The challenge of urinary incontinence is one that plagues many people, most of them women who often limit their activities due to the problem.  However, according to this article at Medical News Today, limiting activities may be the wrong choice.

Reporting on a recent study released in the October 2008 issue of the journal Urologic Nursing, the authors say that limiting mobility due to urinary incontinence leads to a host of other health problems and doesn’t reduce the level of incontinence.  As many nurses already know, immobility leads to issues with the cardio-vascular system, diabetes, obesity, and overall health.

The study showed that increasing activity actually helped to reduce the level of urinary incontinence.  They recommend that those suffering from urinary incontinence contact a health professional, like a nurse specializing in urologic health for assistance and specialized nursing interventions to assist them with improving their urinary control.

Among these interventions is the performance of regular Kegel excercises which isolate the muscles of the pelvic floor and strengthens them allowing for more control over urinary urgency and leaking.

Over at this week’s MedicCast podcast for EMS providers, we take a look as some of the special considerations in the treatment of geriatric patients. First, a look at geriatric trauma considerations and why special care is needed to ensure that the elderly trauma patient is taken to the most appropriate facility just like younger patients. A recent study by the State of Maryland found that geriatric trauma patients were not being taken to trauma centers as much as younger patients with similar injuries.

The show also includes a look at polypharmacy and how it affects the geriatric population. Polypharmacy is the presence of at least 5 to 7 prescribed medications for a patient.  Each additional med increases the risk for adverse drug interactions, compounded side effects and endangers the patient.  Encourage patients to review their medications at least annually with their physicians.

Any person may experience problems with polypharmacy, but an elderly person will have more issues due to decreased metabolism, reduced renal and hepatic function, and slowed GI clearance and absorption.

Visit the MedicCast Episode show notes pages here.

Listener Eric sent this tidbit in from a California newspaper. It examines the trends in geriatric health care. It discusses some alarming statistics brought up in a report from a professor at the University of California San Francisco. In this report, Retooling for an Aging America: Building the Health Care Workforce, the following points are made:

• One Geriatric Doctor per 2500 elderly patients
• Fewer than 1% of nurses are trained in geriatric care
• Nursing aide job turnover at 71%
• 90% of home health aides leave within two years
• National average pay for home health aides is $8.50 per hour

The gist of the article is that major change needs to occur in the training and pay for healthcare workers involved in care for the elderly or the system will continue to collapse under the increasing weight of the aging population. Registered nurse specialists in geriatric care need to be trained. Additional training and financial resources need to be arranged for the aides that assist nurses in the facilities and home environments.

I found a story on a court case in California where a physician has been charged in speeding the death of a disabled and brain damaged patient in order to harvest organs for donation.  Medical ethicists fear that the case may cause organ donations to drop because of the negative publicity.  The story is from ABC News here.

Every time a story like this surfaces I shake my head in disbelief.  What makes these care givers believe that their actions will not be noticed.  In this case, the patient was from a poor family that was not able to be present to oversee care but what about the rest of the care team.

As a nurse, do you monitor the dose levels of drugs in patients who are at risk for abuse or do you just administer what the doctor orders without regard?  According to police reports cited in the story, nurses in the room when the respirator was removed said the doctor ordered additional sedative doses when the patient didn’t die right away.

Organ donation programs are quick to point out that this situation is in violation of their program protocols which require a complete separation of the donor / transplant teams from the provision of palliative and end of life care to the patient.  In other words, the ICU team should not have any contact with the donor/transplant team until death has been declared.

The article linked above is a good one for anyone in the medical community.  It raises some good ethical questions and discussion points for both students and practicing professionals.

Somebody get me the can of worms so I can open it.  I found this article based on research that points at cardiac medication non-compliance following myocardial infarctions and patient mortality.  The authors of the study conclude that one way to increase compliance is to provide the 4 most commonly prescribed cardiac meds to patients for free following their cardiac event.

These meds include: Aspirin, ACE inhibitors, Beta Blockers, and Statins.  While the cost of these medications is not the only reason for patient non-compliance, it is certainly a factor here in the U.S.  The removal of the Medicare copay would improve patient outcome and quality of life for some of these patients if it encouraged them to buy their prescribed medications.

The study out of Harvard University, looks at a theoretical basis for its findings and the authors point out that while their findings appear significant and make medical sense, there should be actual trials set up where some patients randomly get their meds for free and others remain under the current system.  Who would be more compliant with their meds?

I found this article recently that looked at the effects of medication review by geriatric specialists on the overall health of elderly patients. While this seems to be a no-brainer, elderly patients are more at risk for suffering combined effects of multiple medications as well as changes in the way they metabolize drugs out of their systems.

With an increased focus on patient safety on all of our minds, monitoring elderly patients to ensure they are not receiving too much of one medication or a dangerous combination of multiple meds falls to the entire care team.  I’ve reported in the past about studies on nursing home falls and how reducing some medications had a positive effect.

The study in the article above concluded that 26% of patients were either given inappropriate prescriptions or too high a dose of a necessary med.  It reviewed the care of 850,000 U.S. veterans cared for in VA facilities in 1999 and 2000.  Interestingly, the 3% of the studied patients who were cared for by a geriatric specialist had a greatly decreased risk of similar medication errors.

It makes sense that the elderly need specialized care in a similar way that children need pediatric specialists.  With decreased organ function across their body system, the elderly react differently to disease, medication, and injury.  We know this and yet we don’t necessarily change our oversight to account for those differences.  They are often treated under the same guidelines used for a healthy 40 year-old.

A new study published in the New England Journal of Medicine looked at the number of heart attacks following both coronary artery bypass graft surgery (CABG) and the placement of drug coated stents.

The article on the study is here.

The study found that people were more likely to suffer a follow up heart attack following stent placement than with the more invasive surgical option.  The bypass of two or three coronary arteries offered a 30% or 20% better incidence of recurrence of myocardial infarction when compared to the placement of drug coated stents.

While there still may be some candidates with a better risk profile for stent placement, most patients may do better with the more invasive surgical option.

A recent report has listed the increase in Diabetes among the elderly as a pending economic disaster on the nation’s (and world’s IMHO) health care systems.  The report cites the increase by 25% of the number of elderly Americans diagnosed with diabetes in the last ten years.

The cited study in the article concludes that the numbers represent a significant risk of overpowering the health U.S. health care system with the costs of treating and caring for the associated problems of diabetes.

Cardio Vascular Disease, Stroke, Hypertension, Infection, Blindness, Kidney Failure, and general disability all will have a significant impact on the resources available in the near future, according to the researchers.

They argue that:

“Given these possibilities, primary prevention programs must be put in place before the diabetes of advancing age becomes a reality.”

As medical professionals on the front lines of that prevention initiative, I urge you all to beef up your awareness of this issue and include prevention and treatment tips in your patient contacts over the coming years in an effort to help keep the numbers of future diabetics down.

Ever get one of those patients with the shoe box full of medications or a two page list of the prescriptions the doctors prescribed for them?

Never?

Of course you have! We all have run into these patients. I have always wondered whether the symptoms being experienced are related to the disease process or are due to what I like to call MMO

MMO = Massive Medication Overload

One of the problems is the “better living through chemistry” outlook that the drug industry promotes to the medical community at large. Numerous studies have looked at how drug company marketing in TV, Print, and directly to the physician community have a significant influence on how meds are prescribed. The AMA (American Medical Association) along with other international physician groups have all cautioned against this influence.

So, pardon me if I’m not surprised by the news story I found this week over at Medical News Today that points out just how profitable pharmaceutical marketing programs have become. The survey (as reported by two New York and Toronto marketing firms) of marketing spending by pharmaceutical companies as compared to their spending on research is really insightful. It points out that drug companies spend twice as much on selling their existing products now as they do on developing new products for the future. Let me put that another way for you.

1/2 research = marketing

This seems to directly contradict what the drug companies are telling the public about how financially strapped they are by all of the money they spend on research. It seems to me that they could also make money and find new drug cures, too, by spending more on research into new cures and less on marketing to doctors who are intelligent enough to read a drug fact sheet and keep up with pertinent research findings. I am constantly amazed by companies that tell us one thing while actually doing another.

We’re losing money! vs. Record profits in quarterly reports!

We’re saving lives with new drug 2.0 vs. We kept our patent alive by making a small tweak in drug 1.0 chemistry

Hopefully, this survey will educate people about how the money really pans out. Don’t get me wrong. I don’t fault pharmaceutical companies for making money. I just want them to say what they mean and mean what they say. They have their responsibility only to their shareholders to turn a profit. Not to me, not to the doctors out there, and not to the patients. That’s capitalism and I’m ok with it, just don’t cry about your profits only rising 10 percent this year.

We can’t all be oil companies!

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Jamie, the Podmedic