Healthcare Archive

Although it can be difficult to have hard conversations regarding advance care planning, most people find it a relief to know they have voiced their preferences and laid the groundwork for decision making once it is complete. Coming up with an advanced care plan can be overwhelming, but it is important to take it step by step.

The first step is simply gaining a realistic understanding of your current health status. You may be in generally good health, despite having several medical conditions such as high blood pressure or osteoarthritis. You may be doing well now but have a chronic, progressive, ultimately fatal illness such as Alzheimer's disease or metastatic colon cancer. You may be frail because of multiple interacting chronic conditions or one disease that has widespread effects on your daily activities and health. Or you may have a serious advanced illness, such as end-stage heart failure.

The old-fashioned house call is back in a big way. Here's how it works.

It's hard to get to the doctor when you don't drive anymore or you're struggling with several chronic medical conditions. The result may be missed appointments and a lack of needed care.

But a growing trend makes it far easier for older adults to get medical attention, bringing routine exams and diagnostic tests to the patient's doorstep. It's called home-based medical care — when doctors, nurse practitioners, physician assistants, or other providers visit and treat older adults right in their homes.

News briefs

As we've reported before, free medically tailored meals are making a big difference for older adults who have chronic illness or are recovering from a hospital stay. The meals are provided by nonprofit agencies and are customized to your dietary needs — like a potassium-controlled diet if you have kidney disease, or a diet low in vitamin K if you're taking a blood thinner. Now an observational study published online April 22, 2019, by JAMA Network Open suggests that taking part in a free medically tailored meal program is linked to fewer admissions to hospitals and nursing homes, as well as lower medical costs. Researchers looked at about 1,000 adults with health problems such as cancer or diabetes. Half took part in a free medically tailored meal program for about a year; the other half did not. During a two-year follow-up, people who received medically tailored meals had 49% fewer hospital admissions and 72% fewer nursing home admissions than those who did not receive meals. Getting the meals was also tied to a 16% reduction in medical costs each month. To find a program near you, check out the partner section of the Food Is Medicine Coalition (www.fimcoalition.org/partners).

Image: © FredFroese/Getty Images

The FDA may require mammography facilities to notify patients about this breast cancer risk factor, but women don't know what to do with this information.

Do you know how dense your breasts are? If you don't, a new proposal by the FDA may mean you will soon find out.

The agency proposed a change that, if approved, will require mammography facilities to send letters informing women about their breast density — a measure of the proportion of active tissue versus fat in their breasts (see "The FDA proposal").

Drug recalls don't necessarily affect every batch of a pill or potion. You'll need to do a little homework before you stop taking your medication.

We take prescription and over-the-counter medications to get better or avoid getting sick. We know drug side effects can make us feel ill. But we don't imagine that medications can contain toxic impurities. Yet, it happens. Recently, for example, dozens of prescription blood pressure pills (angiotensin-receptor blockers, or ARBs) containing trace amounts of potentially cancer-causing compounds were recalled.

Recalls happen frequently. Sometimes, the FDA finds the manufacturing process to be defective. Other times, a dangerous side effect that was initially not apparent becomes clear later. "Some medication recalls are for problems that are not very serious, but the products have to be recalled nonetheless," says Joanne Doyle Petrongolo, a pharmacist with Harvard-affiliated Massachusetts General Hospital.

These tips on finding the right fibromyalgia doctor may help:

Be upfront about your needs, and set your own ground rules.

 Image: © SelectStock/Getty Images

Allowing your kids to be involved in your health care can have many benefits. The arrangement provides advocates who can help you follow your treatment plan, talk to your doctors, and maybe even make appointments and take you to them. As an added bonus, you get to spend more time with your adult children.

But the arrangement isn't always easy. "There's a tendency for roles to reverse. The child becomes the parent. The parent may not be comfortable with that. Or the parent doesn't want to burden the child, and lets health issues go until they're too far gone," says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center. Consider the following tips to navigate the relationship.

News briefs

 Image: © AlexRaths/Getty Images

Urgent care clinics are convenient when you don't feel well and can't see your doctor right away. But a study published online July 16, 2018, by JAMA Internal Medicine found that people who go to such clinics may be more likely to be given prescriptions for unnecessary antibiotics. Researchers analyzed 156 million insurance claims from 2014 and found that 46% of people treated at urgent care centers for viral conditions — like a bad cold, the flu, or viral bronchitis — were prescribed antibiotics. The problem: antibiotics kill only bacteria, not viruses. The study underscores the need to ask health care workers if you have a viral or a bacterial condition before you take antibiotics.

Research we're watching

 Image: © Gligatron/Getty Images

Do you take generic drugs to lower your blood pressure or cholesterol? You may save money by paying out of pocket at Walmart instead of a paying a Medicare prescription copay, according to an analysis in the July 24 Annals of Internal Medicine.

Walmart (and a number of other large chain stores) offer generic drug discount plans; they sell 30-day supplies of popular generic drugs for $4.