Have You Heard of the Wellderly Study?

My father-in-law is a pretty amazing guy.

He celebrated his 95th birthday recently and I’m pleased to say that he’s in pretty good health – and always has been.

Imagine...a nonagenarian who has never been in the hospital.

Dad was a mail carrier for four decades and worked until he was 70. The most serious problem he’s ever had is a couple of bouts with kidney stones. He also had cataract surgery and is testing out new hearing aids, but that’s it. He reads nearly a book a day and has put together more than a dozen 1,000-piece jigsaw puzzles within the last few months. He regularly joins four other men – including two retired priests – in a meeting room at his senior complex for debate sessions about everything from religious philosophy to politics.

Dad has outlived two wives and several girlfriends and enjoys a bowl of ice cream almost every night before he goes to bed.

I’d like to bottle his DNA – and so would researchers at Scripps Genomic Medicine in San Diego.
They are testing the DNA of disease-free people who are 80 years and older, hoping to discover the genetic secrets to a long and healthy life. Cleverly called the Wellderly Study, it hopes to find at least 1,000 volunteers of all ethnic backgrounds to join. (The study has slightly more than 700 participants at this writing).

Researchers don’t ask much of participants – an interview and a blood sample if the volunteer lives in the San Diego area. For out-of-towners: a saliva sample (in a pre-paid mailer) and a phone interview. There are no costs involved to volunteers, and no one except the researchers will have access to the information provided.

Participants won’t be able to see their individual results because of privacy issues and the cost and time involved, but when researchers come up with general findings, all volunteers will be updated and receive information about the published results.

To see frequently asked questions about the Wellderly Study, visit http://www.scripps.org/services__genomics__wellderly-study__faqs#How_do_I

Maybe you know someone like my father-in-law who has completed at least eight decades and has managed by good luck or good health habits to stay well. If he or she is interested in donating a little DNA to a good cause, have them call 800-727-4777 or email wellderly@scrippshealth.org. Also can visit http://www.scripps.org/services__genomics__wellderly-study__participant-criteria to see the criteria for participation.

We Can't Afford Everything for Everybody

The debate in Congress over health care insurance is making me crazy – and nervous.

Listening to the blow-by-blow daily reports is like reading a suspense novel or watching a serial mystery. How is it all going to turn out? Who’s going to win and who’s going to lose? Which proposals are going to live and which will die? And when it’s all over, are we going to understand what happened and what we have created?

Some days I just wish it would all go away, so I can’t imagine how the legislators working on the grand plan must feel. But I know it can’t go away because we’ve got to come up with a solution to the lack of health insurance for 47 million people and how to pay for it all. One thing is for sure: The trajectory of increasing costs is unsustainable.

Perhaps at the heart of the issue is whether you believe that health care is a right or a privilege.

I’ve come to believe it’s a right from the time you come into the world.

It’s also citizens’ responsibilities to contribute to the cost of insurance based on their ability to pay, to stay as healthy as possible, and to decide how best to use our limited public resources, because – well, they are limited, and as of now, our spending is out of whack.

According to the Centers for Medicare and Medicaid, Medicare spends almost six times as much on patients in their last year of life as it spends for those not in the last year of life. Out-of-pocket spending for those with less than a year to live is three-and-a-half times as much as it is for non-terminal patients, and private health insurance spends three times as much. The spending actually peaks in the last month of life when we spend 20 times as much money on terminally ill patients than we do for those who are not terminally ill.

I found this shocking and sad, and reflective, I suppose, of our attitudes about death. It also speaks to the misconceptions about end-of-life treatment that some people have. This was brought to my attention today in a conversation I had with a family member about the morality of pulling out all the stops to provide medical care for someone who has no chance for recovery.

He was under the mistaken impression that there were only two choices for the terminally ill: to treat or not to treat. I had to explain that deciding to discontinue expensive treatment doesn’t mean abandoning patients and spending nothing; it means providing quality palliative care – doing all that we can to make people's last days the best they can be.

Nurses in and out of the palliative care field can do a lot of educating about this option.

The awareness of palliative care has been growing, but with 76,000 aging baby boomers coming down the pike, the need for this education and awareness is greater than ever. We can’t pay for everything for everybody, but this doesn’t mean that anyone has to suffer. We also need to raise the collective consciousness about the morality of spending millions of dollars for care that will have little or no benefit.

Do As I Say But Don't Ask Me Why

Apparently a lot of nurses and physicians like their vitamins, minerals and other supplements as much as anyone, and they often recommend that their patients take them, too.

This according to a report in the Nutrition Journal, an online publication of BioMed Central.

Nine hundred doctors and 277 nurses were polled in 2007 about their use of dietary supplements, but the survey also found that most of the nurses and doctors had no formal education or training on the topic. Essentially, many are just flying by the seat of their pants when it comes to knowledge about dietary supplements.

Here’s what else the survey found:
• About nine out of 10 nurses and three out of four doctors say they use some sort of dietary supplement regularly, occasionally or seasonally.
• About 80 percent of the nurses and physicians recommend dietary supplements to their patients.
• About one in four nurses and doctors say they take only multivitamins.
• About one in three nurses and one in four doctors say they take other supplements such as green tea, fish oil, glucosamine, flax seed, chondroitin, and echinacea.

It should be noted that this online survey was conducted for the Council for Responsible Nutrition, a Washington, D.C.-based “trade association” (read lobbyist) that represents the dietary supplement industry. I suspect the reason it chose to do the survey is because the association knew it would produce favorable results. If the results had not been favorable for the industry, you wouldn’t be reading about it now.

I’m also wondering if the results might have something to do with the age of the participants.

About 70 percent to 75 percent of the nurses and doctors were 40 years or older -- about the time in life when we start thinking about our mortality and hence nutrition. The demongraphics also means that many of the women are in that window of menopause and must be concerned about osteoporosis.

I think it’s probably a good idea for most people to take a multivitamin. Even if you “eat healthy,” it’s difficult to get all the needed vitamins and minerals. And women must be concerned about their calcium, vitamin D and magnesium intake. But beyond that, unless there is specific pathology that demands supplements, we really don’t need much except multivitamins and minerals needed to maintain strong bones.

Buying basketsful of supplements is for the worried well, and I tend to agree with the nutritionist who once said that Americans have the healthiest urine on the planet.

I also hope that the vitamin and supplement industry does not use the results of this survey to further their quest for less regulation in the hopes that Americans continue to spend needlessly for supplements that don’t really do much.

Be Good to Nurses and They'll Stick With You

Even before the recent economic hard times hit, many hospitals and other places that employ nurses were cutting back on paying for continuing education, according to the recently released 2008 Critical Care Nurses’ Work Environments study.

The survey of nearly 5,600 critical care nurses found that the number of employers who provided no monetary assistance for continuing education rose from 16 percent in 2006 to nearly 24 percent in 2008.

This despite the fact that the work environment is cited as one of the main considerations for nurses sizing up prospective employers, according to the survey.

Support for continuing education and certification also is correlated with the degree of job satisfaction, as well as recognition for earning certification. Sadly, nurses reported that this recognition declined from 45 percent in 2006 to 43 percent in 2008. (A “baseline” study was done in 2006 to measure whether the AACN’s standards for a healthy work environment were being met. This 2008 study, conducted by the AACN, Gannett Healthcare Group and Bernard Hodes Group recruiters, was done to compare results of the two surveys.)

I’m not sure whether “recognition” of certification means a pat on the back or a raise in pay or both, but from years of listening to nurses and other hospital workers, I’ve come to believe that there are many things employers can do that cost little or no money that keep employees happy and retention rates high.

To start, nurses want to be treated with respect, be asked to problem-solve and be considered as important members of a collaborative team. When this happens, job satisfaction ranks high.

Nurses also want to be trusted and treated like grownups. They don’t want to be micromanaged, and when they are, job satisfaction is low. Micromanagement shows a lack of trust and confidence, a nurse-friend of mine told me, and it wastes managers’ time and talents. This friend complained of a boss who spent most of her time rearranging the supply shelves when she should be asking how to help the floor nurses and what they need to do their job more efficiently and thoroughly.

Which brings me to another thing on many nurses’ wish lists: When changes are considered, and it affects nurses, they want input.

Hospitals should be designed first to accommodate patients’ and families’ needs, and secondly, to meet the needs of the caregivers, whether they be family or bedside nurses.

The board of my local community (public) hospital just voted to spend $2.4 million for advertising, marketing and public relations this coming fiscal year. That money would surely hire a few more nurses who would go a long way in promoting the hospital’s good name. A community judges a hospital by what it hears about the nurses at the bedside care and the care they give, not by some slick marketing campaign.

What do you consider the most important perks of your job?

Do you get the type of perks you think you should?

Has your employer cut back on perks?

Tell us about it.

Is the Media Giving a True Picture of Alzheimer's Disease?

I am frustrated by what I read about Alzheimer’s disease in newspapers and magazines.

If you believe the information in the articles, you’d think we could prevent dementia by eating broccoli, staying fit, taking a few vitamins and working crossword puzzles.

One recent Associated Press article that sits on my desk cites a British study that suggests that working a few years past the standard retirement age might stave off Alzheimer’s disease. Each extra year of work was associated with a six-week delay of onset. But could it be that a person works longer because they don’t develop dementia – not the other way around?

Another recent story from the New York Times News Service tells about a long-term study by the University of Southern California. It has followed 14,000 seniors 65 and older and 1,000 seniors 90 and older, checking health status and mental acuity since 1981. The researchers hypothesize that people who spend a minimum of three hours a day engaged in mental activity such as playing bridge may be at reduced risk for developing dementia.

The story also notes, though, that these researchers are aware of the problem of deciphering cause and effect: Are the mentally sharp that way because they are active, or are these seniors active because they are mentally sharp?

Side note: Only one in 600 people makes it to age 90, and of those, 40 percent of the men and 60 percent of the women “qualify” for a diagnosis of dementia.

Another study out of Albert Einstein College of Medicine in Bronx, New York, followed a group of older people for five years and found a significantly lower risk of dementia in those that frequently enjoyed leisure activities that required mental activity, like reading books, playing cards or writing for pleasure.

I just don’t buy any of this and I don’t encourage those who ask about preventing dementia to buy into it either. I don’t know why some people develop dementia and others don't, but I’ll bet it has something to do with genetics.

Sadly, I know too many brilliant people who were physically fit and active in their communities that developed dementia anyway and at a way-too-young age. I knew a physician who was a marathon runner and respected cardiologist who was forced to give up his practice when he began having trouble reading his patients’ charts. He was in his mid-50s.

I know a top OR nurse and avid walker who quit work in her early 60x when she could no longer figure out a tray of instruments.

And I recently met a university professor of physics who also was a runner who developed dementia in his mid-80s.

About the best we can do at this point is provide drugs that temporarily slow the worsening of symptoms for six to 12 months -- and for only about half of those who take the drugs.

What I tell people is that, at this point in time, we don’t know how to prevent or delay the onset of Alzheimer’s disease. But for those who don’t develop dementia, there are plenty of things we can and should do to keep our minds and bodies in tip-top shape.