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Hip Fracture Patients Often Have Other Health Issues That Impact Treatment
April 6, 2012

MP900385793Other existing medical conditions significantly increase the cost of treatment and length of hospital stay for those who suffer hip fractures each year, according to a new study.

More than 250,000 hip fractures occur each year in the U.S., which often results in hospitalization, surgery, nursing-home admission, extended periods of rehabilitation or long-term disability.

“The purpose of our investigation was to gain a better understanding of the coexisting medical conditions that impact the cost of treating patients with hip fractures and how those conditions affect the overall cost and duration of hospitalization,” said Dr. Kevin P. Black, an orthopaedic surgeon and one of the study’s authors.

Black and colleagues from Penn State College of Medicine gathered hospital-discharge data from a 2007 report from the Agency for Healthcare Research and Quality, which included information from 1,044 hospitals in 40 states.

Researched looked at information on 32,440 patients, including their sex, race, age, hospitalization cost, length of stay, type of hip fracture sustained, and type of surgical hip fracture treatment. Nearly 80 percent of patients were 75 or older, with 72 percent being female, 88 percent Caucasian, 4 percent Hispanic, and 4 percent black.

Most patients had two or three existing conditions, also called comorbidities, with only about 5 percent having no comorbidities. High blood pressure was the most common comorbid condition, affecting about 67 percent of the patients. Other conditions, listed from most to less common, were:

  • deficiency anemias (disorders caused by a lack of certain nutrients, such as vitamin B12 or iron);
  • fluid and electrolyte disorders;
  • chronic lung diseases;
  • uncomplicated diabetes;
  • neurological disorders;
  • hypothyroidism (when he thyroid gland does not produce enough thyroid hormone);
  • congestive heart failure.

These  comorbidities significantly raise the cost of hospitalization and length of hospital stay, researchers say. Hip fracture patients who were malnourished or very thin had the greatest increased costs, followed by those with disorders of blood flow to and from the lungs called pulmonary circulation disorders.

Malnutrition or recent weight loss also had the greatest impact on length of hospitalization, increasing the hospital stay by up to 2.5 days, followed by congestive heart failure by 1.1 days, and pulmonary circulation disorders, by 0.9 day.

Paralysis, fluid and electrolyte disorders, and conditions contributing to blood clots also considerably lengthened hospitalization.

The study results may have major implications for doctors, hospitals, and those who pay for medical services, said Dr. Black, as specific comorbidities substantially increases the cost and length of stay associated with hip fracture treatment. Current rates of reimbursement to hospitals only take into consideration whether a patient has a comorbidity, a major comorbidity or no comorbidity.

Two major issues surfaced from this study that deserve further investigation.

“First, we need to better understand the total cost of caring for hip-fracture patients. Our study focused only on acute hospitalization, but care typically extends well beyond this, since many patients are discharged to rehabilitation and skilled-nursing facilities,” said Dr. Black in a news release. “Second, this study did not investigate the quality or outcomes of care. As our population ages, there is reason to believe that the number of hip fractures will increase. Having a better understanding of the comorbidities that affect hip-fracture patients hopefully will lead to the development of strategies to more effectively care for these patients.”

To prevent hip fractures, the following fall-prevention strategies are recommended:

  • Keep floors clutter-free.
  • Wear rubber-soled, low-heeled shoes.
  • Keep all rooms well-lit.
  • Walk on the grass if sidewalks are slippery.
  • Get skid-proof backs for all rugs.
  • Have grab bars installed near the bathtub or shower and toilet.
  • Only use nonskid bath mats in the bathtub or shower.
  • Keep your stairs well-lit and install handrails on both sides.

For more on medical safety issues, see the library of articles by Daytona Beach nursing home injury attorney.

Going to Doctor Visits with Older Loved Ones May Improve Care
March 27, 2012

MP900444270Family companions who regularly accompany older adults at doctor office visits can make a difference in efforts to improve health care quality, a new study shows.

Researchers from the Johns Hopkins Bloomberg School of Public Heath found that about 75 percent of older adults who go to doctor visits with a family companion are  accompanied consistently over time, usually by the same companion.

“Continuity of care is a central tenant of an effective patient-provider partnership,” said Dr. Jennifer L. Wolff, lead author of the study, in a news release. “Our study documents that the patient-provider relationship often includes a consistently present and actively engaged family member. This work suggests that quality of care improvements may result from more productive communication and education that targets both patients and their companions.”

Wolff and fellow colleagues analyzed a nation-wide survey of Medicare beneficiaries ages 65 and older. The team studied the influence of socio-demographic characteristics, physical function and health status in relation to consistent accompaniment to doctor visits. They also looked at the activities performed by the companions during medical visits.

Researchers found that three-fourths of the 9.5 million older adults who attended routine doctor visits with a family companion were consistently accompanied during  follow-up 12 months later. Nearly 90 percent of the patients were accompanied by the same companion over time. Patients who were less educated, older and had multiple chronic conditions were more likely to have consistent accompaniment at follow-up.

Almost 36 percent of these patients were physically disabled and received assistance with daily activities from their companion. The companions of these patients were more active during doctor visits with 70 percent providing information directly to the physician, 67 percent asking the physician questions and 55 percent explaining the physician’s instructions to the patient.

Previous studies indicate Medicare beneficiaries who attend routine doctor visits with a family companion are disproportionately vulnerable by health, age and education, and that their Medicare expenditures are twice the amount of  those patients who are not accompanied by a companion.

Past initiatives to improve older adults’ quality of chronic illness care have often focused on improving the competencies of patients and health care professionals, Wolff said, ignoring the fact that Medicare beneficiaries usually manage their health and attend routine doctor visits with a family member, usually their spouse or an adult child.

“Results from this study may help inform health reform initiatives that seek to improve care quality and lower costs,” Wolff said. For more on elderly health care issues, see the library of articles by Daytona Beach nursing home injury attorney.

Persons With Dementia at Greater Risk for Hospitalizations
March 19, 2012

MP910221087(1)People with dementia are more likely to be hospitalized than those without any impairment in their brain function, according to a new study.

And nearly two-thirds of the hospitalizations of those with dementia are often for potentially preventable illnesses, such as congestive heart failure and urinary tract infection, the study shows.

Compared to individuals without dementia, persons who developed dementia subsequently had a significantly higher rate of hospital admissions for all causes and admissions for ambulatory care-sensitive conditions for which proactive care may have prevented hospitalizations, according to the study.

Dr. Elizabeth A. Phelan and colleagues from the University of Washington, Seattle, conducted a study to determine if the onset of dementia is linked to higher rates of or different reasons for hospitalization. Researchers looked at ambulatory care-sensitive conditions (ACSCs), for which proactive outpatient care might prevent the need for a hospital stay.

This study included an analysis of hospitalizations among 3,019 participants in Adult Changes in Thought (ACT), a study of adults 65 or older enrolled in an integrated health care system. All participants had no dementia when the study began and those who eventually had a dementia diagnosis contributed to nondementia hospitalizations until their diagnosis.

Automated data were used to identify all hospitalizations of participants from time of enrollment in ACT until death, end of follow-up or disenrollment from the health plan, whichever came first.

During the study period between Feb. 1994 and Dec. 2007, 494 people eventually developed dementia and 427 or 86 percent of these persons were admitted to a hospital at least once. Those who remained free of dementia numbered 2,525 and 1,478 or 59 percent of those were admitted to a hospital at least once. Total admissions were 5,328.

Among those who developed dementia, there were 689 admissions prior to diagnosis and 714 after dementia diagnosis. Of ACSC admissions for this group, 121 occurred before dementia diagnosis and 198 after. Forty percent of the dementia group had at least 1 ACSC admission compared with 17 percent  of the dementia-free group.

Among those with dementia, the average yearly admission rate was more than twice that of those without dementia. Admission rates for 5 types of disorders (circulatory, infectious, neurological, genitourinary, and respiratory) were  higher among participants with dementia compared with those without dementia.

The crude admission rate for ACSCs was higher among those with dementia. Bacterial pneumonia, urinary tract infection and congestive heart failure accounted for two-thirds of all potentially preventable admissions, and admission rates among those with dementia were higher for all 3 conditions.

Admission rates for duodenal ulcer and dehydration, though low overall, were also significantly higher among those with dementia. Admissions for ACSCs made up 28 percent of all hospitalizations among those with dementia compared to only 19 percent of those who remained dementia free.

“Our findings that persons with dementia have higher rates of hospitalizations for most categories of medical illness and for ACSCs suggest that there may be important opportunities for improving care of demented older persons, including developing better strategies for delivering anticipatory, proactive primary care to this population,” the study author’s write.

For more on senior medical issues, see the library of articles by Daytona Beach nursing home injury attorney.

Diagnosing and Treating Stroke
March 3, 2012

In many cases, stroke patients will need to have tPA drugs, or tissue plasminogen activators. These drugs are “clot busters,” and if the doctor doesn’t administer these drugs to patients that need them, it is against standard and accepted practices for patient care. In layman’s terms, that means the doctor made a mistake and is negligent.
The American Heart Association has guidelines on the use of tPA, stating that it can be initiated within the first four and a half hours after a stroke. One of the biggest problems that physicians face in this area is in knowing the time that the stroke initially occurred, and unless there is proper documentation it can be difficult to know with any certainty. Thus, it becomes even more important for the physician to consult with family members so that they can learn the time of the stroke. In more and more cases, physicians simply aren’t giving the drug when they should. The outcome for patients who have the doctors administer the tPA is much better than the cases where the stroke victim doesn’t receive the drugs.
tPA drugs aren’t the only area where physicians are having issues with medicines and stroke patients. Not administering heparin or Coumadin can cause issues as well. While the drugs are useful in the care of an embolism in the brain, it doesn’t have value for other types of stroke. The liability issues that physicians can face will often come from withholding the drug in certain cases, which can then lead to a stroke. Other types of stroke may need treatment with aspirin, aggrenox, or plavix. In some cases, a patient might need to have surgery.
With all of the different causes of stroke, it is vital for the physician to be able to diagnose and treat the various types correctly. Giving the incorrect drugs, withholding drugs, and improper diagnoses can cause a host of different liability issues for the doctor. Stroke is a very serious issue facing many Americans today, and doctors need to have the skills, education, and wherewithal to make sure that they are diagnosing and treating properly. If they do not, it’s important that they don’t continue treating patients.

CB051682In many cases, stroke patients will need to have tPA drugs, or tissue plasminogen activators. These drugs are “clot busters,” and if the doctor doesn’t administer these drugs to patients that need them, it is against standard and accepted practices for patient care. In layman’s terms, that means the doctor made a mistake and is negligent.

The American Heart Association has guidelines on the use of tPA, stating that it can be initiated within the first four and a half hours after a stroke. One of the biggest problems that physicians face in this area is in knowing the time that the stroke initially occurred, and unless there is proper documentation it can be difficult to know with any certainty. Thus, it becomes even more important for the physician to consult with family members so that they can learn the time of the stroke. In more and more cases, physicians simply aren’t giving the drug when they should. The outcome for patients who have the doctors administer the tPA is much better than the cases where the stroke victim doesn’t receive the drugs.

tPA drugs aren’t the only area where physicians are having issues with medicines and stroke patients. Not administering heparin or Coumadin can cause issues as well. While the drugs are useful in the care of an embolism in the brain, it doesn’t have value for other types of stroke. The liability issues that physicians can face will often come from withholding the drug in certain cases, which can then lead to a stroke. Other types of stroke may need treatment with aspirin, aggrenox, or plavix. In some cases, a patient might need to have surgery.

With all of the different causes of stroke, it is vital for the physician to be able to diagnose and treat the various types correctly. Giving the incorrect drugs, withholding drugs, and improper diagnoses can cause a host of different liability issues for the doctor. Stroke is a very serious issue facing many Americans today, and doctors need to have the skills, education, and wherewithal to make sure that they are diagnosing and treating properly. If they do not, it’s important that they don’t continue treating patients.

Protect yourself in a nursing home by reading our Daytona Beach nursing home abuse attorney library articles.

Pneumonia Vaccine Approved for People 50 and Older
March 1, 2012

MP900321156The U.S. Food and Drug Administration has approved Prevnar 13, the bacterial pneumonia vaccine for use in people aged 50 and older.

Prevnar 13 targets pneumonia and other diseases caused by the bacterium Streptococcus pneumoniae. The vaccine, which targets 13 serotypes of the bacterium, has already been approved for children 5 and under to prevent invasive disease and certain ear infections.

Pneumococcal pneumonia is the most common disease caused by this bacterium in adults, according to the FDA. When the bacterium invades parts of the body that are normally free from germs, such as spinal fluid or blood, the disease is considered invasive and can even be fatal.

Approximately 300,000 adults 50 and older are hospitalized  each year in the United States because of pneumococcal pneumonia, according to  Dr. Karen Midthun, director of FDA’s Center for Biologics Evaluation and Research. This approval provides another vaccine for preventing pneumococcal pneumonia, which is a significant cause of illness and death.

The FDA approved this new use for Prevnar 13 through  its accelerated approval pathway, which allows for earlier approval of treatments for life-threatening and serious illnesses. The pathway allows for a vaccine’s effectiveness to be demonstrated using an immune marker that will likely predict clinical benefit.

In randomized, multi-center studies in the United States and Europe, people 50 and older were either given Prevnar 13 or another licensed pneumococcal vaccine, Pneumovax 23. The studies found that Prevnar 13 created levels of immune system antibodies that were either higher or comparable than those of Pneumovax 23, the FDA said.

The safety of Prevnar 13 was evaluated in about 6,000 people, 50 and older, who received Prevnar 13 and who had and had not previously received Pneumovax 23. Common adverse reactions to Prevnar 13 included fatigue, headache, chills, decreased appetite,  pain, redness, and swelling at the injection site, limitation of movement of the injected arm, and generalized muscle pain, and joint pain. Similar reactions were observed in those who received Pneumovax 23.

An additional study in 85,000 people aged 65 or older is ongoing, the agency said.

For more on medical issues, see the library of  articles by Daytona Beach nursing home injury attorney.

Watch for Signs of Nursing Home Negligence and Abuse
February 22, 2012

Choosing to place an elderly relative into a nursing home is always a difficult decision, and it’s normal to feel a bit of reluctance at letting others care for that family member. Finding the right facility is important since you want to find a safe place that is run properly and that has a great staff. The last thing you expect is to have your elderly family member suffer abuse or neglect while they are in the nursing home. Yet, that fear is probably going to be in the back of your mind. Too many stories of nursing home neglect and abuse are in the news, and you know that these sorts of things can and do happen.
Fortunately, most of the nursing homes in the country are safe and the staff truly cares about their resident patients. However, some facilities have bad apples among them. Certain facilities might have a staff that is too small to handle all of the work required to care for the patients the right way. Others may have staff members that have no business being in the patient care field.
When you are choosing a nursing home facility for your loved one, you should visit the facility before you make a decision. Visit on more than one occasion. You can call for an appointment, and you can be sure that they are going to show you the best side of the facility when you show up. After that initial appointment, drop in unannounced to see how things are going. This will give you a better opportunity to see how the nursing home works on a regular day.
During your tour of the facility, look for some telling details that will give you a good idea of the quality of the nursing home. If you have a chance to see patients and staff interacting, listen to how the staff member treats the patient. Ask for a report on the facility.
If you find a nursing home that you believe is ideal, and you place your elderly family member into the home, make sure that you listen to him or her when you visit. If they tell you that the staff keeps them in their room all day, or that there are other forms of neglect and abuse happening, you need to listen and take action. You can contact lawyers that will be able to help you with cases of nursing home neglect. Be sure to order a free copy of our nursing home book to protect your loved one in a nursing home.

MP900443298Choosing to place an elderly relative into a nursing home is always a difficult decision, and it’s normal to feel a bit of reluctance at letting others care for that family member. Finding the right facility is important since you want to find a safe place that is run properly and that has a great staff. The last thing you expect is to have your elderly family member suffer abuse or neglect while they are in the nursing home. Yet, that fear is probably going to be in the back of your mind. Too many stories of nursing home neglect and abuse are in the news, and you know that these sorts of things can and do happen.

Fortunately, most of the nursing homes in the country are safe and the staff truly cares about their resident patients. However, some facilities have bad apples among them. Certain facilities might have a staff that is too small to handle all of the work required to care for the patients the right way. Others may have staff members that have no business being in the patient care field.

When you are choosing a nursing home facility for your loved one, you should visit the facility before you make a decision. Visit on more than one occasion. You can call for an appointment, and you can be sure that they are going to show you the best side of the facility when you show up. After that initial appointment, drop in unannounced to see how things are going. This will give you a better opportunity to see how the nursing home works on a regular day.

During your tour of the facility, look for some telling details that will give you a good idea of the quality of the nursing home. If you have a chance to see patients and staff interacting, listen to how the staff member treats the patient. Ask for a report on the facility. If you find a nursing home that you believe is ideal, and you place your elderly family member into the home, make sure that you listen to him or her when you visit. If they tell you that the staff keeps them in their room all day, or that there are other forms of neglect and abuse happening, you need to listen and take action. You can contact lawyers that will be able to help you with cases of nursing home neglect. Be sure to order a free copy of our nursing home book to protect your loved one in a nursing home.

Learn more to prevent nursing home negligence and abuse in our Daytona Beach nursing home injury lawyer library.

Many Older Floridians Have No Backup Plan For When Driving Must End, Survey Shows
February 14, 2012

MP900178033While Florida is home to one of the highest percentages of senior citizens, a new survey shows few of them have thought ahead and planned for the day when they will no longer be able to drive or get around without a car.

In fact, 13 percent of those surveyed said they would never stop driving and 3 percent said  they would die before they would stop driving.

The findings from this survey are important in that they show older drivers are at a higher risk for being involved in a fatal car accident, according to John Reynolds, director of Florida State University’s Pepper Institute on Aging and Public Policy. The survey was developed by FSU and the state Department of Transportation.

Residents who are 65 and older make up nearly 18 percent of Florida’s population, and the Census Bureau expects that number to increase to 27 percent in the next 20 years. In 2008, 447 older adults died in automobile crashes on Florida roads, making up nearly 15 percent of all crash fatalities in the state.

To address this issue, the Pepper Institute has been awarded $475,000 from the state to establish a statewide coalition to create a Aging Road User Strategic Safety Plan for Florida.

Reynolds said reducing the number of fatalities, crashes and injuries that involve older adults in the state would be the measure of success for the grant funding. But in doing so, the roads will be made safer for all Floridians and would hopefully serve as a model for other states.

To establishing a baseline for the safety plan and coalition’s development, Reynolds analyzed the responses from 900 Floridians who took part in the 2011 Florida Aging Road User Survey this past spring and summer. Half of those surveyed ranged in age from 50 to 64, while the other half were 65 and older.

Their survey responses offer insight into the perceptions of older drivers regarding the safety and  mobility challenges they one day may face.

The findings include:

  • Most do not plan for the future when they may be unable to drive safely. Ninety-two percent of those ages 50-64 and 83 percent of survey respondents 65 and older, reported they had no “transportation retirement plan.” About 23 percent said they would rely on family, neighbors or friends when that time came, but about 36 percent said they did not know or had not thought about it. About 13 percent said they would never stop driving , with about 3 percent stating they would die before they needed to stop driving. Just under 4 percent stated they planned to use a community driver program or paratransit service such as Dial-A-Ride.
  • Many older drivers see no alternatives to driving in the communities where they live. When asked how they get around besides driving a car, 40 percent of those 65 and older said they ride with friends or family, 26 percent said they walk, and 15 percent said driving was the only way to get around.  The percentages were 38 percent, 29 percent and 16 percent, respectively, for survey respondents aged 50 to 64.

The survey also revealed that older drivers consider roads in the state to be fairly safe, overall. For those 65 and older, 78 percent said Florida’s roads are somewhat safe (57 percent) or very safe (21 percent). For those 50 to 64, 75 percent said the state’s roads were either safe or very safe.

“Though many aging drivers in Florida view our roads as very or somewhat safe, we found a lot of concern about the other drivers who are on them,” Reynolds said. “People responding to the survey voiced frustration, and sometimes anger, at other drivers who are talking on their phones, texting, or are otherwise being careless while they drive. This concern is being heard all around the country.”

Residents ages 65 and older make up almost 18 percent of the Sunshine State’s population, and the Census Bureau projects that number to grow to 27 percent over the next two decades. In 2008, 447 older adults were killed in automobile crashes on Florida roads, making up about 15 percent of all crash fatalities in the state.

The Pepper Institute is working with the Safe Mobility for Life Coalition, which is composed of members from 28 organizations and agencies in Florida. This coalition was established to improve safety, access and mobility for Florida’s aging drivers in several key areas, including education and prevention; assistance in transitioning from driving to other means of transportation as necessary; advocacy and policy reform; roadway improvements; licensing; promotion of aging in place;  and safety for non-drivers, including those bike, walk or ride a bus.

“There are so many groups and agencies throughout the state that are committed to making our roads and communities safer for older adults,” Reynolds said. “The coalition brings these groups together to work as a team on the objectives and goals identified in the strategic safety plan.”

For more on safe driving issues, see the library of articles by Daytona Beach car accident attorney.

Retinal Changes Linked to Disability in Daily Activities for Older Adults
February 6, 2012

MP900175021Doctors may now be able to predict future disability in performing daily living activities among older adults through microvascular retinal changes, according to a new study.

Researchers say retinal signs may also help in predicting outcomes among this popular of people.

Researchers say they recently found that a higher burden of retinal signs was linked with  poor executive function and physical function in a cross-sectional analysis. Based on that evidence, the study’s authors hypothesized that retinal signs would predict future disability in day-to-day activities.

Using data from the Cardiovascular Health Study, a population-based study of community-dwelling older adults, Dr. Dae Hyun Kim and  colleagues from the Beth Israel Deaconess Medical Center and Harvard School of Public Health, Boston,  examined the link between retinal microvascular changes and disability to perform activities of daily living.

Measured retinal signs included generalized arteriolar narrowing, which is narrowing of the eye‘s blood vessels, generalized venular widening, retinopathy – damage to the retina, arteriovenous nicking, which is constriction of a vein where it crosses an artery, and focal arteriolar narrowing.

At the baseline examination, the prevalence of retinal signs was 7 percent or 92 of 1,294 for retinopathy, 8 percent or 85 of 1,135 for arteriovenous nicking, and 10 percent or 111 or 1,063 for focal arteriolar narrowing.

Patients with two or more retinal signs comprised 7 percent or 61 of 880 of the study population with complete retinal data. During a median follow-up of 3 years and after adjusting for other factors, the presence of two or more retinal signs was associated with a 1.45-fold increased rate of disability.

Research showed that the presence of two or more retinal signs was associated with disability compared with having no signs, while having one retinal sign was not.

The authors found no specific combinations of retinal signs that showed greater risk than others. The association also was independent of vascular risk factors and carotid atherosclerosis, and among those without diabetes or clinical cardiovascular disease.

“Our study supports the hypothesis that microvascular disease accelerates age-related disability and retinal signs can be useful in understanding mechanisms and predicting outcomes,” the authors conclude.

The study also suggests that the presence of two or more retinal signs may be an early indicator of microvascular disease that signals an elevated risk for future disability in community-dwelling older adults.

For more on senior medical issues, see the library of articles by Daytona Beach nursing home injury attorney.

Elderly ER Patients Less Likely to Receive Pain Medicine Than Middle-Aged Patients
January 27, 2012

MP900174884People 75 years old or older are less likely to receive pain medication in hospital emergency departments than people between the ages of 35 and 54, a new study shows.

And such differences were constant even after researchers took into account how much pain the patients were having, said lead study author Dr. Timothy Platts-Mills, an assistant professor of emergency medicine at the University of North Carolina at Chapel Hill School of Medicine.

Of those older patients reporting severe pain, 67 percent received pain medication, compared to 79 percent of middle aged patients with severe pain.

“We’re not exactly sure why this happens,” said Platts-Mills in a news release. “It may be because physicians are more concerned about potential side effects in this population.

Emergency departments (EDs) are a significant source of acute care for older adults, with more than 20 million emergency department visits each year by patients 65 and older. Nearly half of these medical visits are for the treatment and evaluation of pain.

Platts-Mills and colleagues conducted a secondary analysis of data collected from U.S. emergency departments between 2003 and 2009 in order to test the hypothesis that older adults who come to the ED with a primary complaint of pain are less likely to receive pain medication than younger patients.

Results indicate 49 percent of patients 75 and older received an analgesic like ibuprofen, morphine or oxycodone, compared to 68.3 percent of patients  who were middle-aged patients. Also, 34.8 percent of the elderly patients received an opioid like oxycodone or  morphine compared to 49.3 percent of the middle-aged patients.

These differences remained even after the results were adjusted for race/ethnicity, sex, pain severity and other factors. Elderly patients were 19.6 percent less likely to receive an analgesic and 14.6 percent less likely to receive an opioid than middle-aged patients.

Platt-Mills said the gap in pain management for older patients shows the need for medical professionals to understand the best ways to manage pain and recognize the barriers to doing this.

“All patients, regardless of age, deserve to have relief from pain, especially when it is severe,” Platt-Mills said in a news release. “Our group is actively investigating the side effects of commonly used pain medication and the impact of pain on functional outcomes after injury in older adults.

”

The study’s authors say more research is needed to understand the long-term impact of acute pain management for older patients in the emergency department, to find new methods to minimize adverse effects from pain medications, and to explore the role of non-pharmacologic pain management for the elderly.

For more on medical safety issues, see the library of articles by Daytona Beach nursing home injury attorney.

Fecal Transplants Effective in Treating C.-difficile, Studies Show
January 21, 2012

42-15651565Several new studies show  fecal microbiota transplants are an effective treatment for patients who have with recurring bouts of Clostridium difficile associated diarrhea.

Clostridium difficile is a bacterium that causes infection and leads to diarrhea. It is most often related to antibiotic use during medical treatment.  A major cause of illness and increasing health care costs among patients in hospitals, C. difficile infections have increased dramatically in recent years. There are approximately 500,000 cases in the United States annually and approximately 15,000 deaths each year, according to the U.S. Centers for Disease Control & Prevention.

Almost 25 percent of patients will have a recurrence of C. difficile infection, and a proportion will be resistant to antibiotics. C. difficile is especially dangerous for patients who have weakened immune systems such as the elderly and those who suffer with Inflammatory Bowel Disease.

Therapies for this difficult-to-treat subpopulation include antibiotics, probiotics, toxin-binding medications, active vaccination, intravenous immunoglobon, and fecal microbiota transplant, for which the evidence has been mounting as an effective rescue for recurrent and resistant cases of C. difficile associated diarrhea.

The first study included 77 patients from New York, Rhode Island, Okalahoma, California and Washington who previously had a colonoscopic fecal microbiota transplant at least three months ago for recurrent C. difficile infection.

Researchers found that FMT had a 91 percent success rate with 70 out of 77 patients who were on average elderly, debilitated and had undergone multiple failed treatments, including antibiotic and probiotic therapies.

Additionally, in six of the remaining seven patients, a single two-week course of vancomycin or a two-week vancomycin course plus one further FMT resulted in a cure in 98 percent of the patients.

Many of the patients who were followed in this study had been ill for quite a long time,  said Dr. Mark Mellow, of INTERGRIS Baptist Medical Center in Oklahoma. “Once they underwent the fecal microbiota transplant, their response to the treatment was quick and their symptoms improved on average in about six days.”

These patients had been ill on average for 11 months, but after the FMT procedure patients continued to improve, according to Dr. Mellow and his fellow investigators. And without additional antibiotic treatment, the patients did not have a recurrence of C. difficile infection during follow-up which averaged 17 months.

Results from a meta-analysis by researchers at the University of Toledo Medical Center also provided further evidence of the effectiveness of fecal microbiota transplantation.

Researchers reviewed the cases of 148 patients who had received fecal transplants for C. difficile infection.  Follow-up ranged from 10 days to 62 months after the transplant, with an average follow-up of 1 year.

The fecal transplant procedure had an overall success rate of 85.4 percent, according to researchers, who also concluded that the procedure was a safe and effective treatment option for C. difficile infection.

“While the concept of fecal transplantation may sound unpleasant to some, patient acceptance of this treatment is growing, especially when they have been suffering for months with recurrent C. difficile,” said Dr. Mellow.  “When we asked patients in our study about their choice of treatment if their infection recurred, 53 percent said fecal transplant would be their first choice for treatment.”

With the fecal transplantation’s growing success rate for C.Difficile, researchers have started to explore the effectiveness of this procedure for other serious conditions, such as Inflammatory Bowel Disease.  In this separate study, researchers reported successful treatment of severe mixed Inflammatory Bowel Disease, using recurrent fecal microbiota
transplants in three patient cases.

For more on medical safety issues, see the library of articles by Daytona Beach nursing home injury attorney.