Food or Medicine
Culture and ethnicity shape patient’s and families’ view about artificial hydration (AH) at the end of life, with ethnic minorities seeing it as food more often than non-Hispanic European Americans, according to 2012 research.
“Identifying some of the beliefs and barriers regarding the decision-making process in this challenging area may provide preliminary evidence for culturally appropriate end-of-life communication strategies and care that incorporates individual assessments of the pros and cons of hydrating in each particular context,” suggest Isabel Torres-Vigil of the University of Houston, Texas, and co-investigators.
They conducted an interview-based study of 122 terminally ill cancer patients, asking, “Are these fluids more like food or more like medicine?” The study authors sorted answers as food, medicine, both or other.
Results showed 38% saw AH like food, 34% as medicine, 14% as both, and 14% as other (including vitamins and saline). Ethnic minorities perceived the AH as food 66% of the time vs. 41% for non-Hispanic European Americans.
The findings were significant enough that the research team suggest when patients with advanced cancer begin to decrease their oral intake of fluids, healthcare professionals should ask what perceptions they or their caregivers have about the role of AH to promote the most patient-oriented approach to end-of-life care.
Source: British Medical Journal: Supportive and Palliative Care, July 2012.
This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 26. To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.
"Medical Food"
Giving 125 ml of “medical food” once a day to people with mild Alzheimer’s disease appears to improve memory. These were the findings of a trial done in the Netherlands and presented at the 2012 Alzheimer’s Association International Conference.
This was the second large study showing that diet with specialized “medical food” can improve memory. A medical food is specially formulated liquid diet supplement for people with a particular disease or condition and is given under the supervision of a doctor by prescription.
The improvements continued for 48 weeks. At the end of 24 weeks those who had been assigned to take a placebo drink were switched to the active treatment. They also experienced significant memory improvement.
The medical food used in this study, Souvenaid, was developed by researchers at the Massachusetts Institute of Technology in Boston. Lead researcher, Dr. Philip Scheltens, said that the food “is medical nutrition, and we think it may offer a new approach—a dietary management approach, if you like — for people with very early Alzheimer’s disease.” He added that it is very safe and well tolerated. No serious adverse events were reported in the participants who complete the trial.
This article was originally published in Pathways & Partners Newsletter - Issue 27. To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.
We have an amazing new service at Pathways—Care Management. This service provides a nurse or social worker to oversee the care of an older person when loved ones need help to manage the care or don’t live nearby. It can also provide one-time assessment and care planning for families. This is an all-encompassing, privately paid service.
Here are just some of the valuable services care managers provide:
- Scheduling and coordinating medical and dental appointments
- Transporting and accompanying clients to health care appointments
- Helping clients comply with medications and recommendations
- Arranging supportive services such as home care, bill paying, transportation, housekeeping, meal delivery or a handyman
- Overseeing caregivers and other providers
- Arranging for safety devices and medical equipment such as emergency response systems, grab bars, shower chairs and wheelchairs
- Providing crisis intervention and supportive counseling
- Long-term planning for appropriate housing options
Pathways’ first care manager is social worker Stephne Lencioni, LCSW. She is a long-time supporter of Pathways, often referring clients to us in her 25 years of care management with other organizations. We are thrilled to have the experience and expertise of such a respected care manager launching this program for Pathways.
This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 26. To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.
Fewer Hospitalizations
Telemonitoring puts technology to work improving the lives of Pathways’ heart failure patients. By catching problems earlier, it reduces hospitalizations.
Home Health nurses don’t visit daily, so telemonitoring gives Pathways a way to assess the patient 7 days a week, from our office.
The easy-to-use unit can give us the patient’s:
- Weight
- Blood pressure
- Heart rate
- Oxygen saturation
When a patient touches any button on the small unit, a friendly voice talks them through each step of the health check. Patients also receive the data, giving feedback.
The information is sent automatically to a nurse via telephone: there is no phone charge to the patient.
Nurses monitor the health information daily, call the patient if necessary, and make home visits when indicated.
Pathways Telemonitoring Program Criteria
- Patient has heart failure
- Patient or caregiver can understand and follow instructions, and are physically able to use the unit
- Patient or caregiver are open to telemonitoring technology
- Patient does not have an infectious disease (i.e. TB, MRSA, varicella zoster, herpes zoster)
This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 26. To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.
Two of every five patients who experience acute coronary syndrome (ACS) will have depression—a very important psychosocial predictor of poor cardiovascular prognosis.
“A growing body of evidence suggests that mental health problems complicate physical health conditions and that this relationship worsens clinical outcomes, increases hospitalization, and adversely affects quality of life,” Joseph A. Ladapo, MD, PhD, of New York University in New York City.
He and colleagues predicted that treatment of depression after ACS would be cost effective and improve patient outcomes. They conducted a randomized, controlled study comparing enhanced depression care with usual care in patients with ACS and persistent depression 3 months after discharge. Ladapo and colleagues defined enhanced depression care as problem-solving psychotherapy, antidepressant use or both.
Their conclusion at the close of the 6-month, prospective trial involving 157 patients was that treatment for depression reduced total per-patient healthcare costs by more than 40% and was cost effective for almost all patients.
An assessment of quality of life showed improved health utility in the intervention group. Interviews 6 months after discharge showed that in the intervention group 51% were using antidepressants or anxiolytics and 75% had visited a mental health specialist at least once for a total cost of $1,083. In the control group 30% were using antidepressants or anxiolytics and 35% had seen a mental health professional, for an average of $554.
The extra costs for the intervention group were more than offset by the significant reduction in hospitalization for ACS and heart failure (5% vs. 16%), with a mean cost savings of $1,782 for the intervention group and unmeasured improvement in quality of life.
Total healthcare costs averaged $1,857 in the intervention group and $2,797 for the usual-care arm, resulting in an adjusted difference of $1,229, which did not achieve statistical significance (P=0.09). Because the intervention was cost saving, the investigators could not calculate a cost-effectiveness ratio.
The research was reported in Arch Intern Med 2012; DOI: 10.1001/archinternmed.2012.4448, and was supported by the National Heart, Lung, and Blood Institute; the Health Resources and Services Administration; and the American Heart Association.
This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 26. To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.
