Family inHome Caregiving Blog
I always encourage my clients to have important legal documents like a power of attorney and a Physician's Order For Life Sustaining Treatment or POLST on hand in case of a medical emergency. You should give copies to friends, family members and your caregivers and also have a sit-down talk with them and explain exactly what your wishes are should you become incapacitated. Despite the fact that people are living longer and longer, the desire to live longer is not diminishing for the general population. The Pew Research Center has been tracking public opinion on the public's view on end-of-life medical treatments and a growing minority of Americans say that doctors should do everything possible to keep their patients alive. Back in 1990, only 15% of those surveyed said that physicians should always do everything possible to save a patient. That rose to 22% by 2005 and 31% by 2013. But not everyone feels this way, which is why you should not only spell this out in a POLST, but go over various scenarios with friends, family and caregivers so they fully understand your wishes. At Family inHome Caregiving, we have a care plan book which stays in the home and has important phone numbers for friends, family and physicians, as well as copies of documents like a POLST. This can come in extremely handy if you have to call for an ambulance and they are not sure what to do. In the Pew study, a majority of those surveyed (57%) told Pew Research that there are at least some situations in which they personally would want medical treatment halted and be allowed to die. 52% said that they would ask their doctors to stop treatment if they had an incurable disease and were totally dependent on someone else for their care. And fully 27% of the population have given no thought at all or not very much thought to how they would like medical professionals to handle their medical treatment at the end of their lives. Even amongst those over 75 years of age the response was just 25%, and 22% of American's aged 75 and older have not written down or talked to anyone about their final wishes. Unfortunately, many people do wait until it's too late or almost too late to relay important information about their final wishes to their friends and family. Make sure you have a living trust, a will, a POLST and power of attorney made out. In addition, I think that it's just as important to express these wishes verbally to those who will have to make tough decisions should you become incapacitated.
Obesity is a big problem in America and can cause numerous health issues including heart disease, stroke, high blood pressure and diabetes. Researchers are constantly looking for a wonder drug, as many people are unwilling to lose weight via exercise and changing their diet. One company, Orexigen Therapeautics, received good news recently. Following a new study with positive results showing that its drug Contrave didn't dramatically increase the risk of a heart attack or other adverse events, the company announced it would submit a new drug application to The Food & Drug Administration (FDA). The FDA had previously rejected a new drug application for Contrave, requesting more information on the drug's cardiovascular risk. Hopefully, this study will be enough. Although there are numerous diet plans out there, pharmaceuticals which help with weight loss are few and far between. "The resubmission will contain an unprecedented amount of cardiovascular outcomes data for an obesity therapeutic, and we are confident these data will support a favorable benefit risk assessment for Contrave," Doug Cole, President of Takeda Pharmaceuticals, which will distribute Contrave in the U.S., told investors. There are high hopes for the drug, which caused 53% of participants to lose 5% or more of their body weight and keep it off for the next twelve months in a previous trial.
Many cases of breast cancer are linked to genetics, something that you are stuck with if it runs in your family. However, researchers are increasingly finding links to other phenomenon including diet and exercise. There have already been a number of studies linking obesity to breast cancer, and now researchers at Duke University believe they may know why. A byproduct of cholesterol has been found to grow tumors in some of the most common forms of breast cancer. This is an important finding because doctors may be able to prescribe statins to overweight women which will have the double whammy of lowering cholesterol, known to cause heart disease, strokes and diabetes, while also potentially preventing breast cancer. It also may cause some women to decide to deal with the issue on their own by having a healthier diet and exercising more frequently. Although the study, which is published in the most recent edition of the Journal Science, is preliminary, obesity has already been linked to causation in a number of other cancers. Therefore, it would seem prudent for doctors to focus on reducing the number of obese patients that they have in order to ward off a number of life threatening diseases.
There was a story I read not too far back about a cat who lived in a nursing home who would literally run from patients who were about to pass away, and the speculation was that she could literally smell death coming on. Many animals do have a keen sense of smell, and it's true that people who are in ill health don't often smell good. A new study being done by George Preti, an organic chemist at Monell Chemical Senses Center, has teamed up with physicists and veterinarians to study various human odors and to answer the question of whether cancer has a distinct smell or not. If it does, this could be a huge breakthrough because cancer isn't often detected until it's too late to do anything about it. The team is studying ovarian cancer because when it's caught early, 92% of patients live for at least five years but when it's caught late less than 30% live five years or more. Unfortunately, ovarian cancer is only detected early in 15% of patients, so it's fatal in the vast majority of people who have it. I hope this team is successful in their studies. At some point they may be able to develop a scanner which could be waved over your body and detect unusual smells which could signal early-stage cancer or other potentially deadly diseases.
It's a known fact that most seniors want to spend their final years living at home and not be institutionalized. For some, this isn't possible due to the high cost, although this is changing as new technology is being developed which can supplement human caregivers in order to monitor someone in their home to make sure they are OK. The technology varies,, but generally it involves a system of cameras and monitoring devices. This allows you, for instance, to make sure that your mother hasn't fallen if the monitor tells you she got up to go to the bathroom a half an hour ago but never went back to bed. There are myriad devices coming to market to monitor seniors, and this will only increase as more baby boomers retire. One which was recently profiled in USA Today costs only $149. Dubbed MyLively, it's a monitoring kit with six small accelerometers which detect movement. One problem we often see with our clients is that they forget to take their medication. However, another company is generating bottle caps which glow when it's time to take your medicine and yet another has designed a chair that can take your vital signs. There is also carpet coming to market with sensors which can detect whether walking patterns are normal and they can even anticipate physical degeneration. Your home may someday be able to watch over your physical health in partnership with your caregivers and your physician. Although human caregivers will still be needed, this could eliminate the need for some seniors to require 24-hour per day caregiving services, which can quickly erode your retirement assets. I look forward to seeing what new medical technology debuts at the Consumer Electronics Show next January in Las Vegas.
Unions are viewed by many as a dying breed, however, the Service Employees International Union (SEIU) has had a number of successful runs at passing bills through the state legislature in California and is now looking to get ballot measures approved which would further increase their power. The latest bill is one which the SEIU says will lower health-care costs, but hospital officials are saying it's just an effort to make it easier to unionize thousands of workers. The cost to the general public is unclear, but the SEIU has already said it is willing to spend $14-$24 million to get the issue to voters on the November 2014 ballot, so the stakes are clearly high. The SEIU currently represents only 90,000 of California's 400,000 hospital workers so there is clear upside for the union, but I'm not sure how hospitals, many of which are losing money or barely breaking even, will be able to absorb a huge increase in wages and employee benefits. There's no question that the next couple of years are going to be challenging for most hospitals. With government payments being cut from both Medicare and Medi-Cal as well as from many private insurance companies, it's a struggle to remain profitable. On top of that, hospitals will now need to absorb huge legal and lobbying costs to attempt to stave off unionization which would almost surely significantly raise labor costs.
I have always enjoyed going to the Consumer Electronics Show (CES) in Las Vegas. It can be a zoo, but you get to see the latest and greatest gadgets, some of which are just prototypes and won't actually be available to consumers for years. The show is always changing to adapt to new consumer behavior and product demands. It's not surprising that today the CES announced there is 40% growth in the TechZone part of the show devoted to digital health for the upcoming show January 7-10 of 2014. More than 65 exhibitors will showcase their solutions for diagnosing, monitoring and treating a variety of illnesses at the Living in Digital Times segment of the Digital Health Summit. A survey this year by the CEA found that one-third of mobile device owners have used it to track some aspect of their health in the past 12 months. That's a huge number and demand for these apps will only increase as baby boomers continue to retire and they will have more time on their hands to play around with these devices. If you are at the show, I encourage you to visit this TechZone which will be located in the South Hall of the Las Vegas Convention and World Trade Center (formerly the Las Vegas Hilton).
Hospital infections continue to be a huge problem, and some in the medical community have found they have been able to quell the number of these by simply giving patients yogurt. It contains probiotics which help maintain the natural balance of bacteria in your intestines. If you eat yogurt or something else containing probiotics while on an antibiotic, it can help your body bounce back. This is due to the fact that antibiotics kill both good bacteria and bad bacteria, which can cause a condition called Clostridium difficle (C. diff) which causes diarrhea, dehydration and fever. According to the Centers for Disease Control and Prevention (CDC), this condition led to 14,000 deaths last year and those leaving the hospital with this bacteria in their system are 40% more likely to be readmitted to the hospital within a year than patients without C. diff. It's great that a natural solution has been found for a common ailment like this.
Robots are becoming increasingly common in hospitals, but some patients are concerned about the lack of the human element when it comes to medical care. Already, in some hospitals robots roam the halls checking on vital systems of patients and reporting them back to physicians. A big trend is using robots in surgery, with the hopes of reducing the potential for human error during dangerous surgeries. But robots can make mistakes too. There have been a number of stories in the press about robots which have accidentally nicked a blood vessel or made punctures, tears or burns by mistake. The U.S. government is now studying these so-called "adverse events." The number of robots used in surgery has grown from just 1,000 back in 2000 to 450,000 last year. Doctors are mixed on the performance of the robots. Some believe the 3D screens used in tandem with the robot make it easier to see what's going on during surgery, and not having to bend over the patient for hours makes it less tiring for the surgeon. Others, however, fear the technology is growing too quickly. Martin Makary, a pancreatic surgeon at Johns Hopkins University told the Wall Street Journal, "We have a culture that marvels at new technology," he said, as well as a propensity to embrace innovation "without a lot of rigorous , standardized evaluation." If you are considering having surgery, discuss the pros and cons with your doctor and if you aren't comfortable with how the conversation goes, get a second opinion. Any surgery contains a certain amount of risk, and you want to minimize this at all costs.
There have been a number of high-profile drug trials recently which have failed to pan out. These are expensive, and scientists sometimes lose hope when promising drug trials turn out to either not solve problems that they thought they would, or it turns out that the drugs have serious side effects. Researchers now believe that they have a way to increase the odds of a successful clinical trial, using powerful computer simulators to design the trials before they begin. Currently, only 11% of drugs that get to a human trial stage end up getting regulatory approval, according to BioMed Tracker. Many in the scientific community believe this number can be raised dramatically because the Food & Drug Administration (FDA) sometimes will not approve drugs not because they don't work, but because they believe the parameters of the trial design were flawed. This may result in a trial that looks like the drug works, but the results turn out not to be statistically significant. "If we had this five years ago, many of the recent high-risk drug failures might not have happened," Diane Stephenson, executive director of the Coalition Against Major Diseases at Critical Path Institute, told the Wall Street Journal. That's great news. Regular readers of my blog know that I have been closely tracking developments related to the treatment and/or prevention of Alzheimer's disease. Pfizer Inc. is using the computer simulation to help design trials for four promising Alzheimer's drugs. I hope they are successful.