth impacts on how we view other people and, creates a causal scenario where we then treat the other person in a warm or cold fashion.

To ascertain how temperature affects emotions, Lawrence Williams, PhD, assistant professor at the University of Colorado at Boulder, and John A. Bargh, PhD, professor of psychology at Yale University conducted a study on undergraduates.

Students were  casually asked to hold  a tester’s  cup of coffee for a moment prior to entering a room;  half the participants were asked to hold a cup of warm coffee and half were asked to hold a cup of iced coffee.

The students were   subsequently given a portfolio of information  on an unknown person described with words like intelligent, skillful, industrious, practical, and cautious. They were then asked to respond to a questionnaire evaluating the person’s personality. Interestingly, those who had held the warm coffee were much more likely to score the  “person in question”  as warmer than those who had held the iced coffee.

“It appears that the effect of physical temperature is not just on how we see others, it affects our own behavior as well,” Bargh says. “Physical warmth can make us see others as warmer people, but also cause us to be warmer — more generous and trusting .”

In the boardroom and in your social life, never underestimate the importance of  an outreached hand, especially when it’s a warm one!