Hundreds of patients have been languishing for months or even years in New York City hospitals, despite being well enough to be sent home or to nursing centers for less-expensive care, because they are illegal immigrants or lack sufficient insurance or appropriate housing.
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In a recent article in The New England Journal of Medicine, they suggested offering to discuss “overall prognosis,” doctorspeak for probable life expectancy and the likelihood of death, with patients who don’t have terminal illnesses. The researchers favor broaching the subject with anyone who has a life expectancy of less than 10 years or has reached age 85.
“Advanced age itself is the greatest predictor of poor prognosis,” Dr. Smith told me in an interview.
By age 85, the article points out, the average remaining life expectancy for Americans is six years. An 85-year-old has a 75 percent chance of living another three years, but only a one in four chance of surviving for 10. Which category a particular old person falls into has much to do with the medical problems they have, or don’t have, and with their ability to function.
When the odds are that they have only a few remaining years, should doctors discuss that with them?
The most widespread medical implant failure in decades — involving thousands of all-metal artificial hips that need to be replaced prematurely — has entered the money phase.
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New research shows that infants who are exposed to foods with high amounts of sodium are more likely to develop an affinity for salt later on in life than infants who are not fed as much salt. In the study, which was published in the latest issue of the American Journal of Clinical Nutrition and funded by the National Institutes of Health, infants whose parents fed them starchy table foods like crackers and breakfast cereals, which typically contain added salt, were more likely to gravitate to salty foods by the time they reached preschool.
“Our data would suggest that if one wants to reduce salt in the population as a whole, then it’s important to start early because infants and children are very vulnerable,” said Dr. Gary Beauchamp, an author of the paper and behavioral biologist at the Monell Center in Philadelphia, a nonprofit institute that carries out research on taste and smell. “Exactly what constitutes too much salt is somewhat of a matter of controversy. But for kids over the age of 1 and 2, what they’re consuming now is well beyond what is recommended by every major health organization in the world.”
the policy conceit that spending money on patients who die is a waste overlooks the core purpose of health care — to prevent or forestall illness, disability and death among patients at risk of those outcomes.
It also overlooks a key correlation in health care. When people get sicker, they need more intensive — and expensive — health care services. But when they get sicker, they are also more likely to die. When I met my patient, I took him to the intensive care unit, the second-most-expensive place per minute in any hospital. The other place he went, twice, was the operating room — the most expensive place.
Healthy people, who are unlikely to die, are also very unlikely to find themselves in those settings. Thank goodness.
Thus, spending will always be concentrated on people who are the sickest. When one examines spending on patients who die, dollars will be concentrated there, too.
I am not saying that every health care dollar is well spent. But five carefully done studies have now shown that hospitals that spend more on caring for sick patients have better outcomes than those that spend less. So some of the spending is improving health.
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A non-drug dementia intervention piloted in German nursing homes proved as effective as medications in halting progression of disease, a new study reveals.
Scientists followed dementia patients from five Bavarian nursing homes for 12 months, with half of the residents receiving each facility's standard treatment, and half receiving those treatments plus a new intervention program.
After a year, researchers compared participants in test and control groups using the Alzheimer's Disease Assessment Scale. They found that in residents with mild to moderate dementia, the non-medication therapy was “at least as good as treatment with cholinesterase inhibitors.” Additionally, the effect of the therapy on the Erlanger's Test of Daily Living was “twice as high” as results achieved by medication, researchers said.
Dr. Frank Lin, MD, PhD and Doctors Metter, O'Brien, Resnick, Zonderman, and Ferrucci, at the Johns Hopkins University objective was to determine whether hearing loss is associated with the incident of all-cause dementia and Alzheimer disease# Over 600 adults aged 36 to 90 who had their hearing tested between 1990 and 1994. They followed them up to the end of May 2008 to see who developed dementia or Alzheimer's disease. They found that those with hearing loss were more likely to be diagnosed with dementia or Alzheimer's disease during the average 12 year follow-up. They also found that the more severe the hearing loss the more likely they were to have a diagnosis of dementia#
Compared with those who had normal hearing, those with mild hearing loss were 89% more likely to be diagnosed with dementia. Those with moderate hearing loss were three times more likely to receive this diagnosis, and those with severe hearing loss were nearly five times more likely to be diagnosed with dementia. It does remain unclear whether hearing loss is an early sign of the disease or a risk factor for it, so much more research is needed.
Just four medications or medication groups — used alone or together — were responsible for two-thirds of emergency hospitalizations among older Americans, according to the report. At the top of the list was warfarin, also known as Coumadin, a blood thinner. It accounted for 33 percent of emergency hospital visits. Insulin injections were next on the list, accounting for 14 percent of emergency visits.
In a meta-analysis published in the Cochrane database, a University of Toronto team analyzed several studies of 3,100 healthy children at day-care centers.
They found that children chewing xylitol gum were 25 percent less likely to develop acute ear infections. Because the children chewed the gum up to five times a day, it’s not clear whether smaller amounts would have the same effect.
In patients with depression, anxiety and other psychiatric problems, doctors often find abnormal blood levels of thyroid hormone. Treating the problem, they have found, can lead to improvements in mood, memory and cognition.
Now researchers are exploring a somewhat controversial link between minor, or subclinical, thyroid problems and some patients’ psychiatric difficulties. After reviewing the literature on subclinical hypothyroidism and mood, Dr. Russell Joffe, a psychiatrist at the North Shore-Long Island Jewish Health System, and colleagues recently concluded that treating the condition, which affects about 2 percent of Americans, could alleviate some patients’ psychiatric symptoms and might even prevent future cognitive decline.
Patients with psychiatric symptoms, Dr. Joffe said, “tell us that given thyroid hormones, they get better.”
The thyroid, a bow-tie-shaped gland that wraps around the trachea, produces two hormones: thyroxine, or T4, and triiodothyronine, known as T3. These hormones play a role in a surprising range of physical processes, from regulation of body temperature and heartbeat to cognitive functioning.