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ISSUES OF THE ELDERLYJul 1, 2005 Introduction
As the first of the “baby boomers” reach 60, more and more attention is being focused on a growing number of issues affecting senior citizens and the elderly. We have been following a wide range of subjects in this area and, as a service to our subscribers and their families, have assembled many of them below for easy reference.
While many of the items are associated with adverse reports of one type or another, some are positive in nature and may prove to be useful to many of you.
Drug-related Health Risks
In previous Newsletters we have explored the risks associated with the unapproved (“off-label”) use of atypical anti-psychotic drugs in elderly patients. The drugs included in this category are Abilify, Zyprexa, Seroquel, Risperdal, Clozaril, Geodon, and Symvyax,
These drugs are approved to treat mental illnesses such as schizophrenia and depressive episodes associated with bipolar disorder. They are not, however, approved for treating dementia in elderly patients. Nonetheless, doctors have been prescribing them extensively for this “off-label” use.
In 13 placebo-controlled studies, several of these drugs were given to elderly patients with dementia. Ten of these studies showed numerical increases in mortality in the non-placebo groups. Most of the deaths were due to heart failure or other heart related events and infections such as pneumonia.
Due to the findings of this study, Health Canada and the FDA are requesting that all manufactures of atypical antipsychotic drugs include a warning of these risks. The warning should also state that these drugs are not approved for treating dementia in elderly patients. The FDA issued a Public Health Advisory on this very point on April 11, 2005.
A study conducted by researchers at the McGill University Health Centre, found that the COX-2 inhibitor Vioxx created an increased risk of heart attack in elderly patients with no previous risk of heart-attack.
While Vioxx was pulled from the market in September of 2004, this raises concerns about other COX-2 inhibitors which are still available and linked to similar increased cardiovascular risks. Elderly patients should consult their physicians before beginning treatment with any COX-2 inhibitor to make sure that it is the right option for them.
In a study conducted at Brigham and Women’s Hospital in Boston and Harvard Medical School, 40,000 female health professionals 45 and older were asked to take either fake pills or 100 milligrams of aspirin every other day.
After 10 years, the aspirin users who were 65 and older had a 30% lower risk of stroke and a 34% lower risk of stroke caused by blood clots. However, 127 aspirin takers required a blood transfusion due to stomach and intestinal bleeding compared to 91 women in the placebo group.
While aspirin has been recommended for adults who have an increased risk of developing heart problems, this new study raises questions about the benefits of aspirin use for women.
Another new study published in the British Medical Journal warns that aspirin should not be taken by healthy people over 70. The study also warns that health benefits may be outweighed by the same risk mentioned in the previous study – internal bleeding and stomach ulcers.
Many elderly people have turned to aspirin after the recall of COX-2 inhibitors such as Vioxx and Bextra.
Other Drug Related Risks
The following is a list of other drug-related issues that apply to the elderly:
• According to a survey conducted at the Health Institute at Tufts-New England Medical Center, two out of every five senior citizens do not follow doctor’s orders when it comes to prescription drugs. Some senior citizens cite cost as the main reason while others claim that they declined to take their medicines because they didn’t think that it was helping or felt that they were already on too many medications. Another study reported that elderly patients often do not take their blood pressure pills because hypertension “the silent killer” does not have any visible symptoms. Individuals may be more likely to take medications for diseases that produce noticeable symptoms. Seniors were also less likely to take medications for asthma, chronic obstructive pulmonary disease (COPD), depression, gastrointestinal disorders, and osteoarthritis.
• Health Canada’s adverse drug reaction database reported that as many as 3,300 senior citizens die in Canada each year due to adverse drug reactions. In fact, the elderly account for more than one-third of all drug-related side effects that are reported to Health Canada. One reason for this increase in risks is that senior citizens take more prescription drugs than the regular population. It is also sometimes more difficult to detect side-effects in senior citizens as their health may already be failing and it may be considered more understandable when they exhibit certain ailments. In addition, seniors may be more susceptible to health risks because they have less fat in their bodies as compared to a younger person.
• The Beers list outlines the drugs that should be avoided by elderly patients. However, many physicians and medical professionals do not use or know about the list. The Canadian Broadcasting Company reported that in 2004, 1.5 million Canadian seniors were given drugs that were unsuccessful or put them at a higher health risk when safer alternatives were available.
Alzheimer’s disease – Good News and Bad News
Researchers now believe there may be a third type of diabetes, “type 3” diabetes that may be found in patients with Alzheimer’s disease. This new type of diabetes occurs as a result of insufficient insulin levels produced in the areas of the brain affected by Alzheimer’s. These findings may change the way that Alzheimer’s disease is both viewed and treated.
On a brighter note, researchers at the Mayo Clinic have shown that the drug Aricept can slightly slow the progression to Alzheimer’s disease among patients with mild cognitive impairment. Patients who took the drug reduced their risk of progressing to full-blown Alzheimer’s disease within the first year of the study. Yet by the third year, the drug’s benefits were no longer evident. Still, this is a step in the right direction in terms of treating Alzheimer’s disease and memory loss.
NEW DIAGNOSTIC APPROACHES MAY PROVIDE AN EARLY WARNING SYSTEM FOR ALZHEIMER’S DISEASE:
Researchers involved in three separate studies are reporting diagnostic approaches involving brain scans and a blood test may offer a way to identify individuals who are at higher risk of developing Alzheimer’s disease years before the onset of actual symptoms.
This approach, announced Alzheimer’s Association International Conference on Prevention of Dementia, in Washington, D.C., offers a possible two-fold breakthrough by permitting treatment to be commenced at a much earlier stage of the disease and by helping those determined to be at risk to take more complete advantage of preventive therapies which are, or may become, available in the future.
The three studies include one involving “positron emission tomography (PET) scans working in conjunction with a specially designed MRI-linked computer program. The process tracks glucose metabolism in the hippocampus (memory) area of the brain. Decreased metabolic activity is seen as an indicator for cognitive problems and a risk factor for Alzheimer’s.
The second study involved “magnetic resonance spectroscopy (MRS) which is an MRI-type scan used to examine brain biochemical activity as opposed to brain structure. Neurochemical differences between “normal” individuals and those carrying a gene strongly associated with a high predisposition to Alzheimer’s disease indicate the possibility of early detection of cognitive decline.
The final study could be the most promising in terms of availability and expense in that it involves a simple, painless blood test. The test is used to detect two protein markers which when analyzed together and in ratio with one another provide strong evidence of future development of Alzheimer’s disease.
Although the high-tech detection methods seem to be further along in terms of development, the blood screen is attractive because it is far less expensive, requires no special equipment or training at the site of the test only laboratory facilities which may analyze blood samples from many locations, makes screening available in remote and less-developed areas, and is more easily assimilated into normal medical office routine.
Early detection of impending Alzheimer’s disease, while encouraging, is somewhat premature as a method of reducing or eradicating the debilitating condition since effective treatments and preventive therapies are largely nonexistent or only in early stages of development at the present time.
Nursing Homes and Hospitals
Nursing homes have become an increasingly popular option for elderly men and women in the last ten years. In fact, the assisted living industry has grown by about 48% since 1998. One reason for this increase is that people are living longer.
Nursing homes and assisted living facilities can be a welcome option to families who are looking to help their loved ones get the kind of 24-hour attention they need. Sometimes, a visiting nurse or aid who comes during the day is not enough for an individual who requires constant care. Yet there are numerous problems associated with nursing homes and assisted living facilities that should be taken into consideration.
• Medication Errors: Failing to follow prescription orders, not giving patients their medications, failing to have drug-procedures approved by a doctor, and lack of medication.
• Training Deficiencies: Failure to teach staff members resuscitation, failure to provide proper first aid training, and inadequate instruction relating to caring for frail elderly men and women.
• Staffing Shortages: Too few employees on a given work shift and failing to have a qualified administrator on location at all times.
Another issue relating to nursing homes is the amount of annual preventable adverse drug events. Researchers at the Meyers Primary Care Institute reviewed patient records at two long-term care facilities with a combined total of 1229 beds.
In an 8 or 9 month period there had been 815 adverse drug events including 33 life-threatening events and four fatalities. The researchers concluded that 42% of these adverse events could have been prevented and that 61% of the life-threatening and fatal events could have been prevented as well.
Elderly patients often endure repetitive hospital visits. Hospitals are yet another facility which can be a dangerous place for an elderly patient. A study conducted at the Saint Louis University showed that elderly patients who have difficulty taking care of themselves and performing daily tasks such as eating and bathing are at an increased risk to die in the hospital.
In addition, elderly patients who have a body mass index of less than 20 are at an increased risk for death during hospitalization. A normal body mass index is somewhere between 18.5 and 24.9.
The following are two cases relating to nursing home facilities:
Vincenzia Rinaldi died 30 months after entering an assisted living facility when she was mistakenly given another resident’s prescription medication. While she was 91 years-old, her death was attributed to a preventable nursing home error and not old age.
A family in Florida was awarded $1.875 million in a settlement regarding the death of Earl Dean Griffith. Griffith died as a result of receiving hundreds of fire ant bites. The nursing home that he was living in has reportedly had a pest problem for years.
Identity Theft and Related Scams
Senior citizens are easier targets than younger people for scam artists for a number of reasons. They are trusting, usually generous and kind, and often lonely for everyday companionship. Many of them suffer from conditions which may impair their hearing, eyesight, or cognitive awareness.
Thus, they can be taken in by unscrupulous people using a number of deceptions. The following is a partial list of such scams which senior citizens should be aware of:
• Allowing unsolicited contractors to do work they claim is needed to fix dangerous or deteriorating conditions like broken driveways, clogged chimneys, gas or oil burners, and roofs. The work is always unnecessary, expensive, and of poor quality if it is done at all. The scam artists insist on cash claiming that allows them to do the work for a lower price.
• Allowing people claiming to be utility workers into their homes to “check” for gas or water leaks, electrical or telephone problems, or other “dangerous” conditions. While the resident stays with the bogus worker, an accomplice slips into the home and steals valuables.
• Permitting marginal acquaintances to move in alone or with family members for an unspecified period of time due to medical, financial, or for some other bogus excuse. The “tenant” then stays on for an extended period of time without paying rent and secretly stealing valuables from the home. Eventually, the scam artist convinces the victim to sign a power of attorney in order to allow him or her to “help take care of things.” Shortly thereafter the thief empties bank accounts, sells off property like stocks, bonds, and antiques and flees.
• Bogus stock or investment scams where the company does not exist or the assets are worthless.
• Fake investments in things like real estate, race horses, and gold that is either greatly (or fraudulently) overvalued or even non-existent.
• Various telephone scams designed to get social security, bank account, and other identification numbers. The most important thing to remember is: NEVER GIVE IDENTIFYING INFORMATION TO ANYONE OVER THE TELEPHONE UNLESS YOU HAVE INITIATED THE CONTACT AND TRUST THE PERSON YOU ARE SPEAKING TO.
• Never leave mail in mailboxes where it can be stolen and opened in order to gain identification information.
• Never throw away receipts, old checks or bank statements, old credit cards, or any other document with identifying information on it without first tearing or shredding it.
• Be aware of your surroundings when performing bank or ATM transactions.
• Always request to see official identification credentials of any public employee or repair personnel who seek entry into your home.
• Older adults who smoke are at a two-fold risk for developing age-related macular degeneration (AMD), a degenerative eye disorder that is the leading cause of blindness.
• A recent study found that there is an increasing rate of heart failure in the general population which, in large part, is due to the large number of people who are reaching old age.
• Two new studies suggest chronic insomnia may provoke depression even in those without a history of it and may prolong it in those who already suffer from it.
• Women who are obese after age 70 are actually more likely to become frail or disabled than normal-weight women. Signs of frailty include weakness, slowness, weight loss, low physical activity, and exhaustion.
• Elderly patients who have chronic insomnia are at a higher risk for developing symptoms of depression. Earlier research indicates that 40% of elderly men and women have trouble sleeping.
• A new study indicates that elderly patients who watch television may actually develop more negative views about aging. This is attributed to negative stereotyping of senior citizens on television. The study included men and women between 60 and 90 years-old.
• Capsaicin lozenges may help prevent aspiration and pneumonia in the elderly when dissolved in the mouth before meals because they improve reflexes of the upper respiratory system.
While growing older brings with it a number of medical and non-medical problems that can be place enormous stress on individuals and their families, the experience can be made more tolerable and safe by remaining aware of the type of information discussed herein.
Individuals able to care for themselves and families caring for those who cannot should be sure to read as much as possible in news and elder-oriented publications, join organizations like AARP, consult with and ask questions of their doctors, carefully follow all instructions on medications, maintain a positive outlook as well as a support network, eat well, and remain as active as possible.
However, if you or a loved one has been injured by a dangerous prescription or over-the-counter drug, negligence or maltreatment at an elder-care facility, or malpractice by a physician or psychiatrist, please contact Parker & Waichman for a free and thorough case evaluation at http://www.yourlawyer.com.