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'Managing' Elderly Patients Without Powerful Antipsychotics

By Randy Dotinga
HealthDay Reporter

MONDAY, July 25, 2016 (HealthDay News) -- About 25 percent of dementia patients in U.S. nursing homes are still quieted with risky antipsychotic medications. Now, a small study suggests that managing these difficult patients, instead of medicating them, could obtain better results.

"Drugs have a place, but should not be first-line treatments. They don't work well, and there are side effects," said study author Dr. Henry Brodaty, a professor of aging and mental health at the University of New South Wales in Sydney, Australia.

Antipsychotic drugs such as Risperdal (risperidone), Abilify (aripiprazole) and Seroquel (quetiapine) are approved to treat serious psychiatric conditions such as bipolar disorder and schizophrenia. But in seniors, they're often used to calm aggressive or violent behavior linked to dementia.

"They're basically a sedative," said Dean Hartley, director of science initiatives with the U.S.-based Alzheimer's Association. While he agreed that the drugs are warranted in some situations, he said dementia patients who take the powerful drugs are more susceptible to falls and have a higher risk of death.

The new study touts a program that trains nursing home staff members to focus on resolving specific issues bothering the patients and not to automatically sedate them.

It's not clear how much this kind of program would cost in the United States or whether nursing homes could adapt to a new way of doing things. But it's clear that the tranquilizers used on patients with dementia can be dangerous, said Hartley.

U.S. health officials have been trying to reduce the use of antipsychotics in long-term nursing homes. Since 2008, the U.S. Food and Drug Administration has required a boxed warning with all antipsychotic medications noting the increased risk of death in elderly patients with dementia-related psychosis.

The reported percentage of patients using the drugs dipped from 24 percent in late 2011 to 17 percent in 2015, according to background notes with the study.

Still, patients with dementia often need special management. According to Brodaty, 90 percent of people with dementia also experience agitation, depression, aggression, wandering, delusions and/or hallucinations.

His study included 156 patients at 24 nursing homes in Australia. All regularly took antipsychotic medications and were older than 60.

Nurses were trained how to handle difficult-to-manage behaviors without relying on drugs.

Of 135 patients taken off the antipsychotic drugs, 76 percent were still not using them 12 months later, the researchers said.

Hartley, the Alzheimer's Association scientist, said focusing on the needs of patients requires understanding the issues that burden them. For example, he said, they may suffer pain from urinary tract infections but are unable to tell their caregivers.

Hartley mentioned the case of a patient who kept wanting to leave a facility, saying that it was raining outside. When asked, she explained that her kids -- now grown -- needed to be picked up at the bus stop. "They said they'd pick them up for her," Hartley said, and the woman became calmer.

What about cost? This kind of program could actually reduce expenses, Hartley said, because patients would be less disruptive and need fewer emergency room visits due to injuries from falling.

Hartley cautioned that the study was small and needs to be validated. "It's an important study, but it's only the beginning," he said. Still, the approach "may help caregivers or families know that their family members are being treated in a humane way."

The study was scheduled for presentation Monday at the Alzheimer's Association International Conference in Toronto. Medical studies released at conferences should be considered preliminary until published in a peer-reviewed journal.

More information

For more about dementia, visit the Alzheimer's Association.

Women Smokers at Higher Risk for Brain Bleed

By Steven Reinberg
HealthDay Reporter

THURSDAY, July 21, 2016 (HealthDay News) -- Strokes characterized by bleeding inside the lining of the brain are more common among smokers, especially women, researchers report.

These serious strokes -- called subarachnoid hemorrhages -- are eight times more common among women who smoke more than a pack a day compared to nonsmokers, Finnish researchers found. They're three times more common among men who smoke the same amount.

Even light smoking tripled a woman's risk for this type of stroke, the study found.

"There is no safe level of smoking, and naturally, the best option is never to start," said lead researcher Dr. Joni Lindbohm of the University of Helsinki.

"The message for policymakers is that by implementing effective strategies against smoking, they can considerably reduce the burden of subarachnoid hemorrhage," said Lindbohm, who specializes in neurosurgery and public health.

Subarachnoid hemorrhages account for about 3 percent of all strokes, said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine.

These strokes often affect younger people and "can be quite devastating in terms of disability and death, with fatality rates around one in five," said Sacco, who wasn't involved in the study.

This type of stroke usually results from a bleeding aneurysm in the brain. An aneurysm is a small weak spot in a blood vessel that can burst at any time.

For the study, Lindbohm and colleagues collected data on nearly 66,000 adults listed in Finnish national surveys since 1972. Participants were followed for an average of 21 years, until they had a first stroke, died, or until the end of 2011.

The researchers found that among light smokers -- one to 10 cigarettes a day -- women were three times more likely to have subarachnoid hemorrhage, and men were twice as likely to have one compared to nonsmokers.

Among those who smoked 11 to 20 cigarettes a day, women were four times more likely and men two times more likely to suffer this type of stroke, the investigators found.

But those who quit smoking significantly reduced their odds of having a subarachnoid hemorrhage. After six months without smoking, their risk fell to the level of nonsmokers, the researchers reported.

Although subarachnoid hemorrhage is more common among women than men, the reasons why are unclear, Lindbohm and Sacco said. Lindbohm believes the elevated risk in women largely comes down to the harms of smoking.

The link between smoking and these strokes didn't come as a surprise, Sacco noted. "The association between cigarette smoking and subarachnoid hemorrhage has been known for years," he said.

"Although risks do rise with age, it is an important cause of stroke in the young," he added.

As with other strokes, some factors likely increase the risk of developing an aneurysm that eventually ruptures and causes a subarachnoid hemorrhage, he explained.

"Cigarette smoking and high blood pressure are two important modifiable risk factors for subarachnoid hemorrhage," Sacco said. "This study adds more evidence to the call to the public to never smoke, and control their blood pressure to avoid this type of stroke."

Lindbohm said that heavy-smoking females with unruptured aneurysms in their brain are a high-risk population, and their aneurysms should be treated.

The report was published online July 21 in the journal Stroke.

More information

For more on subarachnoid hemorrhage, visit the Brain Aneurysm Foundation.

Sleep Disorders 6 Times Higher Among Veterans

WEDNESDAY, July 20, 2016 (HealthDay News) -- Sleep disorders are six times more likely among American military veterans than in the general population, a new study finds.

And veterans with post-traumatic stress disorder (PTSD) seem to have the highest rates, the researchers said.

The research involved more than 9.7 million veterans treated by the Veterans Health Administration system between 2000 and 2010. The majority (93 percent) of these military service members were men. Slightly more than 750,000 were diagnosed with at least one sleep disorder, the study authors said.

Over the course of 11 years, the investigators found that the rate of sleep disorders rose from less than 1 percent to nearly 6 percent. Sleep disorders were most common among veterans who had experienced combat and those with PTSD.

"Veterans with PTSD had a very high sleep disorder prevalence of 16 percent, the highest among the various health conditions or other population characteristics that we examined," study senior author James Burch said in a news release from the American Academy of Sleep Medicine. Burch is an associate professor of epidemiology and biostatistics at the University of South Carolina.

The study doesn't prove that PTSD triggers sleep disorders, but the researchers noted that diagnosed cases of PTSD tripled over the course of the study.

Sleep apnea was the most commonly diagnosed sleep disorder among the study participants. Sleep apnea, which causes brief pauses in breathing during sleep, accounted for 47 percent of diagnosed sleep disorders, the researchers said.

Insomnia accounted for 26 percent of diagnosed sleep disorders, the findings showed.

Veterans with other chronic health issues -- including heart disease and cancer -- also had higher rates of sleep disorders than other study participants, according to the report.

The findings point to a need for improved management of sleep disorders among U.S. military veterans, the researchers concluded.

The study was published in the July issue of the journal Sleep.

More information

Find out more about sleep disorders from the National Sleep Foundation.

Obese Teens Take Weight-Loss Surgery in Stride

MONDAY, July 18, 2016 (HealthDay News) -- Severely obese teens who have weight-loss surgery may be able to walk faster and with less pain afterwards, new research suggests.

For the study, a team led by Justin Ryder, an assistant professor of pediatrics at the University of Minnesota Medical School, analyzed how weight-loss surgery affected obese teens' ability to walk up to two years after their procedure.

The study involved 242 significantly obese teens who were 19 years old or younger and had weight-loss surgery between 2007 and 2012 at five U.S. bariatric surgery centers.

Gastric bypass (where a portion of the stomach is rerouted) was performed on 161 of the teens. The rest had either gastrectomy (removal of part of the stomach) or LAGB (laparoscopic adjustable gastric band), a procedure in which a band is placed around a portion of the stomach to make it smaller.

The researchers timed the teens as they walked roughly a quarter-mile before their surgery. They repeated the walking test six months, one year and two years after their weight-loss procedure.

Before and after each test, the researchers measured the teens' heart rates. The young people reported how much pain they felt while walking.

Just six months after surgery, the teens were able to walk faster and with less pain. Before surgery, they did the walk in 6.3 minutes, on average. Six months later, their average time dropped to 5.8 minutes. Their pre-walk resting heart rate also improved over that period from an average of 84 beats per minute to 74 beats per minute. Their post-walk heart rate dropped from an average of 128 beats per minute to 113 beats per minute, according to the study.

These improvements were also seen at one year and two years after surgery, the study published online July 18 in JAMA Pediatrics showed.

The study did not include a comparison group of teens who didn't have weight-loss surgery. Researchers said more study is needed to determine if the benefits of weight-loss surgery continue long-term and lead to additional health improvements.

More information

The U.S. The National Institute of Diabetes and Digestive and Kidney Diseases has more on weight-loss surgery.

1 in 5 Americans Uses a Tobacco Product

THURSDAY, July 14, 2016 (HealthDay News) -- Despite decades of declines in smoking rates in the United States, one in five Americans still smokes or uses hookahs, e-cigarettes or other tobacco products, U.S. health officials reported Thursday.

Cigarettes remain the most popular, but the emergence of hookah and e-cigarette use, especially among younger adults, is cause for concern, the U.S. Centers for Disease Control and Prevention report said.

Findings from the 2013-2014 survey underscore the need "to educate the public about the potential harms of all tobacco product use, including risks associated with occasional use," CDC researcher Dr. Sean Hu and colleagues wrote.

Noting that e-cigarettes were used most often by 18- to 24-year-olds, the study authors suggested advertising and misleading marketing claims are to blame.

Patricia Folan, director of the Center for Tobacco Control at Northwell Health in Great Neck, N.Y., agreed.

"There is a misperception, fostered by e-cigarette and hookah pipe industry advertising, that these products are not harmful," Folan said. "These products contain nicotine and other hazardous chemicals."

Because they're perceived as a healthier alternative to smoking, Folan said e-cigarettes and hookahs have the potential to dissuade smokers from quitting.

For the report, researchers from the CDC and the U.S. Food and Drug Administration analyzed data from the 2013-2014 National Adult Tobacco Survey.

More than 49 million Americans (21 percent) reported using a tobacco product every day or some days. And more than one-quarter said they used a tobacco product daily, some days, or rarely, the researchers found.

Cigarettes were smoked by 17 percent of Americans; cigars and pipes by about 2 percent. More than 3 percent reported e-cigarette use, while almost 1 percent had tried hookahs (water pipes). And close to 6 million adults reported using smokeless tobacco, the findings showed.

Among the other findings:

  • Males and adults up to age 44 were most likely to use a tobacco product.

  • Midwesterners and southerners were more likely to use tobacco products than residents of other regions. So were people with less education; singles, including divorced and widowed individuals; poor people; and lesbians, gays and bisexuals.

  • Asians and Hispanics were less likely than whites or blacks to use tobacco products.

Progress has been made over the past five decades to curb smoking, but more work is needed, the researchers said.

What will help?

"A combination of comprehensive smoke-free laws, high-impact media campaigns, tobacco price increases, and easy access to quitting assistance," the study authors suggested.

Such strategies could help reduce tobacco-related disease, which causes smokers to die 10 years earlier than nonsmokers, the CDC said. Cigarettes alone lead to more than 480,000 deaths a year in the United States, including nearly 42,000 deaths from secondhand smoke exposure.

The FDA, which recently gained authority over all tobacco products, intends to ban sales of e-cigarettes and all other tobacco products to minors starting next month.

Hoping to prevent another surge of nicotine addiction, the agency will also require manufacturers to report ingredients and submit new or altered products for approval before bringing them to market.

Folan applauded the new rules.

Hopefully, with the FDA now having the authority to regulate these products, information about ingredients and manufacturing processes will be available to consumers," she said.

The findings were published in the July 15 issue of the CDC's Morbidity and Mortality Weekly Report.

More information

The U.S. Department of Health and Human Services tells how smoking hurts your health.

How to Spot the Warning Signs of Heat Stroke

WEDNESDAY, July 13, 2016 (HealthDay News) -- As people age, they are at added risk for heat stroke and other heat-related illnesses, according to the U.S. National Institute on Aging (NIA).

This is particularly true for those with chronic health issues, the agency cautions.

Heat fatigue, heat-related dizziness, heat cramps, heat exhaustion and heat stroke are all forms of hyperthermia. The condition occurs when the body is overwhelmed by heat and is unable to control its temperature, the NIA explains.

Those who lack access to air conditioning or transportation, who can't move around, wear too much clothing or visit crowded places may be more vulnerable, the agency notes.

Other factors that increase hyperthermia risk include:

  • Dehydration,

  • Poor blood circulation,

  • Less sweat production due to aging,

  • Use of multiple medications,

  • High blood pressure or other health conditions that require a reduced-salt diet,

  • Heart, lung and kidney diseases, or other conditions that cause general weakness or fever,

  • Being very overweight or underweight,

  • Drinking alcohol.

When temperatures, air pollution and humidity spike, older people with chronic health issues like heart disease and diabetes should stay indoors, the NIA advises. Those who don't have air conditioning should go to a mall, senior center, library or other cool location.

Heat-related illnesses require immediate medical attention. The NIA says it's essential to recognize the warning signs, including:

  • Fever (generally above 104 degrees Fahrenheit),

  • Confusion or combativeness,

  • Strong, rapid pulse,

  • Dry, flushed skin,

  • Lack of sweating,

  • Feeling faint,

  • Staggering,

  • Coma.

Anyone who may be suffering from a heat-related illness should be taken to a shady or air-conditioned spot and told to lie down. A cold, wet cloth should be applied to the wrists, neck, armpits and groin to help cool the blood. If the person can swallow, he or she should be given nonalcoholic fluids, like water or apple juice, according to the NIA.

More information

The U.S. Centers for Disease Control and Prevention provides more information on older people and heat-related illness.

Headed to the Pool? Protect Yourself From the Poop

SATURDAY, July 9, 2016 (HealthDay News) -- Swimming is a great way to cool off on a hot day, but beware of fecal contamination that can make you sick, an expert says.

"The most common problems people get while swimming are intestinal infections, either bacterial or viral," said Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University Medical Center, in Nashville.

Symptoms include diarrhea, nausea, vomiting and sometimes fever. These symptoms occur several hours after infection, so people often don't realize they were infected while swimming.

There are a number of ways to reduce the risk of such infections.

Check the pool before you or your children get in. "Does it have clear and clean water? If not, you should reconsider getting in," Schaffner said in a medical center news release.

Before going into a pool, always take a shower. Anyone who has had stomach problems in the previous 24 hours should stay out of the pool.

Parents should check every 30 to 60 minutes that their toddlers haven't soiled their diapers (even plastic swim diapers) or their swimsuits. Change diapers away from poolside and wash your hands afterward.

If a child has an accident in a public pool, alert staffers so they can take steps to clean the water and make it safe again, Schaffner said.

Urine in the pool is not a major concern, he said, because it is sterile, dilutes quickly and poses little health risk to other swimmers.

"None of this should dampen anyone's enthusiasm for the pool. With a few simple precautions, playing in the water can be safe and fun for everybody," Schaffner concluded.

More information

The U.S. Centers for Disease Control and Prevention has more on swimming hygiene.

Many Men Ignore Testicular Cancer Symptoms for Months

TUESDAY, July 5, 2016 (HealthDay News) -- Early detection and treatment of testicular cancer is key to beating the disease, a urology specialist says.

Yet many men who feel something abnormal in a testicle wait a few months before seeing a doctor.

But, when diagnosed while still confined to the testicle, the five-year survival rate for testicular cancer is 99 percent, Dr. Jay Raman, chief of urology at Penn State Medical Center said in a university news release.

"I think part of it is the macho man complex -- that everything is fine. Then you add on top of that the fact that it is a sensitive area, and they may have some embarrassment about it," Raman said.

Men who know about testicular cancer may also be concerned that surgical removal of the testicle is the best way to cure the disease.

"So they wait to see if it gets better on its own. But sometimes they wait and wait, until they've waited too long," Raman said.

About 9,000 new cases of testicular cancer are diagnosed each year in the United States, according to Raman. Risk factors include being white and having a testicle that didn't descend when younger. Since these risk factors are not preventable, the best thing to do is be aware of the risk and know the symptoms of cancer.

All men should do a testicular self-exam at least every six months, Raman advised.

"What you are feeling for is that both testicles have the same contours -- relatively smooth and soft, kind of the consistency of a hard-boiled egg or the palm of your hand," he said. "If you notice anything firm, or lumps or bumps -- something that is different on one side than the other -- you should seek medical attention right away."

Surgery to remove the testicle is the most common treatment. If the cancer is confined to the testicle, exams and blood work may be the only follow-up patients require. If the cancer has spread beyond the testicle, chemotherapy and radiation may be necessary, he explained.

"The most important thing to know is that cure rates are directly tied to how early you find it," Raman said.

More information

The U.S. National Cancer Institute has more on testicular cancer.

U.S. Cancer Survivors Living Longer

By Steven Reinberg
HealthDay Reporter

FRIDAY, July 1, 2016 (HealthDay News) -- As the American population ages, more older adults will survive cancer and live with other chronic conditions that will burden the health care system, U.S. government health officials report.

"Increasingly, we are seeing the impact of an aging population -- fueled by maturing baby boomers -- on major diseases, including cancer," said lead researcher Shirley Bluethmann, a cancer prevention fellow at the U.S. National Cancer Institute.

In 2016, nearly 62 percent of almost 16 million cancer survivors are aged 65 or older, the researchers said. By 2040, an estimated 73 percent of 26 million cancer survivors will be 65 or older.

"This steady and dramatic growth will affect the health care system, and so is sometimes referred to as the 'silver tsunami,' " Bluethmann said. "It not only has implications for older people who are at higher risk for cancer, it also means that we will have higher numbers of older patients with complex health needs."

In the face of this challenge, health care providers will have to build collaborative care teams -- including doctors, nurses and other caregivers -- to be able to respond to the needs of this vulnerable population, Bluethmann noted.

"We also need to emphasize the benefits of lifestyle for cancer prevention and control across the life course," she added.

"Lifestyle choices, including doing regular exercise and maintaining a healthy weight, may prevent some kinds of cancer, but also offer many benefits in preserving function, reducing symptoms and promoting a high quality of life into old age," Bluethmann said.

For the study, Bluethmann and her colleagues used federal health data from 1975 to 2012. With Census data, they projected the incidence of cancer from 2016 to 2040. In addition, the researchers used Medicare claims to estimate the impact of other chronic conditions such as heart disease, lung disease and diabetes.

They found that by 2040, cancer survivors aged 65 to 74 will make up 24 percent of all survivors, those aged 75 to 84 will make up 31 percent of all survivors, and those aged 85 and older will represent 18 percent.

Currently, the prevalence of cancer is about the same for men and women. In older age groups, however, cancer is more common among men.

Among those aged 65 to 69, 14 percent of men and 12 percent of women have been diagnosed with cancer. The gap increases with age. In the oldest group, 90 and up, 37 percent of men and 25 percent of women have been diagnosed with cancer, the study found.

This gap is most likely due to more prostate cancer survivors, which is usually diagnosed at older ages, Bluethmann said.

In addition, aging increases the chances that cancer survivors will suffer from one or more chronic medical conditions. Among cancer survivors aged 65 to 69, 27 percent had a history of other medical problems. Among survivors aged 85 and older, 47 percent had other chronic conditions, the researchers found.

The findings were published in the July 1 issue of the journal Cancer Epidemiology, Biomarkers and Prevention.

One public health expert sees the explosion in the numbers of cancer survivors, especially those with other medical problems, as concerning.

"There aren't many older adults in clinical trials, so we have a limited amount of knowledge about how to optimize treatment," said Kim Miller, an epidemiologist at the American Cancer Society.

"In addition, the number of oncologists is dwindling, which means there will be fewer doctors to treat the growing population of cancer survivors," Miller said.

Also, other medical problems such as heart disease, lung disease and diabetes make caring for these cancer patients more difficult, she said.

"It's going to put a financial strain on the health care system, especially because most of these older cancer survivors are receiving Medicare," Miller said.

More information

Visit the U.S. National Cancer Institute for more on cancer.

Homing In on the Genetics of Migraine

SUNDAY, June 26, 2016 (HealthDay News) -- An international team of scientists has identified dozens of new genetic variants associated with migraine headaches.

The researchers say their findings could lead to new treatments.

Most of the variants are in or close to genes involved in circulatory system regulation. This supports the theory that abnormal blood vessel function in the brain is an important factor in migraines, the investigators said.

"These genetic findings are the first concrete step towards developing personalized, evidence-based treatments for this very complex disease. We doctors have known for a long time that migraine patients differ from each other and the drugs that work for some patients are completely inefficient for others," said John-Anker Zwart, of Oslo University Hospital in Norway, who participated in the research.

"In the future, we hope that this information can be utilized in dividing the patients into different genetic susceptibility groups for clinical drug trials, thus increasing the chances of identifying the best possible treatment for each subgroup," he added in a news release from the University of Helsinki in Finland.

Migraine affects about 1 in 7 people worldwide.

The findings stem from analysis of DNA samples taken from 375,000 Europeans, Americans and Australians. Nearly 60,000 were migraine sufferers.

The team pinpointed nearly 30 new genetic variants linked with migraine. The variants are in 38 genomic regions, only 10 of which have previously been associated with migraine risk.

"Our consortium is devoted to uncovering the genetic causes of migraine and during the past few years we have been able to identify many risk variants," said Dr. Aarno Palotie, leader of the International Headache Genetics Consortium, which coordinated the study.

"Yet, in this latest, large-scale study, tens of new genetic risk factors were discovered," added Palotie, from the Psychiatric and Neurodevelopmental Genetics Unit Center for Human Genetic Research
at Massachusetts General Hospital in Boston.

"Because all of these variants modify the disease risk only slightly, the effect could only be seen when this large amount of samples became available," he noted.

The study was published online June 20 in the journal Nature Genetics.

More information

The U.S. National Institute on Neurological Disorders and Stroke has more on migraine.