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Health of Seniors
Automated external defibrillators at homeAs you read this, someone somewhere in the United States is collapsing from a cardiac arrest. The odds are poor that she or he will survive this sudden disruption of the heart’s normal rhythm. Most of the 1,000 or so people who go into cardiac arrest each day die because they don’t get the treatment they need — an electric shock to the heart — fast enough. Heart-shocking devices were once found only in hospitals and ambulances. Now they’re popping up in airports, movie theaters, fitness centers, casinos, malls, office buildings, and other places. These public versions, called automated external defibrillators (dee-FIB-rih-lay-tors), are so easy to use that sixth graders who have never seen one before can master their use in a minute or so, as shown in a 2002 study. This ease of use, combined with the fact that 3 in 4 cardiac arrests happen at home, have opened a national debate over whether it’s a good idea to have a defibrillator at home.The chances of surviving a cardiac arrest fall about 10% for each minute the heart stays in ventricular fibrillation. Shock the heart back into a normal rhythm within two minutes, and the victim has an 80% chance of surviving. Deliver that shock after seven minutes — the average time it takes an emergency medical team to arrive in many cities — and the odds are less than 30%. If someone near you goes into cardiac arrest, calling 911 is a must. Even if there’s a defibrillator nearby, you’ll need professional help as soon as possible. CPR is also important because it keeps blood flowing to the brain and other vital organs. Still, a home defibrillator could let you restore a healthy heart rhythm several crucial minutes sooner than emergency medical technicians. Can home defibrillators help?With a prescription from a doctor and $2,500 or so, you can buy a defibrillator for your home, office, or car at many large pharmacies or medical supply companies. The question is, should you? Experts in the areas of sudden cardiac arrest, emergency medicine, and public health don’t see eye-to-eye on this issue. Some argue that people who want to buy defibrillators for their homes should be able to do so without needing a prescription from a doctor. Others argue that people won’t maintain the devices so they will be ready when needed, or that most people would be better off spending some of the money on a health club membership and donating the rest to their local emergency response team. Researchers have collected relatively little evidence on the benefits and risks of wider access to defibrillators. A few studies have examined their use in public places. One, published in the October 17, 2002, Journal of the American Medical Association, showed that 11 of 18 people who collapsed with ventricular fibrillation over a two-year period in Chicago’s three airports were revived, mostly by passers-by who used highly visible and well-marked defibrillators. But their use at home is uncharted territory. One project, Neighborhood Heart Watch, is putting automated defibrillators in volunteers’ homes in Indianapolis neighborhoods. When there’s a call to 911 about a cardiac arrest in that neighborhood, it’s routed to both the emergency services and the nearest home with a defibrillator. Another study, the Home Automatic External Defibrillator Trial, sponsored in part by the National Institutes of Health, aims to map out the benefits and risks. It will give home defibrillators to 3,500 heart patients and train their partners to use the devices. The partners of another 3,500 heart patients will get training in CPR, but no home defibrillator. The results aren’t expected until 2007. Who should have one?A home defibrillator would probably be a good investment for anyone who has survived a sudden cardiac arrest but who does not have a pacemaker capable of shocking the heart (an implantable cardioverter/defibrillator, or ICD). Owning this device might also make sense for someone with severe heart failure, unstable angina, or other severe forms of heart disease. So far, though, there’s no good evidence that home defibrillators will save lives in this group of people. Training is a mustIf you decide to buy a defibrillator for your home, or if you just want to be prepared for the chance you’ll someday need to use one in a public venue, make the time now to take a class on using this device. Why bother to go through training when these machines have been designed for virtually mistake-free use? Several reasons. A class can help you use the defibrillator with confidence and speed. It can help you deal with unusual situations, such as where to apply the pads on someone with an implanted pacemaker, a medication patch, or a hairy chest. It will also teach you how to do CPR, an important part of the process. The American Heart Association has developed a 3 1/2-hour course called “HeartSaver AED for Lay Rescuers and First Responders.” To find the closest training center that offers this course, call the AHA at 800-242-8721. January 2003 Update Medications for postmenopausal osteoporosis preventionRisk of osteoporosis increases after menopause, when levels of estrogen — which helps preserve bone density — drop. Until recently, most doctors recommended long-term hormone replacement therapy (HRT) to treat postmenopausal women who need medication to prevent bone loss. But things changed after results from a large trial on a common HRT drug showed that estrogen plus progestin (as the medication Prempro) did more harm than good. An increased risk for breast cancer and cardiovascular events outweighed the benefits of less colorectal cancer and fewer fractures. (See the Update from July 2002 for more information on the trial.) Health experts now encourage most women who have been taking long-term HRT for osteoporosis prevention to consider an alternative. Fortunately there are several options. Each of the FDA-approved treatments (see chart) has potential benefits and risks that women and their doctors should weigh before making a decision. Even with HRT’s proven risks, it may still be a good choice for certain women — especially in lower doses, which recent data have shown to have bone benefits comparable to higher, standard doses.
December 2002 Update Dietary Antioxidants May Decrease Risk of Alzheimer's DiseaseAlzheimer’s disease (AD) is a complex disease that spreads through the brain. It affects some 4 million Americans, causing memory loss, impaired thinking, and changes in personality. Scientists have suspected that substances called antioxidants — vitamin C, vitamin E, and beta carotene, for example — may guard against AD. However, studies testing the relationship between antioxidant supplements and the risk of AD have not found consistent evidence of a benefit. But now two studies published in the Journal of the American Medical Association have found that high intakes of antioxidants from food may reduce the risk of developing AD. In the first study, researchers recruited 5,395 participants with an
average age of 67.7 years, who lived independently. All participants
reported their eating habits and went through two mental state examinations
to ensure that they were free of dementia at the start of the study. Use of dietary supplements was controlled in this study, so the beneficial effects of vitamins C and E were only from food. Vitamin C is found in large amounts in citrus fruits, kiwi, and broccoli, and good sources of vitamin E include nuts, milk, and egg yolk. In the second study, participants were also free of Alzheimer’s disease at the beginning and completed a food frequency questionnaire. The questionnaire helped researchers keep track of the intake of certain foods and supplements. The 815 subjects were 65 years and older, and were followed for four years. After adjusting for age, education, sex, race, and presence of APOE e4 (a genetic characteristic that makes a person more likely to develop AD), the researchers found that those with the highest dietary intake of vitamin E were 70% less likely to develop AD than those with the lowest dietary intake of vitamin E. However, the highest Vitamin E intake for the study was 363.6 International Units (IU) per day, well above the Recommended Dietary Allowance of 22 IU. The other dietary antioxidants tested in this study, vitamin C and beta carotene, did not reduce the risk of AD. More research will need to be performed to find out why vitamin C proved effective in one study but not in the other. While dietary antioxidants are proving more effective in reducing Alzheimer's risk than antioxidant supplements, these weren't randomized, clinical trials, so these studies won't translate into dietary recommendations. August 2002 Update Physical activity benefits all agesThe frail health often associated with aging is in large part due to physical inactivity, according to a report released by the U.S. Department of Health and Human Services (HHS). It also advises that it’s never too late to benefit from becoming physically active. The report cites that even moderate levels of activity — such as washing a car or raking leaves — can produce considerable benefits that can be even more noticeable in older adults. Regular exercise improves cholesterol levels, reduces blood pressure, cuts body fat, and lowers blood sugar. Physical activity also improves bone and muscle strength. All in all, people who exercise live longer — and they also live better. Current guidelines recommend at least 30 minutes of moderate physical activity a day. However, few older Americans reach this level. Lack of physical activity and poor diets are the major causes of obesity, an epidemic that is affecting people of all ages. In the '70s and '80s, doctors were telling Americans to run; now, they are asking people to walk. Walking can be a moderately intense aerobic activity. But even at a more relaxed pace, walking has huge benefits. The distance actually seems more important than the pace — and it doesn't take heroic distances to get real benefit. In 1993, the Harvard Alumni study found that men who walked just 1.3 miles a day had a 22% lower death rate than those who walked less than 0.3 mile a day. Strong muscles also improve your health. So set aside 15 minutes two or three times a week for resistance or strength training as well as 10–15 minutes at least three times a week for stretching exercises. The HHS report provides strategies that individuals, doctors, and even communities can follow to promote physical activity. Individuals are encouraged to take part in activities that they enjoy and to make them a daily part of life. Doctors should help patients start and continue these regimens and overcome any difficulties they encounter. Communities can establish programs tailored to seniors’ physical activity needs and improve walking or bike trails. The complete report is available at www.ahrq.gov/ppip/activity.htm August 2002 Update Annual PSA Test May Not be Necessary for All Older MenProstate cancer is the second leading cause of death for men in the United States. And while the chance of being diagnosed with prostate cancer over a lifetime may be as high as 20%, the chance of dying of prostate cancer is only about 3%. But the risk of prostate cancer increases with age. More than 75% of all cases occur in men over 65, and about 40% of men over 80 have the disease. When it is diagnosed early, prostate cancer is more likely to be treated successfully. Cure rates are excellent for cancer that is discovered and treated when it is still confined to the prostate gland. About 95% of men with localized prostate cancer treated by surgery are alive after five years. The prostate-specific antigen (PSA) test is a primary test for finding early-stage prostate cancer. PSA is a protein produced by the prostate gland, and PSA levels become elevated in men with prostate cancer. Although some respected groups recommend an annual PSA test for all men over age 50, the annual PSA test remains controversial. That is, in part, because it has a high chance of being falsely negative (20%-40% of men with prostate cancer have normal levels of PSA) or falsely positive (PSA levels may be elevated in men with noncancerous prostate conditions). At a meeting of the American Society of Clinical Oncology, researchers presented findings that indicated that an annual PSA test may not be warranted in men over 50 with an initial normal PSA (0–4 nanograms/milliliter). For five years, researchers tracked the annual PSA test results of 27,863 men ages 55–74 whose PSA levels were initially normal. . They found that 98.6% of men with a PSA result of less than 1 ng/ml at baseline would remain negative after 4 more annual tests and that 98.8% of men with a baseline PSA of 1–2 ng/ml would have a negative PSA test the following year. Based on these results, the researchers concluded that performing a PSA test every five years on men with an initial PSA less than 1 ng/ml and every two years for men with a PSA of 1–2 ng/ml would reduce the number of PSA tests performed by 55%. This would save money and help men avoid the anxiety associated with yearly prostate tests. July 2002 Update Healthy Diet Eradicates Need for Trendy Supplements in ElderlyMagazine ads and television commercials tout dietary supplements that claim to be a veritable fountain of youth for seniors. Images of grandparents able to keep up with their grandkids convince older adults that shakes, energy bars, and special vitamins will help boost energy and decrease signs of aging. Health experts, however, stress that a well-balanced diet rich in fruit and vegetables is just as effective and probably safer. But many older adults skip meals and eat small amounts of fruits and vegetables, citing reasons ranging from rotten teeth to unhappiness with eating alone. While doctors acknowledge that nutritional shakes and energy bars are helpful for seniors who need to gain weight or have trouble chewing or swallowing, those who eat a balanced diet or stay active do not need them. In spite of what the experts have said, the savvy advertisements are convincing millions of seniors that they need these expensive supplements, some of which have not even been proven safe. Herbs are also a source of concern. Saw palmetto, an extracts made from the fruit of the saw palmetto plant, is promoted as a treatment for an enlarged prostate. Many people believe that herbs are natural and therefore safe but this is not the case. In fact, as with most nonprescription herbal products, the composition of the extract and the dosage have not been standardized and the supplement is not regulated by the FDA. If you decide to use saw palmetto, tell your doctor in order to alert him or her to possible interactions between it and other medications you may be taking. People who are on strict diets — like those prescribed for kidney disease, heart disease, or diabetes — must be especially wary of adding any special supplements to their diet. Regardless of whether health problems are present, you should always consult a physician before starting any dietary regimen. May 2002 Update New Guidelines for Rheumatoid Arthritis TreatmentRheumatoid arthritis (RA) is a chronic autoimmune disease affecting more than 2 million people in the United States. It causes pain, stiffness, and swelling in the joints, as well as inflammation in organs. Guidelines for the management of the disease were first created in 1996, but significant developments since then prompted the American College of Rheumatology to publish an updated version in the February 2002 issue of its journal, Arthritis & Rheumatism. A key addition to the new guidelines is the emphasis on early diagnosis and treatment. Recent studies have confirmed that if RA is treated early and aggressively, the course can be altered and the onset of joint destruction can be delayed. The report advises patients to consider nonsteroidal antiinflammatory drugs (aspirin, ibuprofen), glucocorticoid injections, or prednisone to control symptoms once diagnosed. But the new guidelines recommend most people begin treatment with the more potent disease-modifying antirheumatic drugs (DMARDs) within three months of diagnosis. If prognosis is poor, however, DMARDs should be initiated as soon as the diagnosis is confirmed. The guidelines give information on the efficacy, potential side effects, cost, and administration methods of several new drugs being used in the treatment of RA. These new therapies include three genetically engineered biologic response modifiers (entanercept, infliximab, and anakinra) which target chemicals that cause inflammation. The use of entanercept and infliximab, which work by blocking important inflammation messenger proteins, represent a major advancement in RA treatment. Also presented is a new DMARD, Leflunomide, which slows the structural damage brought on by RA. The guidelines recommend using the aggressive drugs in combination — for example, a biological agent plus a DMARD or two DMARDs. These new therapeutic options are already being used in the treatment
of RA. But for physicians who treat the disorder, the primary value of
the new guidelines is the parameters they set for RA therapy and medications. Advanced Macular Degeneration and Nutritional SupplementsNutritional supplements may help slow the progression of advanced macular
degeneration (AMD), the most common cause of vision loss in people over
age 55, a new study suggests. Aggressive Therapy for Older HeartsThere's no question coronary artery bypass grafting and angioplasty
can relieve the pain of angina, prevent heart attacks, and add years
to the lives of people with blocked coronary arteries. But most studies
have excluded people over age 70, so the benefits of aggressive therapy
is less clear in the older patient. Statins Associated With Lower Dementia RiskMost people who develop dementia - poor memory and intellectual functioning
that often accompanies old age - have Alzheimer's disease. But a small,
yet sizable group of people appear to develop dementia from a narrowing
of the arteries supplying the brain. The lack of blood can lead to many
small areas of damage to the brain; each too small to be noticeable as
a "stroke," but collectively devastating in their effect. This syndrome
is called "vascular dementia" to differentiate it from Alzheimer's disease
and other types of dementia. Killing H. Pylori Helps Prevent Gastrointestinal Bleeding in Patients Taking Low-Dose AspirinMany people take low-dose aspirin on a daily basis to help prevent heart
attacks. Others take larger doses of stronger nonsteroidal antiinflammatory
drugs (NSAIDs), such as naproxen (Anaprox, Aleve, others), to relieve
musculoskeletal pain such as that caused by arthritis. When taken on
a regular basis, however, NSAIDs often cause ulcers and gastrointestinal
(GI) bleeding. Ulcers, which are raw, crater-like breaks in the mucosal
lining of the digestive tract, may also be caused by excess acid production
and a bacterium known as Helicobacter pylori (H. pylori). Ipriflavone Not Effective for OsteoporosisFor years, estrogen replacement therapy was the drug of choice for treatment
of osteoporosis in postmenopausal women. But the potential risks of HRT
sent women searching for alternatives. One option was phytoestrogens — plant-based
compounds that bind to estrogen receptors in the body, presumably mimicking
the beneficial effects of estrogen without its potential risks. Of the
phytoestrogens, the most promising was ipriflavone, a synthetic
version of a naturally occurring isoflavone, a type of phytoestrogen. Early Cognitive Impairment Following Coronary Bypass May Predict Lasting Cognitive ImpairmentMore than 500,000 coronary-artery bypass grafting (CABG) surgical
procedures are performed in the United States each year to bypass blood
around clogged arteries and improve the flow of blood and oxygen to the
heart. Advances in anesthesia, surgical procedure, and other areas have
made CABG a relatively safe procedure for an expanding group of heart
disease patients including older and other high-risk patients. But while
the risk of death after CABG has decreased, the risk of cognitive impairment
has not. Growing evidence suggests that many patients experience short-term
cognitive impairment after CABG. Sertraline Effectively Treats Depression in Alzheimer's PatientsA large portion of the 4 million Americans with Alzheimer's disease
(AD) — a progressive degenerative disease of the brain that results
in memory loss, impaired thinking, and personality change — also
suffer from major depression. This can make the already devastating condition
even more difficult, not only for patients, but also for their caregivers.
Until recently, the efficacy of antidepressants in such patients was
uncertain. Now, a study from The American Journal of Psychiatry shows
that sertraline (Zoloft) a type of antidepressant known as a selective
serotonin reuptake inhibitor (SSRI) is more effective than placebo in
reducing depression in patients with AD. This study is the first to show
both the efficacy and safety of an SSRI in treating depression in patients
with AD. Reducing Your Risk of Deep Vein Thrombosis During Airline TravelDeep vein thrombosis (DVT), recently featured in the news as "economy
class syndrome," is the formation of a blood clot in the deep veins
of the legs while sitting — particularly in the cramped seats of
an airplane (be it economy class or first class), car, bus, or train — for
long periods. You move less in tight quarters, causing circulation to
decrease and allowing blood to collect and form a clot. The blood clot
may cause pain and swelling in the legs. Serious, even fatal complications
can occur if the blood clot breaks loose in the blood stream and travels
to the heart or lungs. Older people, and those who are obese or have
a family history of DVT tend to be at the highest risk.
Studies do not agree on how long a flight needs to be to pose a risk
of blood clotting. A few studies even suggest that there is no association
between blood clots and air travel. Clearly, more research is necessary.
However, while we wait for a definitive answer to these questions, heeding
these simple instructions may help prevent problems. FDA Approves Weekly Dose of Fosamax (alendronate) for Osteoporosis Treatment and PreventionThe FDA recently approved once-a-week doses of Fosamax (alendronate)
for the prevention and treatment of osteoporosis. The weekly dose for
prevention is 35 mg while the weekly dose for treatment is 70 mg. Fosamax,
which was already approved for once-a-day use, works by slowing bone
loss. More Evidence That Pumping Iron Is Good for Seniors TooTwo recent studies published in the Journal of the American Geriatrics
Society add more data to the mounting evidence that exercise is
important at any age and that resistance (or weight) training has considerable
benefits for older adults. It is well known that strength training can improve muscle strength
and balance — of particular importance in preventing falls and fractures
in seniors. Research on just how much training is required to derive
these benefits has been conducted primarily in younger people. The first
study looked at how often older people must exercise. Forty-six people
(both men and women) between the ages of 65 and 79 years were assigned
to a resistance exercise program to be performed one, two, or three days
per week. Study results showed that seniors exercising one or two times
per week had about the same improvements in muscle strength and coordination
as did those who exercised three times per week. Researchers at the University of Maryland Exercise Science Laboratory conducted the second study, which was designed to look at the effects of strength training on resting blood pressure in older adults (the average age in this study was roughly 69). Eleven men and 10 women who had not been exercising regularly were assigned to a six-month training program using weight lifting machines. Not only did the study volunteers show significant increases in upper- and lower-body strength, but both groups also demonstrated significantly lowered diastolic blood pressure (the bottom number in a blood pressure reading). Interestingly, only the men in the group experienced significantly lowered systolic blood pressures (the top number in a blood pressure reading). Perhaps the best news was that the reduction in blood pressure brought these patients’ readings into the normal range. Investigators also noted that the improvement in blood pressure was not related to weight loss associated with increased exercise. The bottom line, however, is not news at all. Exercise is important, good for individuals of every age group, and the health benefits are many. Even doing a little is a whole lot better than doing no exercise at all. Journal of the American Geriatrics Society, Vol. 47, No. 10,
pp. 1208–14. Purchasing Prescriptions OnlineYour mother always warned you about taking candy from strangers. Now a new study cautions consumers about buying prescription drugs from electronic strangers. The Internet offers unparalleled access to health care information and increasingly unparalleled shopping for prescription pharmaceuticals. However, a survey conducted by researchers at the University of Pennsylvania found these online pharmacies are, at best, expensive alternatives to traditional pharmacies and at worst, potentially dangerous substitutes for your doctor's advice. The study reviewed Internet sites offering prescription drugs directly
to the public. Information examined included the procedures for obtaining
medication, prescription and shipping costs, cost of physician consultations,
and physician qualifications. Study investigators then compared the prices
of consultations and two popular medications — Viagra (for impotence)
and Propecia (for hair loss) — with prices at the clinics and pharmacies
in their area. Thirty-seven of the 45 sites required a prescription or online physician
approval before purchase. Nine sites, all based overseas, required no
physician consent. Most consultations consisted of online medical history
forms and limited interaction through e-mail. The resulting medication
was 10% more expensive on the Web before adding shipping costs. Consultation
costs, too, were higher, averaging 15% above clinic rates. |
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