Dental Hygiene Related to Heart Disease

New Evidence

You may not be a dentist, but get those patients to brush their teeth! People who brush their teeth less than twice a day run a higher risk of heart disease. These are the findings of a recent study published in the British Medical Journal.*

This is the first study of its kind and confirms the established fact that inflammation in the body (including mouth and gums) plays a significant role in the formation of atherosclerosis. Researchers analyzed health data from 11,000+ adults. After adjustment for established risk factors, the study found those with poor oral hygiene also had increased levels of C-reactive protein and fibrinogen. 

Personal Care Services at Pathways 

Pathways Private Duty provides care to assist older adults and the chronically ill in their activities of daily living, as well as with meal preparation, exercises and medication reminders.  Our caregivers can also help with personal care such as bathing, grooming, and oral hygiene.  

When it's time for care in your home, Pathways is here to help.  Give us a call today at 1.888.600.2273 to arrange for an evaluation and assessment of your needs.

*Published online May 27, 2010 in BMJ; corresponding author is Prof Richard Watt (University College London, UK.)

Vitamin D May Reduce Falls in the Elderly in SNFs

Dietary Supplements

Recent studies indicate that adding Vitamin D supplements to the diets of nursing home residents may reduce the frequency of falls, a leading cause of death and disability in the elderly.

Vitamin D deficiency is associated with muscle weakness, which can contribute to falls and fractures. Nursing home residents are especially vulnerable to falling due to advanced age, health problems, and weakened eyesight. In fact, approximately 50% of nursing home residents fall every year, and those who are injured become even more prone to future falls.

Although exercise, appropriate equipment, adequate staffing and a risk-free environment are important, research done at the Sydney Medical School at the University of Sydney in Ryde, Australia found that Vitamin D was a effective measure, although they are not sure why. 

Fall Prevention Resources, Available Online

In an effort to increase awareness about fall prevention hazards the Fall Improvement Taskforce (FIT) at Pathways created colorful flyers that can be printed and used as check-off lists to ensure your environment remains safe and to minimize the risk of falls.

Topics include: “Did you know that clothing can contribute to falls?”; “Medications can increase the risk of falls”’; and “People with vision deficits are twice as likely to fall”.

These helpful resources can be downloaded via our website at www.pathwayshealth.org/resources.

Care at Home vs. Hospitalization

Home Fares Better for Heart Failure Patients

Hospitalization, the standard venue for short-term medical care, may be hazardous for the elderly according to a study reported in the Archives of Internal Medicine in September, 2009.*  The study evaluated the feasibility and effectiveness of physician-managed home care for selected patients with acute decompensation of chronic heart failure.  The prospective, single-blind, randomized trial followed patients 75 years or older who had been hospitalized.  They were randomly assigned to a Geriatric Home Hospitalization Service or a general medical ward.

Overall Improved Status

Findings demonstrated no significant difference in the number of deaths or subsequent hospitalizations, but the mean time until the first additional admission was longer for the patients cared for in their own homes.  Only the home patients experienced improvements in depression, nutritional status and quality-of-life scores.

The research concluded that home care is a viable alternative to traditional hospital inpatient care for elderly patients with acutely decompensated CHF.
  
*Arch Intern Med. 2009 Sep 28;169(17):1569-75.

For more information about Pathways Home Health services for patients with chronic heart failure, please visit www.pathwayshealth.org/home-health.

When It Comes to Hospice, What's In It for Families?

We Know What Patients Get

The multiple advantages of hospice for the family are often lost in our natural concern for the patient.  We know the patient gets to stay at home with expert pain and symptom control as well as spiritual and emotional support.  We know they have volunteers for companionship and the safety and energy conservation provided when a home health aide assists with personal care.  And of course, there are the extras like massage with aromatherapy and music therapy.

“Unit of Care”

But how does the family benefit?  In the very unusual insurance benefit that is hospice, Medicare defines the “unit of care” as the patient and family—and family is loosely defined to include close personal friends and significant others.

Relief from Caregiving

One of the pluses caregivers love most is relief from being the caregiver.  It may be a couple of hours at the bank and beauty shop while a volunteer sits with the patient; it may be a 5-day paid respite stay in a skilled nursing while the caregiver recharges her metaphorical batteries; it may be a home health aide to do the physical care of bathing, dressing, shaving and linen changes several times a week; or it could even be a volunteer to grocery shop, run errands or walk the dog.

Emotional and Spiritual Support

A family at odds about healthcare goals may have a conference facilitated by a hospice social worker.  There is some financial relief as hospice assumes the cost of medications, equipment and supplies related to the terminal illness—even over-the-counter products and disposable briefs.  Then there is the assistance with funeral plans or insurance issues from skilled medical social workers—and sometimes a spiritual care counselor to preside over a memorial service or to pray with family members.

Easing the “Burden”

Those approaching the end of life often express regret over their perception of being a burden.  It is a relief to them to find out that family members can call hospice 24 hours a day to talk to a nurse or arrange a visit if needed, and that their families can have the same spiritual and emotional support that they get.  Patients are also comforted to know their family will have 13 months of support in their bereavement.

Time

And perhaps most important of all, because people who opt for hospice often live longer, patients and families have a few more cherished days or weeks to share this precious finale to life.

And Benefits for the Physician?

• Physicians get fewer calls at night and on weekends
• They have extra eyes and ears in the home. 
• Doctors get to be the heroes by giving patients and families better quality, and often quantity, of life.
• Physicians have hospice medical directors with whom they can consult on complicated symptoms.  

Research Confirms Many Live Longer with Hospice and Palliative Care

Higher Quality of Life Reported By Palliative Care Patients, Study Reports

A recent study published in the New England Journal of Medicine found that among patients with non-small-cell lung cancer, those who received palliative care lived, on average, almost two months longer than those who received standard care. Researchers also found that the patients receiving palliative care reported a higher quality of life through the final course of their illness.

They also found that when patients received palliative care services, they were more likely to elect hospice services. "With earlier referral to a hospice program, patients may receive care that results in better management of symptoms, leading to stabilization of their condition and prolonged survival," wrote the authors of the study released August 18, 2010. 

Pathways Provides Palliative Care

Pathways has a unique and vibrant Palliative Care program that is provided through Home Health. The criteria are that the patient has a prognosis of 12 months or less, has a skilled need (such as symptom management), and that he or she finds leaving home a considerable and taxing effort. (Patients may occasionally visit the barber, attend a special event, go for a drive or attend religious services and still be considered homebound, thus meeting the CMS criteria.) Patients may be receiving active, curative treatment simultaneously with Palliative Care. 

“There’s an inaccurate perception among the American public that hospice means you’ve given up,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. “Those of us who have worked in the field have seen firsthand how hospice and palliative care can improve the quality of and indeed prolong the lives of people receiving care.” Schumacher added that “The time to learn about these services is before a person is in a medical crisis. Patients and families must learn about these options of care as soon as possible.” 

A Growing Body of Evidence

A 2004 study found patients with 16 of the most common terminal diagnoses lived around 20 days (Journal of Pain and Symptom Management, September 2004). In 2007 a study of 4,493 patients found patients lived an average 29 days longer with hospice (JPSM, March 2007). This latest study adds to the body of evidence showing that many patients live longer with hospice and palliative care, and as a rule both patients and surviving families report better quality of life.

Hmmm... Chocolate!

Chocolates

Food of the Gods

Hmmm. Truffles or chips, mousse or bars. No matter how you like it, there is nothing else like chocolate. But that delicious slice of cocoa-laced cake is often served with a helping of guilt. Maybe you shouldn’t feel so bad after all—it turns out chocolate has a good side.

Benefits

We all know it can soothe the soul, but did you know chocolate can also lower blood pressure and reduce the risk of heart disease and blood clots, according to a study published by the American Heart Association. Flavonoid compounds in dark chocolate are also the same healthful antioxidants found in fruits, vegetables, tea, and red wine. Chocolate even appears to reduce bad cholesterol (low density lipoprotein) while increasing good HDL (high density lipoprotein) cholesterol.

Chocolate also contains tryptophan, an amino acid that increases levels of serotonin, a natural antidepressant and stress reducer. And eating chocolate increases the body’s endorphin levels, thereby elevating mood and reducing pain. Dark chocolate also seems to improve the body’s use of insulin and glucose sensitivity, and it is rich in potassium and magnesium, and contains vitamins A, B1, B2, D, and E.

The Downside

Of course some of the benefits of eating chocolate are offset by its high fat, sugar, and calorie content. For example, a cup of broccoli and a cup of sliced apples have 20 and 57 calories respectively, while a cup of chocolate has 1,000 calories or more.

Not All Chocolate is Equal

The amount of beneficial flavonoids in chocolate depends on the type of cocoa bean and the methods used in processing. For instance, Dutch process” greatly reduces flavonoid content. White chocolate has no flavonoids since it has no “cocoa mass” and is not technically chocolate at all.

Dark chocolate, on the other hand, has fewer calories and two to four times the amount of flavonoids found in milk chocolate. Milk binds to the beneficial antioxidants, making them unavailable. To get the full benefits of antioxidants, you should avoid drinking milk with your dark chocolate. The ideal dark chocolate will have a “cocoa mass” content of at least 70%.  With chocolate—the darker, the better.

Thank the Mayans

2,000 years ago the Mayans of Mexico and Central America began cultivating the pods of the cocoa tree that grew wild in the jungle. When mixed with water, chili peppers, and cornmeal, the ground cocoa beans made a spicy, frothy drink. Later the Aztecs adopted the bitter cocoa drink, usually enjoyed only by royalty and the privileged class. Spanish conquistadors brought cocoa beans to Europe in the 1500s where experiments with adding sugar to the new product flourished. The rest is history.

Indulge

So next time you want to indulge your sweet tooth with the silky, smooth, velvety texture of your favorite chocolate, enjoy it without guilt—you could be lowering your blood pressure!

For more information about Pathways Home Health, Hospice & Private Duty please visit our website at www.pathwayshealth.org.

Swearing Makes Pain More Tolerable

Uttering a curse word when you stub your toe or hit your thumb with a hammer could actually make it easier to bear the pain. Swearing is a common response to pain, but until now there has been no research looking into this. 

"Swearing has been around for centuries and is an almost universal human linguistic phenomenon," said Richard Stephens of Keele University in England, and one of the authors of the study.

Stephen’s team thought swearing would exaggerate the pain and people would tolerate it less.  The opposite turned out to be true.

The researchers had 64 university students put their hands in a tub of ice water for as long as possible while repeating a swear word of their choice.  The experiment was then repeated with the volunteers repeating a more common word that they would use to describe a table.

Contrary to what the researchers expected, the volunteers kept their hands submerged longer while repeating the swear word.

A Primal Response

Stephens says that swearing comes from deep-seated, primal, emotional brain centers.  Just as a cat would screech if his tail as stepped on, a primate would make a noise, and in humans our language ability often transforms the screech into a swear word. 

The researchers think that the increase in pain tolerance occurs because swearing triggers the body's natural "fight-or-flight" response. Stephens and his colleagues suggest that swearing may increase aggression (seen in accelerated heart rates), which downplays weakness to appear stronger.

"Our research shows one potential reason why swearing developed and why it persists," Stephens said.

The results of the study are detailed in the Aug. 5, 2009 issue of the journal NeuroReport. This article is adapted from the Live Science website.

For more information about Pathways Home Health, Hospice & Private Duty please visit our website at www.pathwayshealth.org.

When Capacity Is In Question

Let’s say your patient is in the earlier stages of dementia when a malignancy is discovered. Who decides his treatment options? Despite his dementia, it’s possible that it should be the patient himself.

Decision-making capacity is defined as “the patient’s ability to make his or her own decisions about accepting or rejecting medical procedures or treatments,” according to an article in the Journal of Palliative Medicine (November 2009). Author Frank Clore, a hospice spiritual care counselor, lists five considerations for the healthcare professional:

1. Does the person understand the facts involved in making the decision?
2. Does he “have an appreciation of the nature and importance of the decision to be made, including potential alternative choices?”
3. Does he understand the benefits and risks of the decision?
4. Can he communicate the decision to others, including the reasons for making the decision?
5. Can he “deliberate based on consistent personal values?”

Clore suggests that you may be able to elicit the answers using these assessments:

• Ask the patient to explain what he/she understands about his/her illness and about the proposed treatment.
• Ask what the patient thinks about the proposed treatment, how it may help him/her, and what will happen if the treatment is not chosen.
• Ask the patient to repeat his/her choice; answers should be consistent over time.

As with all patients, but especially those whose capacity for decision-making is in question, Clore reminds us the patient should be properly informed and free of coercion, and that the patient be “assessed in relationship to a specific decision, at a specific time, and in a specific context.”

For more information about healthcare decision making visit www.finalchoices.org or visit our website www.pathwayshealth.org.

Spiritual Support in Hospice

Meaning of Life

When a patient may be facing the end of life, spiritual issues often begin to surface—people begin to ponder the meaning of their lives. Hospice is intended to care for not only the physical wellbeing of the patient, but the emotional and spiritual aspects as well. Toward that holistic end, Medicare mandates that hospices provide spiritual support (as they do in the military, another place where death is a possibility).

Spirituality is about those aspects of life that are not material; it is about relationships and finding meaning. Each of us has a spiritual side; some express it through religion, some in other ways.

But when faced with life-threatening illness, many experience feelings of fear, powerlessness, helplessness and despair, which are often expressions of spiritual distress.  Hospice spiritual care counselors are knowledgeable about a wide range of religious and spiritual traditions. They may be a presence in the home, or they may be the connection to the patient’s own faith tradition.
 
A Pathways Hospice Spiritual Care Story

Years ago, Pathways had a Vietnamese patient who had emigrated after the Viet Name war, in which he was an army colonel. His cancer pain was never seemed completely managed, despite multiple approaches.

One day he mentioned he wished he had not stopped practicing his Buddhism and wanted to pray with priest, however he was too weak to leave home. A hospice spiritual care counselor began networking until he found a Vietnamese Buddhist nun who came to pray with the patient.

Interestingly, not only did the patient’s anxiety decrease dramatically, but his pain was gone after these visits.

How Spiritual Support Can Help

Some of the many ways that hospice spiritual care counselors can help as requested by the patient or family are by:

• Giving unbiased spiritual or religious support for patients or family members
• Helping to identify and resolve spiritual concerns affecting the patient or family
• Exploring the “meaning of life” questions
• Administering sacraments
• Caring listening
• Contacting clergy or a spiritual leader of a specific faith community for the patient
• Exploring ways to prepare for “letting go” of this life in preparation for another
• Being another caring presence in times of need or distress

For more information about Pathways Hospice Services, please visit our website at www.pathwayshealth.org or email: info@pathwayshealth.org.