Posts Tagged ‘heart disease’

Living Solo Can Be Hazardous to Your Health

Monday, June 25th, 2012

Living to a ripe old age may depend on a person’s relationship to family, friends and community, according to research that finds lonely older adults are more likely to die sooner than their more socially active peers.  Lonely people who are 60 and older tend to have a 45 percent higher risk of dying over the next six years, according to research in the Archives of Internal Medicine.  Another study showed that people who live alone and had heart disease were 25 percent more likely to die from the illness.

Approximately one in seven Americans live by themselves.  The first study to examine the link between social isolation and death points to the importance of addressing psychosocial needs along with medical ones in improving the health of older adults, according to Carla Perissinotto, a study author.  “We cannot continue to ignore the other things that are happening in people’s lives,” said Perissinotto, an assistant professor of medicine and geriatrics at the University of California San Francisco.  “If we turn a blind eye to what our patients are experiencing at home, we may be missing a place to make a difference in someone’s health.”

The lonely people studied were more likely to have limited mobility and greater difficulty performing basic tasks like grooming and cleaning. Approximately 25 percent of lonely people were likely to develop trouble compared to 13 percent who weren’t lonely.  While the connection between well-being and friendships isn’t new, the latest findings look specifically at people who self-identified as lonely, regardless of how extensive their social network.  “It’s about connectivity,” Carla M. Perissinotto said.  “Someone can have multiple social contacts but still somehow feel that they’re not connecting.”

One study followed nearly 45,000 people aged 45 and older who suffered from heart disease or had a high risk of developing it.  Those who lived alone were more likely to die from heart attacks, strokes, or other heart complications over a four-year period than people living with family or friends, or in some other communal arrangement.  The risk was highest in middle-aged people, just 14 percent of whom lived alone. Solo living increased the risk of heart problems and early death by 24 percent among people ages 45 to 65, and by only 12 percent among people ages 66 to 80.  And there was no association at all in people age 80 and older, a group in which living alone is widespread.

Additional research is needed to confirm the findings, but it may not be a bad idea for physicians to ask heart patients about their living situation, said senior author Dr. Deepak L. Bhatt, M.D., a cardiologist at Brigham and Women’s Hospital, in Boston.  Living solo “could be a little red flag that a patient may be at a higher risk of bad outcomes,” Bhatt said.  But living alone could impact health in more immediate ways.  For example, people who live along may skip their medications or ignore the warning signs of heart trouble, according to Bhatt.

Bhatt notes that patients who live alone should never ignore changes that might be a sign of health problems.  “Many times people just adapt to their circumstances.  Perhaps just lower your threshold a little bit and realize it’s better to call (the doctor) than not to call.”  That might not be the entire story.  “Other mechanisms by which living alone could increase cardiac risk have to do with possible social isolation and loneliness, and these are more challenging to fix,” he said.

According to Emily M. Bucholz, M.P.H., a medical student and doctoral candidate at Yale University, “Living alone, in and of itself, could stand for many different things.  Does it mean you lack companionship?  Or is it that there is no one there to help you out with medications?  Does it have to do with mobility or nutrition?”

Writing in Time, Alice Park notes that “Loneliness can be detrimental in many ways, some of which are biological and some of which are more behavioral.  Feeling isolated can trigger changes in brain chemicals and hormones that can increase inflammation in the body, for example, which can exacerbate conditions like heart disease and arthritis.  Loneliness may also lead to other problems — poor sleep, depression, a disinterest in one’s own healthcare — which can in turn contribute to disability and early death.  Which is why the researchers were particularly concerned over another finding — many of the elderly who said they felt lonely were not actually living alone.

Rather, they were married or living with family members.  That suggests that the size of a person’s social network isn’t the only measure of loneliness, and that studies that look only at the number of people’s contacts may miss an entirely separate factor that can have a significant impact on health, said Perissinotto.  ‘I think that from a public health and policy level, we are doing a disservice by not asking (people) about their subjective feelings of loneliness.  We focus on their diabetes control and treating their hypertension, but are we missing something that may be more distressing to patients and have more of an impact on their health?’”

Loneliness is a common source of suffering in older persons,” according to the study’s authors.  “We demonstrated that it is also a risk factor for poor health outcomes including death and multiple measures of functional decline.  Assessment of loneliness is not routine in clinical practice and it may be viewed as beyond the scope of medical practice.  However, loneliness may be an important predictor of adverse health outcomes as many traditional medical risk factors.  Our results suggest that questioning older persons about loneliness may be a useful way of identifying elderly persons at risk of disability and poor health outcomes.”

Sebelius Asks Civil Right Activists to Defend the ACA

Monday, April 23rd, 2012

Secretary of Health and Human Services Kathleen Sebelius has asked civil rights activists to help defend the Patient Protection and Affordable Care Act (ACA), noting that the healthcare law faces an “enemy” whose goal is to set American health policy back half a century.  The remarks come two months before the Supreme Court is expected to issue a ruling that could strike down the law.

Sebelius described the ACA as an crucial weapon against racial disparities that have long meant higher infant mortality rates, shorter life spans and limited access to medical services for minorities.  “The enemy is at the door and we know that they would like to dismantle these initiatives,” Sebelius told the annual convention of the National Action Network, a civil rights group led by the Reverend Al Sharpton“Healthcare inequalities have been one of the most persistent forms of injustice,” she said. “Now is not the time to turn back.”

Civil rights advocates and the minorities they often represent form a key segment of the Democratic base, especially if the Supreme Court strikes down Obama’s signature domestic policy achievement.  Research shows that low-income Americans, including many minorities, have significantly less access to medical care and suffer higher rates of childhood illnesses, hypertension, heart disease, AIDS and other diseases.

Designed to bring healthcare coverage to more than 30 million uninsured Americans, the ACA has become a pet target for Republicans mainly because of an `individual mandate that requires most Americans to have healthcare insurance by 2014.  “We’ve got folks who are committed to undoing…the important initiatives that we’ve made in the last few years,” Sebelius said.  “Frankly, they want to go back and undo Medicare and Medicaid from the mid-1960s.  They want to roll us back years and years.”

The House of Representatives voted recently to partially privatize Medicare and convert Medicaid to a block-grant program for states, although the legislation is likely to be stalled in the Senate.  “I’m here to ask you to help,” Sebelius said.  “If we can begin to close the disparities in health, we begin to close disparities in other areas, too.”

Sebelius asked religious leaders, health advocates and other minority leaders to help the Obama administration educate the public about the healthcare law’s many benefits. The law, which becomes fully effective on January 1, 2014, has already benefited minorities by extending private insurance coverage to young adults, providing free preventive services for those with insurance and prohibiting coverage denials for children with pre-existing conditions.

Cost of Alzheimer’s High in Dollars and Caregiver Devotion

Tuesday, March 13th, 2012

As baby boomers age, the cost of caring for those stricken with Alzheimer’s Disease has nowhere to go but up. By 2050, the cost of treating Alzheimer’s is likely to rise from $172 billion per year in 2010 to more than $1 trillion per year in 2050.  The disease could cost Americans $20 trillion over the next few decades, according to a report from the Alzheimer’s Association.

“We saw it coming.  We knew the numbers were going to be high in the number of people getting the disease.  We as an organization have been preparing for this,” said Nancy Rainwater, vice president of communications for the Alzheimer’s Association Greater Illinois chapter.  “But to think of trillions of dollars…just the amount of money was pretty staggering.”

The statistics were calculated using an analytical model based on data from research and national surveys.  Part of the problem lies in how successful treatment has become for other diseases, Rainwater said.  “We’re living longer, so that has a lot to do with it,” she said.  “There has been so much work in other diseases – cancer, diabetes, heart disease – and people are surviving those diseases.  But then there’s a higher risk, as people age, of getting Alzheimer’s.  You look at statistics of those diseases, and the rates of death have all declined, whereas Alzheimer’s disease has increased.”

Researchers believe that the number of Americans aged 65 and older with Alzheimer’s will more than double to 13.5 million by 2050 as the population ages.  By the middle of the 21st century, nearly 50 percent of people with the disease will be in its most severe – and costly – stage.  “People in the earlier stages don’t necessarily need as much care or support,” said Darby Morhardt, social worker and research associate professor at Northwestern University’s Cognitive Neurology and Alzheimer’s Disease Center.  “But as they deteriorate, as they decline, they have more and more difficulty managing their daily care, so that care needs to be provided by someone.  Often that’s where most of the money is spent, on those last years.”

What’s most stunning is Alzheimer’s human and financial toll. According to the Alzheimer’s Association’s 2011 Facts and Figures Report, 5.4 million Americans (one in eight older Americans) suffer from the debilitating illness.  Joy Johnston of Atlanta knows how difficult caring for a parent with Alzheimer’s can be.  Her father, Patrick, like more than five million other Americans, had been diagnosed with Alzheimer’s Disease.  “It can be heartbreaking at times,” Joy said in reference to caring for her father.  “You have to relearn your relationship with your loved one.”  Caring for a family member with Alzheimer’s can take a profound financial and emotional toll.  Nearly 15 million Americans are unpaid caregivers for those sick with dementia, according to the Alzheimer’s Association.  Do the math, and it adds up to about 17 billion hours of unpaid care valued at $202 billion in 2010 alone.

To help with the staggering cost of care, the Obama Administration has included $26 million in the proposed 2013 budget.  That money will go to education, outreach and support for families affected by the disease.

“Caregivers are often in a situation where their feelings and what they have to do are in conflict,” Dr. Peter Rabins said.  “That’s very hard for most of us because we’ve related with people that we love in a certain way. The disease forces a change in that relationship.”  Rabins, the director of psychiatry at Johns Hopkins School of Medicine, notes that medical bills can pile up quickly.  “That’s a tremendous financial challenge for many families.” Rabins said.

Money isn’t the only sticking point.  The emotional costs take root as soon as dementia is diagnosed.  Family members often begin grieving a death of someone who is still physically present but disappearing mentally.  “Those feelings of loss can become quite chronic,” Rabins says.

“It’s the sort of crisis that policymakers, clinicians know is happening,” said Len Fishman, CEO of Hebrew Senior Life, the largest provider of elder care services in Massachusetts.  “I don’t think the country has absorbed it yet and in a couple of decades when the number of Alzheimer’s cases has doubled, people will look back and say,  ‘Why didn’t we know this was coming?’”

National statistics suggest that it takes an average three to four people to help care for each Alzheimer’s patient living at home; approximately 11 million Americans are currently helping to care for the estimated 70 percent of Alzheimer’s patients who are able to be at home.  That statistic does not include paid caregivers.

Although Medicaid pays for Alzheimer’s day programs for some low-income seniors; Medicare does not.  As a result, many patients and their families must pay privately for Alzheimer’s care until they’ve spent enough money to qualify for Medicaid.  Medicaid does pay for long-term nursing home care, but not the less restrictive assisted living for seniors.

Americans Spend More on Healthcare Than Comparable Nations

Tuesday, December 13th, 2011

The United States spends far more on healthcare than other countries, although Americans visit the doctor and are hospitalized less often than most of the other 34 member countries of the Organization for Economic Co-operation and Development OECD).  In its Health at a Glance 2011 report, the OECD shows that the United States spent about $7,960 per person on healthcare in 2009 – approximately 2.5 times the average of the countries studied.  It also determined that health spending in the U.S. has grown faster than in all other high-income OECD countries since 1970, even accounting for population growth.

“Why?” asks Julie Appleby in Kaiser Health News.  “Generally, prices for medical care are higher in the U.S. – and some services are performed more often.  Hospital prices are 60 percent higher than the average of 12 selected OECD countries, and the U.S. also generally pays more for each appendectomy, birth, joint replacement or cardiac procedure.  Americans have more imaging tests, such as CT scans and MRIs, than residents of other countries and are far more likely to have knee replacements, coronary angioplasty or surgery to remove their tonsils.  Even with all that, compared with most of the other developed countries, the U.S. has fewer practicing physicians per person, fewer hospital beds, and patients don’t stay as long in the hospital.  Administrative costs in the U.S. are also high, the report notes, accounting for about seven percent of total spending.  That is roughly comparable to what is spent in France and Germany, which have universal health coverage.  In Canada — another country with national healthcare – administrative costs are about four percent of health spending.”

“The U.S. is just this astonishing outlier compared to everyone else,” said Mark Pearson, the head of the OECD’s social policy division. A significant part of the difference relates to pricing.  American patients don’t spend more time in the hospital or visit more doctors than patients in other OECD countries; they pay more for everything.  Physician fees are more than twice the average cost, for example, while drugs and hospital care cost 60 percent more.  In terms of results, however, the U.S. does not come out on top.  Life expectancy in 2009 was 78.2 years, below the OECD average of 79.5.  That puts the nation closer to the Czech Republic and Chile, “not countries you would usually expect the U.S. to be compared to,” Pearson said.

The U.S. also has one of the poorest records in terms of premature mortality in general and mortality from heart disease in particular.  Americans have the highest obesity rate — with more than one-third of the population considered obese.  They also have one of the highest rates of hospital admission for illnesses that are optimally managed by primary-care physicians, including asthma, chronic obstructive pulmonary disease (including emphysema), and diabetes.

The news isn’t all bad.  The OECD report notes that the U.S. does an excellent job of cancer care, with very high survival rates and low mortality rates.  Stroke deaths are well below average in the United States.

Americans spend approximately 17.4 percent of its gross domestic product on healthcare; other OECD nations spend an average of 9.6 percent of their GDPs on healthcare.  According to OECD, the U.S. has an “underdeveloped” primary-care system that physician shortages only intensify.  There are 2.4 physicians for every 1,000 Americans, compared with an average of 3.1 in other countries.  Additionally, there are 3.1 hospital beds per 1,000 Americans, compared with 4.9 per 1,000 in other countries.

The Washington Post’s Ezra Klein thinks that Americans spend too much on healthcare. According to Klein, “There are a lot of complicated explanations for why American healthcare costs so much, but there are also some simple ones.  Chief among them is ‘we pay too much.’  And I don’t mean in general.  I mean specifically.  Mountains of research show that for every piece of care you might name — a drug, a doctor visit, a diagnostic — you’ll pay far more in the United States than in other countries.  That’s why seniors head to Canada to buy drugs made in the United States.  In Canada, the government negotiates one low price.  In America, insurers with much less bargaining power negotiate many higher prices.”

According to Ezekiel Emanuel, a bioethicist and fellow at the nonprofit bioethics research institute The Hastings Center, “Unfortunately, few people really understand how much we spend on healthcare, how much we need to spend to provide quality care, and the difference between the two.  Do we spend too much?  Let’s begin with the costs.  In 2010, the United States spent $2.6 trillion on healthcare, over $8,000 per American. This is such an enormous amount of money, it’s difficult to grasp.

“Consider this: France has the fifth largest economy in the world, with a gross domestic product of nearly $2.6 trillion.  The United States spends on healthcare alone what the 65 million people of France spend on everything: education, defense, the environment, scientific research, vacations, food, housing, cars, clothes and healthcare.  In other words, our health care spending is the fifth largest economy in the world.

“The fact is that when it comes to healthcare, the United States is on another planet.  The United States spends around 50 percent more per person than the next highest-spending countries, Switzerland and Norway.”

“Good” Cholesterol Can Protect Against Alzheimer’s Onset

Wednesday, December 22nd, 2010

Researchers at the Columbia University College of Physicians and Surgeons studied 1,130 people over the age of 65 and determined that so-called “good” cholesterol can reduce the risk of developing Alzheimer’s Disease.   In the study, the researchers recorded baseline measurements of the participants’ cholesterol levels and their neurological status.  Additionally, they determined if the seniors had a certain mutation in their APOE genes that might increase their risk of developing Alzheimer’s.

All volunteers were monitored for four years.  In that time, 89 of the study participants were diagnosed as having “probable” Alzheimer’s; another 12 had “possible” Alzheimer’s.  When comparing the participants with the lowest levels of high-density lipoprotein – the so-called “good” cholesterol, also known as HDL – the volunteers with the highest levels were 60 percent less likely to have a probable or even possible case of Alzheimer’s.

In completing their analysis, the researchers took into accounts age, gender, body-mass index, education and ethnic group.  Another point under consideration was the type of APOE gene,  as well as their general health or the presence of heart disease or type 2 diabetes.

The results are not unexpected, given that high levels of good cholesterol already have been associated with a lesser risk of carotid artery atheroschlerosis — which can lead to cognitive impairment – and strokes.

America Is Losing the War Against Obesity

Wednesday, September 22nd, 2010

America is putting on the pounds during this recession.  Americans are not getting thinner, and obesity rates have hit 30 percent of the population or higher in nine states last year, compared with just three states in 2007. Looking at the numbers from a different perspective, this means that 2.4 million additional Americans became obese in just two years, bringing the total to 72.5 million individuals, or 26.7 percent of the population.  Because the survey is based on a phone survey with 400,000 participants, the statistics probably underestimate true obesity rates.

According to Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC), which issued the survey, “Over the past several decades, obesity has increased faster than anyone could have imagined.”  If the numbers keep climbing, Frieden says that “more people will get sick and die from the complications of obesity, such as heart disease, stroke, diabetes and cancer.”  The report says that obesity’s medical costs could be as high as $147 billion a year and notes that “past efforts and investments to prevent and control obesity have not been adequate.”  Too little exercise and too much fast food that is full of sugar and fat share much of the blame for the obesity epidemic.

The nine states with obesity rates of 30 percent or higher are Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and West Virginia.  Mississippi reported an obesity rate of whopping 34.4 percent.  Colorado and Washington, D.C., had the lowest obesity rates at less than 20 percent.  According to Dr. Heidi Blanck, the CDC’s chief of the obesity branch, Americans aged 50 and above had the highest obesity rates.

Are Short People Predisposed to Heart Disease?

Wednesday, August 4th, 2010

Finnish study links height to likelihood of heart disease.Petite people may be getting the short end of the health stick.  A new study reveals that men under 5′ 5″ and women under 5′ tall may be 50 percent more likely than taller people to suffer heart attacks, according to a report in the European Heart Journal.

“Older people are shorter,” according to the study’s lead author, Tuula Paajanen, M.D., a researcher at Finland’s University of Tampere.  “Also, you have to remember that height is at least a combination of genetics, socioeconomic status, and nutritional status.  So when using heights, we are also thinking about some confounding factors.”  Paajanen and her research team analyzed data from 52 quality studies of more than three million individuals.  Literally hundreds of studies – some dating back to the early 1950s – have investigated the possible link between height and heart disease.  The current study is the first systematic examination and analysis of the earlier studies on the subject.

Dr. Michael Lauer, director of the cardiovascular sciences division at the National Heart, Lung and Blood Institute, cautioned that the study’s “major limitation is a failure to take into account confounding factors.  It’s much easier to measure somebody’s height than it is to measure lots of other fundamental factors that could affect height.”  He noted that nutrition is a vital environmental factor that impacts height and heart health alike.  Jaako Tuomilehto, M.D., a professor in the public health department at the University of Helsinki, says that children who received inadequate nourishment before and after birth, tend to grow more slowly.

While acknowledging the study’s limitations, Paajanen says “People have no control over their height or genetics, but they can control their weight and lifestyle habits such as smoking, drinking and exercise.  All of these together affect heart disease risk.  The more risk factors you have, the more effort you should concentrate to reduce the risk factors you can.”

Don’t Worry, Be Happy.

Thursday, March 4th, 2010

A study has found that happier people are healthier, have fewer heart attacks and strokes.Happy people tend to have fewer heart attacks and strokes, evidence that a positive attitude is heart-healthy, according to a study conducted by Columbia University Medical Center. Researchers tracked 1,739 healthy Canadian adults living in Nova Scotia to determine if positive personality traits such as happiness, contentment and enthusiasm impact risk for heart disease.

Prior to the study, researchers determined the participants’ degree of negative emotions such as depression, hostility and anxiety.  They also measured positive emotions, including joy, happiness and excitement.  Although naturally happy people do experience depression and other negative emotions at times, lead researcher Karina W. Davidson, PhD, recognizes that this is usually caused by a certain situation and is transient.  “We know from previous studies that negative emotion is predictive of heart disease,” Davidson said.  “We wanted to find out if positive affect is protective.”

Taking known risk factors into account, the researchers found that the happiest people were 22 percent less likely to develop heart disease over the study’s 10 years when compared with individuals who fell in the middle of the negative-positive emotion scale.  The most negative people had the highest risk of heart disease.  According to Davidson, “It is just speculation at this point, but there are several possible explanations for how happiness may protect the heart.”

Happy people tend to have a healthier lifestyle, eat better, sleep well, smoke less and exercise more.  Another finding is that happiness may produce positive chemical changes in the body, such as a reduction in stress hormones.  Genetic influences could mean that people who are predisposed to happiness also tend to have fewer heart attacks.

Wellness Is a Proactive Approach to Healthcare

Wednesday, June 24th, 2009

Now is the time for healthcare providers to take a proactive approach to the well-being of their respective communities and target markets.  The American Recovery and Reinvestment Act (ARRA), signed into law by President Obama on February 17, contains $1 billion for the new Prevention and Wellness Fund.  This Fund will make available resources for funding immunization programs; infection prevention programs; and the prevention of mpj040515400001chronic diseases such as high blood pressure, diabetes and heart disease.  Based on statistics provided by the Center for Disease Control and Prevention, more than 70 million people in the United States (approximately 25 percent of our total population) live with cardiovascular disease.  Wellness programs have a direct impact on the prevention of these diseases and will be an important components of any preventative program.

Healthcare providers have historically been hesitant to invest in wellness and fitness centers due to the capital resource requirement and uncertain return on investment.  With careful planning and strategic development, these facilities can bring a substantial new revenue stream into the organization.  Skeptics may point to the Medical Fitness Association, which reports that in 2008 there were approximately 950 medically based wellness and fitness centers in the United States, with one-third reporting operating losses.

While such risks do exist, investing in wellness facilities and programs that directly address the prevention of chronic disease have the potential for more than satisfactory financial results.  If managed with a clear direction, thought and competence, these facilities can provide a financial return far more attractive than the equities market has offered in the recent past.  The resources allocated to fight chronic disease will come back tenfold in cost reductions over the long term.

Now is the time to invest in the well-being of our future.  We should not wait for another opportunity like the one Congress and President Obama have provided.  We need to take advantage of this now.