MATURE MARKET HEADLINES 2/06/2001
Gene Makes You Fit For Extreme Longevity
You can go just about anywhere, as long as you've got the right genes. In fact, a new study suggests that you can go well into your tenth decade of life, a ripe old age of 100 years, if you are born with what is now called "longevity genes". The study found that those who have a certain version of this gene could live for a very, very, very long time.
Researchers identified the gene as "e2 allele" of the lipid-carrying protein apolipoprotein, E (APOE) for short. And those who born with it may reach an extremely old age. The study on longevity and the e2 allele was done by a group of scientists led by Giovanni B. Frisoni of the Laboratory of Epidemiology and Neuroimaging, Brescia, Italy. This research is reported in the February 2001 issue of the Journal of Gerontology: Medical Sciences, a publication of the Gerontological Society of America.
"We found that the frequency of the e2 allele of APOE shows a marked increase after age 100, supporting the view that the allele is related to longevity," the scientists noted. The research was based on a study of data collected in the Finnish Centenarians Study, a population based survey involving all the centenarians living in Finland in 1991.
When Frisoni divided the centenarians in three groups (100-101 years, 102-103 years and over 104 years) he discovered that the frequency of the e2 form increased 5 percent, 15 percent and 25 percent respectively. The E2
form seems to be linked to several positives effects, but a minor risk to the development of memory problems, Alzheimer's and vascular disease.
Mathematical simulations of the changes in genetic compositions of large populations have shown that ," the researchers pointed out, "starting from around age 100, longevity genes have an increased likelihood of being
selected. Thus, the finding of a rise in frequency of the e2 allele with age in the Finnish centenarians strengthens the idea that the allele is related to longevity."
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Expensive Drugs Bad Medicine for Seniors
Medicare beneficiaries with high blood pressure and high out-of-pocket drug expenses purchased fewer medically necessary antihypertensive medicines than those seniors with coverage through Medicaid, state and employer plans. The bottom-line is that seniors will forgo even medically necessary drugs as out-of-pocket costs increase, according to a study by Harvard Medical School researchers in this month's Health Affairs.
The study examined Medicare beneficiaries with six common forms of drug coverage: Medicaid, state funded, employer drug coverage, self-purchased coverage (Medigap), private insurance with no drug coverage, and Medicare fee-for-service only (FFS) (no drug coverage).
As one might expect, the researchers discovered that drug consumption went down as the out-of-pocket expense went up.
"This suggests that a Medicare prescription drug benefit, if passed by Congress, would be of reduced benefit if both the out-of-pocket costs and the ceiling cap are both too high," says Dr. Stephen Soumerai, a study co-author and Harvard Medical School (HMS) professor. The study also found that while overall drug costs per tablet were relatively uniform across coverage groups, the out-of-pocket costs per tablet were substantially lower for those with Medicaid, state, or employer drug coverage.
Drs. Adams and Soumerai developed the study with Dennis Ross-Degnan, HMS professor of ambulatory care and prevention. The research was supported by the National Institute on Aging, the Harvard Pilgrim Health Care Foundation, and the Agency for Healthcare Research and Quality.
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Incontinence Signals Onset of Elder Frailty
Urinary incontinence or the inability to control urination is a common malady, especially among older women. It can be brought on by menopause, surgery, stroke, or excess weight.
But sudden urinary incontinence in elderly women or men, after the individual has reached old age without having the problem, can be a signal for declining health.
“This type of incontinence may be a precursor to frailty and should offer clues to caregivers about how and when to treat their elderly patients,” said Toni P. Miles, M.D., Ph.D., professor of family and community medicine at The University of Texas Health Science Center at San Antonio. Dr. Miles is the lead researcher in a study published in the January 2001 issue of the Journal of Gerontology: Medical Sciences.
Frailty is a definite phenomenon, but there is no exact definition of the condition, according to Dr. Miles. “Caregivers can agree that it includes weakness, slowness and shrinkage, but we are trying to further define the condition and develop ways to prevent or forestall the problem.
People who reach old age without incontinence or frailty and suddenly develop incontinence may be experiencing something specific, perhaps neurological, and may need to be treated differently from people who develop incontinence at an earlier age.
Findings indicated that newly incontinent subjects were significantly heavier, had greater difficulty with activities of daily living and performed more poorly on the physical and balancing tests than similar continent subjects. “This suggests there may be a common process linking difficulty in lower body mobility with the development of incontinence,” the report concludes.
“The emergence of difficulties with certain daily activities such as walking and balancing suggests that the common process may have its origin in neural control mechanisms,” Dr. Miles said. “Incontinence is the hallmark of bad things to come,” she said.
“Often, people with various problems, including frailty, can be treated at home, but once incontinence occurs, it breaks the back of the caregivers and often marks the point at which the patient must enter a care facility. We hope that this research will lead to better prevention strategies and treatment for individuals over the age of 65.”
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Angina Stimulator Big Break for Heart Ache
For years, William Vogel had a refrigerator sitting on his chest and hot pokers burning down the backs of both arms. At least that's how he explains what it felt like to suffer from angina, a serious, chronic medical condition caused by reduced blood flow to the
heart.
Vogel's pain was nearly crippling, preventing him from doing even simple things like getting dressed and walking through his home. And conventional angina therapies weren't helping. Then Vogel started a new therapy at the University of Michigan Health System, called spinal cord stimulation that uses small electrical pulses to reduce pain and improve blood flow to the heart. Almost immediately, the pain eased.
"I can do everything now. I'm truly blessed to have this," Vogel says. "I have control over this pain now, which I never had." The U-M is the only facility in the state now offering spinal cord stimulation as a treatment for the most severe angina sufferers. And soon, the U-M will participate in a nationwide clinical trial to formally study the remarkable effects of this treatment.
Angina is a severe, squeezing pain that usually starts in the center of the chest behind the breastbone and may spread to the arms, neck, jaw or back. It is caused by reduced oxygen to the heart, usually from poor blood supply, and is a symptom of coronary artery disease.
Nearly 7 million Americans suffer with angina. Between 90 percent and 95 percent can be treated with medication, angioplasty or bypass surgery. About 5 percent to 10 percent must explore other options such as laser-guided surgery, a very aggressive lifestyle program or a relatively new treatment called spinal cord stimulation.
Spinal cord stimulation uses electrical impulses to reduce pain and improve blood flow to the heart for angina sufferers. It works by supplying very small doses of electrical current to a key part of the spinal cord. tudies there have suggested that patients who use spinal cord stimulation may not only be getting relief from pain, but could indeed also be improving the blood flow in some of those zones of the heart that are served by blocked arteries, says Kim Eagle, M.D., Albion Walter Hewlett Professor of Internal Medicine at the University of Michigan.
In addition to spinal cord stimulation, Eagle emphasizes that patients with severe angina who have not benefited from other treatments may consider other options. One is laser-guided therapy, where a laser is used to drill small holes in the heart to nourish areas of the heart muscle being served by very narrow arteries. A second option is a very aggressive lifestyle program and medication program developed at the U-M.
For additional information, readers are advised to ask their doctors to contact the University of Michigan at: 1-800-742-2300, category 6220.
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Modern Medicine Nearer My God to Thee
No longer can physicians get by only on the physical facts in their patients' records. Patients believe their physical, mental, and spiritual health are interrelated. To help tomorrow's primary care doctors become more sensitive to their patients' spiritual side, the National Institute for Healthcare Research (NIHR) has awarded a $15,000 grant to Antonnette Graham, professor of family medicine at Case Western Reserve University's School of Medicine and University Hospitals of Cleveland, and colleagues to support spiritual training for new doctors.
The goals of the new curriculum are for residents and faculty to:
- learn about the overall knowledge, skills, and attitudes toward
spirituality in the health care system;
- apply that knowledge and those skills and attitudes in the care of their own patients;
- learn how their own spirituality is involved in interactions with patients; and
- learn how to teach about spirituality in clinical encounters.
Through the spirituality curriculum, residents will be asked to identify spiritual resources such as types and locations of religious institutions, services they provide, and clergy names and telephone numbers, and compile them into a spiritual resource manual. The manual then will be available for patients who are interested in finding a religious institution or obtaining services from a religiously based facility.
In the second year of training, residents will work with hospital chaplains to learn more about the role of chaplains from various faiths and how to make appropriate referrals. In the third year, they will spend time at the Gathering Place, a wellness community for people who have cancer.
According to Graham, "When facing serious illnesses, patients often draw upon their faith and appreciate the inclusion into their medical care of this important aspect of their life. Learning to ask about spirituality and to make referrals to a clergy are important, but infrequently, taught skills. Spiritual well-being is an important part of holistic medical care," says Graham.
Distributed by the NIHR, the Spirituality and Medicine Curricular Awards are funded by the John Templeton Foundation. The awards recognize model programs in spirituality and health at medical schools nationwide at both the undergraduate and residency levels.
The grants underscore the growing importance that medical schools are placing on responding sensitively to patients' spiritual needs. When the awards program began in 1995, only three of 125 medical schools offered courses on how to deal sensitively and effectively with patients' spiritual issues. Today, half of all undergraduate medical schools offer courses in this important area.
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