At-home monitoring, digital health advances, technology, and 5G can play a crucial role in driving the transformation of cardiac rehabilitation and improving patient outcomes. These technologies can provide patients with greater access to healthcare services and support, enable remote monitoring, and facilitate more personalized care. In recent years, there has been a growing interest in home-based cardiac rehabilitation (HBCR) programs as an alternative to traditional facility-based cardiac rehabilitation (CR) programs.  This methodology offers many potential advantages for both patient and clinician.

Remote monitoring: Digital health advances and at-home monitoring devices can allow healthcare providers to remotely monitor patients’ vital signs, medication adherence, and other health metrics. This can enable early detection of complications and prompt interventions, reducing the risk of adverse events and improving patient outcomes.

Personalized care: With the help of digital health tools, healthcare providers can tailor cardiac rehabilitation programs to individual patients’ needs, preferences, and medical histories. This can improve patient engagement and adherence to the program and increase the chances of successful outcomes.

Telehealth: Telehealth technologies, enabled by 5G networks, can facilitate remote consultations between patients and healthcare providers, eliminating the need for in-person visits. This can improve access to healthcare services for patients who live in remote or underserved areas or who have mobility issues.

Wearables: Wearable devices such as smartwatches and fitness trackers can help patients monitor their activity levels, heart rate, and other health metrics. This data can be shared with healthcare providers, enabling them to track patients’ progress and adjust their rehabilitation programs accordingly.

Health apps: Mobile health apps can provide patients with access to educational resources, medication reminders, and other support tools. They can also enable patients to track their progress, set goals, and receive feedback and encouragement from their healthcare providers.

The comfort of home. The home environment can facilitate lifestyle modifications within a patient’s own comfort zone and provide direct family support

A new study has advanced the discussion on home care and the potential role of digital health. In a large and comprehensive clinical trial conducted at the San Francisco Veterans Health Administration compared the mortality rates of patients who participated in HBCR versus those who did not. The study included 1120 patients who were referred and eligible for outpatient CR between 2013 and 2018. Of these patients, 490 chose to participate in HBCR, while 630 chose to attend facility-based CR or did not participate in CR at all.

The results of the study showed that patients who participated in HBCR had a 36% lower hazard of mortality compared to those who did not participate in any CR program. During the median follow-up of 4.2 years, 185 patients (17%) died, and mortality was significantly lower among the HBCR participants (12%) compared to the nonparticipants (20%).

HBCR programs typically involve telephonic coaching and motivational interviewing sessions over a 12-week period, allowing patients to participate in rehabilitation from the comfort of their homes.  In addition, participants received equipment on an as‐needed basis, including resistance bands, a scale, a blood pressure cuff, a pedometer, a heart rate monitoring device, an exercise peddler or stationary bike, and a dietary video. 

This type of program is particularly beneficial for patients who cannot attend traditional CR programs due to various reasons, such as transportation issues, lack of access to facilities, or personal preferences.

Although this study has limitations, it suggests that HBCR may provide a viable and effective alternative to traditional facility-based CR programs. This finding is particularly relevant in the context of the COVID-19 pandemic, which has disrupted access to healthcare services, including CR programs. HBCR programs may offer a safe and effective option for patients to continue their cardiac rehabilitation without the need for in-person visits. Future studies can build upon these insights and incorporate advancing digital health monitoring devices for added data capture and to support analytics that drive frequent physician and patient feedback.

At-home monitoring, digital health advances, technology, and 5G can play a key role in transforming cardiac rehabilitation and improving patient outcomes. These technologies can enable remote monitoring, personalized care, telehealth, wearables, and health apps, among other benefits. By harnessing these tools, healthcare providers can provide patients with more accessible, convenient, and effective cardiac rehabilitation programs, ultimately saving lives.  But more importantly, current clinical data validate this concept and offer a life-saving path, accessible, and patient-friendly path for care.

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Let’s cut to the chase and look at the six lifestyle interventions the study indicates slow aging:

• Diet
• Sleep
• Physical activity
• Relaxation
• Probiotics
• Phytonutrients

“How many loved your moments of glad grace,
And loved your beauty with love false or true;
But one man loved the pilgrim soul in you,
And loved the sorrows of your changing face.”
― William Butler Yeats, The Collected Poems of W.B. Yeats

Biological aging (senescence)

Biological aging, or senescence, is a complex process involving genetic, environmental, and lifestyle factors. Here are some of the major factors that contribute to biological aging:

1. Genetic factors: Aging has a hereditary component, meaning that certain genes can predispose individuals to age faster or slower than others.
2. Oxidative stress occurs when there is an imbalance between the production of free radicals and the body’s ability to neutralize them. Free radicals can damage cells, tissues, and DNA, leading to aging and age-related diseases.
3. Telomere shortening: Telomeres are protective caps at the end of chromosomes that shorten each time a cell divides. Over time, telomeres become too short to function properly, leading to cell damage and aging.
4. Epigenetic changes: Epigenetic modifications, such as DNA methylation and histone modification, can affect gene expression and contribute to aging.
5. Inflammation: Chronic inflammation can damage cells and tissues, leading to aging and age-related diseases.
6. Environmental and lifestyle factors: These include exposure to pollutants, UV radiation, and other stressors, as well as lifestyle factors such as diet, exercise, and stress management.

It’s important to note that biological aging is a complex process that involves many different factors, and scientists are still working to understand all the mechanisms involved.

Reversing biological aging

Do we have some evidence that we can reverse aging? For example, the first human study reported in 2019 showed biological age reversal of up to three years.

This small clinical trial from California (USA) suggested reversing our body’s epigenetic clock (the timekeeper for our biological age) is possible.

Nine healthy volunteers consumed a cocktail of three common drugs, including growth hormone and two diabetes medicines, for one year. On average, they shed 2.5 years off their biological ages, measured by analyzing genomic markers. The subjects also had signs of immune system improvements.

While the results were impressive (and surprised the researchers), the study was small and did not include a control arm. Here is Steve Horvath, the University of California, Los Angeles geneticist who performed the epigenetic analysis:

“I’d expected to see slowing down of the clock but not a reversal. That felt kind of futuristic.” The scientists published their findings in Aging Cell.

A separate study of obese African Americans with vitamin D deficiency discovered this finding:

The African American study subjects — deficient in vitamin D — reversed their biological age by 1.85 years in 16 weeks with a vitamin D supplement program.

For this clinical trial, researchers enrolled 70 overweight or obese African Americans with serum vitamin D levels of less than 50.

They randomized the participants into four dose groups, including 600 IU, 2,000 IU, and 4,000 IU of daily vitamin D3 supplements or placebo, followed by 16-week interventions.

The results suggested that vitamin D supplements may slow epigenetic aging. The study is not definitive, as it was small, short, and not randomized.

“The wisest are the most annoyed at the loss of time.”
― Dante Alighieri

Reversing biological aging — new evidence

In an eight-week clinical trial, multi-institutional researchers examined how diet and lifestyle intervention might reverse biological age. Here are the results:

The intervention, which included sleep, diet, exercise, relaxation guidance, supplemental probiotics, and phytonutrients, was associated with a 3.23-year decrease in biological age.

Each study participant followed this regimen:

1. A healthy diet with dense, colorful cruciferous vegetables; low glycemic fruits; and some animal protein (for example, eggs or liver). In addition, subjects consumed foods with polyphenol compounds, such as tumeric, curcumin, green tea, and mushrooms.
2. Hydration
3. Exercise for a minimum of 30 minutes daily, five days weekly, at a perceived exertion of 60 to 80 percent of one’s maximum.
4. Meditate regularly.
5. Sleep for at least seven hours per night.
6. Two supplements: extra polyphenols (a greens powder) and a simple probiotic.

The researchers designed each component, brick by brick, on what influences DUA methylation and epigenetics favorably. As one researcher put it, they aimed to “sweet talk gene expression and turn off bad genes, like genes associated with cancer or even inflammation, and turn on good ones.”

Lead author Kara Fitzgerald adds, “the best time to start implementing diet and lifestyle changes to impact your biological age is in your 30s as changes in the aging journey really kick in during our 40s.”

My take

Biological age reflects the rate at which you are aging physically. On the other hand, your chronological age is simply the number of birthdays that you have celebrated.

While we are stuck with our chronological age, a growing body of evidence indicates that you have more flexibility with your biological age. That is good news for those who aim to optimize our lifestyles, however imperfect we are.

Aging remains a central risk factor for both acute and chronic diseases. The recent study reminds me that we are moving closer to understanding how to wind back our biological clocks.

The post Stop Getting Older! Six Steps to Slow Aging appeared first on Medika Life.

COLUMBIA FALLS, Mont. — On a recent rainy afternoon in this small town just outside Glacier National Park, Lisa Beaty and Kim Hilton were preparing to sell most of their belongings before moving out of their three-bedroom, two-bathroom rental home.

Hilton, who was recovering from a broken leg, watched from his recliner as friends and family sorted through old hunting gear, jewelry, furniture, and clothes. “The only thing that’s not for sale is the house — everything else has to go,” Hilton, 68, said as he checked his blood sugar.

Hilton has Type 2 diabetes, heart disease, and other health issues that have left him disabled and unable to work for years. For income, he relies on federal disability benefits. Because of a shoulder injury and fibromyalgia, 64-year-old Beaty — Hilton’s partner of seven years — does, too. Combined, their income is roughly $1,500 a month.

That’s no longer enough, though. Investors bought their house this year and raised the rent from $1,000, including utilities, to $1,800, plus the cost of utilities.

“They’re not evicting me — on a fixed income, I can’t do it,” Beaty said as she sorted through her belongings.

They have nowhere else to go. And they were not just losing their home: The stress of the ordeal caused them to end their relationship. Beaty planned to move into her daughter’s one-bedroom apartment.

Despite his poor health and still relying on leg braces to prevent another broken leg, Hilton, who is on Medicare, planned to live out of his truck while he waited for a spot to open up at one of the few assisted living facilities in Flathead County, which is mostly rural. The wait could last days, or months.

Beaty and Hilton are part of a recent surge of homelessness among people older than 60. The housing affordability crisis, driven in part by the covid-19 pandemic, and high inflation are chipping away at their fixed incomes. Although data is limited, advocates for seniors and people who are homeless say greater numbers of adults are showing up at shelters across the country.

The problem is particularly acute in Montana, where the snow has started to fly as the long Rocky Mountain winter sets in.

Rents in Montana have skyrocketed since the pandemic started. Since 2019, Lewis and Clark County, for example, has seen rental costs jump 37%, one of the largest spikes in the U.S., according to data from the research firm CoStar Group published by The Washington Post. Nationally, rents rose 11% on average in 2021.

The fast-paced growth in Montana and elsewhere in the Mountain West has been driven in part by an influx of highly paid remote workers, drawn to wide-open spaces and abundant recreation opportunities in communities that were plagued by housing shortages even before the pandemic. Kalispell, the largest city in Flathead County, is the fastest-growing city among those in the U.S. with fewer than 50,000 people, according to Census Bureau data.

Inflation and rising rents are leaving many older Americans on the brink of ruin. The poverty rate for people 65 and older rose from 8.9% in 2020 to 10.3% in 2021, according to Ramsey Alwin, president and CEO of the National Council on Aging.

Alwin said people who rely on traditional retirement income, such as Social Security, are having trouble affording the basic necessities. “You’ll find that individuals are often coming up short by about $1,000 a month in order to meet their true needs,” she said.

As a result, many older people must make hard choices about whether to pay for daily needs such as food and medication or rent. Others simply can’t stretch their money and must leave their homes. An upcoming 8.7% cost-of-living increase in Social Security benefits will help offset the effects of inflation, which was 8.2% for the 12 months that ended in September. But Alwin said that won’t be enough to stem the tide of seniors who are losing housing because of rising rental prices.

Montana is home to one of the oldest populations in the country. According to a recent survey of older adults in the state, about 44% struggled with housing during the previous year, and only 10% considered housing affordable.

Emergency homeless shelters in Montana, and across the country, are reporting that more seniors have been showing up at their doors over the past year, many of whom could no longer make rent or couldn’t find a new place to live after their homes were sold out from under them, said Steve Berg, vice president for programs and policy at the National Alliance to End Homelessness.

Berg said it’s impossible to say how many seniors are winding up homeless for the first time because national homeless counts don’t break down the number of people 25 and older into smaller age groups and other data isn’t granular enough to differentiate people losing housing for the first time from older people who are chronically homeless.

Community organizers working directly with homeless people have a deep understanding of how the trend is playing out in their areas.

At the Poverello Center in Missoula, Montana, people in their 60s have become the second-largest age group served by the shelter, said Programs Director Lisa Sirois. She said that she has seen people in their 80s and 90s with no place to go and that the shelter has had to turn away some of them because it wasn’t designed for their needs.

People in wheelchairs have difficulty navigating the narrow hallways, she said, and the shelter’s elevator often breaks down, forcing people to use the stairs to access its dorms. The dorms are lined with bunk beds, which also present challenges.

“Any senior clients or folks with disabilities usually can’t do a top bunk,” Sirois said.

Brian Guyer, housing department director for the Human Resource Development Council Bozeman, said that when his shelter can’t serve a senior, it also must ask the person to leave. A memory that still haunts him, he said, is of an older man who froze to death three days after being denied a spot in the Bozeman shelter because he was incontinent and had mobility problems. “He actually was found outside of a Lowe’s store here in Bozeman,” Guyer said.

And with the older homeless population growing, his staff, already overworked and underpaid, cannot take care of them all, he said.

To prevent the worst outcomes, state and national groups are proposing a slew of changes.

The Montana Coalition to Solve Homelessness, a new organization that plans to lobby on behalf of shelter providers during the legislative session that starts in January, wants the state to modify its Medicaid program to make shelters eligible for funding. They would use the money to provide Medicaid services that could assist seniors living in a shelter or pay for case management services to help seniors navigate benefit programs that offer food assistance and subsidized housing or find assisted living and nursing home facilities.

But the number of available spots in those facilities is shrinking. Nationally, nursing home closures have displaced thousands of residents. In Montana, eight nursing homes either have closed this year or are slated to close by the end of December, according to Montana health officials. Rose Hughes, executive director of the Montana Health Care Association, said other facilities are having difficulty keeping their doors open because Medicaid reimbursement rates are often lower than their operating costs.

Other advocacy organizations want to focus on economic stabilization initiatives that would help older people stay in their homes. One idea is to change how Social Security payments are calculated by pegging them to the Elder Index, an online calculator that estimates living expenses by location. But that would require congressional approval.

“Your current housing is your best chance for keeping housing for this population,” said Mark Hinderlie, CEO of Hearth, which focuses on homelessness among seniors nationally.

Then there is increasing the housing supply, which most people agree is a long-term solution. In Montana, Republican Gov. Greg Gianforte is proposing policies that would create incentives to encourage the building of more market-rate apartments. But critics say developers are unlikely to create enough subsidized housing on their own.

For Hilton, any sort of open housing unit can’t come soon enough. As he leaned against his truck in the driveway of his now former home, he hugged Beaty as she sobbed into his shoulder before they parted ways.

He drove away in search of a place to camp out, waiting for a call from a local assisted living facility with an opening. He hoped that call would come before winter temperatures settled in.

This story is printed with permission from Kaiser Health News and in a partnership that includes Montana Public Radio, NPR, and KHN.

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While this is appropriate that we know that our elderly family members, friends, neighbors, etc. may be at risk and we may want to ensure they maintain their health, there is information missing that I believe needs to be included. What about all the other factors that result in hospitalization?

What information would be useful? We know that older individuals probably are taking a number of medications and may have several illnesses. That is a given and it also means their immune system is probably not functioning as it once did when those individuals were younger.

However, it is not a simple matter of medications and illnesses that may result in hospitalizations. Jamming everything into one number, i.e. hospitalizations, fails to recognize all of the other factors that come to play.

Considering that many elderly may be living alone, depending on relatives or neighbors, or may have a visiting aide or nurse or some other healthcare professional visiting intermittently, you can quickly see one factor; the ability to access resources in the community. In addition, how many of the elderly are aware of the gravity of the current situation? We’re getting conflicting information from health officials who are bickering regarding whether or not people should wear masks, where they should wear them and if we can consider going back to the office.

I live in a large complex where we recently had a water main break which resulted in E. coli getting into our drinking water. The six affected towns and our complex sent out emails and posted notices on their websites to alert individuals of this dangerous situation and indicated all water for drinking or washing dishes had to be boiled first. Does every elderly person have access to a computer and Internet? Come to think of it, suppose the power goes down?

Being on somewhat meager incomes, many people have had to cut themselves off from a variety of services. If they had Internet access, it may have proven too much of a burden and they may have canceled it. If they don’t have a computer and don’t have Internet access and don’t have a cell phone, how did they get the information? In our buildings, notices were posted in English on the main entrance, but suppose someone doesn’t read English?

Do people realize how large swarths of the United States are deficient in Internet access? Twenty-one million people still don’t have access. Go to poverty pockets and see how many don’t have an Internet connection. Where do the elderly live? Not usually in luxury condominiums.

The information that was sent out over the Internet in our area was only in English, and we live in an area that is multicultural where people speak several languages, prominent ones being English, Korean, Chinese, and Spanish. I did not see one notice that was in Chinese or Korean, or even Spanish.

Years ago, there was a book that attempted to put a fresh face on the world of statistics. It was “Lies, Damn Lies, and Statistics: The Manipulation of Public Opinion in America.” I know it has been updated since its original 1976 publication, but the facts remain, statistics say whatever you want them to say. Statistics can be twisted or fail to tell the whole truth, and they shouldn’t be accepted at face value (or as we say, “face validity”).

Next time you see the covid hospitalization stats and they say the greater number are elderly, stop and think: How many could have been prevented from being hospitalized if they had been given the information and help they needed?

The post Why Are the Elderly the Greater Number Hospitalized with Covid? appeared first on Medika Life.

Nursing homes are not the paragons of safety they would have us believe by providing an allegedly “safe,” racially accepting place to live out your final years. Nor are they necessarily the place that meets all the needs of older adults.

Home environments are especially important for older adults whose lives are more home-based than earlier life stages. Despite a focus on ageing in place, there often remains a mismatch between housing options prioritised by government and industry, and the needs and preferences of older adults.

Thinking of these eldercare facilities, I am reminded of two things; the Rene Spitz studies with orphans in Albany, New York, and my experiences in an upscale nursing home, aka residential senior care facility.

Spitz saw that after WWII, an excessive number of infants required care in large facilities. These orphanages or hospitals would provide food, medicine, and a safe place for the children.

One thing they failed to consider that was not provided was frequent touching and interaction with an attendant staff. Spitz’s studies emphasized maternal deprivation and its relationship to later life development and depression. He called it anaclitic depression. Sometimes, it was referred to as hospitalism.

While provided all that was needed to maintain life, the infants were not vigorous, and many died of what we might call not a failure to thrive but a failure of emotional connection. Others in the field, such as Bowlby and Harlow, would continue to investigate this connection, albeit a maternal one.

But what of this type of deprivation in adult life when our needs are increasing, and our connections may be withering? Are nursing homes or residential care facilities the answer?

One thing nursing home placement does is uproot older or disabled individuals from familiar settings of psychological and physical comfort to one of regimentation and unfamiliarity. Neighbors and friends are now no longer close at hand. Instead, a paid staff is there for them. Does this honestly respond to the emotional needs of these individuals?

The Concept of Aging in Place

Given a choice, which would you want; total care where your wishes might be dismissed and the ability to control your own life removed for semi-independence? The choice, to me, would seem obvious, and now the idea of aging in place is receiving research attention. One study indicated a need to consider the person and the changing neighborhood over time and how community development plans and social institutions play a role.

The conclusion suggests that further attention must be given to the changing dynamics of the places where people grow older. It also makes policy suggestions for how aging in place could be supported, taking account of the needs of people as they grow older as well as changes in the communities in which they live.

Although the neighborhood in which they lived and had strong ties may be emotionally desirable for older individuals, there may also be a degree of exclusion. This new detachment can stem from upheavals in the structure of the community, newer perceptions of housing accommodations that favor renting over ownership, and other factors leading to social exclusion.

Indeed, research in the UK has shown that age is associated with an increased chance of exclusion, with people aged 80 and over more likely than their younger counterparts to feel excluded from social relationships, and be detached from leisure and cultural activities and basic services.

The Census Bureau has outlined the increasing challenge of families to several factors, including childlessness, divorce, and an aging population. “According to the US Census Bureau, older adults (ages 65 and older) are projected to outnumber children under the age of 18 for the first time in US history by the year 2035.”

How many of us have considered where we’ll be living once we reach the last decade of our lives? Often, this is a question too many are reluctant to ask, and many families are loathed to consider. But in today’s world, it is becoming more acceptable for older adults to remain in their homes, aka aging in place, and to form a multi-generational group living situation once again.

Anyone interested sufficiently in sociology will quickly find that in the 19th and early parts of the 20th century, multi-generational living arrangements were typical. Structures were built to accommodate the needs of each generation. The nuclear family had the main house, possibly a smaller house next to it or attached by a walkway, and younger members might be living in a third-floor apartment. Yes, houses were large as family groups were at that time.

Technology, however, began to change the face of housing, as Louis Wirth pointed out in his sociological exploration of cities. We live in groups, but the elderly and the poor often were left to the undesirable sections of cities as the affluent younger generation moved to large homes in the suburbs.

A Return to the Past

Now there is a reversal of sorts, and a hybrid form of living may become more acceptable. Almost half of the American workforce that has the option will continue to work from home rather than returning to the office in the city. How will this affect the elderly population? Will it be a benefit to them and will it have unexpected pleasant aspects we hadn’t considered before?

The nursing home, equivalent to warehousing the elderly in either meager circumstances or opulent ones (considering their income streams), is not desirable. Who would find them so? Imagine having everything taken away from you and being placed in a sterile environment meant to serve your physical needs but perhaps not your emotional and social needs. This social need is endemic to human beings and must be considered in any living situation we may concoct now or in the future.

Medical research continues to advance, and we will extend our lifespan due to breakthroughs. The more members of a population that live beyond the age of 90 or 100, the more we need to consider their humanity. The terrible stories associated with large nursing homes run by corporations are still plastering the front pages of newspapers and hitting the Internet with an impact that cannot be denied.

One facility even, during the height of the pandemic, stored bodies in a tool shed on their property. This is only one dreadful example of what can happen when there is insufficient oversight, too much emphasis on bottom-line thinking, and a total disregard for the decency of human beings.

Yes, we may be in for a new age that may mimic what we had a century ago, but with appropriate upgrades that enable the frail and the strong elderly to remain in their homes. Designs for the layout of homes that meet the needs of the elderly are already available, and groups are willing to provide labor for individuals who cannot afford remodeling for their increased need for accommodation.

Aging in place is not a new idea but requires sufficient consideration from all of us for those who made our lives possible and enabled us to have a better life than they may have had in the past.

We talk about “the Greatest Generation,” but are we treating them in that same frame of reference, or are we dismissing them? Think hard and frequently about this because we will all be there one day.

5

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The incidence of walkers and other assistive devices like canes has increased 50% in the last ten years since a survey was completed. With the aging of our population and the increasing incidence of orthopedic surgeries requiring aids, the numbers will only increase in the future.

But as the numbers increase, what’s happening with the design of these walkers? We don’t live in elevator buildings, nor do we all have ramped sidewalks or never have to ascend a flight of stairs or go down one.

What happens when someone dependent on a walker is in a situation like that? You know what it is; they need a helper. Independence is terminated either permanently or for a time.

A study indicated that 25% of the older American public now use assistive devices such as walkers. It is expected to double to 50% in the next decade or two.

What happens when you take a gut punch at someone’s self-esteem by removing their independence? The stress leads to immune system problems in persons already at risk. They are also at risk for mental health problems such as anxiety and depression, which furthers their feelings of inability to care for themselves. Their main concern for using walkers is what? They fear they’ll fall without one and won’t be able to get up. If they do fall, that compounds the worry they experience.

Design and Walkers

I quickly searched on Youtube to see what was being done with walker design. The only walker that allows someone to go up and down stairs by themselves utilizes a motorized tread and complicated electronics, plus it weighs over 65 lbs.

The walker was the brainchild of a group of engineering students where one member, who had taken a trip to Europe, noticed how difficult it was for persons with walkers to board buses or freely move about cities. Isn’t it difficult in the US for persons with walkers? And did they ever get a patent for the design? I don’t know, but I think expense would be a formidable barrier to overcome. And Medicare will only allow for ONE assistive device such as a basic walker or a cane; you can have either, but not both.

What is desirable in a walker? A few things are essential: a seat, a storage compartment, brakes, medium-sized wheels, and the ability to fold up and be reasonably priced. A lighter walker that accommodates gait differences didn’t have the seat and braking system other units feature. Not all walkers consider a person’s walking stride, and the seat on the unit may not slide, therefore, hitting their knees as they walk.

Here’s another with a bag to carry items and a small seat for fatigued individuals. But what about handles that can be extended upward for taller individuals? Most have a maximum height that may not suit everyone — unless you want to pay more for one that is heavier. The person is constantly slouching forward if it doesn’t have adjustable handles.

Another can be adjusted for going up stairs but has no brakes and isn’t height-adjustable, so it is for a limited number of people. With no brakes comes increased anxiety.

Who cares about colors? Persons who use walkers want stability, durability, and lightweight units that are not abhorrently expensive and have to fold into the trunk of something less than an SUV.

We have excellent, creative minds in our rehabilitation/bioengineering programs in the US, so why aren’t we seeing more attention being paid to the type of walker people need and can afford? A walker isn’t a luxury item; it is an essential life aid for anyone with a disability.

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There are specific types of sampling for clinical trials or any research, and they are random, systematic, stratified, clustered, and convenience sampling, and the sampling type may result in older patients being excluded. There are other types of sampling, but these are the more usual. Convenience sampling is one where it is probably easiest to get the sample size required.

Of course, each clinical trial will also, in addition to their sampling method, have rule-in and rule-out criteria eligibility. Here, the principal investigator makes decisions based on factors they wish to control, such as a history of alcoholism, familial sudden death syndrome, or other medical conditions. Age can be an important concern and serve as a “rule-out.”

Of course, institutional review boards bear responsibility here, too. Questioning by board members regarding the reason for not including older patients is mandatory.

Every patient has the potential to bolster our knowledge and research base if we see past our bias. And what would a specific bias be in these cases? Are we selecting in only those who have many decades of life left and tossing aside those with possibly one decade of life left to them? How much is a decade of life worth these days?

The Ethos of Medical Ethics

Clinical research trials are essential for any headways to be made in the many wars medical science is currently engaged in worldwide for various diseases. It would stand to reason that these research trials would be comprised of individuals of all ages, ethnicities, and gender groups to ensure that we are utilizing a representative sample to come to valid results. But that doesn’t seem to be the case with two groups, particularly older adults and Black individuals.

Regarding Black individuals, we know a long history has contributed to a reluctance to engage in clinical trials. No one needs to tell us about the horrific trials in the South with Black men who thought they were being treated for a sexually transmitted disease (syphilis) when, in fact, they were being followed to catalog the progression of the disease and their deaths. They never received the medicine that would have cured them, penicillin.

Despite mandates by the federal government to ensure the inclusion of women and minorities in all federally funded research, African Americans continue to participate less frequently than Whites. Lower participation rates among African Americans have been reported across various study types (e.g., controlled clinical treatment trials, intervention trials, as well as studies on various disease conditions, including AIDS, Alzheimer’s disease, prostate cancer, and other malignancies, stroke, and cardiovascular disease).

Medical history must always keep that in the record books and understand the impact it has had on generations of Blacks. There are other examples of equally unethical research or experiments on this group.

Now, we face another difficulty or impediment, and that is in the area of age disparities in some clinical trials, but cancer is of utmost importance.

Cancer and the Aged Patient

Statistical census data released annually by major research entities indicate that 10% of those over the age of 65 have some form of cancer. The latest census figures for the United States suggest that there are over 65 million people in this age group, both male and female. Logically, this indicates almost seven million in that group have cancer.

Worldwide the World Health Organization indicates that each year 10 million people die from cancer worldwide, or one in six. In the US, in the 60–70-year-old group, cancer is the second most common cause of death.

The FDA has noted an underrepresentation of older adults in cancer-treatment trials. The National Cancer Institute’s data show decreasing enrollment in trials both FDA and SEER with advancing age. At ages 75 and greater, only 9% of research samples were in this age group. At 65, it was 36%.

By 2030, it is estimated that 70% of people over 65 will have some form of cancer. If that isn’t a compelling reason to begin enrolling this population into cancer clinical trials, I have to question the trials.

Arrogance and Ignorance in Research

I have to question the rationale for the trials, who is underwriting the trials, the background of the principal investigator in terms of ageism potential, and how significant the trials would be in a rapidly aging world. We cannot deny that the silver tsunami is upon us and will require billions of dollars of care for these patients.

If we do nothing or little to provide innovative, new treatments garnered from new research, we will find ourselves trying to swim without any floaties to support us.

One research paper indicated that if we fail to include this population in cancer clinical trials, there will be a lack of generalizability that can lead to challenges in treatment decisions for OA (older adults) and concerns regarding health inequity. Do older adults receive equal medical treatment today? I question that.

The editors indicated that trial structure, design, physician perspective, and patient or caregiver perspectives must be carefully evaluated and included as required. They call for actionable recommendations to address the challenges these types of cancer trials face, which may have been ignored in the past.

There is no room for ageism in clinical research, and when found, it must be addressed as strongly as possible because lives are on the line. To do less is extreme arrogance and ignorance in the face of what is coming down the road. No gods are working in medicine, and everyone must adhere to the strictest ethical guidelines possible and care for those who may have, either on purpose or thoughtlessly, fallen through the safety net.

Yes, I have heard chiefs of service refer to older patients as PIAs (no, it’s not Prolonged Infantile Apnea), a term which should have been erased from medicine many decades ago but is still held close in the minds of those who live in the past.

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Approximately 1 in 3 Americans 65 and older who completed their initial vaccination round still have not received a first booster shot, according to the Centers for Disease Control and Prevention. The numbers have dismayed researchers, who note this age group continues to be at the highest risk for serious illness and death from covid-19.

People 65 and older account for about 75% of U.S. covid deaths. And some risk persists, even for seniors who have completed an initial two-dose series of the Moderna or Pfizer vaccine or gotten one dose of the Johnson & Johnson vaccine. Among older people who died of covid in January, 31% had completed a first vaccination round but had not been boosted, according to a KFF analysis of CDC data.

The failure to boost more of this group has resulted in the loss of tens of thousands of lives, said Dr. Eric Topol, founder and director of the Scripps Research Translational Institute. “The booster program has been botched from day one,” Topol said. “This is one of the most important issues for the American pandemic, and it has been mismanaged.”

“If the CDC would say, ‘This could save your life,’” he added, “that would help a lot.”

Although the initial one- or two-dose vaccination course is effective at preventing hospitalization and death, immunity fades over time. Boosters, which renew that protection, are especially important for older people now that covid cases are rising again, more transmissible omicron subvariants are proliferating, and Americans are dropping their masks, Topol said.

Some older people, who were prioritized for initial vaccination in January 2021, are now more than a year from their last shot. Adding to the confusion: The CDC defines “fully vaccinated” as people who have completed an initial one- or two-dose course even though a first booster is considered crucial to extending covid immunity.

Numerous studies have confirmed that the first booster shot is a critical weapon against covid. A study of older veterans published in April found that those who received a third dose of an mRNA vaccine were as much as 79% less likely to die from covid than those who received only two shots.

A central question for scientists championing boosters is why rates have stalled among people 65 and older. Surveys have found politics and misinformation play a role in vaccine hesitancy in the population at large, but that’s not been the case among older people, who have the highest initial vaccination rate of any age group. More than 90% of older Americans had completed an initial one- or two-dose course as of May 8.

By contrast, 69% of those vaccinated older Americans have gotten their first booster shot.https://datawrapper.dwcdn.net/7X0hm

Overall, fewer than half of eligible Americans of all ages have received a booster.

The discrepancy for seniors is likely due to changes in the way the federal government has distributed vaccines, said David Grabowski, a professor of health care policy at Harvard Medical School. Although the Biden administration coordinated vaccine delivery to nursing homes, football stadiums, and other targeted venues early last year, the federal government has played a far less central role in delivering boosters, Grabowski noted.

Today, nursing homes are largely responsible for boosting their residents, relying on pharmacies they traditionally hire to administer flu shots, Grabowski said. And outside of nursing homes, people generally must find their own boosters, either through clinics, local pharmacies, or primary care providers.

Dr. Thomas Frieden, a former CDC director, said that, in theory, shifting responsibility for ongoing covid immunization from government-sponsored clinics to individual providers might seem logical, given the privatized design of U.S. health care. In reality, Frieden said, that approach is not working because “our primary health care system is life-threateningly anemic” and not set up to readily take on a public health mission.

Most health care providers don’t have the technology to securely track which patients have been vaccinated and schedule follow-up shots, Frieden said. Nor are there financial incentives for doctors to get their patients vaccinated and boosted.

Even before the pandemic, 28% of Americans didn’t have a regular source of medical care.

Grabowski said nursing homes in particular need more support. Although fewer than 1% of Americans live in nursing homes or assisted living facilities, they represent more than 20% of covid deaths. He would like the Biden administration to resume coordinating booster delivery at nursing homes through mass vaccination efforts. “I would have these centralized clinics go back to get residents and staff boosted all at once,” Grabowski said. “That strikes me as a no-brainer.”

The Biden administration has touted its continuing efforts to vaccinate older people. For example, the Centers for Medicare & Medicaid Services has sent quality improvement teams to advise nursing homes with low vaccination rates. The Medicare program has mailed letters to all 63 million beneficiaries to encourage them to get boosters and has sent millions of emails and text message reminders.

Still, many health advocates agree that the country has lost the momentum it had during the first months of the covid vaccination campaign.

“There doesn’t seem to be the urgency that we saw with the initial shots,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group.

Some researchers attributed the slowdown to the initial disagreement among health leaders over the value of boosters, followed by a staggered rollout. Boosters were approved in stages for different age groups, without the fanfare that typically comes with a single major policy change. The CDC recommended booster shots for people with weakened immune systems in August; then for older people in October; for all adults in November; and for kids 12 and up in January.

In addition, although advertisements for vaccines seemed to be everywhere a year ago, government agencies have been less vocal about encouraging boosters. “I felt like we were all getting hit over the head originally and all roads led to vaccines,” Grabowski said. “Now, you have to find your own way.”

For many older people, the barriers that can make private health care difficult to access in non-pandemic times also exist for boosters. For example, many seniors prefer to walk in to receive a vaccination, without an appointment, or to make appointments by phone, even as pharmacies increasingly turn to online-only scheduling that requires customers to navigate a multilayered system. Some seniors also lack ready transportation, a sometimes-towering obstacle in rural areas where health clinics can be 20 to 30 miles apart.

“If people have to take two buses or take time off from work or caregiving for their family, people are less likely to be vaccinated,” Smetanka said.

Dr. LaTasha Perkins, a family physician in Washington, D.C., said she has worked hard to persuade her family in Mississippi to get vaccinated. Her grandmother agreed to get her first shots in the fall, just as the CDC approved boosters for all adults.

“We finally got to a place where we got people to get two shots, and then we said, ‘Oh, by the way, you need a third one,’” said Perkins. “That was jarring for a lot of communities. They would say, ‘You convinced me to buy in, and now you’re saying that two shots aren’t good enough.’”

Although national leadership is important, Perkins said, local connections can be more powerful. Perkins has given talks about vaccines at her church. Congregants are more likely to trust her medical advice, she said, because she’s a tithing member whom they see every Sunday.

Some communities have done a better job of overcoming reluctance than others. Minnesota has boosted 83% of vaccinated residents ages 65 and older, a larger share than in any other state, according to the CDC.

Minnesota’s Dakota County has boosted a greater percentage of vaccinated people 65 and older than any other U.S. county with at least 50,000 seniors, according to a KHN analysis of CDC data.

Christine Lees, an epidemiologist and public health supervisor for Dakota County, said her department hired an agency to provide booster shots to residents and staffers in nursing homes and assisted living facilities. The health department runs vaccine clinics at lunchtime and some evenings to accommodate working people.

The department drew on money from the federal Coronavirus Aid, Relief, and Economic Security, or CARES, Act to purchase a mobile vaccine clinic to bring boosters into neighborhoods and mobile home parks. “We ran it all last summer, and we’ve started it back up again,” Lees said. “We went to food shelters and libraries. We went out at least once a week to keep those numbers high.”

Community health workers paved the way for vaccine clinics by visiting residents in advance and answering questions, Lees said.

Dakota County also used funds from the American Rescue Plan Act to provide $50 incentives to people receiving initial vaccines and boosters, Lees said. The incentives “were really important for people who might have to pay a little extra to travel to a vaccine site,” Lees said.

Topol, at Scripps, said it’s not too late for federal leaders to look at what’s working — and not — and to relaunch the booster effort.   

“It will be hard to reboot now. But an aggressive, all-out campaign for seniors — whatever it takes — is certainly indicated,” Topol said. “These people are the sitting ducks.”

Phillip Reese, an assistant professor of journalism at California State University-Sacramento, contributed to this report.

The post Why Won’t More Older Americans Get Their Covid Booster? appeared first on Medika Life.

“Do you think my surgery was a success?” the elderly gentleman asked me.

I was taken aback by the question. By all rights, this now 90-year-old man should have been dead. I considered his survival one of my greatest successes, and I told him so. He was not convinced.

It had been the middle of the night when the phone rang. The ER attending from an outlying hospital was in a panic. He rushed through the story: an 89-year-old man had come into the little rural ER complaining of abdominal pain, and collapsed. It turned out he had ruptured his abdominal aortic aneurysm, and his heart was pumping blood into his abdomen. The patient’s blood pressure was hardly detectable, and he was unresponsive. The ER doctor on duty wanted me to race out there and fix the problem. Unfortunately, that was not realistic because the hospital, which only had two ORs, lacked the equipment and resources to deal with such a dramatic problem.

I told the ER attending to put the man into an ambulance and send him to the main hospital. Then I gave serious consideration to going back to sleep. The patient was 89 years old, had suffered a high mortality event, and was nearly dead already. The chances of him still being alive when he arrived at the main hospital seemed minuscule. I felt guilty calling in the OR staff and anesthesiologist knowing I would most likely send them home when I pronounced the guy DOA.

But when the ambulance arrived, though the patient had only a tenuous connection to life, he wasn’t dead. We took him directly from the ambulance bay to the OR, transferred him onto the operating table, and, without ceremony or anesthesia, started the operation, and got control of the bleeding aneurysm. The patient was still (miraculously) alive, so I proceeded to repair the aneurysm while the anesthesiologist placed lines, gave blood, and resuscitated the man. Surprisingly, he survived the operation and continued to improve in the ICU.

After eight days in the hospital, I discharged him to a nursing home. I saw him back for a couple of post-operative visits as he continued to improve, and then returned him to the care of his primary physician.

It was a year later when I saw him again in the hospital regarding a question about his aneurysm repair. I reviewed his scan and reassured the patient that all was well. He did not seem to agree with my assessment. I asked him if there was something else bothering him.

He responded with a question: “Do you think my surgery was a success?”

I did think his surgery was a success — I considered his survival to be one of my great successes. I had bragged about it on many occasions.

“Yes, I think your surgery was a success,” I said.

“I don’t think it was,” he replied.

“Why is that?” I inquired.

“I’m still in that home you put me in.”

He had been living in a nursing home since leaving the hospital. It looked like that was where he was going to stay. And, because he would never leave the nursing home, he did not consider his operation a success. His inability to return to independent living meant that, for him, the operation had failed. He would, it seemed, have preferred to die from the ruptured aneurysm than to live in a nursing home.

I had not discussed this man’s goals for surgery with him beforehand. Of course, I had not done so because he was unresponsive and, with no indication that he did not want me to try, I proceeded to provide him with the best care I could. That meant fixing his aneurysm and saving his life. But now he was telling me that he would have preferred I let him go.

It is always hard for a surgeon when an operation does not turn out well but in my mind, this operation had been an unexpected success — because my metric for success was that the patient was still alive. But the patient’s metric was more nuanced. For him, being alive wasn’t enough. He needed to be able to live his life in a meaningful way, and only he could define what that meant. For him, living in a long-term care facility was not satisfactory. He saw the operation as a failure because the excision of his aneurysm had also excised his independence.

The lesson I took away from this encounter was that I need to view the success of what I do from the viewpoint of the patient. As physicians, we often assume that we know what is best. In this case, I made a decision based on my understanding of the standard of care. To be fair, I did wonder what the man would have wanted, but at the time, there had been no way to ask him. That said, the experience has made me more circumspect in making medical decisions in complex situations. I now ask patients what their goals are. I present surgical and medical options and make sure the patient understands — and then I ask them more questions.

“What are you hoping will happen?”

“What outcome would be satisfactory to you?”

“What can I do to help make that happen?”

What I have learned is that the patient, not the doctor, defines the success or failure of medical treatment. To achieve success, I need to know the patient’s hopes, dreams, goals, and fears. And the only way to learn those things is to ask. We need to explicitly ask patients what they want, what they fear, and how they would define a satisfactory outcome. If we don’t take the time to find out what kind of outcome is meaningful to the patient, the best care in the world may be ineffective.

The post I Thought I Saved My Patient’s Life. He Didn’t Agree. appeared first on Medika Life.

First, realize that mental health professionals aren’t feeling somewhat concerned that they don’t have an instant answer, a pill, a technique, something to lift this gray veil from our mind’s eyes miraculously.

One physician at a major hospital poured out his feelings in an article. An elderly patient had asked him if he could help her with feelings of loneliness. “I wish I could say yes. I wish I could prescribe her some antidepressants and be satisfied that I had done my best, but the truth is she’s not clinically depressed. It’s just that she has been left behind by a world that no longer revolves around her, not even the littlest bit of it.”

The physician said he saw the hospital as a “last resort” for people who found their beloved elderly relatives interfering with the holiday celebrations, requiring too much attention, being too needy. Did those people stop and think about how they would feel if they were no longer relevant to what the physician termed a culture addicted to youth?

Being tossed aside is terrible enough. Having it happen when everyone is in a celebratory mood and you’re excluded kills people earlier than they need to die. How disheartening for the physician, but most of all, for those abandoned to the care of strangers. BTW, that is the title of an excellent book on the history of the American hospital system.

Of course, we have studies of loneliness, especially during a time of a lockdown in a pandemic. Isn’t that what mental health professionals provide?

Who are those who suffer from loneliness most during this time? Younger adults, people with low income, the economically inactive, and people with mental health conditions were more likely to be in the highest loneliness class than the lowest. Everyone in these groups has a good reason to feel isolated and lonely. Wouldn’t you?

The thread that connects all of them and all of us is seen in the data; social connection. If we can maintain social relationships, we may keep ourselves afloat during particular times of emotional privation where the intensity ratches up—holiday times.

During the year, any year without a pandemic, we work toward solidifying our human and even animal connections. Some will join like-minded groups for activity; others will be sure to schedule regular social interactions either face-to-face or via technology. It will include quiet walks in parks or interactions with animals in the home or outside for some.

Pet ownership, in my opinion, can be quite a healthful activity. They may provide a sense of need and security and prevent rash actions. If it’s true that dogs have masters, cats have staff; then we know they have the power to help us. Fighting loneliness is one of their tasks. For dogs, they provide unconditional love as they perceive our need and they give it to us. Dogs can be saviors, but not everyone can have one.

Articles aplenty will appear now in all manner of publications. They will offer sure-cure ways to tackle loneliness and make it something positive. And some of the advice is good because everything can be seen in more than one light. My advice?

Seek to firm up your relationships now and remind yourself that you have power over your life, no matter where you are or what you no longer do. Unfortunately, we live in a world that defines us not simply by age (ageism) but by what we do for a living.

What is one of the first questions people ask you when you meet? Of course, it’s “And what do you do?” I am almost bursting at the seams because I want to respond, “Do about what?” I am not what I do or what I did. I am me, and that matters.

Want to fight loneliness? Begin today in whatever way you can (I leave the creativity up to you) and work at it as you would have worked (or work) at a career. This is the most important, satisfying work you will ever do.

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