Yesterday we blogged about the growing problem our healthcare system is facing with hospital-acquired infections. Today, we’ll investigate a bit further into these infections by examining urinary tract infections which are most common HAI. According to recent statistics, UTIs account for around 40% of all hospital-acquired infections which makes them crucial to stop.
Recent studies have concluded that “the risk of infection increases as the duration of catheterization increases” so the best solution may be to reduce patients’ length of stay in hospitals. The problem is that less “than 1 in 10 hospitals in this country used [the simple methods] for preventing unnecessary catheterization”.
This is dangerous because urinary tract infections like other nosocomial infections increase morbidity and mortality, prolong hospital stay and increase patient care costs. The methods of preventing these infections are hazy and not fully agreed upon which makes patient care tough.
Patients and their loved ones can do their part to decrease the chance of contracting a UTI. While in the hospital, patients are advised to ask their health care provider every day if the catheter is still necessary. The CDC also has guidelines for patients, and recommends that patients do the following when coming home from the hospital with a catheter still inserted:
- Make sure to ask questions so as to understand how to care for a catheter once home from the hospital
- Contact a doctor or nurse immediately if any symptoms of a urinary tract infection develop, such as a burning pain in the lower abdomen, fever, or an increase in the frequency of urination
- Always clean hands before and during catheter care
- Keep urine bags below bladder level
- Do not tug or pull on the tubing, or twist or kink the tubing
While a catheterized patient is recovering at home, highly-trained health care providers will be able to monitor a patient’s catheter, preventing infection and giving peace of mind to patients and their families.
 “Preventing Hospital-Acquired Urinary Tract Infection in the United States: A National Study”, Clin Infect Dis. (2008) 46 (2): 243-250.
Hospital acquired infections are a growing problem in today’s healthcare scene. The problem is that these infections continue to spread at rapid rates because hospital patients have weakening immune systems and open wounds.
This rise in infection rates is disappointing because as hospitals become more aware, they should have been able to reduce these easily preventable infections, yet they are failing. The only thing that is needed is for doctors, nurses and other hospital employees to follow regulations and well-known prevention procedures. However, too many of these workers, continuously refuse to follow these simple steps and risk the lives of patients instead. “Among the most egregious of these practices are when patients with contagious infections are placed in rooms with uninfected patients, rooms are not adequately cleaned between patient stays and medical professionals fail to wash their hands”. All of these practices can be changed, yet progress has been slow.
Inadequate medical treatment should never be acceptable. So you’re left with this knowledge:
Fact: Hospital-acquired infections cost $30 billion annually and lead to the deaths of an estimated 100,000 people a year, making them among the nation’s leading causes of death.
Fact: No health agency currently tracks these cases.
Fact: This all can be prevented.
How you ask? Home healthcare is a proven alternative to hospital care and companies like Hotelrecovery are ready to serve you. Please use the links above for further inquiries.
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. 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.
 Gretchen Reynolds, “How Exercise Can Keep the Brain Fit”, http://well.blogs.nytimes.com/2011/07/27/how-exercise-can-keep-the-brain-fit/?ref=health#
According to a new study, people with hypertension can see a reduction in blood pressure if they replace some of the carbs in their diet with soy and low-fat dairy products.
The findings weren’t necessarily revolutionary as scientists have long known that high-carb diets were unhealthy for the heart while soy based products decrease the risk of heart disease. Although these facts were known, less was understood about how these foods affected blood pressure.
To figure out an answer to that question, these researchers tested over 350 people with higher than normal blood pressure on different daily supplements (soy protein, milk protein and carbohydrates) for two months. The results showed that the carbohydrate supplement caused no change in blood pressure whereas the soy and milk supplements reduced systolic blood pressure by about two points.
The decreases in blood pressure were small on the individual level “but they would be very, very important at a population level…[as] annual deaths from heart disease and stroke could be expected to drop by 6% and 4%, respectively”. That being said, the researchers cautioned patients saying that this study was not a reason to go overboard on soy and dairy at the expense of a balanced diet.
 Anne Harding, “Swapping carbs for soy, dairy protein may help lower blood pressure”, http://www.cnn.com/2011/HEALTH/07/18/swap.carbs.protein/index.html
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”. 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.
 Sarah Jio, “Defy your age: What truly helps you stay younger inside and out”, http://www.cnn.com/2011/HEALTH/07/19/defy.your.age/index.html?hpt=he_c2
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”. 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”.
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
 Eli Jacks, meteorologist at the National Weather Service, http://www.theatlanticwire.com/national/2011/07/whats-heat-dome-anyway/40291/
 HealthDay, “Elderly at Greater Risk for Heat Stroke, Experts Warn”, http://news.yahoo.com/elderly-greater-risk-heat-stroke-experts-warn-130609458.html;_ylt=AqL5A21cJKH.mEb7cpaqkE_VJRIF;_ylu=X3oDMTM4OTg0ZnBlBHBrZwMzZjQwYzc3ZC0yMTVmLTM2MmQtYTAwOC1jYzQyYzhjYmI2YmEEcG9zAzMEc2VjA2xuX0FnaW5nX2dhbAR2ZXIDODEyZDRjYzAtYjM5YS0xMWUwLWJmZGItNWNlODFkYThjNGI1;_ylv=3
Wages for home healthcare workers has been a topic of dispute for a long time running. The question has been whether a home health employee should receive minimum wage and overtime pay if they work over 40 hours a week. This seems reasonable seeing that if the aide worked in a nursing home, they would get minimum wage under the Fair Labor Standards Act.
In 1974 Congress exempted people providing “companionship services” from the act which today has caused over 1.5 million home health workers to be excluded. When those lawmakers made this law three decades ago they did not even consider this field because it was virtually non-existent in that time. But now the industry does exist, it is growing and wants to keep the exemption in place.
This debate occurred both during the Clinton and Bush administrations as the former proposed ending the exemption while the latter reversed that course back to the status quo. And now it’s back as the Labor Department has announced that it intends to re-examine the exemption.
While this is happening, the Direct Care Alliance (representing mostly women who provide care) is lobbying the House and Senate to extend the FLSA to home care and improve training. The industry obviously has taken a strong stance against this legislation saying “clients will have no choice but to choose nursing homes”.
Already 21 states mandate minimum wage by paid to home health workers and another 15 states require overtime payment. But the industry is still butting heads with the nurses who work for them. This is a tough problem to solve because families already struggle with the expenses involved with home care while home aides are one of the lowest paid jobs in America. Let’s all hope that the lawmakers come to successful compromise solution that fits both sides needs in the end.
 Leann Reynolds, president of Homewatch CareGivers, http://newoldage.blogs.nytimes.com/2011/07/20/a-fair-wage-for-home-care-workers/?ref=health
Dieters think they are doing themselves a favor when checking restaurants calorie counts for certain items before ordering. Apparently that’s not the case as a new study from Tufts concludes that nearly 1 in 5 restaurants had inaccurate calorie ratings of their offerings.
The researchers found that several foods had over a 100 calorie disparity with what the restaurant stated on its website. This study encompassed 42 fast food and sit-down restaurants in three states including Chipotle, Olive Garden, Outback Steakhouse and Boston Market.
Lead researcher Lorien Urban, a former Tufts graduate student, and others bought the foods from the restaurants without revealing their purpose and then brought them back to Tufts for testing. In most cases the calorie counts were accurate but about 20% of foods tested had a large variation (over 100 calories off). Sit-down restaurants had more inaccurate readings probably because their foods are more subject to individual variation when compared to fast food places.
This brings up a huge issue for dieters who expect to be staying on course by ordering a soup at Olive Garden or salad at Chipotle. It turns out that these “healthier” offerings were the ones that unexpectedly had more calories. Although the new labeling law has helped many, this study illustrates one of the places it can still be improved. Linda Van Horn, a research nutritionist and professor of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago, said: “Labeling is a wonderful thing, but periodically, there should be some external monitoring so restaurants would need to know they should be conscious of any changes that take place”.
Although a 100 calorie discrepancy per day doesn’t seem like much, over the course of a year that can add 10-15 extra pounds. So it is important that restaurants display more accurate numbers for the well-being of everyone and hopefully this study speeds the correction process up.
 Kay Lazar, http://www.boston.com/lifestyle/health/articles/2011/07/20/restaurant_calorie_counts_often_inaccurate_study_finds/?page=full
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. 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”. 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.
 PubMed Health Definition, “Dementia”, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001748/
 Marlowe Hood, AFP, “For dementia, common painkillers may work best: study”, http://news.yahoo.com/dementia-common-painkillers-may-best-study-160607059.html
A group of scientists, led by Betsy Sparrow (assistant professor of psychology at Colombia), have recently connected the increased use of the internet with how people remember information.
Dr. Sparrow, Jenny Liu (University of Wisconsin, Madison) and Daniel M. Wegner (Harvard) used four memory tests to see whether participants were more or less likely to remember information that they could simply find on a computer. One experiment had people try to remember information that they expected to later have online access to. They were given trivia facts like “The space shuttle Columbia disintegrated during re-entry over Texas in Feb. 2003” and half believed the information would be later accessible on the computer while the half did not. This experiment showed that the subjects were much more likely to remember the information if they thought they wouldn’t be able to access it later.
Other experiments included saving the trivia questions to certain folders on a computer and seeing if the participants remembered the question or saved location better. Shockingly, the people remembered the saved folder location much better than the original statement. The researchers concluded that “when people expect information to remain continuously available (such as we expect with Internet access), we are more likely to remember where to find it than we are to remember the details of the item”.
This study suggests what many have already speculated: we are now more dependent on internet connectivity than ever before. Whether this turns out to be a boon for society or a growing barrier has yet to be seen so we’ll just have to wait and see.
 Betsy Sparrow, Jenny Liu, Daniel M. Wegner, “Google Effects on Memory: Cognitive Consequences of Having Information at Our Fingertips”, July 14, 2011, http://www.wjh.harvard.edu/~wegner/pdfs/science.1207745.full.pdf
A presentation at this week's Alzheimer's Association International Conference has brought up a link between falls and Alzheimer's disease.
Elderly adults with Alzheimer's are more likely to fall than elderly adults without the disease. That's why scientists at the Alzheimer's Disease Research Center at Washington University have been following 125 older adults over 8 months and having them record any time they've fallen.
To determine whether any of the study participants have preclinical Alzheimer's, they were tested for the presence of amyloids, a known sign of the disease. Among those without amyloids, the fall rate was about 30 percent. Among those with amyloids -- and by extension, preclinical Alzheimer's -- the fall rate was 66 percent.
"There was a statistically significant marked difference in the fall rates between the 2 groups," study author Dr. Susan Stark told Medscape.
"These are all cognitively normal, healthy, aging people who otherwise do not look any different from us, so this hints to us that there are probably things other than the changes in the brain that are occurring that are affecting other things," Dr. Stark said.
"We are trained to look for cognitive changes, but in fact there probably are other changes that are happening. In this case, it's the motor changes that are making a fall occur."
The results are important because falls witnessed by a caretaker or relative or nurse could cause increased vigilance for the disease by physicians and even earlier diagnoses. There are even some promising potential treatments for the disease, but Alzheimer's must be caught early for them to be effective.
This blog usually only covers past studies and developments but today this post will discuss a current event that may have a huge effect on every American but specifically senior citizens.
President Obama and Congress have yet to come to an agreement to raise the debt ceiling even though the US Treasury has said that on August 2nd it will run out of money to pay for the country’s bills. Senate GOP leader Mitch McConnell recently said “a real solution to the U.S. debt problem was unlikely while Obama was in office”.
This presents a scary situation for all Americans but in particular for the elderly because Obama has warned that these seniors could suffer first due to lack of Social Security checks. “I cannot guarantee that those checks go out on August 3rd if we haven't resolved this issue…there may simply not be the money in the coffers to do it,” Obama said. Other areas like veterans’ checks and disability benefits could also be affected if a compromise is not reached soon. Senator Harry Reid has seconded Obama’s statements today but the Republicans continue to balk, calling these “scare tactics” by the Democrats.
Hopefully our country’s leaders will come to their senses and put together a deal that allows our government to continue to function normally. Otherwise, not only will seniors see their benefits end, but “this could have catastrophic consequences for our economy as well as the economic stability of the rest of the world…threatening to take us into a second Great Depression”.
 Reuters, “Obama: seniors could be hurt without debt deal”, http://reut.rs/pcZuM7
 David Min, Associate Director for Financial Markets Policy, Center for American Progress, “The Big Freeze”, 10/28/2010, http://www.americanprogress.org/issues/2010/10/big_freeze.html
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”. 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” .
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.
 Nadia Kounang, “General health may tell your Alzheimer's risk”, http://thechart.blogs.cnn.com/2011/07/13/general-health-may-tell-your-alzheimers-risk/?hpt=he_c2
Generally, it is thought that business people should run hospitals while medical doctors should stay focused on their patients. Within the 6,500 hospitals in the United States, only 235 are run by MD’s according to a 2009 Academic Medicine survey.
But a new study suggests that having a doctor leading a hospital is connected to better hospital care. The study published in the journal Social Science & Medicine, cites 300 top hospitals in America, tracks the background of each hospital’s CEO and then compares the performance of those led by an MD versus an MBA. The researchers concluded that hospitals ran by doctors quality scores were 25% higher than those run by a business person.
The study does not offer any potential explanation for why hospitals run by doctors may be more effective but it may be because doctors more thoroughly understand patient care and the best work conditions. Dr. Amanda Goodall, who led the study and is a senior researcher at the Institute for the Study of Labor in Bonn, said “M.D. C.E.O.’s are more likely to prioritize patients because patient care is at the heart of their education and working life as a physician. When it comes to making hard budgetary decisions or rationing choices, M.D. C.E.O.’s may be able to make more informed decisions”.
It seems like simply having an MBA and some medical exposure is no longer ideal for leading a large hospital. Hopefully this study will open up new avenues of thought for those hiring CEOs of hospitals and create more acceptance for medical doctors to lead.
 Tara Parker-Pope, “Should Hospitals Be Run by Doctors?”, http://well.blogs.nytimes.com/2011/07/07/should-hospitals-be-run-by-doctors/?ref=health
It has long been advised by doctors that everyone should reduce their salt intake due to its effects on blood pressure and overall health. New research supports that reducing salt intake keeps blood pressure down but is inconclusive on its effects in preventing heart attacks and cardiovascular disease.
Professor Rod Taylor of the University of Exeter and his team examined data of 6,500 patients and found a correlation to lower blood pressure but no evidence of effectiveness in preventing death or cardiovascular disease. The authors concluded that further, more rigorous studies are needed to actually draw strong connections between salt intake and cardiovascular events.
Despite this, there is still an abundance of research from a consensus of experts that agree that excess salt intake hurts cardiovascular health. Therefore, you should take any of these preliminary studies with a grain of salt.
There is a healthy amount of salt you should have in your diet (2,300 mg daily for adults is the government dietary guideline) but most people go way over that amount. The easiest way to reduce your sodium intake is to cut out frozen, processed and packaged foods in favor of fresh fruits and vegetables. You can also minimize your use of the tabletop salt shaker. Overall, until new, more conclusive studies are done you should stick with the advice of a trained professional to suit your own needs.
 Meredith Melnick, “Does Cutting Salt Really Improve Heart Health?”, http://healthland.time.com/2011/07/07/cutting-salt-may-not-reduce-heart-attacks-or-risk-of-death/
It has long been known that daily exercise is crucial in maintaining a strong body and living a long, healthy life. But more recently, researchers have discovered that exercise can be an effective method of reducing anxiety as well.
Most times when a patient is seeking treatment for anxiety or depression, doctors prescribe psychotherapy or medication. But exercise is becoming a reliable third option or supplement to other treatments, although it is rarely prescribed. Daniel Landers, a professor emeritus in the department of kinesiology at Arizona State University concludes that “exercise seems to work better than relaxation, meditation, stress education and music therapy”. Unlike medication through pills, exercise serves as therapy that is easier to stick with because of its immediate mood boost and results.
Recent studies by researchers at the National Institute of Mental Health and Princeton University have revealed that exercise in mice has proven to reduce their levels of stress and anxiety. Although mice are obviously not human, scientists are confident that these experiments were strongly representative of how humans would also act. In addition, a survey by Norwegian researchers this month “found that those who engaged in any exercise, even a small amount, reported improved mental health”.
It is believed that exercise helps reduce depression by:
- “Releasing feel-good brain chemicals that may ease depression (neurotransmitters and endorphins)
- Reducing immune system chemicals that can worsen depression
- Increasing body temperature, which may have calming effects”
Make sure to talk to your doctor before engaging in an exercise regimen to find out which activities and how much exercise is good for you. Exercise is a great way to reduce anxiety or depression but it is not a substitute for medication, therapy or other treatments, so please act accordingly.
 Kim Painter, “Exercise helps fight anxiety, depression”, http://www.usatoday.com/news/health/painter/2010-04-26-yourhealth26_ST_N.htm#
 Gretchen Reynolds, “Why Exercise Makes Us Feel Good”, http://well.blogs.nytimes.com/2011/07/06/why-exercise-makes-us-feel-good/
 Mayo Clinic staff, “Depression and anxiety: Exercise eases symptoms”, http://www.mayoclinic.com/health/depression-and-exercise/MH00043
A growing problem in nursing home care is the over-medication of patients. This is an issue that has existed for many years but it is now just coming to the forefront of many healthcare discussions.
A recent study by a team of University of South Florida researchers discovered that “71 percent of Medicaid residents in Florida nursing homes were receiving a psychoactive medication…even though most were not taking such drugs in the months before they moved in”. This illustrates the large degree to which nursing homes are over-using medication.
Many speculate that this practice of over-medication is being used by nursing homes in order to stop patients from requiring extra attention and making them less of a hassle to their care-takers. This problem has been compounded by the fact that only half of nursing homes provide weekly patient consultations with mental health experts which means medication has been overused because it is simpler when patients are suffering.
This can cause several problems as the FDA “says elderly people with dementia face a higher risk of death when treated with such drugs”. It also can cause your loved ones to act differently and show increased confusion about their surroundings and in their interactions with others.
There are several potential solutions to this scary situation including attending federally required nursing home quarterly care planning conferences. This will allow you to have a voice in your loved one’s treatment which is crucial to changing this practice of over-medication.
An even more direct solution would be pursuing nursing home alternatives like private healthcare companies. These companies such as Hotelrecovery guarantee you the best care for those you love while avoiding the institutional constraints of nursing homes.
 Paula Span. The author of the recently published “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions”. “Overmedication in the Nursing Home”. New York Times. January 11, 2010. http://newoldage.blogs.nytimes.com/2010/01/11/study-nursing-home-residents-overmedicated-undertreated/
 AP. “Gov't warns on use of psych meds in nursing homes”. http://old.news.yahoo.com/s/ap/20110509/ap_on_he_me/us_nursing_homes_overmedication