Good Medical Care for the Elderly and How to Get It

The "Don't kill Granny" list

Rosanne M. Leipzig is a physician and professor at Mount Sinai School of Medicine. She wrote in the New York Times today about how lacking in skill and training most doctors are in the practice of geriatrics. This is particularly troubling to her because geriatrics is not a required course in medical schools around the country. If you’re a caregiver or if you are one of those who is “of a certain age” to need competent curative and/or preventative care from a doctor, you’ll want to read what Dr. Leipzig has to say. In a nutshell . . .

“I was part of a group of doctors and medical educators who recently published in the journal Academic Medicine a set of minimum abilities that every medical student should demonstrate before graduating and caring for elderly patients. Nicknamed the “don’t kill Granny” list, it includes being able to prescribe medicines, assess patients’ ability to care for themselves, recognize atypical presentations of common diseases, prevent falls, recognize the hazards of hospitalization and decide on treatments based on elderly patients’ prognosis and their personal preferences.

“The 2008 Institute of Medicine report “Retooling for an Aging America” resolved that all licensed health care professionals should be required to demonstrate such competence in the care of older adults. But this resolution lacks teeth. Medical resident training programs that receive Medicare money should be required to demonstrate that their trainees are competent in geriatric care. Medicare should finance medical training in nursing homes. And state licensing and medical specialty boards should require demonstration of geriatric competence for licensing and certification.

“Basic geriatric knowledge is preventive medicine. Nurses, social workers, pharmacists and other health care professionals should have it, too, in order to improve care for older people. But until doctors get this basic training, we can’t even begin to give 80-year-olds the care they need.”

Dr. Leipzig’s entire op-ed piece can be read here.

Are you going to finish strong?

This is amazing. What strength and courage. Are you going to finish strong? We could all learn from this young man.  As famiy caregivers, we all need to find motivation and encouragement. Try this:

A good death | Jane Brody's Guide to the Great Beyond

I have just finished reading an extraordinary book, a book so remarkable that I am making a list of all of the people with whom I will share it. The book is Jane Brody's Guide to the Great Beyond: A Practical Primer to Help You and Your Loved Ones Prepare Medically, Legally, and Emotionally for the End of Life. Imagine next time you celebrate an occasion, giving your spouse, your child, or children a book about preparation for dying. The idea may seem strange to you. I ask you to suspend your negativity until you’ve seen this book.

Can you imagine spending two weeks in the hospital after suffering a seizure, being cared for by nurses, seen by doctors, having medications prescribed, being transferred for "rehab" to a nursing home, then arriving home to find that most of your care wasn't covered by Medicare?

That's exactly what is happening to some patients. The Chicago Tribune published an article on March 10th explaining a little known category of hospital care called "observation stay."

Parents' Wish | Preserving dignity for your loved one

My niece sent me a link to a web site featuring a very powerful message about how our elderly loved ones wish to live and to die with dignity. Set to the music of Josh Groban ("You Raise Me Up"), this is very thought-provoking. I'll be honest. It moved me to tears.

Parents' Wish - view it here.

Survey shows many primary care doctors plan to quit or cut back

Reuters reports that a survey released on November 18, 2008 shows that nearly half of the primary care
doctors in the United States feel overworked and nearly half of them plan either to retire or to cut back
on how many patients they see or to quit the practice of medicine altogether. This poses serious
problems for the elderly, most of whom are cared for by primary care doctors, either family practice
doctors or internists.

In the survey 60 percent of 12,000 general practice physicians surveyed said that they wouldn't recommend medicine as a career.

The survey was conducted by the Physicians' Foundation. One doctor participating in the survey was quoted as saying: "The whole thing has spun out of control. I plan to retire early even though I still love seeing patients. The process has just become too burdensome."

Lack of communication in ER results in post-discharge complications

The New York Times reports on September 16, 2008 that most ("a vast majority") of emergency room patients are discharged without understanding the treatment they received or how to care for themselves once they get home. As borne out by earlier studies, and in particular, by the research of Dr. Eric Coleman who is the director of the Care Transitions program at the University of Colorado, the lack of communication when patients are discharged from one care setting to another can lead to medication errors and serious complications that can send them right back to the hospital.

You can read the entire New York Times article here. E.R. Patients Often Left Confused After Visits

For more information see Dr. Coleman's website caretransitions.org. Be sure to look at the intervention section and also to access a Caregiver's Tool kit for caregivers and patients. This toolkit will help you safety negotiate not only safe care in the emergency department, but also to handle successfully transitions between hospital and home or hospital and another care facility such as a rehab center.

Evercare private Medicare plans under scrutiny

Thursday, July 31, 2008: According to the Boston Globe, Massachusett’s Division of Insurance is investigating sales of Evercare private Medicare plans following complaints from Massachusetts seniors about sales representatives using misleading and abusive marketing. These plans are sold in Michigan, according to the company’s website. [Enter a zip code.]  NOTE: I checked this. These plans are being sold in Michigan.

The importance of eliminating risks for falling

Falls can be deadly. About 10,000 elderly persons die every year in the U.S. as a result of injuries suffered in falls. Over one-third of these deaths occur among persons older than 85 years. The vast majority of these deaths are related to hip fractures; patients with hip fractures are 15 to 20 times more likely to die than those who have not had a fracture. Even when falls do not cause death, they can cause significant disability in the elderly, such as minor soft tissue injuries, hip fractures, other types of fractures, and serious soft tissue injuries. Injuries from falls may mean that your loved one won't be able to grow old in his or her own home.

Antipsychotics inappropriately prescribed for dementia

Even short-term use of typical or atypical antipsychotic medications in the elderly with dementia produces serious events. If you are a regular reader of this Blog, then you know that I frequently write about the dangers of using antipsychotic medications with the elderly. My earlier posts may be accessed here. A new study, released on May 28, 2008, makes clear that even short-term use of these drugs may cause serious complications and even death for the elderly patient. That study was discussed in my May 27 Blog article, and is discussed in a recent article in Journal Watch Psychiatry June 23, 2008

Antipsychotics prescribed to elderly | Adverse event

Today, the Archives of Internal Medicine published a "retrospective cohort study" in which is is reported that the short-term use of antipsychotic therapy in older people with dementia is often followed by adverse events leading to hospitalization or death.

Shortly after my mother died in November 2000, I filed a report with the FDA's Med Watch --a reporting system for adverse medication reactions causing death and other serious complications. I told the FDA that risperidone, an atypical antipsychotic, prescribed for my mother when she was delirious was a likely contributing factor in her death. What did MedWatch do with this report?

Is online medical record storage safe?

As I have earlier written on Aging in Place, companies like Microsoft and Google are getting into the medical record storage business.  Last week, however, the New England Journal of Medicine raised important questions about whether medical privacy rules should be extended to these private firms. Steve Lohr wrote in the New York Times that the authors of The New England Journal article say there are still more questions than answers about the new “personalized health information economy.'’

Soaring co-pays for prescription medications

How many people really read those thick pamphlets that credit card companies, banks, and/or insurance companies send out periodically to advise of a change in policies, interest rates, etc.? Many of these mailings surely end up in a stack that you’ll read when you “get around to it.”

Thus many seniors accustomed to paying a $20 co-pay may have been surprised the last time they went to pick up a refill of commonly used medications used to treat diseases such as multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. New pricing systems adopted by many insurance companies now require patients to pay hundreds or even thousands of dollars for medications prescribed to help them save their lives or to slow a disease process.

For more about this troubling trend, see the April 14, 2008 New York Times,
Co-payments for Expensive Drugs Soar.

See also earlier posts Saving money on prescription medications and   Getting medications without charge

New restrictions on anti-anemia drugs

An FDA advisory panel has recommended further strengthening warnings for the use of erythropoiesis-stimulating agents in cancer treatment, according to news reports.

The panel voted to recommend keeping Aranesp (darbepoetin alfa) and Procrit (epoetin alfa) on the market to treat anemia resulting from chemotherapy. But it said they should be given only to patients with incurable cancer and should not be used for those with breast or head and neck cancer. Evidence that the drugs may increase the risks for death and tumor growth led to the new restrictions.

The panel also advised that patients should sign forms indicating that they consent to receive the drugs after being fully informed of the dangers associated with them, according to the New York Times.

The New York Times story may be read here.

Seniors cautioned about reverse mortgages

Some seniors struggle financially while trying to age in place. The Financial Industry Regulatory Authority (FINRA) recently advised senior homeowners to proceed with caution before using reverse mortgages to access their home equity. The group warned that a reverse loan--meaning that a bank makes payments to a homeowner instead of the homeowner making payments to a bank--can be a risky financial move.

Heparin contamination

If you or one of your loved ones takes heparin, a blood-thinner often prescribed for patients with heart conditions, you should be watchful for the following symptoms:

• difficulty breathing
• nausea
• vomiting
• excessive sweating and
• rapidly falling blood pressure

Avoiding an inappropriate psychiatric hospitalization

Recently, a caregiver complained that a hospital would not allow her to elect a transfer to a psychiatric unit for her parent suffering from dementia. The hospital’s position was that the health care power of attorney did not allow the patient advocate to make a psychiatric admission. They said that only the patient could make that choice. The patient was described as being “delusional.” What seemed probable was that this patient was delirious, not psychotic. If that were the case, then a psychiatric admission would potentially be very harmful to the patient.

Avoiding an inappropriate psychiatric hospitalization for an elderly person can be life-saving for that patient.

Reducing incidence of bedsores using teamwork

Bedsores can be a serious complication of aging. The clinical name is pressure ulcers. These ulcers occur when skin breaks down because blood circulation is cut off by sustained pressure. Bedsores can be so difficult to heal that prevention is the recommended approach. A recent study shows that a teamwork approach can reduce the incidence of bedsores by 69%.

Patients who are confined to beds and wheelchairs in hospitals and nursing homes are most at risk for bedsores. Other complications, such as dehydration and poor nutrition, can put the elderly at greater risk to develop bedsores. Incontinence also can lead to bedsores.

Heparin warnings

The New York Times reports today that Baxter Healthcare, the manufacturer of about half of the heparin used in the U.S., has stopped making it after hundreds of patients reported severe allergic reactions to the drug. Heparin is a blood thinner widely used in surgery and dialysis. Reportedly, at least four people have died. It's important to note that the complications reported were related to large dosages being injected in patients. Most of the cases were reported in late December or January. 40 percent of the cases were reportedly serious.

Federal regulators say that a shutdown in manufacturing will surely result in shortages of the drug.
Alternative drugs do exist. However, doctors were warned today of serious consequences if heparin becomes truly scarce.

You may read the New York Times article, Problems in Drug Lead to Halt by Factory here.

The checklist | A simple way to reduce medical error

In the December 10, 2008 issue of the New Yorker, author Atul Gawande writes: “If something so simple [as a checklist] can transform intensive care, what else can it do?”

Gawande gives some amazing examples of extraordinary ICU care evolving through the use of checklists. ICU care is complicated. A time and motion study of ICU care in Israel was cited. The study showed that the average ICU patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs. Any kind of mistake, in the procedure or in the sequence of actions, could result in fatal error.

Rizzo & Associates new blog

A Traverse City elder law practice, Rizzo & Associates, has just begun a new blog -- Michigan Elder Law Updates. I've already emailed friends in Kentucky a link to the article about changes in Michigan's property tax. As summer residents and property owners in my neighborhood, they will be very interested in this update.

You'll find Michigan Elder Law Updates here: http://michiganelderlaw.blogspot.com/

Aging in Place | A change in the tax law may help

On January 30, 2008 the Wall Street journal reported an important change to the tax code. A cherished tax break is the exclusion of as much as $500,000 of gain from gross income when, as a one-time event, a couple sells their principal residence as long as they file their tax returns jointly. (The exclusion is $250,00 for a single person). Yes, there are some conditions. You aren’t entitled to the exclusion unless you owned the home -- and lived in it as your primary residence -- for at least two of the five years prior to the sale.

Healthy Survivorship | Wendy Harpham coined the phrase!

Usually I write about issues important to the elderly. Today, I want to introduce you to Wendy S. Harpham, M.D. I am proud to call Wendy my friend, and I am grateful for her mentoring. Without Wendy’s thoughtful suggestions and encouraging words, Taking Charge: Good Medical Care for the Elderly and How to Get It would not exist. Wendy read the manuscript twice. She helped me “find my voice” as an advocate and she encouraged me every step of the way.

Wendy is an amazing woman. She was a young internist with a thriving private practice when she was diagnosed in 1990 with non-Hodgkin's lymphoma. Her children were 1, 3, and 5. While going through chemotherapy, she was amazed by and grateful for all she was learning about life on the other side of the stethoscope. From her useful perspective as physician-patient, she wrote a manuscript to guide patients through diagnosis, evaluation and treatment. WW Norton, a major publisher, offered Wendy a contract two days after she sent them the manuscript. Now in its third edition, it is entitled, Diagnosis Cancer: Your Guide Through the First Few Months of Healthy Survivorship.

Speak up and prevent health care errors

Caring at Home has published a valuable article about how seniors can help prevent serious medical errors by paying attention and speaking up when they have questions about their care or the medications prescribed for them.

You can read and reprint this article here.

"To Prevent Health Care Errors, Patients are Urged to SPEAK UP"

Palliative Care & End-of-Life Care articles available

Three articles in the current Annals of Internal Medicine provide useful information about palliative and end-of-life care. A helpful table is included with each article to help caregivers manage decision-making. Although written for doctors, many family caregivers will find this information useful.

Rosalyn Carter's message about caregiving

I'd like to share with you today, a wonderful message from Rosalyn Carter about caregiving. Our former First Lady has been actively involved in caregiving for a long, long time. The Rosalyn Carter Institute provides a wide variety of valuable resources for family caregivers and for professional caregivers.

Mrs. Carter writes:

"My interest in caregiving goes back to my childhood. I was deeply influenced by how chronic illness affected and shaped my family and by the heroic and selfless efforts of health care providers, including Jimmy’s mother, Lillian Carter.

                                                                          * * *
In fact, the backbone of our country’s long-term, home-based, and community-based care systems is the family caregiver. The approximately 15 million caregivers in the United States provide $306 billion worth of unpaid services each year. That amount is almost twice as much as is spent on homecare and nursing home services combined ($158 billion).

                                                                          * * * 

But the strains on our society and on these individuals as a result of providing care are becoming apparent. To read more, click here.

Commonly prescribed drugs cause most adverse drug events in elders

When I began my research to learn what had caused the death of my mother only 65 days after she had been diagnosed with a simple urinary tract infection, one of my first goals was to learn whether an antipsychotic medication that had been prescribed for her could possibly be linked to her death. I learned that this drug was frequently used in nursing homes to control “behavior problems,” that the drug was intended for use with schizophrenics and that use in the elderly was “off-label” – meaning that the FDA had not approved the drug for that use.

I also learned that research linked use of antipsychotics in the elderly with unacceptable risk of harm to the elderly. In fact, the FDA has since issued a public health advisory to alert health care providers, patients, and patient caregivers to new safety information concerning an unapproved (i.e., “off-label”) use of certain drugs called “atypical antipsychotic drugs.” No research has demonstrated that antipsychotics are effective in “treating” behavioral problems in the elderly. The side effects of antipsychotics make them particularly dangerous to the elderly. These side effects include anorexia, drowsiness, dizziness, and dangerous “extrapyramidal side effects” such as dystonia (Involuntary movements and prolonged muscle contraction resulting in twisting body motions, tremor, and abnormal posture), Parkinsonism (motor stiffness, difficulty initiating movements, shuffling, stiff gait, resting tremors, and reduced facial movements), and others. EPSs can be life-threatening.

Do not resuscitate orders | A family's dilemma

The Boston Globe today (December 3, 2007) explores the complicated subject to DNR orders -- do not resuscitate orders. When are they appropriate? What if the elderly patient waits too long? What decisions must be made and how can they be made?

The problem is, says the Globe's writer Patricia Wen, many families aren't sure about how to discuss this difficult subject. Often they wait too long, and by the time it's obvious that this decision needs to be made, the elderly loved one is not mentally competent to execute the required documents.

My book Taking Charge: Good Medical Care for the Elderly and How to Get It, discusses end-of-life decisions, the Five Wishes (called by the Miami Herald "the Living Will with a Heart"), and how and when to have this difficult conversation with your elderly loved one.

The Boston Globe article, by Patricia Wen may be read here:

For many, 'Do Not Resuscitate' too painful to discuss
Relatives, doctors often delay in offering patients the option

More from the Hartford Courant - Understaffing

The Hartford Courant ran the second of a three-part series today (November 20th) on one of those multi-corporation, tiered nursing homes where the goal is to insulate from liability for harm that befalls the residents through neglect. According to the Courant, the minimum staffing requirements haven't changed in 25 years even though currant research shows serious understaffing in nursing home and shows that this can lead to disastrous results.

The topic this time is understaffing and how this leads to neglect of residents and serious harm or death.  Today, the Courant said:

"For four days in April, Bogardus and his close friend, Leona Brenner, tried to convince the staff of the Haven Health Center in South Windsor that he was dying. Bogardus, who had sought nursing-home care after complications from heart surgery, was coughing, struggling to breathe and couldn't walk the six steps from his bed to the bathroom, he and Brenner said.

Only after Brenner threatened to call 911 herself did the nursing staff finally summon an ambulance, the couple recounted. By the time the 69-year-old retired civil engineer arrived at St. Francis Hospital and Medical Center in Hartford, hospital records show, he was dehydrated and his kidneys were failing." More

Dehydration, malnutrition, and falls in nursing homes

From the Hartford Courant on November 19, 2007 comes an indepth expose of nursing homes operated by Haven Heathcare, which owns 25 nursing homes -- 15 in Connecticut and 10 in other New England states. The article cites a litany of deaths caused by neglect of the nursing home staff and/or understaffing leading to resident harm.

What good is oversight when nursing homes are fined only a few hundred dollars where a resident dies of dehydration after the home has been cited for violations numerous times, has been made to come up with a plan for correcting the deficiencies leading to harm, but continues to neglect its residents?

The Courant also notes that these nursing homes are owned by limited liability corporations in a maze of three and four-tiered structure, such as the New York Times exposed earlier this year. [See Choosing a good nursing home for your loved one, September 23, 2007] Families can spend a year or more suing a nursing home to recover damages for the needless death of their loved one only to learn that they sued the wrong corporation.

See No Haven for the Elderly: Nursing Home Troubles Show Lack of State Oversight.

Stronger FDA warnings for Procrit, Epogen, & Aranesp

Additional boxed warnings and label updates for the erythropoiesis-stimulating agents Aranesp, Epogen, and Procrit have been approved by the FDA. Ths issue causing the new warnings relate to drugs dosages that raise hemoglobin levels over 12 g/dL.

Research shows these high dosages stimulated tumor growth and decreased survival in patients with certain cancers: advanced breast, head and neck, lymphoid, and non-small cell lung cancer. It is important to note that researchers have not ruled out higher mortality and tumor progression when hemoglobin rates are raised to levels under 12 g/dL.

Chronic renal failure patients taking these drugs in order to keep hemoglobin levels over 12 g/dL are at increased risk for death, stroke, heart attack, and heart failure. For these patients, the FDA in recommending that hemoglobin levels be maintained between 10 and 12 g/dL.

FDA press release (Free)

Earlier Blog articles related to initial FDA warning, dosing change for erythropoietin

Technorati Tags: Amgen, Epogen, Aranesp

Patients & caregivers as partners in care

Jim Conway, chairman of The Partnership for Healthcare Excellence and senior vice president of the Institute for Healthcare Improvement was a featured Op-Ed writer in the Boston Globe on October 29, 2007.

Conway advocates for partnerships between patients, their advocates and the healthcare system. These key points are part of his important message:

Informed, empowered, and engaged patients are key to preventing medical errors and improving the quality of healthcare

Patients who view themselves as partners in their care

• seek doctors and hospitals who provide quality of care
• are empowered to ask more questions about their conditions and to more accurately describe their symptoms
• are better able to comply with treatment regimens because they understand them

What keeps patients from being actively involved in their treatment decisions? Conway says that evidence indicates it’s a lack of knowledge. He says that his partnership is working to empower patients and caregivers by providing them with information on crucial topics such as medication safety, how to choose a doctor or hospital, how to make the most of doctor or hospital visits, etc.

You may read Conway’s editorial, Partnering for better care here.

Medicare audits reveal problems with insurers

The New York Times reported on October 7, 2007 that federal audits of insurance companies selling Medicare drug coverage to seniors reveal that “tens of thousands of Medicare recipients have been victims of deceptive sales tactics.” The Times said that many private insurers also improperly denied claims. In fact, Medicare has levied fines of over $770,000 on 11 companies. Among those fined are three that control a hefty portion of the Medicare supplemental insurance market, UnitedHealth, Humana and WellPoint.

Medicare cited two major concerns about the insurers. These were marketing abuses and failure to implement procedures to allow for proper handling of claims and appeals.

The information revealed by the Times might help you choose a supplemental insurance carrier.

You can read the New York Times article here: Medicare Audits Show Problems in Private Plans. A one-time registration may be required.

Technorati tags: Medicare, health care, medicare part d

Health Vault - online medical records

Is this what we've been waiting for? Continuity of care is enhanced when consumers' medical team has access to a broad health record of patients. Microsoft announced on October 4, 2007 a free online service where folks can store their personal health records. Called HealthVault, this is an online project based upon two years of collaboration with partners Johnson & Johnson, the American Heart Association, the Mayo Clinic, and numerous hospitals. Of course, privacy is a huge issue. According to the New York Times, each individual putting his or her health information online will do so in secure, encrypted files. The individual is in charge of setting the privacy controls and can decide what information goes into the files and who can have access to it. Take a look and judge for yourself. Microsoft HealthVault can be accessed at www.healthvault.com

Read the New York Times article, Microsoft Offers System to Track Health Records.

Take a look and judge for yourself. Microsoft HealthVault can be accessed at www.healthvault.com

Read the New York Times article, Microsoft Offers System to Track Health Records.

Technorati tags:health vault, online medical records

Baby Boomers ambivalent about longevity in parents

Today, it's not unusual for Americans to live to be 90 or even 100. Problems occur when the elderly outlive their savings. Sometimes elderly parents own their own home and a reverse mortgage can help them stay there.

And now about the Baby Boomers -- one quarter of the US population. These folks are accustomed to the idea that their parents might bail them out from time to time, contribute to a down payment on a home, etc. And last, but not least, leave them an inheritance.

Well, it's not happening. Longevity means eating into capital. Not everyone is a Rockefeller. How do baby boomers feel about their parents spending what they'd counted on as an inheritance.\?

Read Hey Folks, You're Spending My Inheritance in the Fall 2007 issue of Dissent Magazine.

Choosing a good nursing home for your loved one

Charles Duhigg reports in the New York Times Health section on September 23, 2007 that private investors have purchased groups of nursing homes, reduced staff (often below minimum requirements), and cut other expenses. As a result, profits for the owners have increased, but quality of care is down, mobility and health of nursing home residents is compromised, and complaints to regulatory agencies are higher.

Families of patients who have died as a result of alleged negligence in such nursing homes increasingly find that complex corporate structures are like mazes and act to insulate the real owners of the facilities from any negligence that might be proven.

Read More Profit and Less Nursing at Many Homes

For help in choosing a safe nursing home for your loved one, see the resources in Appendix A of Good Medical Care for the Elderly and How to Get It. This and other appendices are online and yours to use without charge.

Cancer | The challenges of getting good care

The challenges patients face in ensuring the best possible treatment for cancer is the topic of an extraordinary article in the July 30, 2007 issue of the New York Times.

The Times explores the complicated decisions patients must make regarding their treatment and care. According to the Times, cancer patients are often "lost in a maze of uneven care." a case history of a young mother diagnosed with colon cancer shows that even for the most educated patients, it is difficult to find the right doctors and to ensure proper care and treatment.

An estimated 15% to 25% of female breast cancer patients do not receive radiation that would increase their survivorship. 20% to 30% don't take anti-estrogen drugs. Lack of prescription drug coverage, fear of side effects, or lack of necessary information leads to inadequate care. Insurance coverage greatly affects access to screening for colon cancer because the cost of a colonoscopy is so high, thus only half the patients who need this critical procedure get it.

Inadequate care is often received by patients residing in rural areas or small cities, and also by the poor since they are often seen by physicians who don't treat enough patients to justify continuing medical education that would keep their skills abreast of new developments. Another barrier to good medical care is the inability or failure of many patients to seek a second opinion. Lack of education and skills to advocate for themselves means that many patients are unable to find the kind of specialized care they need.

The American College of Surgeons and the National Comprehensive Cancer Network have developed and issued treatment guidelines for various cancers, which may help some patients advocate for better care and treatment.

Cancer Patients, Lost in a Maze of Uneven Care by Denise Grady is a must read article.

Additional resources are included. See also Doing Battle with the Insurance Company in a Fight to Stay Alive and Push Hard for the Answers You Require. Numerous valuable resources for cancer patients are included in these articles.

See also National Comprehensive Cancer Network treatment guidelines (Free)

Technorati tags: cancer treatment, cancer diagnosis, cancer clinical trials

Saving money on prescription medications

Recently, I’ve been exploring Medicare and prescription drug issues. I’ve posted on my blog an article about prescription assistance programs run by drug companies. If you or your loved one are unable to get help from these programs, here’s another way to save money on prescription medications.

Walmart began a program to sell certain generic prescription drugs at the highly discounted price of $4 for a 30-day supply in early October 2006. By the end of 2006, Walmart had expanded this program to all states but one. This includes stores in the Walmart chain (Wal-Mart, Neighborhood Market and Sam’s Club).

Target soon jumped on the bandwagon and began its own $4 generic medication program. It’s easy to see why. Even if a person can’t fill all of his or her prescriptions in this low-cost program, once someone changes pharmacies, it makes sense that they will continue to fill and re-fill prescriptions all in one place.

Heart attacks | No. 1 killer

Victims of heart attacks often make crucial mistakes that can critically affect their survival and their recovery. One of the most frequent mistakes is not calling 911 and arranging transportation by ambulance to the hospital. Another is not adhering to medication regimens prescribed by a doctor to decrease the potential for heart attacks. Some people refuse medications. Other people start to feel better and stop taking medications that their doctors have prescribed.

Doctors are able, if a heart attack victim arrives quickly at a hospital, to use treatments and techniques that will open clogged arteries, preserve heart muscle, minimize the amount of heart damage caused by the heart attack, and prescribe medications that reduce the risk of a future heart attack by treating conditions such as high cholesterol that put people at risk.

Watch the New York Times online video” Heart Disease No. 1 Killer” in which a doctor and heart attack victim discuss the dos and don’ts for those who suffer a heart attack. A one-time registration may be required.

Read, in addition, a New York Times article, "Lessons of Heart Disease, Learned and Ignored"
By Gina Kolata,published on April 8, 2007. A one-time registration may be required.

Critical facts about heart attack treatment and prevention

Victims of heart attacks often make crucial mistakes that can critically affect their survival and their recovery. One of the most frequent mistakes is not calling 911 and arranging transportation by ambulance to the hospital. Another is not adhering to medication regimens prescribed by a doctor to decrease the potential for heart attacks. Some people refuse medications. Other people start to feel better and stop taking medications that their doctors have prescribed.

Doctors are able, if a heart attack victim arrives quickly at a hospital, to use treatments and techniques that will open clogged arteries, preserve heart muscle, minimize the amount of heart damage caused by the heart attack, and prescribe medications that reduce the risk of a future heart attack by treating conditions such as high cholesterol that put people at risk.

Watch the New York Times online video "Heart Disease No. 1 Killer" in which a doctor and heart attack victim discuss the dos and don’ts for those who suffer a heart attack. A one-time registration may be required.

Read: "Lessons of Heart Disease, Learned and Ignored" by Gina Kolata, published on April 8, 2007 in the New York Times. A one-time registration may be required.

What you should know about strokes

You can access an online video at the New York Times website that discusses the risk factors for stroke and the importance of recognizing symptoms of stroke and getting promptly to the hospital. TPA administered within 3 hours of the onset of an ischemic stroke can vastly increase a person’s chances for a good recovery. This is part of the New York Times’ Health sections archives of valuable health materials. A one-time registration may be required.

Crucial Facts About Stroke | One of the Nation’s Top Killers

Stroke: The importance of getting to an ER quickly

A report prepared by the Morbidity and Mortality Weekly Report (MMWR) Series for the Centers for Disease Control and Prevention (CDC) states that less than one half of the victims of stroke (of the patients for whom data about the time of the onset of stroke was collected) presented to an emergency room in time to obtain optimal treatment.

To avoid potential for death and significant disability, ischemic stroke patients should receive the most effective treatment—intravenous t-PA therapy, as soon as possible after diagnosis and determination of eligibility. This therapy must be given within 3 hours of the onset of symptoms. The report indicated that fewer than half of the patients arrived at the emergency room within 2 hours of symptom onset. Of those patients arriving within 2 hours of onset, only 2/3 received brain imaging within 1 hour of their arrival.

Arrival at the ER by ambulance was tied to a significantly shorter wait time for brain imaging—i.e., to quicker diagnosis and ordering of the life-saving treatment. According to the report, however, approximately half of the patients in the registry population arrived by ambulance.

New concerns raised about anti-anemia drugs

New concerns are raised today by the New York Times’ lead story. According to reports, Amgen and Johnson & Johnson, two of the world’s largest drug companies, are rebating hundreds of millions of dollars to doctors every year to reimburse a portion of the doctors’ expenditures for anemia medicines administered in the doctors’ offices. The drugs— Aranesp and Epogen, manufactured by Amgen; and Procrit, made by Johnson & Johnson — often referred to as EPO, are among top-selling drugs world-wide. Amgen and Johnson & Johnson sold about $10 billion worth last year. Medicare pays more for these drugs than any other class of drugs.

The drugs are commonly prescribed to treat anemia in patients with kidney disease or cancer caused by chemotherapy. Reports in March 2007 revealed that Americans who receive the drugs in dialysis centers, where they is typically administered intravenously, receive much higher dosages than is required if the drugs are administered by injection. This is cause for much concern because studies earlier this year have linked use of the use of EPO to higher risk of heart attacks and strokes. The FDA issued warnings after that study was released.

New report criticizes government oversight of nursing homes

The New York Times revealed on April 21, 2007 that the Government Accountability Office (GAO) will release a report this week about the failure of federal health officials charged with oversight of nursing home regulations to impose penalties upon nursing homes repeatedly cited for “poor quality of care.” The net result is that nursing homes that should have been closed remain open and residents of those nursing homes continue to be abused.

The report notes that federal investigators found that a Michigan nursing home (unidentified) was still open even though it had repeatedly been cited for “poor quality care,” poor nutrition services, medication errors and employing people who had been convicted of abusing patients.

The US has about 16,400 nursing homes in which about 1.5 million people live on any given day. Annually, more than 3 million people receive nursing-home care. Medicaid and Medicare pay for more than two-thirds of this care. The cost is significant. In 2005, the most recent year for which figures are available, $122 billion was spent on nursing home care. 60% of that was paid for by Medicaid and Medicare.

I’ll be watching for this report and will post a link to it when it is released.

Read the NY Times article Oversight of Nursing Homes is Criticized

Technorati tags: caregiving, caregiver, family caregiver, nursing homes, nursing home, GAO, Government Accountability Office,

Should family caregivers be paid?

An article from Reuters published in the April 21, 2007 edition of The Washington Post poses this question: Should families pay the dutiful daughter or son who steps up to be an aging parent's primary caregiver?

Experts in the field of eldercare suggest there are good reasons why families should work out formalized agreements so that the family member shouldering the greatest care-giving burden is paid. To avoid hard feelings or disagreements later, it’s important for families to sit down, figure out what’s best for their aging parent, and perhaps put their agreement in writing.

Sometimes this care-planning is done as part of overall estate-planning. Some families transfer money out of an aging parent's name to help the parent more easily qualify for Medicaid if nursing-home care becomes necessary. Some states, Arkansas, California, Oregon and Washington, for example, have initiated programs that pay families to provide care so that seniors can remain at home. Home care is still less expensive than nursing home care. Some long-term care insurance polices will pay for home care also.

The article provides some helpful advice and can be the first step that helps families plan for the future. You can read “Compensating family caregivers” here.

Technorati tags: caregiving, caregiver, family caregiver, aging parents, aging, baby boomer, baby boomers, sandwich generation

More on the anti-anemia drug story

According to an article in the Boston Globe today, the higher dosing of the expensive antianemia drug Epogen occurs more frequently at for-profit dialysis chains in the United States than at nonprofit clinics. A study, to be published today in the Journal of the American Medical Association says tht in many cases,
the larger doses boost red blood cell levels beyond what is recommended by the Food and Drug Administration, the study said.

In earlier reports, this higher dosing was linked to an increase in heart attacks and strokes. According to the Globe, "he article suggests the increased use of Epogen is the result of financial incentives built into the federal Medicare reimbursement rate for the drug, and volume discounts offered by its manufacturer, Amgen Inc. , of Thousand Oaks, Calif."

Read the Bloston Globe article here:

Earlier reports are found in these articles in this Blog's archives:

Who's Taking Care of your Kidneys
March 20, 2007

Black Box Warnings for Procrit, Epogen & Aranesp
March 10, 2007

Amgen discloses risks in 'off-label' use February 2, 2007

Doctors warn about overuse of anti-anemia drugs
November 8, 2006

Technorati Tags: Amgen, Epogen, Aranesp

Who are those guys in the white coats?

In the Boston Globe, on April 10, 2007, Reporter Liz Lowalczyk writes about the significance of the while costs in training hospitals that are associated with medical school. The public is usually aware that those folks in the white coats are different—some are doctors and some are residents, interns, or medical students. But how many of us knew that there might be a way to tell the difference. White coats certainly signify that the wearer is a medical professional. But look closer, and you will notice that not all white coats are alike.

There are long coats, and there are short coats. And who wears what is sometimes a sign of their position within a hospital's hierarchy. Read more in the Boston Globe.

Merck announces plans for new Vioxx-like drug

The Boston Globe reported on March 30, 2007 that Merck is scheduled to appear before the FDA to seek approval for a new painkiller “that is just like Vioxx,” the drug Merck was forced with withdraw from the market in 2004 when research proved that it increased the risk of heart attacks substantially. Just so you know, the new drug is called Arcoxia. While some analysts doubt that the FDA will approve the drug, others are skeptical about the FDA. Legislation is pending that seeks to avoid another Vioxx mess by limiting the type of advertising that can be done with new drugs and to limit the number of doctors who can prescribe them when safety concerns arise after the FDA has already approved a drug.

You can read the entire Globe article here.

Technorati tags: Merck, vioxx, fda, drug safety

Living with Alzheimer's

On March 29, 2007, the New York Times published an article about “early Alzheimer’s” disease. The article—Living with Alzheimer’s before a Window Closes—describes this as a period “when short-term memory is patchy, organizational skills fail, attention wanders and initiative comes and goes. But there is still a window of opportunity — maybe one year, maybe five — to reason, communicate and go about [one’s] life with a bit of help from [others.]”

A recent study done by the Alzheimer’s Association reveals that about 5 million Americans have Alzheimer’s and that about half of them are still in the early stages. The New York Times article discusses coping methods and also contains lots of resources for caregivers.

Boston Globe: Preventing cures that also kill

An editorial in the March 27, 2007 Boston Globe decries the ineffectiveness of the FDA in overseeing the drug industry and in protecting US citizens from dangerous drugs.

In "Preventing Cures that also Kill," the editorialist states:

"The arthritis painkiller Vioxx leads a rogues' gallery of drugs that have made it to market without sufficient testing, causing cardiovascular problems long after alarm bells began to go off. It is one dramatic example of how the Food and Drug Administration has failed in its mission. It approves too many drugs and medical devices without a close enough review, and then acts too slowly when evidence mounts of problems with new drugs or devices after they are in the market."

Financial ties between drug companies and doctors who have a substantial financial interest in a company introducing a new drug or device have been under scrutiny lately. Pending changed in FDA regulations seeks to limit the advisory input from doctors with a conflict of interest / financial stake in the drug commpaines.

See related content here: Taking Back the FDA, an Op-Ed piece in the Globe published on February 26, 2007.

Technorati tags: vioxx , merck , vioxx recall