Education As Preventative Medicine

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I always enjoy “meeting” someone on the internet who seems to hold the same views that I do and just recently, I came across an interesting article, Lifelong Learning and Wellness One Component to the Enlightened Gerosphere, in which the author, Paul David Nussbaum, Ph.D., Director, Neurobehavioral Services at St. John Center in Mars, Pennsylvania, put forth the suggestion that just as exercise and healthy eating are preventative, education can be a means of avoiding the dreaded Alzheimer’s.  As he writes:

Imagine an America where health insurance companies paid for attendance at church or synagogue, enrollment in higher education, residence within technologically advanced homes (smart homes) which can relay health information directly to the primary care physician, and even sustained employment. This approach to wellness stands in sharp contrast to the current model that incentivizes annual, invasive procedures such as a pap smear. While these ideas may render a humorous response, we must remember that the total dollar allocation for health care in this country is approximately one trillion dollars, and that one third (33%), or 300 billion dollars, of that total cost is for services delivered to the older adult. Despite this, Medicare and Medicaid are financially unstable. Imagine running a business in which you invest 300 billion dollars and yet the business is bankrupt! Perhaps we are not approaching the care of older Americans in a proper manner!”

I totally agree with Dr. Nussbaum’s assessment that nursing homes are not an answer, as I have written in previous posts, but because he writes it so eloquently, I will share what he writes:

Older Americans do not need high technology medicine, should not be treated in acute care centers as they suffer chronic illness, should not be forced to choose a nursing home, and should not be forced to retire or withdraw from a personal role and purpose. Instead, older Americans should have access to geriatricians who are afforded the same status of primary care physician as are pediatricians, should have access to a chronic care system, should be afforded multiple long term care options which do not include institutionalization and consequent family/financial death. Further, older Americans should be incentivized (financially) to remain well by promoting the social/human factors of health listed above.

I have championed the need to end the existence of nursing homes in the United States as I believe they represent the neglect of a great country to care for a vulnerable and needy segment of our population. Nursing and other services can be delivered without the cement walls of an institution. Nursing homes were built post-World War II and represented a warehousing model of care. Think about where nursing homes are located and you can understand the resulting removal of individuals from the vitality of life. My beliefs have nothing to do with the quality care and hard work that occurs every day in most of our nursing homes. In contrast, the United States must awaken to the fact that nearly one third of Americans would rather die than enter a nursing home, and the market has demonstrated consistently that potential employees seek work elsewhere— human beings do not want to live or work in nursing homes!

Again, Dr. Nussbaum so nicely summarizes the reality of aging in our society today:

Today, the United States has an extremely primitive understanding of aging. Our country maintains a negative perception about getting older, one that reflects a genuine misunderstanding of the facts regarding aging. For example, our entire social and legislative policy is based on an invalid age-threshold of 65. Clearly, we need to increase this age-threshold to reflect more accurately the expected lifespan of Americans. Most people are not aware that age 65 was employed for social benefits by Chancellor Bismarck in Germany over 100 years ago.  Americans believe that advanced age leads to poverty, illness, Alzheimer’s disease, nursing home placement, depression, and loneliness. These entrenched perceptions exist despite facts that nearly 70% of older adults (those living beyond 65) are independent, financially stable, happy, healthy, and productive. Further, the vast majority of older Americans do not have Alzheimer’s and do not live in nursing homes.

So my blog is entitled “education as preventative medicine”  Where does this part of the article begin.  Right here!  Dr. Nussbaum states that

Fortunately, researchers interested in neurodegenerative disorders such as Alzheimer’s disease (AD) which affects four million Americans, and costs the country 100 billion dollars annually in direct care and 30 billion dollars in indirect care related to caregiver illness, have underscored the importance of education as a potential preventative factor against AD. Multiple studies have demonstrated a reduced risk of AD for those with advanced education. The neurobiological explanation of this has been labeled Reserve Theory. Essentially, information which is learned must be processed by our brains, itself a physiological event. Such learning promotes development of new neurons and neural pathways. The theory advances that with increased cell density and cell volume, a progressive disease such as AD will not impact the brain or will impact the brain at a later age because the disease will have to destroy a greater number of cells to manifest clinically. The increased volume of cells in the brain provide a reserve to fight off invading diseases such as AD. Interestingly, the Reserve Theory has been advanced for other etiologies of dementia besides AD.

Although there is more in Dr. Nussbaum’s article on studies demonstrating more proof, I would refer the reader’s to his article, as I have reached my word quota for this particular blog.  Thank you, Dr. Nussbaum.

Copyright Yvonne Behrens 2014

 

 

 

 

 

Health Care or Mis-Care

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[Although I know that most people prefer to watch inspirational videos rather than harsh ones like the one I am showing in the next frame, how our society treats the elderly needs to be looked at in all of its harsh realities.  So for the next few weeks to parallel the blogs I have been writing about the elderly, the video will remain.  Please do view it, because in order to change things, one has to confront square in the face what is or can be unpleasant.  Bear with me.  I promise the next video will be inspirational. ]

In my last two blogs,  I have been exploring anti-psychotic drugs and the elderly.  According to a research done by the University of Florida in 2010,  70% of those entering nursing homes end up on psycho-active drugs within three months of entering the home in spite of having no prior history of psychotic problems. Although dementia may occur in old age, more often than not, the delirious or dementia like behaviors are most likely caused by medication or the interactions of several medications the elderly person may be taking.  Benzodiazepines, opiates and tricycic anti-depressants are the main culprits.  These pills come in very many variations and are extremely prevalent in our society.  Today’s blog is exploring the effects that these drugs can have on older users.

AFFECTS ON OLDER PEOPLE

As one ages, The body’s ability to clear drugs decreases often because of a normal age-related decrease in kidney and liver function. This results in a greater accumulation of drugs in the body.

Secondly, Older patients are often prescribed multiple drugs at the same time. Due to complicated interactions between different drugs, side effects can become more prominent.

Last, Some research have demonstrated that neurotransmitters become naturally imbalanced as people age, increasing the brain’s sensitivity to drugs that have activity in the central nervous system.

With the regular use of anti-psychotic drugs in nursing homes, it is no wonder that the Rovner, et al study concluded that nursing homes were “de facto psychiatric institutions.”

Let’s look at the above facts in more detail:

Number 1.  When doctor’s prescribe medication, they often prescribe the full dose without recognizing that in an older patient, “the body’s ability to clear drugs decreases with age.” For example the equivalent dose of diazepam (a short-acting Benzodiazepine) in an elderly individual on lorazepam (a long-acting Benzodiazepine) should be up to half of what would be expected in a younger individual.  Giving full doses of these medications are sure to cause the side effects to increase in severity the more the drug accumulates in the system.

Paradoxically, an overdose of Benzodiazepines can cause the effects it has been prescribed to diminish, ie, anxiety, delirium, combativeness, hallucinations, and aggression.[ (Wikipedia)

Number 2: “Older patients are often prescribed multiple drugs” many patients do not realize that they are taking too many drugs or taking drugs that might interact with the other drugs in an adverse way. Sometimes they may have two prescriptions for the same drug under two different names, thus inadvertently increasing the dosage.

With the fact that “Some research suggest that neurotransmitters” change as we age affecting the brain’s sensitivity to drugs continues the argument that prescribing drugs to older patients has to be done with extreme care.

With all these factors at play, it becomes of utmost importance, then, that in-depth evaluations are done if and/or when an elderly person begins to manifest dementia-like symptoms.

Public Citizens points out:

“Because cognitive impairment caused by drugs is so frequently overlooked, it is important that when symptoms of confusion, altered concentration or difficulty thinking occur that you and your physician review any medications you are taking to determine if any of them might be the cause.

Fortunately, if the cause is a medication, your symptoms should go away or become less severe after stopping the drug, even if it takes weeks or months. (http://www.worstpills.org/includes/page.cfm?op_id=459)”

And Dr. Gary Oberlender, a Specialist in Geriatric medicines,  points out that

“Dementia as the cause of a senior’s cognitive decline should only be considered after a thoughtful and thorough medical evaluation has excluded a potentially reversible cause. The list of common causes of dementia in seniors is short. It includes Alzheimer’s disease, vascular dementia (stroke), Parkinson’s disease, Lewy body dementia, and alcoholic dementia.”

In recent months, the overuse of anti-psychotic drugs is beginning to be noticed.  In an article that appeared in The Telegraph, doctors can get up to five years jail time in the British Isles for prescribing these drugs to the elderly.  Here in the U.S., nursing homes are being forced to reduce their use of anti-psychotic drugs 

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