Who is listening to mom & dad?

I watched my dad and parent-in-laws grow old and it is now my turn to care for them. Well, in a modified way. They are still very independent. What I have noticed over the years is the ever increasing number of stories they tell. Many are repeats, but they have a sense of joy each time they tell their story. A joy as if it were the first time they recited it. But my thoughts go out to the many elderly parents in nursing homes and assisted living facilities. Some too frail to talk, others disengaged. For those who can vocalize their life stories, who is listening?

The real question is, are our parents given the opportunity to speak their life stories? What we have failed to notice, as a society, is the therapeutic effect of simple actions. Simple actions such as person centered social engagement can have a profound effect on a person. An effect that could be the difference between taking an antidepressant regimen or not. Non-pharmacological interventions have long been my favorite topic of discussion. Adding new interventions to my list is just as rewarding. Personal experience life stories ignite youth and happiness. Why not allow people to share them, verbally or written? A picture may be worth a thousand words, but a thousand words may be worth a lifetime. Let’s make a difference!

Antimicrobial Stewardship

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Nursing homes are preparing for Antimicrobial Stewardship to be incorporated to their infection prevention and control processes. The purpose is to ensure antibiotics are used appropriately and safely. Avoiding adverse reactions and preventing bug resistance is a positive outcome. Patients should know the facts when it comes to antibiotic use. Don’t be afraid to ask questions.

Which would you select? A cruise or a nursing home?

I came across this video on social media. What an interesting concept. I have never been on a cruise and I do not know what the cost would be to continuously live on a cruise ship in place of a nursing home. Of course this concept is interesting if you do not need continuous clinical care. But then again, why would you be in a nursing home at that point? Maybe the author meant to compare it to a Assisted Living??? In either case the concept of vacationing with clinical care is interesting. Maybe this could be the nursing home of the future? Hmmmmmmm……….

video link

 

Can the mind heal the body?

I read an article in the Wall Street Journal this week on why placebos really work. It indicated that new studies of placebo use found the brain, through neurobiological effects, releases  neuromodulators that reduce the symptoms of the illness or disease state. It also found that placebos work along the same pathway as the pharmacological agents. The directors of the study are from Beth Israel Deaconess Medical Center in Boston and a professor at Harvard Medical School.

If this is true then we may be able to significantly reduce the cost of healthcare with a sugar pill (as long as they’re not diabetic). Unfortunately, I don’t see physicians adopting this new way of treating any time soon.  It will probably take more studies and many years to support a change in treatment guidelines. A change that academia will have to adopt but one the drug companies will try to block.

CASPER 2016 data

CASPER is Certification And Survey Provider Enhanced Reporting. It is the data collected by surveyors during the nursing homes annual certification inspection.

New York State had 56.9% of the residents on a psychoactive medication. The following is the breakdown by category:

  • Antipsychotic 19.4%
  • Antianxiety 14%
  • Antidepressant 41.5%
  • Hypnotic 3%

In comparison to 2015 all categories decreased except for Antidepressant . To see the entire 2016 report by state click here . How does your facility compare to the rest of the state?

How much is your health worth?

The cost of medications keeps rising at astronomical rates. Drug companies are raising their prices up to 2000% plus. Insurance companies are then forced to raise their rates and you get stuck with the bill. And if that isn’t enough we now have clinical trials that support combination medication regimens as more effective. The latest coming from the  Wall Street Journal article on combination drug therapies for cancer. Drug manufacturers are co-marketing these combinations. Many regimens run in the six digit range.

Healthcare has become a business and the government is not doing a lot to curtail it, so isn’t it about time that we focus on prevention? Lets take a good look at a few countries and their cultures.  What is it about their lifestyle that leads to good health? Sardinia, Italy; Ikaria, Greece; Okinawa, Japan; Loma Linda, California; Nicoya Peninsula, Costa Rica are a few that have the oldest and healthiest people.

What habits do we need to change? How do we change them?

Answering these questions will lead us down the path to good health. It may take more effort and time but it would cost a lot less. It is up to each and every one of us to change the business of healthcare.

Closeup Money rolled up with pills falling out, high cost, expensive healthcare
Get healthy so we can stop giving them business.

 

A new way to look at pain

According to the medical examiner’s report, the autopsy found that  the pop star Prince died of an overdose of the opioid fentanyl. As we find ourselves amidst an opioid overdose epidemic, we need to question our approach to pain treatment.

For many years, we were taught to see pain as the 5th vital sign, (with blood pressure, temperature, pulse and respiration being the other four). I can’t help but wonder if we overdid it. No one should live with pain, but pain is perceived differently by everyone. While some people have a high pain tolerance and can get by with non-pharmacological interventions, others need medical interventions. Do we assess pain tolerance? Commonly, we ask the patient to assess the pain themselves by pointing to a face on a wall chart that matches how they feel. So if we are not assessing pain tolerance how do we prescribe a pain regimen? How do we determine what tapering schedule is adequate? Do we have a tapering protocol based on specific pain states?

The DEA and CDC among many organizations are implementing programs to help combat the opioid overdose epidemic by calling in many healthcare professionals. What about psychologist and the use of mental health to assist in the treatment of pain? Can this be a piece of the puzzle?

According to the DEA there were 2000 opioid deaths since the pop stars death. Regardless of how many interventions we implement, we can all agree that urgency is paramount.