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Physical Therapy Cutbacks Hurt Elder Disabled
Congress' decision to place an annual cap on Medicare benefits for physical therapy services would cut off rehabilitation treatments for many seniors before they would have a chance to reach full functional ability. The current mandate, which is scheduled to take effect January 1, 1999, severely limits Medicare benefits, allowing for a total of only $1,500 per patient per year for outpatient physical therapy.
If left as is, the current law could require seniors to pay for a substantial portion of rehabilitation treatments out of their own pockets, and could leave them without medical coverage for additional injuries sustained in the same year, unless they go to a hospital. "What this means," says Jan Richardson, President of the American Physical Therapy Association (APTA), "is that after January 1, our government will be telling people over the age of 65 that they may have to accept a secondary lifestyle, a dependent existence."
Richardson calls the $1,500 cap "woefully inadequate" because it could leave many patients physically dependent. Patients with symptoms related to stroke, hip fracture, and conditions like multiple sclerosis and Parkinson's disease would be hardest hit by the current law because rehabilitation for such conditions involves physical therapy as well as other therapies such as speech/language treatments, leaving the patient to choose between the ability to speak or the ability to walk.
According to the APTA, the average stroke patient requires physical therapy about three times per week for a period of six weeks immediately after an incident. At an average cost of $82 a visit, the $1,500 would barely cover half the cost of necessary treatment. In addition, no funds would be left for extended treatment or costs related to additional illnesses and injuries that might occur in the same year.
Among people who have had a stroke, two-thirds of the current four million living with the effects of the disease are over age sixty-five: 51% require assistance, 16% are institutionalized, and 71% are vocationally impaired, according to the National Stroke Association. The APTA recommends that Congress support HR 3835 "Reinstate the Medicare Rehabilitation Act of 1998", a bill which seeks to remove the Medicare limits for outpatient physical, occupational, and speech therapy.
HR 3835 also supports the development of an alternative payment method based on diagnostic classifications. The American Physical Therapy Association is a national professional organization representing more than 75,000 members. Its goal is to foster improvements in physical therapy education, practice, and research.
See related articles in the AgeVenture archives.
"Nursing Home Therapy Declared Excessive"
"Healthy Habits Delay Disability By 8 Years"
"Dysfunctional Syndrome Hinders Healthcare"
AgeVenture News Service, www.demko.com
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Vaccine Triggers Immune System to Fight Cancer
Using a vaccine made from specialized white blood cells called dendritic cells spiked with cancer proteins, University of Michigan scientists have found a way to activate the immune system to attack malignant tumors and prevent the development of new tumors in mice.
"Immunization with the dendritic cell vaccine was effective against two types of solid tumors---sarcomas and breast carcinomas---in two unrelated strains of mice," said James J. Mulé, professor of surgery in the U-M Medical School and director of the Tumor Immunotherapy Program in the U-M Health System's Comprehensive Cancer Center.
"Based on these encouraging results, we have begun a Phase I clinical trial in pediatric and adult patients with advanced solid tumors." Results of the study were published in the Aug. 4 issue of the Proceedings of the National Academy of Sciences. Ryan C. Fields, from Bloomfield Hills, Mich., who received his U-M undergraduate degree in May 1998, and Koichi Shimizu, M.D., U-M research fellow, are joint first authors on the study. Fields, Shimizu and Mulé used immature dendritic cells from mouse bone marrow as the basis for their vaccine.
Dendritic cells are specialized white blood cells whose job it is to alert the immune system to the presence of invading cancers, bacteria or viruses, so the invaders can be surrounded and destroyed. When they find cancer cells, dendritic cells sound the alert by displaying pieces of tumor proteins called antigens on long projections extending from the center of the dendritic cell.
Like Cinderella's prince searching for a woman who matches the glass slipper, the dendritic cell presents these antigens to other white blood cells called T-lymphocytes until it finds those with receptors that fit the tumor antigen. Once a match is made, T-lymphocytes produce messenger chemicals which stimulate production of a flood of T-lymphocyte "clones," all equipped with the exact receptor needed to attack and destroy one specific type of tumor cell.
"Cancer cells often hide from lymphocytes by becoming invisible," Fields explained. "Instead of displaying foreign proteins on the surface of tumor cells, most remain inside the cell where the immune system cannot detect them. Dendritic cells bring these hidden antigens out of hiding triggering this intense immune system response." The research was supported by the National Cancer Institute/National Institutes of Health, the U.S. Army Research Office and by gifts from C.J. and E.C. Aschauer and Abbott Laboratories to the U-M's Department of Surgery and the Tumor Immunotherapy Program.
See related articles in the AgeVenture archives.
"Scientists Discover Cancer Checkpoint"
"Cyber Solace for Cancer Recovery"
"Tomatoes Play Catch-up With Cancer Cure"
AgeVenture News Service, www.demko.com
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Johns Hopkins Joint-Ventures Wellness Clinics
Johns Hopkins Medicine and Fitness Forum, a Syracuse-based health care provider and
consulting firm, have signed an agreement to establish a network of rehabilitation facilities
throughout metropolitan Baltimore. The joint venture, known as Fitness Forum of Maryland, will operate four facilities to be located inside the Merritt Athletic Clubs in Annapolis, Security, Towson and the Downtown Athletic Club in Baltimore.
Johns Hopkins Medicine will provide clinical oversight and quality control to the facilities and have a presence on the Fitness Forum of Maryland management committee. While there are no immediate plans to expand beyond the four sites, officials from Hopkins and Fitness Forum say future expansion is possible. "This partnership extends our ability to serve our community by providing an important service conveniently and effectively," says Terry Langbaum, director of hospital affiliations for The Johns Hopkins Health System.
Fitness Forum will hold a series of lectures, seminars and injury clinics throughout the year for its communities on such topics as sports medicine, fitness during pregnancy and estrogen therapy. Under terms of the joint venture, Hopkins has an equity interest of about 25 percent in Fitness Forum of Maryland. Following other recent Hopkins' business partnerships, Fitness Forum of Maryland is expected to generate a two-way referral stream, according to Langbaum.
"We may get referrals from patients who come to the sites with sports injuries and who need a physician referral for rehabilitation services," she says. "Conversely, we expect to refer patients to the Fitness Forum rehabilitation facilities when it is convenient and appropriate for them." "This is clearly a unique partnership," says James Smith, CEO of Fitness Forum.
"Combining physical therapy clinics and health clubs is a natural fit, and we believe we are among the first to do this. Our ability to deliver patient focused care, coupled with Johns Hopkins' clinical expertise, is very powerful. This partnership with Johns Hopkins Medicine strengthens our position as providers able to service all covered lives for physical therapy, fitness and wellness under managed care contracts."
See related articles in the AgeVenture archives.
"Health Club to Monitor Member Hearts"
"Science Continues to Drive Wellness Boom"
"What's Your Fitness Personality"
AgeVenture News Service, www.demko.com
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Pharmacists Monitor Patient Blood Pressure
Getting people with high blood pressure to take their medicine and watch their diets is a major challenge for the doctors who treat them. Many people feel no symptoms from the disease itself and are reluctant to take medicine that may cause unpleasant side effects.
But the consequences of leaving high blood pressure (hypertension) untreated can be serious---diseases of the heart and arteries, stroke, kidney damage---and can shorten life expectancy by up to 16 years. Could a little
extra attention from the pharmacist who fills patients' prescriptions help keep them on course? A study under way in Detroit is designed to find out. In the study, which is being directed by researchers Stephanie Taylor, Eddie Boyd and Leslie Shimp of the University of Michigan College of Pharmacy, two Detroit independent pharmacies are offering extra services to hypertension patients enrolled
in the project.
At each site, a pharmacist will work closely with about 25 patients, checking their blood pressure once a month, watching for drug side effects and suggesting any necessary medication changes to their doctors. At the beginning and end of the six-month study, patients will be given questionnaires that assess their quality of life, satisfaction with their medical care, and compliance in taking the medicine that has been prescribed for them.
The researchers hope to learn whether patients who get extra attention from pharmacists will be more likely to take their medicine and follow other recommendations aimed at getting their blood pressure under control. If the pharmacists' attention does make a difference, the U-M team wants to pinpoint exactly which services produce the greatest effects.
While it may be impractical for pharmacists to offer intensive personal attention to large numbers of patients all the time, they could concentrate on delivering the kind of care that has the biggest benefit. The pharmacy project is part of a larger health research program through the Michigan Center for Urban African American Aging Research. The Center, which is a cooperative research arrangement among the U-M Institute for Social Research, Wayne State University and several community-based organizations in Detroit, is one of three Aging Centers in the nation funded by the National Institute on Aging. Its overall objective is to promote good health habits among African Americans.
See related articles in the AgeVenture archives.
"New Trends in African-American Eldercare"
"HOT Therapy Lowers Blood Pressure"
AgeVenture News Service, www.demko.com
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Elder Experts Weigh-in On Water Wellness
Drinking ample water is important for everyone, but especially for seniors, according to Susan M. Kleiner, PhD, R.D., a dietitian and fitness expert who has researched the effects of hydration on the body. Water aids digestion and regularity, helps carry nutrients in the blood stream, increases blood volume and helps circulation.
When seniors don't drink enough water, says Kleiner, they may experience fatigue, minor headaches, and loss of appetite. Even mild dehydration can be a special problem for seniors, says Dr. Kleiner. "By our 70's, our kidneys filter waste about half as fast as they did when we were 30. So increased fluid intake is crucial for waste removal and it also helps to prevent kidney stones."
In addition, studies show that to produce perspiration, the senior's internal body temperature must rise higher than someone younger. Since heat escapes through sweat, older people tend to retain heat, which can rise to dangerous levels if the body is not properly hydrated. Kleiner recommends that seniors have a water plan to remind themselves to drink sufficient water during the day.
"If you wait until you feel thirsty, you're probably already somewhat dehydrated". Recently, Dr. Kleiner and the Brita Products Company joined forces to produce these hydration tips for seniors.
- Don't wait until you are thirsty to drink. Being thirsty means you're already dehydrated.
- Drink at least eight, 8-ounce glasses of water a day, about one glass every hour.
- Increase water consumption when physically active, or during hot weather.
- Drink an extra glass or two when dieting to eliminate extra waste from the body.
- Caffeine and alcoholic drinks are diuretics so accompany them with extra water.
- Medications, taken during colds or flu, work better when you are properly hydrated.
The Brita Products Company, based in Oakland, California is the maker of water filtration systems for the home.
AgeVenture News Service, www.demko.com
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