Are you or a family member receiving dialysis? ProPublica has done a series of articles in the past month spotlighting the lack of proper oversight of dialysis clinics (Led by California, Inspection Backlogs Weaken Dialysis Oversight) that you should read. They report that in California alone, for example, regulators responsible for ensuring that dialysis facilities meet health and safety standards have not conducted full inspections of at least half of the state's 500 dialysis centers for five years or more.

ProPublica has also posted a database that will let you check the trackrecord of your dialysis clinic and those in your area. ProPublica used the Freedom of Information Act to obtain reports to Medicare by dialysis clinics across the country, going back to 2002. This is data and information that the public should have but which the government has not shared with us. ProPublica analyzed the data and the result is a web database that allows consumers to search for a dialysis clinic by name or location. Using the database, you can see how a dialysis clinic is rated and compares on 15 key quality of service measures, ranging from mortality rate, complications, and hospitalization to transplant rates and infection control. The database will help you make informed choices about where to receive dialysis.

Studies show that when this type of data is made publicly available, in report card type form, the mere fact of getting the data out in the open motivates the health care providers who are reviewed to improve their care, because they don't want to lose out on business that might go to better rated competitors.

I looked at the data for dialysis clinics in Oakland, for example, and there's a big difference in mortality rates among different clinics. Medicare will pay for you to have dialysis at any licensed clinic, so use the data base to make an informed choice about where to go.

The url for the ProPublica database is: http://projects.propublica.org/dialysis ... 2&w=10

To go the the dialysis website, click here.

To read about the faulty federal oversight of dialysis clinics, click here

Felicia Curran
www.ElderAdvocacyBlog.com
www.ElderAdvocacyLaw.com

If a senior in your family is taking narcotic pain medications such as OxyContin, Roxicodone, Oxycodone, Narco, or Vicodin, chances are your doctor thought it was the safest alternative compared to either TYLENOL (which can causes liver damage), or NSAIDs such as Ibuprofen, Advil or Aleve. Because "NSAIDs" (nonsteroidal anti-inflammatory drugs) have been reported to cause bleeding ulcers, stroke, and other cardiovascular problems, doctors often recommend narcotic pain killers instead of NSAIDs. So it may be a shock to find out that narcotic pain medicines have more deadly effects than NSAIDs, as reported by the New York Times, in “Narcotic Painkillers May Pose Danger to Elderly Patients, Study Says.” The Brigham and Womens Hospital study compared elderly patients taking narcotics, NSAIDs, and cox-2 inhibitors during 1999 to 2005. It found that, “patients in the narcotic group were four times more likely to experience a compound bone fracture, apparently as a result of a fall, and they were twice as likely to have a heart attack, [compared to patients taking NSAIDs such as Motrin]. The cardiovascular risks posed by narcotics were the same as for drugs like Celebrex and Vioxx, which have come under scrutiny for that hazard. ...The review also found that the rate of gastrointestinal bleeding among patients taking narcotics was about the same as those taking drugs like Advil and Aleve. A principal reason that medical experts have advocated narcotics in older patients is the belief that they reduce such problems.”

Because of the sedative effect that narcotics have, it makes perfect sense that they would increase the risk of falls in the elderly, but it is a shock to read that they make a person 4 times more likely to break a bone due to a fall. The finding that such drugs can double the death rate due to heart attack is also very surprising and disturbing.

But perhaps the most disturbing aspect of this study is that we are not learning about deadly effects of these drugs from the Food and Drug Administration (the governmental agency who is supposed to regulate these drugs and warn us about the dangers) or from the companies that make and sell us these drugs. Why is that these drugs have been on the markets for years but this is the first time these kind of deadly effects on the elderly are being made known? Have the drug companies known about the risks for the elderly and not told us? They certainly make enough money from selling these drugs to be able to do this kind of study. What kind of follow-up is the FDA going to do on this issue? Are they going to require the drug manufacturers to warn doctors and patients about these risks? If not, why not?

The conclusion of the study appears to be that if you're a senior on OxyContin, Roxicodone, Oxycodone, Vicodin, or other narcotics, you should talk to your doctor about getting off of them, and switching to NSAIDs instead. Bring a print out of the New York Times article or the Archives of Internal Medicine abstract to the doctor’s appointment.

To read the New York Times article, click here.

To read the abstract from the Archives of Internal Medicine, click here.

To contact the FDA, call 1-888-INFO-FDA 1-888-463-6332

Felicia Curran, Esq.
www.ElderAdvocacyBlog.com
www.ElderAdvocacyLaw.com

Based on new biomarker tests that allow the diagnosis of Alzheimer’s disease some ten years before symptoms begin to appear, the National Institute of Health (NIH) is proposing to change the diagnostic criteria of Alzheimer’s disease, to permit diagnosis of the disease before a patient has started to exhibit the telltale signs of memory loss that are the hallmark of the disease. Scientists believe that the brain of patients who will go on to develop Alzheimer’s disease start to exhibit detectable changes in the brain (such as plaque or amyloid) some 10 years before the patient exhibits symptoms such as memory loss and confusion. Recent scientific advances, such as a PET scan of the brain developed by Dr. Daniel Skovronsky M.D. (recently reported on in The New York Times) allow scientists to detect these changes in the brain that are the precursors of Alzheimer’s disease. The NIH is proposing that doctors be able to diagnosis Alzheimer’s disease when these biomarker tests show the brain changes associated with Alzheimer, even if the person has not yet exhibited clinical symptoms. Within the next few years, it is expected that these tests will be available to the general public.

That means that you or your family members will be able to be tested before you have become impaired. Right now, the prospect of being tested when there is no cure seems like a scary one. But doctor’s ability to diagnose Alzheimer’s disease before a patient has started to exhibit memory loss carries with it the promise of being able to treat the disease and prevent it from progressing to the stage where memory loss is present. Scientists are optimistic for the first time that treatment will be available in the coming years to diagnose and treat Alzheimer’s disease before impairment sets in.

What the NIH is doing is important, to assure that patients receive early treatment for the disease. Insurance companies are not big on paying for preventive treatment, and by labeling certain persons as having Alzheimer’s, before memory loss appears, it will be easier for such persons to qualify for insurance coverage for whatever pre-memory loss treatment that becomes available.

To read the New York Times article (Promise Seen For Detection of Alzheimer's) about Dr. Skovronsky’s test for Alzheimer’s disease, click here.

To read the Times article ("Rules Seek to Expand Diagnosis of Alzheimer's) about the proposed change in diagnostic criteria for Alzheimer’s disease, click here.

Felicia Curran
www.ElderAdvocacyLaw.com
www.ElderAdvocacyBlog.com

If you have an elderly parent or grandparent you should take time now to familiarize yourself with the causes of aspiration and its signs and symptoms. When a patient aspirates, food, drink or even saliva that should be channeled from the mouth into the stomach instead gets channeled into the lungs, causing a pneumonia in the lungs. Aspiration is usually, but not always, a life threatening situation, compromising the person’s ability to breathe on their own.

When my Dad landed in the hospital in 2002, after having a fall at home and breaking his hip, I had heard of aspiration, but that was the furthest thing from my mind. After all, how could a broken bone lead to aspiration? My Dad was aging amazingly well – he was mentally and physically intact, sharp as a tact, with normal blood pressure and no health troubles other than a bad back. My main concern was that the hip surgery go well, which it did. Without a hitch in fact.

The night before he was to be discharged from the hospital, I visited him at night after work. We were looking forward to the next day, when he would be discharged to a rehab center for physical therapy, and after that, to go home. He had already eaten dinner when I arrived at 8 pm. He had told me that earlier that day he had become confused and thought that the furniture was flying around the hospital room, and realized that it must be the pain medication. I noticed that he was wheezing off and on -- something he had never done before. Dad said that the wheezing had started just before I arrived. I asked the nurse what that meant, and she said that he “might just have a little congestion.” I asked her to ask the doctor about it and get back to me. Other than the intermittent wheezing, Dad seemed fine, so I left at 11 pm without having heard back from the doctor.

The hospital called me at 2 a.m. and said that my Dad was transferred to the ICU. I rushed to the hospital and was told that he had aspiration pneumonia -– most likely caused by aspirating his dinner the night before. That’s what that wheezing meant. When I spoke to Dad’s doctor, he said that most likely the pain medication Dad was on for the hip fracture (the Oxycontin and Vicodin) interfered with his swallow mechanism, causing the food Dad ate at dinner to go down his windpipe instead of into his stomach.

My Dad never regained consciousness, and within 48 hours he was dead from complications of the aspiration.

There are many other unlikely causes of aspiration. For example, patients who became malnourished are at risk of aspirating. Safe swallowing depends on working swallowing muscles, and drastic weight loss diminishes the swallowing muscles’ ability to function properly. A malnourished elderly patient can be at risk for aspirating simply because their swallow muscle has atrophied due to malnutrition. Because malnutrition is so prevalent in nursing home residents (for many reasons, most of which are preventable), that's one reason why nursing home residents are vulnerable to aspirating in a nursing home.

The New York Times New Old Age Blog has just posted an article on swallowing disorders, When The Meal Won't Go Down. It is an excellent introduction to swallowing issues in the elderly and will refer you to other resources on the web, such as the American Speech-Language-Hearing Association website.

Felicia Curran
www.ElderAdvocacyLaw.com

After Keith Olbermann’s (CountDown With Keith Olbermann, on MSNBC) Dad went in the hospital, Keith and his family dealt up close and personal with end of life issues. Keith is passionate about everything he cares about, and that applies to the issue of living wills a.k.a. advanced directives, legal documents which state your wishes regarding end of life care issues and which control the type and level of care you receive.

Family members who are forced to make such decisions for their loved ones in the crisis of the moment, after their loved one is in the hospital, often feel terribly conflicted –-Are they putting their loved one through unnecessary pain and suffering at the end of life, with no real chance of meaningful recovery, or Are they giving up too easily, when their loved one might be able to pull through and return to a good quality of life? Once your loved one lands in the hospital, they may not be able to tell you their wishes. By having the discussion in advance of hospitalization, you will give yourself some peace of mind that you know your loved one’s wishes, and you will be confident of making the decisions they would want for themselves.

Click on the youtube link below to hear Keith’s impassioned pitch for discussing end of life issues with your family and formulating a living will expressing your wishes.



Although most states including California recognize living wills or advanced directives, the requirements vary from state to state. To see what the options are in your state, check out this article from Findlaw:

http://estate.findlaw.com/estate-planni ... wills.html

Felicia Curran
www.ElderAdvocacyLaw.com