Poor Sleep Linked to Hardened Blood Vessels, Small Strokes in Seniors

Poor Sleep Linked to Hardened Blood Vessels, Small Strokes in Seniors

A Sunnybrook-led study suggests that elderly people who sleep poorly and awaken frequently are more likely to have hardened blood vessels or small strokes in the brain, boInfographic: click to read fullth of which can contribute to cognitive and motor impairment.

Published in the journal Stroke, the study is the first to conduct a detailed examination of blood vessels from autopsied brains of seniors who had undergone sleep monitoring before death.

The researchers found that greater sleep fragmentation was associated with 27 per cent higher odds of having severe arteriosclerosis. For each additional two arousals during one hour of sleep, they reported a 30 per cent increase in the odds that subjects had visible signs of oxygen deprivation (infarcts) in their brain.

Fragmented sleep occurs when sleep is interrupted by repeated awakenings or arousals. In this study, sleep was disrupted on average almost seven times each hour.

“There are several ways to view these findings: Sleep fragmentation may impair the circulation of blood to the brain, poor circulation of blood to the brain may cause sleep fragmentation, or both may be caused by another underlying risk factor,” said Dr. Lim.

The findings suggest that sleep monitoring may potentially be another way to identify seniors who may be at risk of stroke.

People with Dementia Live Better When Empowered to Manage Their Condition

People with Dementia Live Better When Empowered to Manage Their Condition

People with early-stage dementia benefit when they are empowered to manage their own condition, a study led by researchers at the University of Exeter has found.

Researchers found that attending weekly ‘self-management’ group sessions which encouraged socialization, discussion, problem solving and goal setting fostered independence and promoted social support among people with dementia.

The groups, led by trained facilitators, were focused on providing people with a better understanding of their dementia and ways to cope with it. Participants were supported in their ability to manage their own symptoms, treatment and lifestyle changes with information and expert help. They were then encouraged to share ideas and strategies for dealing with their condition and were encouraged to record notes and reminders in a handbook.

“Developing dementia can be a scary and isolating experience. We developed a group program to help people with dementia manage their condition and find ways of dealing with the changes in their lifestyle. We found early evidence that empowering people to manage their own symptoms and bringing them together helped them feel more confident about managing everyday life with dementia,” said lead researcher Dr Catherine Quinn, Senior Research Fellow in The Centre for Research in Ageing and Cognitive Health (REACH).

Group Recommends Screening For Depression For All Adults

Group Recommends Screening For Depression For All Adults

The U.S. Preventive Services Task Force (USPSTF) is recommending screening for depression in the general adult population, including pregnant and postpartum women, and that screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. The report appears in the January 26 issue of JAMA.

Depression is among the leading causes of disability in persons 15 years and older. It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting, and also common in postpartum and pregnant women. The U.S. Preventive Services Task Force (USPSTF) reviewed the evidence in the medical literature on the benefits and harms of screening for depression in adult populations. The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive care services such as screenings, counseling services, and preventive medications.

The USPSTF found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women, and found adequate evidence that programs combining depression screening with adequate support systems in place improve clinical outcomes.

Effective treatment of depression in adults generally includes antidepressants or specific psychotherapy approaches, alone or in combination. Given the potential harms to the fetus and newborn child from certain pharmacologic agents, clinicians are encouraged to consider evidence-based counseling interventions when managing depression in pregnant or breastfeeding women.

Hmmm. Behavioral health is a big issue in the country and one whole argument in the gun control debate centers on behavioral health. This is a slippery slope however. Do we need to scare an entire population? And given the anti-depressants are already the #1 prescribed medication in the country, are we just encouraging more unnecessary drug use that big pharma benefits?

Earlier Hospice Enrollment Would Improve Quality of End-Of-Life Care

Earlier Hospice Enrollment Would Improve Quality of End-Of-Life Care

Among family members of older patients who died of advanced-stage cancer, earlier hospice enrollment, avoidance of intensive care unit (ICU) admissions within 30 days of death, and death occurring outside the hospital were associated with perceptions of better end-of-life care, according to a study in JAMA.

Patients with advanced-stage cancer receive aggressive medical care at the end of life. Few studies have examined whether these aggressive end-of-life care measures reflect patients’ preferences or bereaved family members’ perceptions and expectations of the quality of end-of-life care.

Alexi A. Wright, M.D., M.P.H., of the Dana-Farber Cancer Institute, Harvard Medical School, Boston, and colleagues assessed the relationship between aggressive end-of-life care and family member-reported quality ratings of end-of-life care.

Of 1,146 patients with cancer (median age, 76 years; 56 percent male), bereaved family members reported excellent end-of-life care for 51 percent. Family members reported excellent end-of-life care more often for patients who received hospice care for longer than 3 days than those who did not receive hospice care or received 3 or fewer days. In contrast, family members of patients admitted to an ICU within 30 days of death reported excellent end-of-life care less often as did family members of patients who died in the hospital.

The authors suggest that multifaceted approaches might result in more preference-sensitive care for patients and overall improved quality of end-of-life care.

In another JAMA study looked at the intensity of end-of-life treatment and the likelihood of dying in a hospital between physicians and the general population.

In one study, Joel S. Weissman, Ph.D., of Brigham and Women’s Hospital, Boston, and colleagues examined whether physicians receive higher or lower intensity end-of-life treatments compared with nonphysicians.

Physicians were less likely to die in a hospital compared with the general population (28 percent vs 32 percent), less likely to have surgery (25 percent vs 27 percent), and less likely to be admitted to the ICU (26 percent vs 28 percent).

“The possible reasons physicians received less intense end-of-life care than others could be knowledge of its burdens and futility as well as the benefits and the financial resources to pay for other treatment options, such as palliative care or skilled nursing required for death at home,” the authors write.

Would seem more physicians need to practice what they preach and have patients emulate what their end of life wishes entail.