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Hospitalized Elders Dying to be Treated
Ever play the game of musical chairs? Lots of fun. Until the music stops ... and you're left without a place to sit. But when it's just a game, there's really no harm done. There's always next time. But when it's a game of life and death, as when hospitals choose who gets life-sustaining treatment and who does not, then being left out means losing your life. A recent study found that some elderly patients often find themselves without a chair when it comes to life-sustaining treatment.
Researchers at Beth Israel Deaconess Medical Center studied elderly patients who are hospitalized with life-threatening illnesses receive less life-sustaining care than younger patients. The study, reported in this month's Annals of Internal Medicine, offers an intriguing explanation of this practice. Einstein might have found this argument interesting. It's about relativity, healthcare relativity. Mary Beth Hamel, MD, general internist, Beth Israel Deaconess Medical Center, and lead author of a study, says the practice may reflect an overly aggressive approach to treating young people.
We are talking about very ill patients and there may have been good medical reasons not to offer certain treatments, says Dr. Hamel, whose Annals study, Patient Age and Decisions to Withhold Life-Sustaining Treatments from Seriously Ill, Hospitalized Adults, is part of the ongoing SUPPORT project, the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.
SUPPORT is a 10-year study of nearly 10,000 patients at five teaching hospitals, designed to understand decision-making and dying. In the long run, we may learn that the way we take care of older people is more sensible than our approach to caring for the young, says Hamel. In the study, patients 80 years old or older were about twice as likely as those younger than 50 to have a decision made to withhold ventilator support.
Ventilator support, surgery, and dialysis were more likely to have been withheld for older patients. The three treatments analyzed were chosen because they are invasive, expensive, and commonly used in clinical practice. Although the current study found that even after adjusting for a patient’s prognosis and preferences for CPR and life-extending care, older age was associated with higher rates of decisions to withhold life-sustaining support in the elderly, ageism on the part of healthcare providers is just one possible explanation for the findings, says Hamel. For example, the decision may reflect a physician’s own personal values and preferences.
When doctors in the study were asked what type of care they would want for themselves if they were in the same situation as their patients, they said they would want life-extending care 48 percent of the time if the patient was younger than 50, but only 8 percent of the time if the patient was 80 years old or older. Alternatively, the study may be reflecting a cultural bias that encourages physicians to do everything humanly possible to save the lives of the young, even when this care is administered in the face of a terminal illness. We need to communicate better with our patients to make certain that patients are getting the type of care they want at the end of life, says Hamel.
The SUPPORT project, sponsored by the Robert Wood Johnson Foundation and the agency for Health Care Policy and Research. Source: National Council on the Aging, Washington, DC.
See related articles in the AgeVenture archives.
"Heaven's Waiting Room Studies End-of-Life "
"Strengthening Doctor-Patient Relationships"
"New Beginning for End-of-Life Therapy"
AgeVenture News Service, www.demko.com
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Home-Schooling Good for What Ails Elders
Home-schooling isn't just for kids. Not any more. Seems like learning in the comfort of your home can do wonders, especially for ailing elders. Yes, older adults with chronic illnesses are benefiting from "home schooling". Seems like the health education and self-help training they're getting are just the ticket for promoting wellness. The Center for the Advancement of Health reports that a home-based wellness program combining videotaped instruction in relaxation, exercise, and nutrition is just as effective in helping older adults cope with chronic illnesses as providing the program in a classroom setting.
Patients who completed either wellness program reported greater reductions in anxiety, depression, and other medical symptoms and fewer problems sleeping compared to a control group, says a research team led by Bruce Rybarczyk, PhD of Rush University in Chicago. The experimental group ranged in age from 50 to 87 years old, and all suffered from one or more chronic medical conditions, including hypertension, diabetes, and arthritis. "Classroom programs require extensive staff time and on-site attendance for participants, which can be difficult for employed participants," Rybarczyk and colleagues write in the winter issue of Behavioral Medicine. By comparison, home-based programs have "several key advantages, including lower costs, greater accessibility, and the potential for dissemination on a much larger scale."
Although patients clearly felt better after completing the wellness courses, they did not seem to make significant changes in their exercise, diet, or other health-promoting activities. Rybarczyk and his colleagues suggest that patients learned to "look at their chronic illnesses differently, rather than acquiring new health behaviors that change the actual course of the disease." Also noteworthy, the researchers say, is that the wellness programs were shown to be effective in this group of older, mostly African-American women, who are traditionally under-represented in such programs.
Despite moderate education, the researchers add, patients in both the home and classroom programs spent considerable time reading supplemental materials that focused almost exclusively on practical self-help techniques, a quality that "may have contributed to the appeal." They cautioned, however, that their research did not examine long-term benefits of the programs.
See related articles in the AgeVenture archives.
"Lower Score Makes Hire Harder for Elders"
"NIA - NASA Start Count-Down To Wellness"
"Religious Are More Faithful to Ways of Wellness"
AgeVenture News Service, www.demko.com
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Social Security Earnings Cap Endangered
In their quest to stave off Social Security’s bankruptcy, some policymakers have called for raising payroll taxes yet again. But a
new Heritage Foundation study shows that one such proposal eliminating the cap on
how much of a worker’s income is subject to Social Security taxes would saddle
Americans with the largest tax increase in history.
Under current law, Social Security is funded by a payroll tax of 12.4 percent on the first
$72,600 of a person’s income. Making the payroll tax apply to all income would result
in a tax increase of $425.2 billion over five years, according to Heritage analysts Gareth
Davis and Mark Wilson.
The Heritage’s Center for Data Analysis says eliminating the
earnings cap would:
Increase the top federal marginal tax rate to 54.9 percent, its highest level since the
1970s;
Reduce the family income of 23.4 million Americans by an average of $9,147, and
Weaken the economy by reducing personal savings by $34.4 billion in 2004 alone.
All this, Davis and Wilson say, for a plan that would not even accomplish its presumed
goal of saving Social Security from bankruptcy. "Completely removing the maximum
taxable amount beginning in 1999 only extends Social Security’s financial lifetime from
2013 to 2019," they write. Social Security would also continue to run a deficit $240
billion in 2046 instead of $300 billion under current law.
Nor would the proposal enable Social Security to pay full benefits. For example, a
19-year-old who retires at age 67 in the year 2046 can expect 73 cents for every dollar
of promised benefits under the current earnings cap. If the cap is eliminated, the
analysts say, that worker can expect just 79 cents for every dollar of promised benefits.
If raising taxes were the answer, Davis and Wilson say, it would have worked before.
But Congress has raised Social Security taxes 24 times an average of once every two
years since the program was established in 1937. In 1982, for example, the "Tax
Equity and Fiscal Responsibility Act" was supposed to restore Social Security to permanent solvency, but a mere 16 years later the system again faces bankruptcy, they note.
See related articles in the AgeVenture archives.
"NCSC Wants Social Security Tax Cap Raised"
"New Retirement Age Won't Fix Social Security"
AgeVenture News Service, www.demko.com
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All Stressed Up and No Place to Blow
Frequent headaches? Can't sleep? Difficulty concentrating? You may be suffering from job-related stress. Studies now indicate that one-fourth of the workforce view their jobs as the number one stressor in their lives and that workers widely perceive job stress as being on the rise. More importantly, work stress may increase a person's risk for cardiovascular disease, psychological disorders, workplace injury, and other health problems.
But if job stress is a headache for workers, it's a migraine for employers. That's because stressful working conditions also are associated with increased absenteeism, tardiness, disability claims, and other factors that reduce a company's productivity and competitiveness. "Work stress imposes enormous and far-reaching costs on workers' well-being and corporate profitability," says National Institute for Occupational Safety and Health (NIOSH) Director Linda Rosenstock, M.D., M.P.H. "The good news is at least some of these costs are avoidable."
"Research and experience tell us that certain factors such as heavy workload, conflicting or uncertain job responsibilities, and job insecurity are stressors across organizations and that the risk for job stress can be reduced through smart, strategic action." And that's why the CDC's NIOSH is suggesting practical approaches that can be taken by employers and employees to prevent workplace stress. "Stress ... At Work" finds that organizational changes and stress management for
employees, with organizational changes given top priority, may be the most effective approach for reducing work stress. The booklet offers a three-step process for preventing stress problems by identifying stress factors in the workplace, designing and implementing solutions, and evaluating the outcome.
Job stress is defined as the harmful physical and emotional responses that occur when the
requirements of a job do not match the capabilities, resources, or needs of the worker.
Conditions that may lead to stress include heavy workload, lack of participation in
decision-making, poor social environment, conflicting or uncertain job expectations, job
insecurity or lack of opportunity, and unpleasant or dangerous work environments.
Organizational changes may include efforts to ensure that workload is in line with workers'
capabilities and resources; to design stimulating, meaningful jobs; to define workers' roles
and responsibilities clearly; to give workers opportunity to participate in decisions about their
jobs; to improve communications; to provide opportunities for social interaction among
workers; and to establish work schedules that are compatible with demands and
responsibilities outside the job.
"The new NIOSH booklet offers employers, human resources personnel, and workers a
practical, easy- to-read resource, with real case studies, to help them answer three critical
questions: What causes job stress, is there a problem in my workplace, and if so, what can
be done to find sensible, meaningful solutions?" added Dr. Rosenstock.
Copies of "Stress ... At Work," DHHS (NIOSH) Publication No. 99-101, are available by
calling the NIOSH toll-free information number, 1-800-35-NIOSH (1-800-356-4674).
See related articles in the AgeVenture archives.
"Sources of Stress Vary for Men and Women"
"Stress of Care-giving Often Health-robbing"
AgeVenture News Service, www.demko.com
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