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.

As we work with administrators to help navigate the world of Long Term Care it is hard not to be hyper-aware of our own mortality and the eventuality that we, too, are likely to reach a point where we will need some level of assistance in getting through the tasks of day-to-day living.  This awareness, combined with our mission to be a resource for those who serve the aging, means that our antennae are up for any news related to maintaining our bodies and minds well into our twilight years!

A New York Times review of the new book The Secret Life of the Grown-Up Brain caught my eye a week or so ago, and the author, Barbara Straunch, had some interesting insights to share relative to what middle-aged brains are actually good at, and how to keep our brains functioning well into the future.

• Our brains are still growing and developing far into adulthood.  Although we do have some compromises in short term memory (Where are my keys anyway? And what is your name?), the middle-aged brain is actually better in many ways than at any other point in our lives.

• Logic, creativity and social skills are all at a high point during those middle years.  Although you might not remember the name of the person to whom you are speaking, you will be an excellent judge of his character.

• We do not, as previously thought, actually lose brain cells as we age.

• Exercise and diet recommendations that benefit your heart are also likely to benefit the health of your brain.  Exercise in particular can actually help strengthen and grow your brain.  So get out there and start moving!

• Although there are benefits to making your brain work hard, crossword puzzles and learning a foreign language hold no particular magic powers in terms of maintaining the health of your brain.  Partaking in vigorous debates on subjects of interest can be just as helpful, so unless you just love the Sunday Times crossword puzzle, you can stop doing it!

• Meeting and engaging with people is healthy for your brain, and your mood!

It is so refreshing to hear that middle age is not necessarily the beginning of a slow slide into senility.  Staying engaged and active in life, both in terms of intellectual pursuits and social involvement, seems to be key to keeping your gray matter from graying.

I am hopeful that by maintaining an active life filled with fulfilling relationships, creative pursuits and lively conversation, I can remain one less consumer of Long Term Care services in New York!

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.

Brace yourself – that’s the number of flu shots that may be necessary to protect oneself from the upcoming flu season. Two vaccines will be required for the H1N1 strain (swine flu) and one for seasonal flu.

As of yet, only 45 million swine flue vaccines will be ready by Oct. 15, a far cry from the 120 million doses originally anticipated. Pregnant women, public health workers and small children will be the first to be immunized and this priority group numbers approximately 160 million individuals, according to the U.S. Centers for Disease Control and Prevention.

After those considered high-risk are inoculated, U.S. health officials will recommend that people ages 25 through 64 receive H1N1 shots. It is interesting to note that those 65 and older are actually at lower risk of contracting swine flu, since the flu strains they encountered as children provides some protection.  As soon as the seasonal flu shot is available it is highly recommended that all seniors get them. Once all those under 65 receive the  swine flu vaccine, inoculations will be recommended for seniors.

The vaccine production is moving slower than expected due to the slow growth of the vaccine substance, as well as a shortage of manufacturers available to actually package the vaccine.

“The amount vaccine manufacturers are getting out of millions of eggs is less than expected, and it’s taking longer to make,” explained Dr. John Treanor, professor of medicine and of microbiology and immunology at the University of Rochester Medical Center in New York.

The second delay factor is being addressed by the government who has increased efforts to recruit more companies for packaging.

By Nechama Drillick

Will those stinging booster shots be a thing of the past, fading into oblivion together with walkmans, analog TV and Kodak film? With the advent of a new Band-aid-like painless patch lined with microneedles, our grandchildren may never know the ouch of a needle at an annual checkup.

Scientists have developed a patch that can simply be applied to a patient in place of using hypodermic needles, a big boon to diabetics and others suffering from diseases that require frequent pricks. This was presented at the 238th National Meeting of the American Chemical Society in Washington, D.C.

“If you can move to something that’s as easy to apply as a Band-Aid, you’ve now opened the door for people to self-administer their medicine without special training.” said Mark Prausnitz of Georgia Tech, one of the developers.

This development was enabled by advances in the electronics industry, which has microminimized all forms of technology – opening the door for the creation of needles that are only a few hundred microns long, about the width of a few strands of human hair.

Researchers are hopeful that the patch which will initially be used in a clinical setting could ultimately be self applied at home, replacing many other needle injections – even flu shots!

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

You’ve been given fair warning – the more socially active you are, the slower you’ll age. Research data in the June 22 issue of Archives of Internal Medicine reveal a direct connection between social activity and physical function.

The study focused on a group of 906 adults who averaged age 66.5 and were free of stroke, Parkinson’s disease, and dementia at the onset.

Everyone’s activity level was scored on a range from 1 to 4.17, with a mean baseline of 2.6.

Participants who volunteered, played bingo, ate out with friends, attended church and partook of other activities with greater frequency had a slower decline in motor function than those who were more socially withdrawn.

“For each point below the mean social activity score at baseline, the average rate or decline in global motor function was 33% more rapid,” they wrote. “In terms of declining motor function, a 1-point decrease on the social activity scale was equivalent to being five years older at baseline.”

And that age difference of five years translated into a 40% increase in the risk of death and more than a 65% increase in the development of a disability.

There you have it. There are significant benefits to being a social butterfly as opposed to a wallflower. Staying socially fit is an essential part of staying young.

by Ruth Folger Weiss

“Aha!” :  all those Eureka moments I’ve come to count on as a creative professional in the advertising and marketing field, were really instances of insight reflective  of an active mind with some serious neuron brain activity. And though the classically cerebral thought processes of my so analytical spouse are  more often associated with “smarts”, researchers mapping the anatomy of the brain’s breakthrough moments reveal that insight is crucial to intellect.

Epiphanies that lead to bursts of mental clarity are often so physical because of the intense activation of alternating electrical currents- that have lead to monumental breakthroughs and revelations  in the sciences. Think Einstein imagining trains and lightning when the idea of special relativity hit him like a bolt of lightning. Sir Isaac Newton, lolling in his orchard, espies universal gravitation. And perhaps the one most readily identified with: Archimedes taking his bath came upon his formula calculating density and volume- and, as legend would have us believe, emerged from the tub, exclaiming: “Eureka! I’ve got it!

Daydreaming, scientists have found, is often the brain hard at work; MRI scans indicate intense activation in problem solving areas. Patterns of high frequency neural activity in the right frontal cortex are easily manifested right before an answer to a problem dawns upon the person!

Sudden insights are the fusion of  a complex series of brain states that require more neural resources than methodical reasoning!

A  person’s frame of mind influences whether she has a Eureka moment.

Your state of mind affects your inclination to insightful thinking.

Your positive mood impacts your likelihood to experience insight.

Which leads me to my exit, as I anticipate the drawing of a luxurious bath… and some brilliant flashes of insight…

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