Category: Health in Aging

Older Married Couples and Advance Directives

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JAGS graphicJournal of the American Geriatrics Society Research Summary

Advance directives (ADs) are legal documents you can use to state in advance what medical treatments you do or do not wish to have under certain circumstances. You also can use an AD to name one or more people to act on your behalf if you are ever unable or uncomfortable making your own healthcare decisions.

Studies have shown that, at the end of life, people who have ADs receive less aggressive life-sustaining treatment and are less likely to be admitted to intensive care units, sometimes because those may not be options an older person wants to pursue. They are also more likely to die at home instead of in a hospital, and they receive hospice care earlier and for longer periods of time.

About 50 percent of people 65 and older in the United States have completed ADs. However, little is known about why some people have them while others do not. Most research treats the decision to complete an AD as an individual choice, but we know little about the roles that spouses and other family members may play in a person’s decision to engage in end-of-life planning.

A new study examined the effects spouses had on the decision of older adults to have ADs. The study was published in the Journal of the American Geriatrics Society. Continue reading →

Should Your Primary Care Physician be a Generalist or a Specialist? New Study Sheds Light on Benefits vs Costs

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JAGS graphicJournal of the American Geriatrics Society Research Summary

Your primary care provider (PCP) is usually your first medical contact when you’re ill. Beyond taking care of you when you’re sick, PCPs help coordinate your health care and make sure you’re up-to-date with your check-ups, tests, and immunizations.

Typically, PCPs are family medicine practitioners, general internists, pediatricians (for children) and geriatricians (for older adults). Some health plans, such as health maintenance organizations (HMOs), require you to choose a PCP whom you must see first before being referred to specialists when necessary. These PCPs play a special role in coordinating your care.

However, other plans—including traditional Medicare and most preferred provider organizations (or PPOs), don’t require you to see a PCP before seeking more specialized care. As a result, many people may see a specialist as their main doctor rather than a PCP who would act as “gatekeeper.” Continue reading →

For Older Adults, Antibiotics May Not Be Appropriate Treatment for Some Urinary Tract Infections

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JAGS graphicJournal of the American Geriatrics Society Research Summary

In a new research paper published in the Journal of the American Geriatrics Society, Thomas E. Finucane, MD, of the Johns Hopkins Geriatrics Center at Johns Hopkins in Baltimore, suggests that prescribing antibiotics for urinary tract infections (or “UTIs”) may often be avoided among older adults.

Here’s why:

  • “UTI” is a vague, overused diagnosis that may be applied to older adults who have no symptoms but may have bacteria in the urine and also may be experiencing confusion, falls, or other vague signs (including changes in the odor or color of urine). In most cases, antibiotics do not benefit these older people.
  • Researchers are coming to a new understanding about the kinds of bacteria, viruses, and other microorganisms that live in the human body naturally. We now know that everyone’s urine contains bacteria and viruses, for example. We also know that these microorganisms are usually helpful to overall well-being.
  • In some cases, antibiotic treatment can be harmful, especially for older adults.

Some groups of people do still benefit from antibiotic treatment of UTIs. These individual include:

  • People who are sick enough to require urgent antibiotic treatment regardless of findings in the urine.
  • People with invasive bacterial diseases, especially kidney infections.
  • Pregnant women and people about to have bladder or urinary tract surgery.

In his paper, Dr. Finucane says that microbiome studies—which examine the benefits and harms cause by the billions of organisms that naturally live in the human body—suggest that UTI treatment with antibiotics actually may be more harmful than we previously thought. If you think you have a UTI, or if you’re currently using an antibiotic to treat a UTI, it’s important to speak with a healthcare professional first before changing your care plan. Your doctor, nurse, or other provider can work with you to find a treatment plan that’s best for you.

This summary is from “Urinary Tract Infection: Requiem for a Heavyweight.” It appears online ahead of print in the March 2017 issue of the Journal of the American Geriatrics Society. The author is Thomas E. Finucane, MD, Co-director, Elder House Call Program, Johns Hopkins Bayview Medical Center and Professor of Medicine at Johns Hopkins Medicine.

Specific Long-Term Therapy May Not Prevent Fractures in Older Women

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JAGS graphicJournal of the American Geriatrics Society Research Summary

Osteoporosis is a disease that causes thinning of the bones, loss of bone density, and increasingly fragile bones.  This puts people at higher risk for bone fractures. Risk for the disease increases as we age. In fact, 50% of women over the age of 50 will experience a bone facture due to osteoporosis.

By 2020, an estimated 61 million American adults will have low bone mineral density. A group of medications known as “bisphosphonates” are sometimes used to treat osteoporosis.  These medications increase bone mineral density, which strengthens bones and is thought to make them less likely to fracture. Studies have shown that the risk for bone fractures lessens when women with low bone mineral density take these medications for between 1 and 4 years. However, little is known about whether taking bisphosphonates for longer periods of time has the same effect.

Recently, a team of researchers examined whether older women taking bisphosphonates for 10-13 years had fewer bone fractures than older women with similar fracture risks who took these medicines only briefly. Their study was published in the Journal of the American Geriatrics Society. Continue reading →

PTSD, Certain Prescriptions for PTSD May Raise Risk for Dementia

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JAGS graphicJournal of the American Geriatrics Society Research Summary

Researchers are discovering that post-traumatic stress disorder (PTSD) is a significant risk factor in developing dementia. Dementia is a memory problem that affects a person’s ability to carry out usual tasks. Dementia is a leading cause of serious illness, disability, and death.  It often requires care in a nursing home or other long-term care facility for people aged 65 and older.

Until now, researchers didn’t know whether the kinds of medications used for people with PTSD could increase risks for dementia. (These medications include including antidepressants, antipsychotics, sedatives, or tranquilizers.) A new study, published in the Journal of the American Geriatrics Society, examined this connection.

In their study, researchers examined information from 3,139,780 veterans aged 56 and older. At the beginning of the study, in 2003, the veterans were receiving health care from a Veterans Health Administration facility. Almost all the veterans were male and 82% were white.

Of the veterans in the study, 5.4% had been diagnosed with PTSD. As the researchers looked at the data over the study’s nine-year follow-up period, they also included veterans who were diagnosed with dementia.

Research has previously shown that veterans with PTSD are more likely to have health problems linked to a higher risk for dementia. These include traumatic brain injury, diabetes, chronic obstructive pulmonary disease (COPD), psychiatric disorders, substance abuse, and other health issues. Continue reading →