Discharge Planning - getting home and staying safe

  

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Discharge planning is a complex process that each patient must go through. The goal of this transition is to send patients home safely and to ensure patients stay healthy.  At the time of discharge, the patient should be provided with a document that includes language and literacy-appropriate instructions and patient education materials to help in successful transition from the hospital.  But the statistics demonstrate that this transition is not always successful.

Among Medicare patients, however almost 20 percent who are discharged from a hospital are readmitted within 30 days. The Joint Commission has provided guidelines for discharge so that these sorts of events don’t occur.

Discharge planning is fraught with challenges.  While the exact number of avoidable readmissions is unknown, between 9 and 50 percent of readmissions were judged to be preventable in studies involving retrospective chart review.  Research has demonstrated that in the long term, patients who are readmitted to the hospital within the 30 days have a longer and more difficult time getting healthy again.

Discharge information, both written and verbal, should be reviewed with the patient/family caregivers with an emphasis on assessing and ensuring comprehension. However, the pace in US hospitals today means this step is often rushed; leaving patients, caregivers and family members with their heads spinning and with a weighty responsibility on their hands. 

Because of climbing readmission rate, patients are relying more and more on private nursing care in the home.  Nursing care has been shown to reduce anxiety in patients, reduce medication errors and keep patients at home and safe. The Joint Commission has also published that home is the healthiest place for a patient to be.

It makes sense in this current healthcare climate to be as active in your healthcare management as possible. In New England, Hotelrecovery is one of the most successful private nursing care programs.  Regardless of what our client’s needs are or where they wish to recover, Hotelrecovery will build a personalized, detailed and comprehensive care plan that exceeds their expectations.

Alzheimer’s Harder to Detect in Elderly

  

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A new study suggests that symptoms of Alzheimer’s may be harder to detect in patients over the age of 80. The study tested the relationship between age-related brain shrinkage and Alzheimer’s correlated memory loss. It used just over 100 Alzheimer’s patients and 125 dementia-free people who were grouped by age.

These participants then underwent a series of brain tests with scans that looked at attention, information processing speed and memory.

“People in both groups had similar levels of overall cognitive impairment, but the pattern of changes associated with Alzheimer's disease seemed to be less noticeable in very-old patients than in the young-old”[1].

Compared to other younger patients, the immediate memory and processing speed in very old Alzheimer’s patients was less abnormal indicating that it may be harder to diagnose. 

The study also demonstrated that 80+ Alzheimer’s patients had less thinning of certain areas of the cerebral cortex and cerebellum than the younger patients. This also supports the “hard to diagnose” conclusion because thickness of these brain areas decreases in everyone with age so the differences aren’t as noticeable.

Antidepressants Not Better than Placebo for Alzheimer’s

  

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A new study revealed that two commonly prescribed antidepressants for dementia patients are not better than a sugar pill for reducing depression symptoms in Alzheimer’s patients.

This study published in the Lancet tested Zoloft (sertraline) and Remeron (mirtazapine), which are both generic antidepressants that have generated more severe side effects than placebo. These side effects have led researchers to suggest that these types of medicine should be only used in dementia patients who cannot be treated in a simpler fashion.

The study only tested around 300 patients but was still the largest placebo-controlled trial to date on antidepressants in dementia patients.

More than one-fifth of the 35 million people around the world who have dementia have also been linked with depression symptoms, making this study immensely important. “Alan Manevitz, M.D., a psychiatrist at Lenox Hill Hospital, in New York City, agrees with the authors' conclusion that doctors should consider nondrug treatments before prescribing antidepressants to depressed dementia patients”[1]. 

This study is a key step forward yet it is surely not a final statement on the subject. It was a bit small and the findings weren’t diverse enough to apply to a large population of patients. Hopefully more progress will be made on this issue in the future.

Progress with Blood Tests for Alzheimer’s

  

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Scientists are getting closer and closer to a critical milestone in diagnosing Alzheimer’s patients. They are extremely close to succeeding at creating a blood test to screen people for the disease.

Currently, Alzheimer’s is diagnosed only after people start having memory problems or unexpected change in behavior. They then undergo an in-depth medical interview, a memory assessment test and occasionally an MRI to look for brain shrinkage. The problem is that these processes are overly expensive and impractical for routine use.

That’s why two recent studies are being hailed around the medical world as a large step forward in Alzheimer’s research. Australian researchers reported a few weeks ago that their blood tests showed more accuracy than ever seen before when tested with over 1000 patients. “The test correctly identified 83 percent of people with high amyloid levels and correctly ruled out 85 percent of people without this condition”[1].

The other study used blood tests to screen for autoantibodies (special markers in blood) and showed even better experimental results. “The blood test correctly detected Alzheimer's disease in people already diagnosed with the devastating brain disorder with 96 percent accuracy, according to the researchers. The test could also distinguish who didn't have the disease from a control group of non-affected adults with 92.5 percent accuracy”[2]. 

This research is a huge step forward but the scientists cautioned spectators saying that there is still a long way to go. Let’s hope that future studies like these continue to show as exciting and ground-breaking results.

Exercise Keeps the Brain Strong

  

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A few weeks ago, we blogged about how exercise not only is crucial to maintain a healthy and fit body but also can play an important role in reducing anxiety. Today new studies reveal that exercise may also be vital to keeping your mind strong and preventing memory loss and brain disease.

The most encouraging study, by Canadian researchers, concludes that even modest activity had a significant effect on brain function as the years progressed. The study measured the energy expenditure and cognitive functioning of a large group of seniors over five years and discovered that 90% of the people who exercised could think and remember perfectly for a longer time.

Laura Middleton, an associate professor at the University of Waterloo in Ontario and lead author of the study, said that their “results indicate that vigorous exercise isn’t necessary” to protect your mind[1]. All you need are simple activities like walking the dog or gardening on a regular basis to keep your mind fit and healthy.

A similar study of women in their 70s with vascular disease came to the same conclusion as there was a decreasing rate of cognitive decline among the more active group. Dr. Eric Larson, the vice president of research at Group Health Research Institute said “if we can push out the onset of dementia by 5, 10 or more years, that changes the dynamics of aging” and he was hopeful that exercise can be the solution. Now all that’s needed is to find a way to get everybody active and moving.

How to Feel Younger

  

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Everyone wants to feel younger. Whether it’s to help deal with that aching back, constant tiredness or diet, these solutions have been coveted for generations. Use these simple tips to help you feel a lot younger:

Go to bed earlier – getting adequate amounts of sleep is one of the best ways to feel younger fast. Henry Lodge (MD and co-author of “Younger Next Year for Women”) calls sleep “the only time your body can truly restore itself…it helps build a more vibrant body and brain”[1]. It’s very likely you aren’t currently getting enough sleep. It is recommended that adults get 7-8 hours of sleep a night. Try to get to this number for six weeks straight and you’ll feel the energy difference.

Eat healthier, revitalizing food – Try to have something healthy at the start of every meal. It can be simple like a big glass or water or your favorite fruit. But by increasing your vitamin and antioxidant intake you will feel refreshed and recharged all the time.

Go to the gym – A good, regular gym workout can help you feel 10-20 years younger. This is because a good workout involving weights causes micro-tears in your muscles which then allow your body to create thicker, stronger muscle fibers. Working out will also increase your stamina and reduce your risk of injuries during everyday activities.

Freestyle a bit – your brain and body love variety so you need to stimulate that to help create that sense of novelty that you had when you learned something new as a child. These don’t have to be drastic changes every day. They can be as simple as trying out a different workout machine at the gym or getting a different coffee in the morning. 

Try these tips and you’ll be making the right steps toward feeling 25 again.

Seniors at High Risk in Heat

  

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With the so called “Heat Dome” affecting much of the continental United States, it seemed like a prudent time to write about being safe and keeping cool outside. The Heat Dome is “a perfect storm of sizzling summer weather exacerbated by relatively cloudless skies and the higher angle of the sun in the summer”[1]. This has caused the entire continental US to face a huge heat wave that has already broken 221 records across the country.

With this increased heat, experts at the US National Institute on Aging recently stated that the risk of heat-related illness increases with age. As people get older, their bodies are less able to adapt to increased temperatures which can exacerbate their pre-existing conditions. Furthermore, medications that seniors take may also cause dehydration or decrease their body’s ability to respond to heat.

Once the body reaches 104 degrees Fahrenheit, a heat stroke may occur which can be deadly. Signs that indicate this has occurred include “a strong, rapid pulse; lack of sweating; dry flushed skin; faintness; staggering; and mental status changes, such as confusion, combativeness, disorientation or even coma”[2].

Researchers strongly cautioned seniors to avoid the heat as much as possible by staying inside with air conditioning as much as possible. However, if someone is suffering from a heat-related illness the following steps should be taken:

- Call 911 immediately

- Move them into air conditioning or another cool place

- Urge them to lie down and rest

- Remove or loosen tight-fitting or heavy clothing

- Encourage them to drink water or juices if they are able to drink, but avoid alcohol and caffeine

- Apply cold water or cold compresses to their skin[3]

Dementia: Can Painkillers Help Recovery?

  

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Dementia is a reduction in brain function that occurs with certain diseases such as Alzheimer’s. It adversely affects memory, thinking, language, judgment, and behavior[1]. Alzheimer’s is extremely common as it affects 13% of people over 65 and 50% over 85 years old. Extreme agitation and aggression are commonalities in patients with advanced dementia and can create extreme stress for loved ones as well as medical practitioners. These facts make new research increasingly important in the fight to help as many people as possible.

A new study concludes that ordinary painkillers may work more effectively than antipsychotic drugs to calm agitation in dementia patients. Normally, powerful antipsychotics are the primary medications prescribed but this treatment can cause strokes and even death. This new study led by Dag Aarsland treated over 300 patients with one of four different medications. 

The patients treated with ordinary painkillers such as paracetemol showed a marked improvement leading researchers to conclude that “the intervention produced a clinically and statistically significant reduction in agitation and pain”[2]. The scientists urged more studies to confirm their results but this definitely opens the door to newer and simpler treatments for dementia patients. Hopefully this is another key step in the path to helping every patient in their recovery.

Alzheimer’s and its Connection to General Health

  

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Previous articles both on this blog and other sources have indicated that genetics and age are the primary factors that contribute to Alzheimer’s and dementia but new studies show that there are other more surprising indicators as well.

The author of the study, Kenneth Rockwood concluded that “keeping up with your general health may help reduce the risk for dementia”[1]. The study followed over 7,000 people who were older than 65 and cognitively healthy. It evaluated their conditions at both the five and ten year marks after the start of the study.

This study looked beyond the normal factors associated with Alzheimer’s and dementia. “Researchers evaluated the group based on an index that included 19 different health deficits frequently associated with aging...it was the first time an evaluation of dementia using non-cognitive factors has ever been done. After 10 years, 40 percent of the participants had died. Of the participants left, 607 had developed Alzheimer’s or some other form of dementia, while an additional 677 participants had developed some other cognitive problem. The remaining 883 participants who were cognitively healthy were the subject who scored lowest, or healthiest, on the initial health index evaluation. Those who had died or had developed dementia or Alzheimer’s were among patients who had scored highest on their initial health index evaluations. Researchers also found that each health problem a participant had, made him or her 3% more likely to develop dementia over those who didn’t have the same problems” [1].

Although further research is needed in this area, it is clear that by improving general health people should be able to lessen the likelihood of having to deal with Alzheimer’s or dementia later in life.