Study: Kids safer in grandma's car

Let Gramps or Grandma drive the kids: It's safer.

That's the finding of a new study by researchers at The Children's Hospital of Philadelphia, who say that the risk of injury to children in crashes was 50% lower when grandparents were behind the wheel.

Hospital researchers studied data from State Farm insurance claims covering 11,859 children 15 and younger in motor vehicle crashes from 2003 to 2007 in 15 states and the District of Columbia; they also conducted telephone interviews with drivers.

The findings were counterintuitive, because previous studies have found that drivers over age 55, and especially those past 65, have a higher risk of motor vehicle crashes.

"It was the exact opposite of what we expected to find," says Fred Henretig, lead author of the study and a staff physcian in the emergency department at the hospital. "(Why) is the million-dollar question."

Henretig speculates that the reason might be quite simple: "Grandparents, when they have the opportunity to interact with their grandchildren find that to be the primary focus of their time together," he says. "They're perhaps not as distracted by trying to do a million errands, or get the dinner on the table, or wonder about their response to the latest e-mail.

"Speaking as a grandparent, about the worst thing that could happen is one of your grandchildren getting hurt on your watch, and trying to communicate that to your children," Henretig says.

He says it's also possible that automobile trips with the grandparents involved shorter distances and less time on interstates. He says the surprising results require more study: "Let's figure out what the grandparents are doing right, and get everybody to do it."

The study was published online Monday in the journal Pediatrics.

"I'm really happy to see this study that debunks some of the myths about older drivers," says Amy Goyer, AARP's family expert. "A study last year by the Insurance Institute for Highway Safety found that older drivers tend to self-regulate. When grandchildren are in the car with grandparents, they're motivated to self-monitor the danger."

Falls, eye test may give clues to Alzheimer's

Falls, eye test may give clues to Alzheimer's

By MARILYNN MARCHIONE, AP Medical Writer – 3 days ago 

PARIS (AP) — Scientists in Australia are reporting encouraging early results from a simple eye test they hope will give a noninvasive way to detect signs of Alzheimer's disease.
Although it has been tried on just a small number of people and more research is needed, the experimental test has a solid basis: Alzheimer's is known to cause changes in the eyes, not just the brain. Other scientists in the United States also are working on an eye test for detecting the disease.
A separate study found that falls might be an early warning sign of Alzheimer's. People who seemed to have healthy minds but who were discovered to have hidden plaques clogging their brains were five times more likely to fall during the study than those without these brain deposits, which are a hallmark of Alzheimer's.
Both studies were discussed Sunday at the Alzheimer's Association International Conference in France.
More than 5.4 million Americans and 35 million people worldwide have Alzheimer's, the most common form of dementia. It has no cure and drugs only temporarily ease symptoms, so finding it early mostly helps patients and their families prepare and arrange care.
Brain scans can find evidence of Alzheimer's a decade or more before it causes memory and thinking problems, but they're too expensive and impractical for routine use. A simple eye test and warning signs like falls could be a big help.
The eye study involved photographing blood vessels in the retina, the nerve layer lining the back of the eyes. Most eye doctors have the cameras used for this, but it takes a special computer program to measure blood vessels for the experimental test doctors are using in the Alzheimer's research, said the study's leader, Shaun Frost of Australia's national science agency, CSIRO.
Researchers compared retinal photos of 110 healthy people, 13 people with Alzheimer's and 13 others with mild cognitive impairment, or "pre-Alzheimer's," who were taking part in a larger study on aging. The widths of certain blood vessels in those with Alzheimer's were different from vessels in the others and the amount of difference matched the amount of plaque seen on brain scans.
More study is planned on larger groups to see how accurate the test might be, Frost said.
Earlier work by Dr. Lee Goldstein of Boston University showed that amyloid, the protein that makes up Alzheimer's brain plaque, can be measured in the lens of the eyes of some people with the disease, particularly Down syndrome patients who often are prone to Alzheimer's.
A company he holds stock in, Neuroptix, is testing a laser eye scanner to measure amyloid in the eyes. Goldstein praised the work by the Australian scientists.
"It's a small study" but "suggestive and encouraging," he said. "My hat's off to them for looking outside the brain for other areas where we might see other evidence of this disease."
Eye doctors often are the first to see patients with signs of Alzheimer's, which can start with vision changes, not just the memory problems the disease is most known for, said Dr. Ronald Petersen, a Mayo Clinic dementia expert with no role in the new studies.
Other signs could be balance and gait problems, which may show up before mental changes do. Susan Stark of Washington University in St. Louis led the first study tying falls to a risk of developing Alzheimer's disease before mental changes show up.
It involved 125 people, average age 74, who had normal cognition and were taking part in a federally funded study of aging. They kept journals on how often they fell, and had brain scans and spinal taps to look for various substances that can signal Alzheimer's disease.
In six months, 48 fell at least once. The risk of falling was nearly three times greater for each unit of increase in the sticky plaque that scans revealed in their brains.
"Falls are tricky" because they can be medication-related or due to dizziness from high blood pressure, a blood vessel problem or other diseases like Parkinson's, said Creighton Phelps, a neuroscientist at the National Institute on Aging.
Falls also can cause head injury or brain trauma that leads to cognitive problems, said Laurie Ryan, who oversees some of the institute's research grants but had no role in the study. Older people who hit their heads and suffer a small tear or bleeding in the brain might seem fine but develop symptoms a month later, she said.
The bottom line: "If you see somebody who's having falls for no particular reason," the person should be evaluated for dementia, said William Thies, the Alzheimer's Association's scientific director.
The warning signs of Alzheimer's:
—Memory loss that disrupts daily life
—Trouble planning or solving problems
—Difficulty completing tasks
—Confusion with time or place
—Trouble understanding images and spatial relationships
—New problems with speaking or writing words
—Misplacing things and inability to retrace steps
—Decreased or poor judgment
—Social withdrawal
—Changes in mood or personality

On the Net:

• National Institute on Aging: http://www.nia.nih.gov/Alzheimers
• Alzheimer's Association: http://www.alz.org

Home care cutbacks put strain on elderly

Plans sacrificed to trim budgets

July 17, 2011|By John Seewer and Shaya Tayefe Mohajer, Associated Press

TOLEDO, Ohio - Born with cerebral palsy, Jennifer McPhail relies on a home health aide to help her get dressed for work and ready for bed at night.
Her motorized wheelchair keeps her active, working as an organizer with a disability rights group in Austin, Texas, and volunteering to help people find housing and to staff hurricane shelters. She now fears deep reductions in the state’s Medicaid spending will prevent her from living independently.
“What it says to me is that the state doesn’t value the lives of people with disabilities,’’ said McPhail, 39. “A lot of people are going to be hurt in a very intimate way.’’

It’s a concern facing families across the nation as states with budget deficits cut home health services that help keep the elderly and disabled out of nursing homes. States are reducing how much time a nurse can spend making house calls and ending meal deliveries for the homebound. Many also are gutting adult day-care programs that give seniors a safe place to spend their days while relatives work.
Aging and disability services in three out of four states have been reduced during the past two years or face cuts, even though demand is increasing.
Texas lawmakers underfunded Medicaid by nearly $5 billion in the state budget, a move that home health advocates say leaves the elderly and adults with disabilities unsure how their care at home will be provided.
California eliminated funding for about 330 adult day centers, a move that will affect some 35,000 seniors who use them for medical care and socializing. Lawmakers are hoping to restore about $85 million to transition seniors into an as-yet undetermined alternate program - about half the amount cut from the budget.
Minnesota is considering cuts to home-health aides and a program that allows disabled people to live on their own.With each cut, the ability to live at home becomes more difficult. “You end up losing control over your decisions,’’ said Neil Johnson of the Minnesota HomeCare Association.
Home-health services are an easy target for budget-cutters because they are not required by federal law, have been subject to fraud, and don’t have deep-pocketed special interests advocating for them. Steep cuts in these services eventually could cost states more money by pushing more people from their houses to nursing homes that would require taxpayer subsidies.
“Just because you cut the budget doesn’t mean their needs go away,’’ said Anita Bradberry of the Texas Association for Home Care & Hospice Inc.
Medicaid, the state-federal program that pays for medical and long-term care for the poor and disabled, is generally required to help fund nursing homes but not home care.
Because the programs are not required, most states first look at cutting home health care funded through Medicaid, even though such programs are much cheaper than nursing homes.
The price of an adult day health center is $67 a day on average, compared with $229 a day for a private room at a nursing home, according to a 2010 survey released by MetLife Inc.
Overall, Medicaid spending on nursing homes came to $46.5 billion in 2007, the latest figures available, while home health services cost $6.3 billion, according to the US Department of Health and Human Services.

New End-of-Life Care Laws

Law on End-of-Life Care Rankles Doctors

By JANE E. BRODY

I shouldn’t be surprised when doctors object to laws telling them how to practice medicine, as does New York State’s new Palliative Care Information Act — not surprised, but in this instance, distressed.
Vehemently opposed by the Medical Society of the State of New York, the law passed last summer by a two-thirds majority of the Legislature and took effect in February. The legislation was written in collaboration with Compassion and Choices of New York, an organization that advocates for informed choices and greater physical and emotional comfort at the end of life.
The act, which I discussed in this column last August, states that when patients are found to have a terminal illness or condition, health care practitioners must offer to provide information and counseling about appropriate palliative care and end-of-life options. Patients or their surrogates are entirely at liberty to refuse an offer to discuss these options.
California passed a similar law in 2009, and other states are considering them. These measures promise to reduce the cost of care at the end of life, as well as the suffering often associated with it; palliative care is meant to reduce the severity of disease symptoms, pain and stress.
Although there are penalties for violation, it is not the specter of punishment that raises the hackles of some physicians. Rather, they say the new requirement interferes with how they choose to deal with their patients and does not take into account the nuances of a doctor-patient relationship.
In an article in The New England Journal of Medicine last month, Dr. Alan B. Astrow and Dr. Beth Popp of Maimonides Medical Center in Brooklyn wrote that they were troubled by “the law’s heavy-handed intrusion into the doctor-patient relationship.” They stated, “In asserting power over the way in which deep and troubling human questions should be addressed, the New York Legislature seems likely only to generate cynicism at the times when critically ill patients and their families are most in need of honesty, kindness and engagement.”
Another New York physician, Dr. Yashar Hirshaut, an oncologist at NewYork-Presbyterian/Weill Cornell Medical Center who also objects to the act, said in a letter to me that “the new law is going to have a direct negative effect on too many cancer patients.” He wrote that when he explained what the law required to a patient with a life expectancy of six months, her response was, “What, are they trying to kill me?”
How the Law Can Help
This law is not about ending a patient’s life. Rather, it is intended to make the end, when that end is near, as physically and emotionally painless as possible. The law is intended to spare terminally ill patients from futile medical interventions that can detract from the quality of their remaining days.
Despite their opposition to this legislation, Dr. Astrow and Dr. Popp acknowledged that “seriously ill patients and their families need accurate information about prognosis and treatment options; physicians’ repeated failure in this realm is clearly a public health problem that the profession should be required to address.”
David C. Leven, who heads Compassion and Choices of New York, said in an e-mail that “the law simply requires physicians to do what the authors say should be required of them. The profession has not addressed this public health problem. The Legislature did.”
While legislation may not be the ideal way to go about this, the fact is that too many doctors fail to inform their terminally ill patients about the risks of continuing aggressive treatments to the bitter end and the benefits of opting only for treatment of discomforting symptoms through palliative or hospice care.
Doctors are notorious death-deniers, often more reluctant than their patients to admit that it is pointless to pursue treatment that is medically futile. They either fail to mention hospice care or suggest it far too late — usually within a week of death, when hospice personnel have little time to get to know the patient and family and to provide the kind of care that can make for a graceful exit from this world.
Studies have shown that patients with a short life expectancy who choose hospice over continued treatment and last-ditch assists like ventilators and feeding tubes live not only better but, surprisingly, longer on average. Researchers also have found that surviving family members are less likely to experience prolonged depression and grief when their loved ones are spared grotesque medical interventions and receive only comfort care at the end of their lives.
Even knowing these facts, some patients are likely to choose to take advantage of anything and everything in the medical armamentarium that could conceivably grant them extra days, weeks or months of life. And such a choice is the prerogative of every terminally ill patient; the new law does not in any way deny that choice. It merely says that patients should be offered the chance to learn about the alternatives.
Nor does the law prohibit patients (or families) from changing their minds and requesting aggressive measures after an initial acceptance of palliative care.
Communication Skills Needed
Many physicians fear that merely broaching the subject of palliative care will strip terminally ill patients of hope. But I have to wonder whether offering unrealistic hope for a cure, or overly optimistic prognoses, isn’t more harmful to patients and their families. If patients are unaware that the remaining time is short, they may lose the chance to resolve important personal issues, say meaningful good-byes, and leave legacies or memories that survivors can cherish long after death.
Few physicians trained more than a decade ago were taught how to communicate emotionally challenging information to their patients. But in recent years the medical literature and continuing education courses have sought to fill in this gap.
For example, Dr. James A. Tulsky of the Center for Palliative Care at Duke University Medical Center wrote in The Journal of the American Medical Association that “talking about treatment choices at the end of life does not necessarily rob patients of hope. Redirecting the patient’s goal toward realistic hopes and being present with compassion can serve as a powerful act in helping patients make decisions while maintaining a hopeful outlook.”
Dr. Tulsky advised that patients be told, in effect, to hope for the best but to prepare for the worst. Their goals can be broadened to include not just successful treatment, he suggested, but also the measures they want taken if they cannot be cured and advice on how to accomplish important tasks that might otherwise be left undone.
Terminally ill patients may fear not just death, but also that in choosing palliative or hospice care, they will be abandoned by their primary physicians. Disappearing doctors are all too common when curative treatment options are exhausted. If doctors truly want to preserve hope, they owe it to their patients to stick around until the end.

Missouri Bar Publishes New Version of Durable Power of Attorney

Missouri Bar Publishes New Version of Durable Power of Attorney
for Health Care and Health Care Directive

Although the statute hasn’t changed, the bar’s DPA for Health Care form has – online where it can be downloaded, as well as in hard copy. The online version can now be filled out on screen, and then printed. Instructions for the online version are included as hover text, next to the lines they pertain to.
A number of changes have made the printed form more useful and convenient. The old form included the DPA for health care, a health care directive and the HIPAA privacy authorization form. The new form offers Missourians the ability to control several other related end-of-life decisions. Part of the form can authorize the Agent to execute an outside-the-hospital do not resuscitate order. Additionally, the form provides an option to give the Agent the right of sepulcher and instructions on whether or not to make anatomical gifts or to consent to an autopsy. The HIPAA Privacy Authorization form has been modified so that medical records can be disclosed to the Agent and several other individuals.
The old form included Spanish along with the English text. To make the form easier to follow and less bulky, two separate versions will be available. The English version has been printed already; a Spanish version will be available in a few weeks, after translation has been completed. The new form is also designed so that after it has been completed, the legal documents can be separated from the instructions, making the document easier to file.
The form was approved at the May Board of Governors meeting. Work on developing the new form was conducted by the Task Force to Review and Revise the Bar’s Durable Power of Attorney for Health Care and Health Care Directive Form. Representatives of the Task Force were appointed by the Elder Law Committee, Health Law Committee and Probate and Trust Committee. The following lawyers comprised the Task Force:
Christine Alsop, St. Louis
Dan Berry, Cape Girardeau
Ann Curchin, Jefferson City
Brigid Fernandez, MSW, St. Louis
Ellen Harmon, RN, MBA, St. Louis
Steve Newman, Jefferson City
Don Otto, Jefferson City
Jerry Sill, Jefferson City
Reg Turnbull, Jefferson City
Scott C. Yost, St. Louis
Martin Zehr, PhD. (clinical psychology), Kansas City

Via: http://www.mobar.org/