UK: Terminally ill 'should write down how they want to die'

.
LONDON, England / The Telegraph / Health News / May 31, 2011

Terminally ill patients are to be asked by their doctors to write down how they want to die, under new guidelines to be unveiled today.

Doctors want to encourage more dying patients and their relations

to discuss their deaths and write down their wishes Photo: ALAMY

 
By Stephen Adams, Medical Correspondent

Dying people will be encouraged by GPs to set out clearly whether they wish to be resuscitated by medical staff and how they want to be treated in their final days.

A legally binding record of their wishes will then be kept, potentially on the new NHS database, so staff other than the family GP could be able to tell how to treat a dying patient in A&E or in an ambulance.

The advice is contained in the first patients’ charter, drawn up by the Royal College of GPs and the Royal College of Nursing.

The charter, to be posted in 8,500 family surgeries in England, is announced today amid growing concern over how the dying are treated.

Besides damning reports about care for the elderly and infirm in hospitals, there have also been high-profile cases in which relations have complained that their loved ones’ wishes were ignored.

In some instances, staff have been accused of putting patients on a fast track to death by taking away life support without relations being informed.

The Liverpool Care Pathway, a palliative care programme designed for cancer patients, has come in for particular criticism, with some experts warning that patients who might still recover are being allowed to die unnecessarily.

In 2007, the Mental Capacity Act came into force, under which people could stipulate “advance directions” about how they wanted to be treated if they became incapacitated. However, these guidelines have been taken up by only a few people.

Doctors want to encourage more dying patients and their relations to discuss their deaths and write down their wishes.

The charter pledges that doctors and their practice teams will “assist you to record your decisions and do our best to ensure that your wishes are fulfilled, wherever possible, by all those who offer you care and support”. Two of the seven points in the charter mention that patients’ intentions should be written down.

In the second instance, it advises that doctors and nurses should “ensure clear written communication of your needs and wishes to those who offer you care”.

Wishes could be recorded on the computerised NHS database of medical records, which is currently being developed.

Explaining the need for the charter, Dr Clare Gerada, chairman of the RCGPs, said: “Care seems to break down at the very end. So often a GP has looked after someone really well, and then they are not there.”

For example, a patient might be taken ill in the night, driven to hospital in an ambulance, and die in casualty. Even if the GP knew the patient’s wishes, casualty staff would not.

Medical legal experts said such written requests could be used in court by doctors as evidence that they had taken patients’ wishes into account, or by family members seeking to prove they had not.

Charles Foster, a leading barrister and a lecturer in medical ethics at Oxford University, said: “They could be used by doctors, by relatives and on the patients’ behalf.”

If properly prepared – signed and witnessed – they would carry the same legal weight as advanced directions, he said. He warned that people should know that patients often wanted to hold on to life at the bitter end.

He said: “Because we value life so much, when we have everything stripped from us, we value all the more what we have left.”

Andrew Davies, a consultant in palliative medicine at the Royal Marsden Hospital in Surrey, said written requests that stipulated treatment be withheld – for example requesting no resuscitation – already carried significant legal weight.

Those that stipulated actions that should be taken to keep the patient alive carried less weight, he said.

Some anti-euthanasia campaigners fear that doctors could interpret parts of the charter as a green light to help people die.

Kevin Fitzpatrick, of the organisation Not Dead Yet, said he was “outraged” by what he described as “a blatant attempt by GPs to circumvent the law”.

The charge was dismissed by Dr Gerada, who said the RCGP’s position remained that there should be no change in the law on assisted suicide.

© Copyright of Telegraph Media Group Limited 2011

CANADA: OK, really: How much fruit should you be eating?

.
TORONTO, Ontario / The Globe and Mail / Health / Nutrition / May 31, 2011

Confused about fruit?
Here's what you need to know

Nutritionwise, not all fruits are created equal.
(iStock Photo)


By Leslie Beck, Columnist
 Lately, I’ve been bombarded by questions about fruit. Is fruit good for me? What about the sugar? Am I eating too much? What’s the best type of fruit to eat?

I thought the crash of the low-carb diet – Atkins, South Beach and the like – meant we were over our fear of healthy carbohydrates like fruit and whole grains. Apparently not.

Many new diet books are banning fruit or limiting how much of it can be eaten and when it should be eaten. The reason: Too much carbohydrate from fruit can prevent weight loss, or worse, make you fat.
That may be true if you eat a dozen apples every day (which would add 1,140 calories to your diet). But who does that? As a dietitian in private practice, I assess people’s diets every day. For many people, fruit just isn’t a regular part of their diet. Instead of giving strategies to cut down on fruit, most often I give tips to increase fruit intake.

Even national surveys agree that most Canadians aren’t filling up on fruit. It’s easier to grab a bagel or granola bar than an apple or handful of grapes.

Recently, The Globe and Mail’s Dave McGinn reported on the fruit paradox: some diet gurus say fruit is nutritious and help reduce disease risk; others warnit can also promote weight problems.

If you’re as confused about fruit as many of my clients are, this column will help set the record straight.

From a nutrition standpoint, fruit is a great source of fibre, potassium, vitamin C and folate, nutrients that help guard against disease. A diet rich in fruit has been linked to lower rates of heart disease, stroke, high blood pressure, cataract, macular degeneration and type 2 diabetes.

And contrary to certain food-combining claims, you don’t have to eat fruit on an empty stomach to absorb all of its nutrients.

Along with those nutrients, you also get carbohydrate, mainly in the form of the naturally occurring sugar, fructose. That means fruit also delivers calories – unlike most vegetables which contain much less carbohydrate.

For example, one medium apple has 25 grams of carbohydrate and 95 calories; one medium banana has 27 grams of carbohydrate and 105 calories and one cup of blueberries has 21 grams of carbohydrate and 84 calories. (One cup of broccoli has only 6 grams of carbohydrate and 30 calories.)

In one sense the diet-book claims are right: If you are trying to lose weight, you can’t eat all the fruit you want. But eating a couple of fruit servings per day has never slowed a client’s weight-loss progress. So, when I develop weight-loss plans, I usually include two to three daily fruit servings, depending on calorie intake.

Health issues

But those with health issues do have to consider fruit choices carefully.

If you have prediabetes (also called impaired fasting glucose) or diabetes you need to limit your fruit intake to help manage your blood sugar level. And if you have high blood triglycerides (too much fat in your bloodstream), extra sugar from any source, including fruit, can worsen the condition.

Quantity and type of fruit matter.

To manage blood sugar, choose low-glycemic fruits that release their sugar gradually into the blood sugar. Most fruits have a low-glycemic value. The fruits to be wary of, those with a high glycemic index, are bananas, cantaloupe, dates, raisins and watermelon. They release their sugar quickly.

To manage high triglycerides, avoid fruits with a high fructose content. Consuming too much fructose enhances fat production in the liver. In this scenario, the good fruits, the ones with a lower fructose content, also include bananas and cantaloupe, but add grapefruit, nectarines, oranges, peaches and strawberries.

So yes, some people do need to limit their fruit intake, but they certainly don’t have to avoid it. The rest of us could stand to increase our fruit intake.

The general populace

Health Canada advises adults to consume 7 to 10 servings of vegetables and fruits (combined) per day. Although there’s no official guidance on how many of these servings should be fruit, I recommend that you eat at least four fruit servings – two cups of fresh fruit – per day.

(One fruit serving equals 1 medium-sized fruit, ½ cup of berries or fresh cut-up fruit, half a grapefruit, mango or papaya, ¼ cup of dried fruit, or half a cup of 100% fruit juice.)

Keep in mind that dried fruit contains more sugar and calories per serving than fresh fruit. That’s because fresh fruit is mostly water, which gives fruit its bulk.

Limit fruit juice to one serving per day and keep your portion to half a cup (measure!). It lacks fibre so it doesn’t fill you up.

The following strategies will help you increase your intake:

• Keep fruit at work. Keep apples, bananas, pears and dried fruit in your desk so you’ll have a healthy snack on hand when you feel hungry.
• Keep fruit visible. Decorate your table, kitchen counter or desk with a bowl of fresh fruit, to encourage healthy snacking.
• Include fruit at breakfast. Make a fruit smoothie with milk or soy milk, berries and half a banana. Or top a bowl of breakfast cereal with fresh or dried fruit.
• Serve fruit for dessert. Serve fresh fruit salad, fruit kebabs, frozen grapes, or simply eat a piece of fruit out of your hand, instead of a high calorie treat.
• Add fruit to salads. Toss dried or fresh berries, berries, orange segments or apple slices into green and whole grain salads.
• Consider convenience. Buy packages of frozen berries or cut fruit to add into smoothies. Pick up a fresh food salad or pre-cut fresh fruit.

© Copyright 2011 The Globe and Mail Inc.

USA: A Long-Awaited Advance in the War on Blood Pressure .

.
NEW YORK, NY / Wall Street Journal / Heart Beat / May 31, 2011

By Ron Winslow

 Americans are finally making headway in the battle against high blood pressure, one of the biggest contributors to cardiovascular disease.

At Kaiser Permanente's big northern California health plan, 80% of more than 600,000 patients diagnosed with hypertension, or high blood pressure, have the condition under control, up from 44% a decade ago. In the Southeast, 70% of nearly a half-million patients whose doctors participate in a South Carolina-based quality-improvement network had reduced their high blood pressure to medically recommended levels. That's compared with 49% in 2000.

These achievements, reported last week at a meeting of the American Society for Hypertension, reflect broader gains against the problem nationwide. A major study published last year in the Journal of the American Medical Association that was based on national health surveys found that half of Americans with high blood pressure had it under control in 2008 compared with 31% at the beginning of the last decade and 27% in the early 1990s.

"The progress that's been made nationally is really striking," says Brent M. Egan, a blood-pressure expert at Medical University of South Carolina, in Charleston, and senior medical director of the multi-state quality-improvement network that is attacking the problem. "It has exceeded what I thought was possible."

A recent push by her health-care provider has helped Marjorie Bushman control her blood pressure. Lori Eanes for The Wall Street Journal

What's changing the tide isn't a major research breakthrough, new medicine or fresh insight into the nature of the problem. Rather it is a deliberate, intense focus on tweaking and executing nuts-and-bolts strategies. Some of these strategies have proven effective in clinical studies but are only recently beginning to take hold in medical practices.

Kaiser Permanente's initiative is based partly on established clinical guidelines for diet, exercise and medical treatment. In addition, Kaiser solicited ideas from its individual clinics with a high percentage of patients whose blood pressure was under control, and used the most effective strategies.

Among the changes: Kaiser began encouraging its doctors who prescribed hypertension medication to start patients on a single pill that combines two blood-pressure drugs. The institution made the change after seeing positive results from the approach in clinical trials. Previous guidelines called for treating patients initially with a single medication.

Kaiser started a registry to track patients with hypertension. To gather names, one medical group at Kaiser culled patient lists to find members who hadn't had a recent checkup and ask them to come in for a blood-pressure test. Another group looked at prescription records to help identify patients who might benefit from a more effective treatment. Such efforts helped expand Kaiser's hypertension-patient registry to 660,000 people in 2009, up from 394,000 in 2001.

Marjorie Bushman working in her garden.

___________________________________________________

ONE PATIENT'S RECORD
Marjorie Bushman, 62 years old, is in generally good health but had high blood pressure. Here's how the Brisbane, Calif., resident got it under control.

* January 2007: Ms. Bushman learns at a regular checkup with her Kaiser Permanente doctor that her blood pressure is 145/74.
* The doctor starts her on two hypertension drugs: an ACE-inhibitor and a diuretic. Getting below 140/90 is the goal; the ideal is below 120/80.
* At follow-up visits over several months, doses of the drugs are adjusted to find the most effective treatment for her. Her blood pressure initially drops to 140/70.
* By July 2007, it falls further to 135/76. For convenience and better adherence, her doctor switches her to one pill that combines both drugs.
* Ms. Bushman keeps active, walking three miles three mornings a week and attending strength-training classes at a gym once a week. She makes sure fruits and vegetables are a staple of her diet.
* In March 2009, her blood pressure stabilizes at about 120/70.
* About every two months, Ms. Bushman has her blood pressure checked by a medical assistant at a Kaiser clinic.
* Early 2011: Ms. Bushman's most recent blood-pressure: 117/74.
__________________________________________________

"We can't just rely on patients showing up on our doorsteps," says Marc Jaffe, a Kaiser doctor who is clinical leader of the health plan's northern California cardiovascular-risk-reduction program. "That won't result in extremely high blood-pressure control rates."

When Marjorie Bushman, a 62-year-old printing-services broker from Brisbane, Calif., came in to her Kaiser clinic for a regular checkup in early 2007, she was told she had high blood pressure. Her reading: 145/74. Her doctors prescribed two pills, Ms. Bushman says, a diuretic and an ACE-inhibitor, both commonly used to treat hypertension. (Before 2005, Kaiser's policy was to start hypertension patients on a diuretic alone and add an ACE-inhibitor to the drug regimen if the initial treatment wasn't enough to get blood pressure below 140/90.)

Click here to continue reading

Ron Winslow
E-Mail: ron.winslow@wsj.com

Copyright ©2011 Dow Jones & Company, Inc.

USA: Aging Well - Facing the Fact of Mortality

.
NEW YORK, NY / The Huffington Post / Healthy Living / May 31, 2011

By Michael Friedman

"That's morbid", a student blurted out when, during a lecture on geriatric mental health policy, I commented on the inevitability of death and the need for older people -- such as myself -- to prepare for it. "Literally true," I responded. "Death is morbid, but coming to terms with it is a key developmental challenge of old age and a major challenge for our health and mental health systems."

My student's horror at an open discussion of death reflects widespread difficulty accepting mortality in our society. For example, news reports about people who die after long illnesses almost always state that death came "after a long battle", making it seem that everyone fights death to the bitter end and that no one dies at peace.

Photograph Courtesy: Experientia Docet 

Dylan Thomas articulates this sensibility in a frequently quoted poem to his dying father:

"Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light."

This sense that we ought to fight death makes it difficult for people to die well -- to be open about the fact that they are dying; to say goodbye to, and to accept loving goodbyes from, those they care about; to let go of hope for their personal future and to value the future of their children and grandchildren and the generation that will survive them; to accept or even take pride in who they have been; and to be at peace with the fact that all human lives end in death.

Many, but not most, people take practical steps to prepare for the inevitable. They make wills, choose health proxies, and leave directions about whether and how long to prolong their lives if they are terminally ill and unable to communicate. But often these actions are rational rather than visceral. Many of us imagine ourselves at our own funerals.

Many of our eulogizers will say, "I am sure that s/he is looking down from heaven now..." This cliché conveys how hard it is to imagine a person gone. For those who believe in an afterlife with continuing consciousness, it may not be necessary to accept ultimate non-being. But for those who believe that immortality is found in memory or non-conscious merger with the universe, there is no presence at one's own funeral, no looking down from heaven, no final reunion with those we love.

It is not easy for those of us who are old and coming closer and closer to the end of our lives to accept the inevitable. Some of us live in denial. Some of us are afraid. Some of us are angry. Some of us grieve for ourselves and for the people we will lose when we are dead. Some of us achieve a state of peace about death. Some of us never do.

Actually, most of us don't think much about death unless our health is poor or someone we care about is in terminal condition or has died. In fact, if we did think frequently about death it would be a symptom of depression. What is best for those of us who are old is to live as fully as we can.

Still, there are at least two practical steps we should all take whether death is much on our minds or not.

• Complete legal advance directives that will hopefully assure that we are treated at the end of our lives and in death as we want.

• Talk openly to those who have to carry out our wishes. We need to be specific about when to withhold further treatment if that's what we want or to be kept alive by all means if that's what we want. We also need to be specific about the disposition of our bodies -- whether to donate organs, whether to let our body be used for teaching in a medical school, whether to be buried or cremated, what kind of service we want to have, and so forth.

In addition, work needs to be done to ensure that health care reform will make it easier than it now is for people to die well. This includes access to information about options at the end of life; greater respect for advance directives; enhanced access to palliative care; more health care in the home so that people are not forced into strange and frightening environments as they approach death; greater comfort and privacy in health care facilities and not just in hospices, and greater respect for, and greater access to, spiritual conversation and guidance within the health system for those who will find this comforting.

Facing the fact of mortality may be morbid, as my student suggested, but it is also a critical need during this time of the aging of America.

Michael Friedman has worked in the field of mental health for over 40 years as a direct service provider, an administrator, a government official and as an educator. He has served on numerous advocacy and public advisory groups including, among many others, the Geriatric Mental Health Alliance (which he founded in 2004), the Veterans Mental Health Coalition of NYC (which he co-founded in 2009) and the Advisory Committee to the NYC Commissioner of Health. He currently teaches at Columbia University's schools of social work and public health.

.Copyright © 2011 TheHuffingtonPost.com, Inc

THAILAND: Housing programme supports Bangkok's elderly

.
BANGKOK, Thailand / Bangkok Post / Business / Housing / May 31, 2011

The Bangkok Metropolitan Administration (BMA) is moving ahead with a senior citizens' housing programme to support the capital's elderly, as the current number of homes for the elderly will be insufficient to accommodate the growing numbers of senior citizens.

Sawangkanives was launched by the Thai Red Cross for elderly residents.

Early this year, the Board of Investment agreed that more housing units for the elderly were needed in Bangkok but said more study was required.

"Baan Bang Kae 1 and 2, the current elderly shelters, are already full, and there's a long waiting list. These won't be enough to support the larger numbers expected in the future," said Thaiwat Triyapirom, director of the BMA's Housing Development Office.

He expects the new programme of building residential units for the elderly will be successful because the BoI will grant tax privileges to participating developers.

Eligible developers must have experience constructing elderly housing. Unit designs must incorporate medical equipment and special features such as reclining floors or elevators.

Bangkok has 6 million registered residents, 12-13% of whom are aged 65 and above.

However, most estimates put the capital's actual population at more than 10 million, including those who have relocated here for work or other purposes.

The BMA estimates the proportion of elderly will reach 20% of the city's population in the next decade.

Mr Thaiwat said Bangkok was entering an "elderly era" because birth and death rates were both declining.

Aliwassa Pathnadabutr, the managing director of the property agency CB Richard Ellis Thailand, said the country had yet to design very many property projects specifically targeting elderly Thais.

Broadly, two property types cater to this market - nursing homes and serviced residences attached to hospitals - but both have limited capacity.

Some small low-rise residential projects have been converted to nursing homes in the past, but these tend to fill up quickly.

Projects of this nature must take into account affordability, facilities required by the aged and on-site medical support.

The Thai Red Cross recently launched its second such project. Sawangkanives Phase 2 will comprise eight six-storey buildings with a total of 300 units worth a combined 270 million baht.

Phase 1, with 168 units priced from 850,000 baht, sold out.

Facilities include prayer, meeting and treatment rooms. Residents must be Thai and at least 55 years old.

As for serviced residences, Ms Aliwassa said those attached to hospitals target long-stay patients requiring extended recovery time and ongoing professional medical support.

These are aimed more at foreigners due to cost considerations.

Properties that target the elderly are specially designed, said Ms Aliwassa.

First, they should be located in the outer areas of the city, where traffic is less congested and the air quality is better, but still accessible from the central business district, she said.

On-site medical support is essential, along with direct hotlines to hospitals and police stations for emergencies.

In-room and common facilities should be designed with the needs of older residents in mind such as non-slip flooring materials in bathrooms, an in-room emergency line and wheelchair access.

Wheelchair ramps should also be installed throughout the project with clear signage, ample gardens and recreational space and extensive common areas. Also important is creating a sense of community among residents such as by scheduling regular activities.

Copyright The Post Publishing PCL 1996-2011

AUSTRALIA: Healthy heart, healthy brain

.
SYDNEY, NSW / The Sydney Morning Herald / Wellbeing / May 31, 2011

Chew On This

By Paula Goodyear

Mental health ... exercise is good for your brain as well as your body

Not all the news about dementia is gloomy. The flipside of scary statistics like a predicted doubling of dementia cases by 2030 is that we’re not entirely helpless when it comes to keeping our minds as we age – we just don’t realise it.

We might have grasped the fact that keeping the brain active can help prevent its decline, but there’s another important message that hasn’t got through – that healthy blood pressure from mid-life onwards is one of our best anti-dementia defences. That’s why a new NSW Health campaign to boost awareness of the blood pressure-dementia link is aiming at 40-somethings, not just the over-60s.

“Only around 20 per cent of us understand that we can reduce the risk of dementia by keeping blood pressure levels healthy,” says neuroscientist Dr Michael Valenzuela, senior research fellow with the School of Psychiatry at the University of NSW. “But many risk factors for dementia that we do have influence over like blood pressure and cholesterol levels and being overweight can start to have an impact in our 40s and 50s – often decades before people start worrying about dementia.

“Pharmacological treatment of high blood pressure is the only medical treatment found so far to reduce the incidence of dementia,” he adds.

So what is it about high blood pressure that can ultimately mess with our minds? In a nutshell, the same damage it inflicts on arteries that leads to heart disease can also affect the brain – hence the Healthy Heart Healthy Mind name given to the new dementia prevention campaign underway in the Illawarra and Shoalhaven areas south of Sydney.

High blood pressure contributes to the second most common type of dementia after Alzheimer’s disease – vascular dementia that’s caused by having a stroke. But there’s also some evidence that keeping blood pressure levels healthy can help prevent Alzheimer’s disease as well, says Valenzuela. One theory is that micro-haemorrhages from tiny blood vessels feeding into our brain tissue could cause the damage that kicks off Alzheimer’s, he says.

‘These micro-bleeds are strongly linked to high blood pressure and the thinking is that they affect the blood supply to the brain. This not only means the brain gets less nutrients, but also that there’s less clearance of toxins from the brain. Another explanation is that the leaking blood may also have a toxic effect on brain tissue,” he explains.

Valenzuela is the author of Maintain Your Mind, a new guide to preventing dementia to be published by ABC Books later this year – and which has really good news about the protective role of exercise.

“The assumption was that physical activity helps prevent dementia because it helps lower blood pressure and improves the blood flow to the brain. But there’s evidence that exercise can also have more direct effects on the brain, stimulating new brain cells to grow as well as increasing connections between the cells in the hippocampus - the brain’s memory centre,” he says. "Some of these effects could be due to the positive role of growth factors and molecules called cytokines that are stimulated after exercise.”

Are some kinds of exercise better than others? Most studies suggest that aerobic exercise is important, but Valenzuela’s recommendation is for at least three brisk 30-minute walks and at least one session of resistance (strength) training each week. A combination of both is good for health generally – and also helps prevent diabetes which is another risk factor for dementia, he says.

So while you’re tossing up whether to learn Mandarin or mah-jong in the interests of maintaining your brain, don’t forget to schedule a few brisk walks as well.

Blood pressure – what’s normal?

As a general guide, the Heart Foundation suggests:

Normal blood pressure: generally less than 120/80 mmHg

Normal to high blood pressure: between 120/80 and 140/90 mmHg.

High blood pressure: 140/90 mmHg or higher. If your blood pressure is 180/110 mmHg or higher, you have very high blood pressure.

Copyright © 2011 Fairfax Media

JAPAN: Elderly drivers face higher premium

.
TOKYO / The Japan Times / Life in Japan / May 31, 2011
Kyodo

Mitsui Sumitomo Insurance Co. said Monday it will raise auto insurance premiums by an average of 1.9 percent, mostly for elderly drivers, from October.

The nonlife insurer is making the hike to meet higher payout claims related to traffic accidents involving elderly drivers.

The insurer will review its uniform age bracket for drivers 35 and older and set new decade-based brackets for drivers 30 to 70, raising premiums mainly for drivers aged 50 and older.

In normal cases, premiums will rise 2.5 percent for drivers in their 50s and 6.5 percent for those 70 and older, while those in their 30s to 40s will see premiums drop by about 2 percent.

Sompo Japan Insurance Inc. also hiked premiums in April.

(C) The Japan Times

CANADA: Elder abuse often goes unreported in our society

.
SAINT JOHN, New Brunswick / Telegraph-Journal / Canada East / May 30, 2011

A Toronto couple accused of keeping an elderly mother in despicable conditions at their home have been in jail since the police first discovered the situation. Initially, the couple was refused bail, and in a later hearing they were again remanded into custody. Their lawyer pointed out that this was their first offence, but the judge was having none of that. It appears that the justice system can occasionally become bloody minded enough to keep someone in jail who has deeply offended community standards.

Kwong Yan and his wife, Qi Tan, lived in a suburban bungalow with their daughter, and her mother. Mr. Yan's mother sort of lived there as well. Through this winter, she was kept in an unheated garage, had a bucket of water, a pot, and a bed composed of a blanket on some boards.

 When discovered, she had frost bitten feet, and showed signs of starvation. She suffered from dementia.

A 68-year-old woman lived for four months in a makeshift bedroom -- several sheets of drywall -- set up in an uninsulated Scarborough garage. She is in hospital in life-threatening condition.

Photograph Courtesy:
Tony Aw/SING TAO DAILY/ Star.com

This was a clear case of elder abuse, and the couple has been charged with failing to provide the necessities of life, and of criminal negligence causing bodily harm. Activists are now demanding that legislation be created to include elder abuse in the Criminal Code of Canada.

I am afraid that elder abuse occurs often in our society. Reporting on this case, the police stated that roughly 4 to 10 per cent of elderly people suffer abuse. This estimate was described by others as a serious underestimation. An American study concluded that for every one case of elder abuse reported, five other cases go unreported.

Abuse of the elderly takes a variety of forms. The foregoing example is abuse because of neglect. Another abuse is a result of abandonment after someone had assumed responsibility for care. There are also physical and sexual abuse. Financial exploitation is a form of abuse as well. This can take the form of relatives taking assets without the consent of the older person, through to workman who offer services or goods, and fail to carry through after receiving the money.

There was a shocking example of elder abuse illustrated in Saint John when an apartment building for low-income seniors was renovated with the residents left inside, and the entire building wrapped in plastic. Left with compromised breathing and no view of the outside for what is now estimated to be over a year, the residents began to suffer from health problems. It is particularly disturbing that this situation was the responsibility of the Department of Social Development.

As the number of seniors double over the next 20 years, elder abuse will join child abuse and spousal abuse as behaviours requiring intervention by the authorities. In the United States Congress, an Elder Abuse Victims Act is being discussed that would improve law enforcement's ability to prosecute crimes against seniors. British Columbia is combining teams of police officers and social workers to investigate cases of elder abuse. The city of Hamilton has the only dedicated squad exclusively investigating crimes against seniors.

At the moment, many elderly people are too embarrassed to report abuse, especially within their families. The National Seniors Council, a federal government agency, has commented on underreporting. It also reports that senior abuse can affect everyone, but it occurs more often when the following characteristics are present. These are: seniors who are older, female, isolated, dependent on others, frail, and having a cognitive impairment or a physical disability. Living in an institutional setting or being cared for by someone with an addiction can also result in higher rates of abuse.

Abuse is normally a crime against the poor and powerless in our society. In this regard, a recent report from Statistics Canada shows a sharp increase in seniors living in poverty. The number of seniors living in poverty jumped nearly 25 per cent between 2007 and 2008. It's the largest increase among any group. Women make up 80 per cent of seniors who have fallen into poverty. The decline into poverty is blamed on the recession.

Our national pension programs had maintained seniors in relatively good financial shape up until this recession. We need to be mindful of the pervasive nature of elder abuse. It's not enough to accept abuse because its victims are old and poor. These are the very people who need care and attention.

Jo-Ann Fellows is a writer living in Fredericton. Her columns on seniors' concerns and on public policy issues appear twice a month.

© 2010 CanadaEast Interactive, Brunswick News Inc.

CANADA: The secret to happiness? Live a 'good enough' life

.
TORONTO, Ontario / The Globe and Mail / Life / Relationships / News & Views / May 30, 2011

By SARAH HAMPSON, Columnist

The secret to happiness? Live a 'good enough' life

Some experts say the secret to happiness is to figure out

 what is truly worth pursuing. (iStock photo)

Oh, I know. It sounds pathetic, defeated: the goal of someone who lacks high standards and a good work ethic, someone who is willing to settle for mediocrity. Not a doer; a pessimistic loser.

Well, happiness experts say satisfaction is largely a matter of expectations. Expectations can sink you. You always thought you would live in a nice house with a double-car garage, have a couple of lovely children, an influential, well-paid job, a devoted spouse and savings in your bank account.

And when you don’t? Yeah, help yourself to a slice of misery pie.

On the other hand, when you don’t expect much, when you manage the ideas of what you think your life should be, you can be pleasantly surprised – and grateful – for the good fortune that comes your way.

The trouble is, that attitude doesn’t fit with society’s prevailing imperatives. There’s a fundamental tension at play in how we’re encouraged to think about our lives. We’re exhorted to achieve our dreams and never give up, to think positive, and yet the resulting expectations – some unrealistically high – can make us dissatisfied, even depressed.

Go ahead, start by blaming your parents. “Have you ever heard a parent say ‘I only want what’s good enough for my children?’ ” offers Barry Schwartz, a professor of social theory at Swarthmore College in Pennsylvania and author of The Paradox of Choice: Why More is Less.

“You can’t even get that sentence out, can you?” he says, laughing. “Whatever standards we have for ourselves, they’re not true for our children. We create people who are perfectionist because they observe us trying to provide the very best, showing us day after day that good enough is just not good enough for our precious jewels. And when the time comes to make their own decisions, children adopt the same standards.”

The idea that realistic parenting might yield happier, more well-adjusted adults is also at the heart of Alina Tugend’s new book, Better By Mistake: The Unexpected Benefits of Being Wrong. She identifies a similar tension in the conflicted messages that mistakes should be avoided (and even punished) even though they’re our greatest teachers.

“There are no simple fixes but there are ways all of us can shift our thinking about mistakes, starting with our children,” she writes. “We can emphasize effort and de-emphasize results. We can appreciate that we – and they – can’t be perfect, nor is it a goal we should aim for.”

Apart from the influence of parents, Prof. Schwartz also fingers the culture of abundant choice. Everything about modern Western life encourages a pursuit of “the best,” he says, adding that “every time a company comes out with a new product they’re trying to convince you it’s the best so you will throw out the old one. This notion of best so suffuses the culture that you almost look like a shirker if you go through life trying to live the good enough life.”

The solution is not about lowering standards, he says. It’s about adjusting the way we think. “High standards are very different from wanting or expecting the best all the time,” he says.

And the same is true for how we should think about our personal accomplishments. “Having very high standards of achievement – working hard, persevering, not being satisfied with what is merely acceptable – no doubt spurs people to achieve things that they would otherwise not achieve,” Prof. Schwartz says. “But there’s a crucial difference between shooting for perfection, realizing you can’t achieve it and yet still being satisfied with your accomplishments and shooting for perfection, thinking you can and should achieve it and thereby living a life of misery and perpetual disappointment.”

What’s required for a contented life is a personal investigation into what matters most. “It’s having to figure out what is worth pursuing. If you have high standards, you need to say ‘this is what’s important to me,’ in a job, in a college, in a relationship, in a house or whatever. It takes more reflection than simply allowing externally imposed ideals dictate what you should want.”

Of course, increasing age can make a person adjust the sails on her ship of expectations. Who among us mid-lifers hasn’t had to weather the knocks of life and realize that sometimes just being healthy, solvent and connected to good friends is more important than the big job you lost, the marriage that failed or the house you had to sell?

“It’s about how you redefine what is excellence,” observes Dominique Browning (left) , author of Slow Love: How I Lost My Job, Put on my Pajamas and Found Happiness. The former editor of House & Garden lost her job when the magazine folded in 2007 and found herself reeling from a number of changes. Her two sons had left home. Her post-divorce relationship of 10 years ended. She sold her “forever” house and downsized to Rhode Island. A high-achiever, accustomed to the kind of success people could see from the outside – a limo lift to a high-powered job, a house in New York, a social life among the media elite – she was suddenly adrift, caught in a “feeling of loss and disintegration.”

Photo by Brigitte Lacombe

But one step at a time, she built a new life – freelancing, working in her garden and enjoying the beauty of each day – that didn’t have all the external markers of fulfilled expectations that she once had. “It’s about making a distinction between structure and values,” the now-55-year-old explains on the phone from Rhode Island. “My values remain the same. You can still keep your values even if you lose the structure, which can look like failure to others. I want to do the best that I can do. I care about meaningful work. I want to work with people I admire. I want to grow and I want to overcome fear.

“That’s how I would define my good enough life. That’s not defeatist. It’s the best life for me.”

© Copyright 2011 The Globe and Mail Inc.

CANADA: The longer you practise yoga, the happier and healthier you'll be

TORONTO, Ontario / The Globe and Mail / Fitness / Exercise / May 29, 2011

By Alex Hutchinson, Columnist

Levels of psychological and physical well-being among the participants of a study on yoga were proportional to how long and how often the women practised yoga – a greater dose produced a greater effect.


When Nina Moliver decided to study the long-term health and wellness effects of yoga for her doctoral research in psychology, one of her professors offered some advice.

“The yoga world doesn’t need more testimonials,” the professor at Arizona’s Northcentral University told her. “The only way you’re going to communicate with the medical community is with numbers.”

Yoga science is a burgeoning discipline, with researchers probing yoga’s effects on everything from stress hormones to skin conditions. But how can a typical four- to six-week study capture the benefits of an ancient mind-body discipline that takes years, if not decades, to master? It can’t, Dr. Moliver concluded – so she decided to take a radically different approach that offers the first quantitative look at yoga’s long-term benefits. And the results of her study are promising for dedicated yoginis.

The “gold standard” in medical research is the randomized controlled trial, or RCT. Subjects are randomly assigned to receive either an experimental treatment or a placebo or sham treatment. Yoga fits uneasily into this model: It’s impossible to “blind” participants to which group they’re in, and imposing a standardized protocol runs counter to yoga’s ethic of individual progress.

But the more serious problem is practical. Prospective trials tend to last only a few weeks or months, which means conventional studies are “forever studying beginners,” says Dr. Moliver, who is now a research consultant in Boston. It’s simply not practical to randomly assign volunteers to a yoga practice and expect them to maintain it for a decade.

The alternative is observational studies. Dr. Moliver’s thesis, completed last year, surveyed 211 women who had been practising yoga for as long as 50 years, plus 182 matched controls. Her goal was to search for a “dose-response” relationship between cumulative yoga experience and positive psychological attitudes, perceptions of aging, medication usage and other traits, while using statistical analysis to eliminate confounding factors like age, education, body-mass index, other exercise and processed-food consumption.

“I wanted to see if there were linear relationships, where more yoga leads to more benefits,” she says. “Because the yoga masters make these claims, but nobody has ever tested them.”

Sure enough, the study found that levels of psychological and physical well-being among the study participants were proportional to how long and how often the women practised yoga – a greater dose produced a greater effect.

Interestingly, the most experienced yoginis weren’t necessarily happier or healthier than the happiest and healthiest non-yoginis, at least in the parameters Dr. Moliver was able to measure. “They didn’t find ‘enlightenment’ that others can’t reach,” she says. The biggest differences were at the other end of the scale, in the scarcity of unhealthy or unhappy long-time yoga practitioners.

RELATED
Advanced yoga pose requires training

Samantha Pynn during yoga class at energyexchange in Toronto

Unfortunately, one question observational studies can’t address is how yoga works. Traditional yoga teaching ascribes its benefits to prana, a Sanskrit word meaning “vital life” – a concept that’s difficult to measure, and thus, as Dr. Moliver points out, easy to ignore.

Timothy McCall, a doctor and the author of Yoga as Medicine, cites studies investigating more conventional explanations for yoga’s powers, such as its influence on the body’s physiological response to stress, the connection between breathing and the autonomic nervous system, and the emerging evidence that the brain can rewire itself in response to techniques like meditation – “crucial components, though not the whole story, of yoga’s efficacy,” he points out.

Dr. Moliver’s research can’t settle this question, and it can’t conclusively untangle cause from effect. After all, it’s possible that happy people do yoga, rather than the other way around, or that the discipline necessary to maintain a yoga practice over many decades is the type of character trait that leads to a happy and healthy life, with or without yoga.

But such debates don’t undermine Dr. Moliver’s central finding. Whatever the reason, those who make a long-term commitment to yoga tend to be happier and healthier – and the benefits continue to accrue the longer you stick with it.

“There’s no plateau,” she says. “What the masters promised was true.”

What type of yoga is best?

The subjects in Nina Moliver’s study reported following more than a dozen different yogic traditions, including Kripalu, Hatha, Iyengar, Anusara and Kundalini. She found no significant differences between the followers of different traditions – in fact, she says, most people end up taking elements from several traditions to create a program that works for them. So what’s the “essence” of yoga that distinguishes it from, say, an aerobics class? For the purposes of her study, Dr. Moliver emphasized three elements:

Asana: These physical postures and patterns found in yoga are dominant in many Western practices

Breathing: Controlled breathing exercises, or pranayama, link the physical and spiritual realm

Awareness: Meditation and concentration on internal sensations differentiate yoga from most conventional forms of exercise.

Alex Hutchinson blogs about research on exercise at sweatscience.com. His new book, Which Comes First, Cardio or Weights?, is now available.

© Copyright 2011 The Globe and Mail Inc.

SOUTH AFRICA: "It was them or my family"

.
DURBAN / Sunday Tribune / May 29, 2011

The 55-year-old building contractor chainsmoked as he paced the lounge floor of his daughter and son-in-law’s home in Winklespruit, marking out the events that led to the fatal shooting of a robber in the early hours of Tuesday.

“When I entered the house it was dark and completely silent; even the five dogs were missing. I thought my grandson and his parents were dead. My heart turned to stone,” he said.

Father and daughter hold hands as they recount their terrifying ordeal last week.

The traumatised man, who asked that his identity be withheld until the final member of a four-man armed gang who raided the property is apprehended, said the country was in “a state of siege” – families needed to barricade themselves in their homes and make sure they had the means to protect themselves.

“I am consumed by anger at what happened. I am not a violent man, but I do not feel a shred of remorse for shooting him,” he said. “It was either them or my family.”

The night before, the family’s home had been filled with laughter and conversation as the man’s daughter celebrated her birthday with their extended family. When her parents left for their home in nearby Amanzimtoti, she went to bed, allowing her seven-year-old son to sleep with her as a special treat. Her husband watched television, before turning in himself in the early hours.

“At around 2.30am the dogs started barking aggressively,” her husband said. “I got up to check on them, and three men were squeezing into the kitchen past a faulty burglar guard.” Unknown to him, there was a fourth man standing lookout in the garden.

Screaming, to wake his wife to call for help, he picked up the nearest possible weapon – his son’s hockey stick, and flailed at the intruders until it broke. One of the men pulled out a knife, and another said: “Move again and we’ll shoot you.”

In the bedroom, his wife had managed to phone her parents, “They’re in the house,” she screamed.

Her father sprang into action, taking his .38 special from the safe, then covering the distance between the two homes in minutes. CCPO and Blue Security company officers were already at the scene and followed close on his heels as he activated the gate’s remote control and inched around the building to the kitchen.

“I left my bakkie’s lights on, because the house was in complete darkness,” he recalled. “I got in through the sliding door to the kitchen, and took the safety catch off the gun, praying that the kids were not already dead.”

He called out: “This is the police. Come out or I will shoot.” Two men emerged from a room, pushing his son-in-law before them as a shield. He repeated the command, as the taller of the two angled a knife blade into his captive’s neck.

“Then he threw himself towards me, slashing with the blade. I aimed low and fired, knowing it would not be a fatal shot,” the man said. “He stumbled and I fired again, then he got behind the couch and a second man attacked me.”

The grandfather fired at his assailant, hitting him in the throat, but still the attack continued. “The first man reared up when I prodded him with my boot, and grabbed the gun with both hands.”

At that point his daughter emerged from the bedroom, where her son was cowering under blankets, and threw a battery-operated stun gun to her husband. He shocked the man clinging to his father-in-law’s back until he fled – back the way he had come in. He was apprehended a short while later by security guards – along with a third man spotted hobbling along a nearby bridge with a bullet wound to his foot.

Speaking of her ordeal, and her father’s bravery, the woman said:

“I told my son to keep his eyes shut tight, and pretend he was sleeping, and I piled blankets and pillows over him. I had the Taser in my hand under the blanket while one of the men shone a torch on our faces. He would not have got to my child unless he killed me first.”

“I am just so grateful I had the privilege of being able to save the people I love,” the grandfather said. “We all need to do whatever it takes to keep our families secure. If our homes have to become fortresses, then it’s a small price to pay.”

He praised the community watch body, the security company that had provided backup, and the SAPS for going the extra mile in the aftermath of his family’s crisis.

“The police could not have been more professional, or more caring,” he said.

George Snodey of the Amanzimtoti CCPO, had recently warned people living in the area to be extra-vigilant.

“If you see suspicious-looking people on foot or in a vehicle, contact the SAPS and security as soon as possible.”
Sunday Tribune © 1999 - 2010 Independent Online

NEW ZEALAND: Plans to increase number of over-65s who keep working

.
AUCKLAND / New Zealand Herald / Business / News / May 29, 2011

By Maria Slade

New Zealand needs to tap into the economic potential of the retiring baby-boom generation if it is to offset the cost of supporting them, a new report says.

The Ministry of Social Development document says within 40 years nearly a quarter of our population will be of retirement age, an enormous financial burden on the nation.

But it outlines two key ways of counteracting that: increase the number of over-65s who choose to keep working, and better target this well-heeled retiree consumer market.

The baby boomers will be healthier, better educated and have more spending power than any other post-65 New Zealand generation, it said. By 2051, 23 per cent of the population will be over 65 - up from today's 13 per cent - with 41 per cent of them aged 80-plus.

At the same time fewer younger people are coming through, meaning total workforce size is expected to decline from this year. Encouraging older, skilled people to keep working is one way of addressing this, the ministry says.

The notion of retiring at 65 is changing, with more people continuing in paid work after their first superannuation cheque. In 1991, 25,000 over-65s were still working, but that had risen to 62,000 by 2006.

In 20 years, the number should be 240,000, the report said.

Today, about 3 per cent of the total labour force is over 65. That figure is forecast to grow to 7-10 per cent by 2051.

But to maximise older workers' potential, the country needs to improve their opportunities, the report says. Inflexible work arrangements, discrimination and poor health are key barriers, and government, employer and employee groups will need to develop policies that address these issues.

Building on existing skills, a flexible workforce and improved workplace practices "will be critical tools for managers facing population ageing in their industries", it says.

On the other side of the ledger, the new generation of retirees has enormous spending power. People aged 65-plus will spend $10.9 billion this year. That figure will rise to $45 billion in 2051, the report predicts.

But work is needed on how to market to specific segments within this group, the ministry says. The tastes of our parents and grandparents will not necessarily predict the demands of older baby boomers: "The economic potential of the older market will not be realised if businesses marketing to the new generation of older people target them as a homogenous group."

Kate Ross, of recruitment agency Kinetic, says there are now skills shortages again and recruiters are "crying out" for people. Employers are adapting to that, but it doesn't have anything to do with age, she says. While some 65-year-olds are young at heart others dislike change, and it is about having the attitude and skills set: "If you fit that box then there's no reason you can't get the work."

Jeff McDonald, client solutions manager at recruiter Ranstad, says older workers are more loyal, take fewer sick days and offer experience.

"[But] we want to have these people embracing new technology, new ways of working, and being mindful we're constantly going through a period of change."

The situation presents a unique opportunity for employers, he says. "If companies can do this successfully they can do very well out of it."

Richard Poole, co-founder of website grownups.co.nz, says there is a general feeling among his 45 to 65-year-old audience that "there needs to be more recognition that they've got lots of good years left".

Significant change in the attitudes of marketing managers and advertising agencies has occurred in the past 12 to 18 months, he says.

Apart from the marketing of obvious products such as retirement homes and travel, there had been an unwillingness to consider older groups. "The main theme was like 'it's not going to be cool if we're seen to be marketing to people over 50, it may damage our brand'. It's just an awakening, really."

Retirement not in plans

Liz Allen, who works in accounts, says retirement doesn't add up. Photo Doug Sherring

Reaching her 65th birthday certainly did not mean retirement for Liz Allen. She continues to work part-time in accounts for a central Auckland firm, with no intention of stopping.

"I just couldn't do it, sit around all day and watch television."

Working keeps her active. "You're still interacting with people and there isn't any reason to [stop]. The whole concept of retirement to me is pretty foreign."

To those who say the retiring baby boomers will be a huge economic burden, her answer is this: "Don't write us off, because we can keep working."

As well, many retired people also give back by volunteering, says Allen, who helps arts organisations.

Copyright 2011, APN Holdings NZ Limited

UK: Hugh Hefner - ''I am still very romantic. Being in love completes me'

.
LONDON, England / The Independent / People / Profile / May 29, 2011

Interview by Adam Jacques

I was very conservative as a teenager I was raised in a Puritan home and I was planning to get married to a girl from high-school, once we graduated. But right before we tied the knot, she had an affair. It was devastating for me; she had been the only person I'd had sex with and it doomed the marriage.

Hefner with his fiance Crystal. 'She makes me feel like a teen again', he says

Getty Images

'Playboy' was a flag of liberation for myself and society at large I was trying to bring sex into the fold of a healthy lifestyle. But I had no idea what was going to happen. The first issue had no date as I didn't know if I was going to be able to publish a second. But in the first few weeks the magazine took off.

I helped change the law The 1950s was a very conservative decade, and if the sex laws in the 48 states at the time were effectively applied, most adult men in the US would have been serving prison time. The Playboy Foundation was the activist arm of the Playboy Philosophy and in the 1960s we helped a lot of people; we helped a woman who was serving time for manslaughter for having an illegal abortion get out of prison, and we helped free a married man for having anal sex with his wife. In a social-sexual sense the world is a Playboy world now and I take great pride in that.

Viagra has freed older people We are living longer now and we should live life to the fullest as long as we are able. I got my first prescription in the weeks my marriage [to former Playboy Playmate Kimberley Conrad] was ending [they separated in 1998 and finally divorced last year]. It was a hallelujah moment for me. I went through a period of excess and I had seven girlfriends. I said at the time, "Seven girlfriends are easier to handle than one wife."

People talk about religion as a civilising force. It's not; sex is The attachment between the two sexes is the beginning of family, tribe and most things on the planet. Responding to a woman's beauty is in our DNA; it makes the world go round.

I am still very romantic Being in love completes me. I went from having seven girlfriends down to three – Holly, Bridget and Kendra – but for the past two-and-a-half years it's been one, Crystal [whom he is marrying next month]. She makes me feel like a teen again. I don't think I can do any better than spend the rest of my life with her.

Re-Opening the London Playboy Club has real meaning for me The original London club, which opened in 1966, was iconic. London was the centre of the world back then and everybody came – members of the Beatles, Mick Jagger... There was the Mod scene, mini-skirts were here; the sexual revolution had arrived and I felt like I needed to get ready for it.

America is still schizophrenic when it comes to sexuality There have always been two threads of America. One is the rebel part, which says, "Don't tread on me." The other is the puritan part, where the only moral purpose of sex is procreation; if you're enjoying it, well, that's immoral, and based on nothing. Our attitudes towards sex in the US are still very screwed.

I always tried to treat the women in my life decently I've remained good friends with the majority of my wives and the other romances I've had in life, and I take great pride in that. The only one who gives me bad reviews is someone [former Playboy Playmate Izabella St James] who has gotten left behind. Her book [Bunny Tales: Behind Closed Doors at the Playboy Mansion] was just a projection of her own negativity.

Hugh Hefner, 85, is an American magazine publisher and chief creative officer of Playboy Enterprises. The Playboy Club London is to re-open on Saturday at 14 Old Park Lane, Mayfair, London W1 (playboyclublondon.com)

©independent.co.uk

USA: Coffee Addiction Cuts Cancer Risk

.
NEW YORK / FORBES / Blogs / May 28, 2011

By William Pentland

Men who drink abnormally large amounts of coffee everday are at lower risk of prostate cancer and much lower risk of lethal prostate cancer, according to a new study by researchers at Harvard University.

Men who consumed six or more cups per day had a lower adjusted relative risk for overall prostate cancer compared with nondrinkers. The association was stronger for lethal prostate cancer. The average level of daily coffee consumption is slightly less than two cups, according to the study.

Kathryn Wilson, a professor of epidemiology at Harvard’s School of Public Health, was the lead author of the study, “Coffee Consumption and Prostate Cancer Risk,” which appears in the most recent issue of the Journal of the National Cancer Institute published by Oxford University Press.

Ironically, the potential health benefits associated with heavey coffee consumption appear to be related to non-caffeine components of coffee.

From the study:

"Coffee contains many biologically active compounds, including caffeine and phenolic acids, that have potent antioxidant activity and can affect glucose metabolism and sex hormone levels. Because of these biological activities, coffee may be associated with a reduced risk of prostate cancer. We conducted a prospective analysis of 47 911 men in the Health Professionals Follow-up Study who reported intake of regular and decaffeinated coffee in 1986 and every 4 years thereafter.

From 1986 to 2006, 5035 patients with prostate cancer were identified, including 642 patients with lethal prostate cancers, defined as fatal or metastatic . . . We observed a strong inverse association between coffee consumption and risk of lethal prostate cancer. The association appears to be related to non-caffeine components of coffee.

2010 Forbes.com LLC™

USA: For Those With Diabetes, Older Drugs Are Often Best

NEW YORK / The New York Times / Health / May 28, 2011

Dr. Wendy L. Bennett of the Johns Hopkins University School of Medicine

said becoming educated was the most important thing a person

with diabetes could do to stem costs and avoid complications. 

Steve Ruark for The New York Times

By WALECIA KONRAD

WHEN it comes to prescription drugs, newer is not necessarily better. And that’s especially true when treating diabetes.

One in 10 Americans has Type 2 diabetes. If the trend continues, one in three will suffer from the disease by the year 2050, according to the federal Centers for Disease Control and Prevention.

Most Type 2 diabetes patients take one or more drugs to control blood sugar. They spent an estimated $12.5 billion on medication in 2007, twice the amount spent in 2001, according to a study by the University of Chicago. (That figure does not including drugs that diabetics are often prescribed for related health conditions, like high blood pressure and high cholesterol.)

Why the increase? More diagnosed patients, more drugs per patient and an onslaught of expensive new drugs, according to Dr. G. Caleb Alexander, assistant professor of medicine at the University of Chicago and lead author of the study. Since 1995, several new classes of diabetes medications have come on the market. Diabetes drugs are important to the pharmaceutical industry, more lucrative than drugs for many other chronic diseases, Dr. Alexander noted in an interview.

Simply put, many of these drugs help the body produce less glucose or more insulin, the hormone that shuttles glucose into cells for use as energy, or they increase the body’s sensitivity to its own insulin.

Patients and health care professionals have long hoped that as pharmaceutical companies found ways to help the body lower blood sugar, they would produce safer and more efficient alternatives to older medications. But a true breakthrough doesn’t seem to have happened yet.

A report released in March by the federal Agency for Healthcare Research and Quality and conducted by researchers at Johns Hopkins University reviewed data from 166 studies to evaluate the effectiveness and risks of various diabetes medicines. The researchers concluded that drugs that have been around for years are more effective at lowering blood sugar and often work with fewer side effects than the newest drugs. And because so many older drugs now are available as generics, they often cost just a fraction of the price of newer brand-name drugs.

Low-cost treatment is imperative to turning back the diabetes epidemic, said Dr. Wendy L. Bennett, assistant professor of medicine at Johns Hopkins University School of Medicine and the lead author of the A.H.R.Q. study. Experts estimate that only 25 percent of diabetic patients are getting the treatment they need, and expense is a big reason. Even well-insured patients may reel when confronted with the $6,000 a year it takes on average to manage the disease (not counting the costs of such complications as heart disease, stroke, and liver and kidney damage).

Becoming educated is the most important thing a person with diabetes can do to help stem the cost of medications as well as avoid complications, said Dr. Bennett. Here, three crucial things you should know.

Step 1: Fight diabetes with lifestyle changes.

Cost: Free or low cost.

If you are pre-diabetic or recently diagnosed, you may be able to dodge the expense of drug treatment with exercise and a better diet and by quitting smoking. None of this has to cost a fortune, and in any event healthier foods and, if necessary, a gym membership or other exercise program are well worth the investment. Even if you are taking medication, these lifestyle changes can help the medicine work better and longer.

For more information go to www.cdc.gov/diabetes and the Web site for the American Diabetes Association, http://www.diabetes.org/.

Step 2: If you need to begin taking a drug to control blood sugar, start with metformin, the most common and one of the least expensive diabetes drugs.

Cost: $36 for 100 pills (500 milligrams); usually taken twice a day. Prices may be even lower at Wal-Mart, Target and other discount pharmacies.

Metformin almost always works as a first-line drug, except for patients suffering from severe kidney disease, said Dr. Bennett. What’s more, metformin generally does not cause hypoglycemia, a common and dangerous side affect of many diabetes drugs.

It also does not seem to cause weight gain, as some other diabetes drugs do, said Dr. Bennett. “The last thing you want if you’ve been diagnosed with diabetes is additional weight,” she added.

A study published in Consumer Reports Health in February 2009 also found that older, less expensive diabetes drugs were just as effective as the new ones. Better yet, they have established safety records, while some newer diabetes drugs have been found to increase cardiovascular and other health risks.

“The expensive drugs are third- and fourth-line drugs,” said Dr. Marvin Lipman, chief medical adviser for Consumer Reports Health and a practicing endocrinologist in Westchester County, N.Y. “If you don’t get results with the less expensive drugs, you go to those. But you shouldn’t start there.”

Avoid: Certain newer diabetes drugs have been associated with heart failure and other risks.

Avandia, for example, has been linked to an increased risk of heart attacks. In September 2010, after years of debate, the Food and Drug Administration severely restricted Avandia’s availability, allowing it to be prescribed only to patients in a special program who had not responded to other drugs and were taking the medicine under a doctor’s strict supervision. This month the agency expanded those restrictions to include related drugs Avandamet and Avandaryl, which also contain rosiglitazone, the active agent in Avandia.

Step 3: Choose combination drugs from among inexpensive generics.

Cost: Glimepiride, $13 for 100 pills (1 milligram). Glipizide, $64 for 100 pills (5 milligrams).

Most diabetics will have to eventually take more than one drug to keep blood sugar under control. The good news here from the Johns Hopkins study is that inexpensive metformin is also quite effective in combination with other generics, such as glimepiride and glipizide.

“Most combinations worked equally well, so when you’re adding a drug, you could choose a generic to save costs,” said Dr. Bennett. She added, however, that some drugs used with metformin might increase the risk of side effects such as hypoglycemia or weight gain. Patients should discuss each drug’s pros and cons, as well as cost, with their doctors.

Avoid: Do not start with one of the more expensive drugs in combination with metformin. In some cases, patients ultimately may need a combination of both generics and the newer drugs, but this usually becomes appropriate only after a less expensive combination has been used for some time or if the patient isn’t responding to the less expensive combination, said Dr. Bennett.

© 2011 The New York Times Company

USA: Elderly mother takes issue with daughter's doctorly caution

.
LOS ANGELES, California / The Los Angeles Times / Health / May 30, 2011

In Practice

Elderly mother takes issue with daughter's doctorly caution

A doctor upsets her 86-year-old mother after questioning the need for certain screening and personally confronts a long-running issue: Everyone deserves the best healthcare, but it's difficult deciding what that is.

It may be hard to tell a patient, or mother, but a mammogram

may not be recommended for a woman older than 80.

Ben Edwards, Getty Images / May 30, 2011)

By Pamela M. Davis, Special to the Los Angeles Times

My mother has always had a special way of teaching me lessons, and a recent discussion about her healthcare was no exception.

She knows that healthcare costs are an area of concern for our country and for her doctor-daughter. We all hear daily from the pundits that we must tame Medicare or face financial ruin. This focus on Medicare leaves the aging feeling that their future health and well-being may be jeopardized by attempts to reduce what is spent on them in an effort to hold down the costs for the younger population.

As a family physician educator who teaches young doctors on a daily basis and cares for my own longtime patients, I discuss these issues every day. But I've found that the hardest battles can be fought right at home.

My mother is a charming and vivacious 86-year-old. Blessed with a strong Minnesota constitution, she is still driving, volunteering at a grade school, attending weekly genealogy meetings and is learning to paint with watercolors, a hobby she picked up some time after her 80th birthday. She is also more informed on national news topics than most young people. She is interested in what happens to our country.

The small details of life can fluster her, however, such as recently, when she called me about losing some paperwork she needed before her next doctor's visit. When I asked what she was looking for, she said it was her mammogram slip and some stool cards that test for colon cancer.

I was surprised that she was doing both tests and made the mistake we doctors make when we speak as daughters, not in our family doctor role.

"Why are you doing those? They aren't necessary at your age."

The mistake was made. I had said it — "your age." My mother was furious.

"Why shouldn't I get these tests? I'm just as important as the next person. You doctors just want to save money to spend on the young people and just let us old folks die."

My jaw dropped at her anger. Surely my mom, who was smart enough to understand the fiscal policies debated endlessly in the news, could understand the meaning and value of screening tests — when they made sense and when they didn't.

Couldn't she?

Mammograms and colorectal screening tests are meant to screen a healthy population for conditions in which it's proved that treatments give significant benefit, i.e. longer life or better quality of life. In order for a screening test to be helpful, the patient has to live long enough to make the follow-up tests and treatments worthwhile.

The studies show that mammograms probably aren't beneficial after 80 because cancer rates drop by that age and those cases that are picked up are slow-growing and easily treated even when they've reached the size of an easily detectable lump.

Colorectal cancer screening was developed to find polyps and precancerous growths that can turn into cancer in 10 to 15 years. Although recommendations indicate there are increasing numbers of precancers with age, many physicians question the value of screening in this population, because studies to prove long-term benefit don't exist at this time. The U.S. Preventive Services Task Force, which makes science-based recommendations on best practices in preventive medicine, recommends screening for colorectal cancer only until the age of 75.

The conversation only worsened when my mother declared, with obvious dismay and disappointment, "I guess you think I don't even need a doctor anymore."

I replied that yes, she does, but that she knows I worry that unnecessary contact with healthcare at her age can be detrimental to her health. Hospitals are sources of infections, tests such as colonoscopies come with risks. Even the prep for such a test is much harder on an octogenarian than it is on a younger person.

That did it. This conversation proved it: I really was a bad daughter.

I struggled again later to explain these concepts to my mother, and she was resistant and aloof. When it was her life we were discussing, she was either unwilling or unable to rationally analyze the statistics about longevity.

I've wondered since then where this leaves the debate on healthcare. As doctors struggle to be stewards with our resources, will we face these conversations over and over with our patients? If a mother doubts even her doctor-daughter's desire to give her the best care, how can we expect patients not to question our motivations?

Every day, physicians strive to do the right thing for our patients without doing more than is necessary, to prevent complications as well as conserve resources. Yet this issue is wrought with difficulties, as patients feel that any attempt to avoid high-tech tests or treatments is somehow taking something important from them — something that they deserve. There is always pressure to do more.

All of my patients, like my mother, deserve the best. It's just not always so easy deciding what the best is.

For doctors, patients and public policymakers to ever come to a consensus on healthcare, we need to educate ourselves on and agree upon the interventions that evidence and experience have proved to be beneficial — or we will be forever linked to a healthcare system that does too much for those who don't need it and not enough for those who do.

I hope that we find this balance, just as I hope that my mother will understand that I only want what is best for her.

Pamela M. Davis is a family physician and director of the family medicine residency program at Northridge Hospital Medical Center. She can be reached at pamela.davis@chw.edu.

Copyright 2011 Los Angeles Times

CHINA: China conducts law enforcement inspections to help the elderly

.
BEIJING / People's Daily / Politics / May 28, 2011

Chinese legislators are conducting inspections to ensure the interests and rights of the elderly are protected in accordance with the law.

Yan Junqi, vice chairwoman of the Standing Committee of the National People's Congress (NPC), concluded her three-day inspection tour of Anhui Province on Friday.

Yan's tour is one of the seven visits of Chinese legislators to inspect the law enforcement situation in Shanghai and the six provinces of Anhui, Fujian, Shandong, Yunnan, Shaanxi and Xinjiang from May to July.

"To learn about the law enforcement situation for protecting rights and interests of aged people is at the top of the NPC agenda this year," said a NPC statement on Friday.

Yan's Anhui tour focused on how the insurance scheme is being implemented, the medical care system, aid for those with financial difficulties, as well as home-based and institution-sponsored care service for the elderly.

Her tour was also aimed at urging authorities to improve social security for the eldery.

"The aging of the Chinese population is one of the serious challenges for China," she said.

The country, with 178 million people aged over 60 -- about 13.26 percent of its population, only has about 2.66 million beds in nursing home, enough for about 1.5 percent of the senior population.

The ratio compares with an average in developed countries of 7 percent and in developing countries of 2 percent to 3 percent, according to the Ministry of Civil Affairs.

Source: Xinhua

NEW ZEALAND: Older find it harder to tell truth from lies

.
WELLINGTON / The Dominion Post / News / May 28, 2011
By Tim Donoghue

Bernie Lynch interviewed Japanese servicemen after World War II, so he reckons he ought to be able to tell when people are telling porkies. But according to Otago University research, older people cannot lie as convincingly as younger folk and are worse at detecting lies.

Mr Lynch, 84, disagreed that older were poor liars. They were particularly likely to lie about their health problems, he said, sometimes downgrading them for social acceptability reasons.

"When you get to my age it is a risky business asking people how they are, because you don't want them to tell you. "People distort the truth for social fibbing reasons and sometimes do it very well."

TRUE FEELINGS: Bernie Lynch, 84, disagreed with a study's finding that older people are poor liars. He says they are likely to lie about their health problems, sometimes saying their health is better than it really is. Maarten Holl / The Dominion Post

But according to Otago University research, older people cannot lie as convincingly as younger folk and are worse at detecting lies.

Mr Lynch, 84, disagreed that older were poor liars. They were particularly likely to lie about their health problems, he said, sometimes downgrading them for social acceptability reasons.

"When you get to my age it is a risky business asking people how they are, because you don't want them to tell you.

"People distort the truth for social fibbing reasons and sometimes do it very well."

However, he agreed that older participants in the lie detection study were not as good as their younger counterparts at differentiating between lies and truths.

The study involved 60 participants being shown video clips of 20 people expressing their actual or false views on topical issues such as factory farming and stem cell use in humans.

Ten speakers were aged 30 or under and 10 were 60 or over. Two clips of each speaker were shown.

In one they were lying and in the other were being truthful.

The 60 listeners, who consisted of two equal-sized groups with average ages of 21 and 71, were asked to determine if the person in each clip was being truthful or lying. They also underwent tests that required judgments of emotional expression and age in faces.

Mr Lynch, an interpreter between the occupation forces and the Japanese at the end of the war, described the research findings as largely common sense.

The study also found:
* People who were lying often sent out detectable signals with some emotional content;
* The scores of older people in an emotion recognition test strongly predicted how well they would do in the lie detection test;
* Both young and older listeners found it easier to tell the difference between truths and lies when the speaker was an older adult, compared with a young adult.

 * The Dominion Post

© 2011 Fairfax New Zealand Limited