Posts Tagged ‘Hypertension’

Living Solo Can Be Hazardous to Your Health

Monday, June 25th, 2012

Living to a ripe old age may depend on a person’s relationship to family, friends and community, according to research that finds lonely older adults are more likely to die sooner than their more socially active peers.  Lonely people who are 60 and older tend to have a 45 percent higher risk of dying over the next six years, according to research in the Archives of Internal Medicine.  Another study showed that people who live alone and had heart disease were 25 percent more likely to die from the illness.

Approximately one in seven Americans live by themselves.  The first study to examine the link between social isolation and death points to the importance of addressing psychosocial needs along with medical ones in improving the health of older adults, according to Carla Perissinotto, a study author.  “We cannot continue to ignore the other things that are happening in people’s lives,” said Perissinotto, an assistant professor of medicine and geriatrics at the University of California San Francisco.  “If we turn a blind eye to what our patients are experiencing at home, we may be missing a place to make a difference in someone’s health.”

The lonely people studied were more likely to have limited mobility and greater difficulty performing basic tasks like grooming and cleaning.  Approximately 25 percent of lonely people were likely to develop trouble compared to 13 percent who weren’t lonely.  While the connection between well-being and friendships isn’t new, the latest findings look specifically at people who self-identified as lonely, regardless of how extensive their social network.  “It’s about connectivity,” Carla M. Perissinotto said.  “Someone can have multiple social contacts but still somehow feel that they’re not connecting.”

One study followed nearly 45,000 people aged 45 and older who suffered from heart disease or had a high risk of developing it.  Those who lived alone were more likely to die from heart attacks, strokes, or other heart complications over a four-year period than people living with family or friends, or in some other communal arrangement.  The risk was highest in middle-aged people, just 14 percent of whom lived alone. Solo living increased the risk of heart problems and early death by 24 percent among people ages 45 to 65, and by only 12 percent among people ages 66 to 80.  And there was no association at all in people age 80 and older, a group in which living alone is widespread.

Additional research is needed to confirm the findings, but it may not be a bad idea for physicians to ask heart patients about their living situation, said senior author Dr. Deepak L. Bhatt, M.D., a cardiologist at Brigham and Women’s Hospital, in Boston.  Living solo “could be a little red flag that a patient may be at a higher risk of bad outcomes,” Bhatt said.  But living alone could impact health in more immediate ways.  For example, people who live along may skip their medications or ignore the warning signs of heart trouble, according to Bhatt.

Bhatt notes that patients who live alone should never ignore changes that might be a sign of health problems.  “Many times people just adapt to their circumstances.  Perhaps just lower your threshold a little bit and realize it’s better to call (the doctor) than not to call.”  That might not be the entire story.  “Other mechanisms by which living alone could increase cardiac risk have to do with possible social isolation and loneliness, and these are more challenging to fix,” he said.

According to Emily M. Bucholz, M.P.H., a medical student and doctoral candidate at Yale University, “Living alone, in and of itself, could stand for many different things.  Does it mean you lack companionship?  Or is it that there is no one there to help you out with medications?  Does it have to do with mobility or nutrition?”

Writing in Time, Alice Park notes that “Loneliness can be detrimental in many ways, some of which are biological and some of which are more behavioral.  Feeling isolated can trigger changes in brain chemicals and hormones that can increase inflammation in the body, for example, which can exacerbate conditions like heart disease and arthritis.  Loneliness may also lead to other problems — poor sleep, depression, a disinterest in one’s own healthcare — which can in turn contribute to disability and early death.  Which is why the researchers were particularly concerned over another finding — many of the elderly who said they felt lonely were not actually living alone.

Rather, they were married or living with family members.  That suggests that the size of a person’s social network isn’t the only measure of loneliness, and that studies that look only at the number of people’s contacts may miss an entirely separate factor that can have a significant impact on health, said Perissinotto.  ‘I think that from a public health and policy level, we are doing a disservice by not asking (people) about their subjective feelings of loneliness.  We focus on their diabetes control and treating their hypertension, but are we missing something that may be more distressing to patients and have more of an impact on their health?’”

Loneliness is a common source of suffering in older persons,” according to the study’s authors.  “We demonstrated that it is also a risk factor for poor health outcomes including death and multiple measures of functional decline.  Assessment of loneliness is not routine in clinical practice and it may be viewed as beyond the scope of medical practice.  However, loneliness may be an important predictor of adverse health outcomes as many traditional medical risk factors.  Our results suggest that questioning older persons about loneliness may be a useful way of identifying elderly persons at risk of disability and poor health outcomes.”

As Many As 112 Million May Have Pre-existing Conditions

Wednesday, May 16th, 2012

Between 36 million and 112 million Americans have pre-existing conditions, according to the Government Accountability Office (GAO).  Previously insurers have been able to deny coverage to sick people or offer policies that don’t cover their pre-existing conditions.  The Patient Protection and Affordable Care Act (ACA) prohibits insurers from charging higher prices to people with pre-existing conditions.

Americans with pre-existing conditions represent between 20 and 66 percent of the adult population, with a midpoint estimate of 32 percent.  The differences among the estimates can be attributed to the number and type of conditions included in the different lists of pre-existing conditions.

The GAO compared several recent studies that tried to determine how many adults have pre-existing conditions,  based on the prevalence of certain common conditions.  Hypertension, mental health disorders and diabetes are the most common ailments that lead insurers to deny coverage, GAO said.  The report doesn’t say how many of those people are presently uninsured, but the insurance industry said that number could be relatively low.  Most people have insurance through an employer that is available irrespective of pre-existing conditions, according to America’s Health Insurance Plans (AHIP).  The trade association stressed that requiring plans to cover everyone is closely linked to the individual mandate, which the Supreme Court could strike down this summer.  There is widespread agreement that the two policies must go hand-in-hand — the Obama administration told the Supreme Court that if it strikes down the mandate, it should also toss out the politically popular requirement to cover people with pre-existing conditions.

Adults with pre-existing conditions spend $1,504 to $4,844 more annually on healthcare, and the majority — 88 to 89 percent — live in parts of the country “without insurance protections similar to the Affordable Care Act provisions, which will become effective in 2014.”

GAO’s analysis found that nearly 33.2 million adults age 19-64 years old, or about 18 percent, reported hypertension in 2009.  People with hypertension reported average annual expenditures of $650, but expenditures reached $61,540.  Mental health disorders and diabetes were the second and third most commonly reported conditions.  Cancer was the condition with the highest average annual treatment expenditures — approximately $9,000.

Sebelius Asks Civil Right Activists to Defend the ACA

Monday, April 23rd, 2012

Secretary of Health and Human Services Kathleen Sebelius has asked civil rights activists to help defend the Patient Protection and Affordable Care Act (ACA), noting that the healthcare law faces an “enemy” whose goal is to set American health policy back half a century.  The remarks come two months before the Supreme Court is expected to issue a ruling that could strike down the law.

Sebelius described the ACA as an crucial weapon against racial disparities that have long meant higher infant mortality rates, shorter life spans and limited access to medical services for minorities.  “The enemy is at the door and we know that they would like to dismantle these initiatives,” Sebelius told the annual convention of the National Action Network, a civil rights group led by the Reverend Al Sharpton“Healthcare inequalities have been one of the most persistent forms of injustice,” she said. “Now is not the time to turn back.”

Civil rights advocates and the minorities they often represent form a key segment of the Democratic base, especially if the Supreme Court strikes down Obama’s signature domestic policy achievement.  Research shows that low-income Americans, including many minorities, have significantly less access to medical care and suffer higher rates of childhood illnesses, hypertension, heart disease, AIDS and other diseases.

Designed to bring healthcare coverage to more than 30 million uninsured Americans, the ACA has become a pet target for Republicans mainly because of an `individual mandate that requires most Americans to have healthcare insurance by 2014.  “We’ve got folks who are committed to undoing…the important initiatives that we’ve made in the last few years,” Sebelius said.  “Frankly, they want to go back and undo Medicare and Medicaid from the mid-1960s.  They want to roll us back years and years.”

The House of Representatives voted recently to partially privatize Medicare and convert Medicaid to a block-grant program for states, although the legislation is likely to be stalled in the Senate.  “I’m here to ask you to help,” Sebelius said.  “If we can begin to close the disparities in health, we begin to close disparities in other areas, too.”

Sebelius asked religious leaders, health advocates and other minority leaders to help the Obama administration educate the public about the healthcare law’s many benefits. The law, which becomes fully effective on January 1, 2014, has already benefited minorities by extending private insurance coverage to young adults, providing free preventive services for those with insurance and prohibiting coverage denials for children with pre-existing conditions.

Hospitals, CMS Butt Heads Over Too Many Readmissions

Tuesday, February 14th, 2012

Medicare has plans to penalize hospitals that frequently readmit patients who really don’t need hospitalization. According to one estimate, this practice costs the federal government $12 billion every year.  Medicare’s goal is to persuade hospitals to be certain that patients get the care they need following their discharge.  This new policy is likely to excessively impact hospitals, particularly those that treat low-income patients, according to a Kaiser Health News analysis of data provided by the Centers for Medicare & Medicaid Services.  Hospitals that admitted the most underprivileged Medicare patients were approximately 60 percent as likely to have significantly higher readmission rates for heart failure.  At these hospitals, lower-income people comprise a larger share of the patients than they do at 80 percent of hospitals.

“When some of our patients get home, their lights and gas are shut off,” said Roland Abellera, vice president of quality and corporate compliance at St. Bernard Hospital in Chicago’s blighted Englewood neighborhood.  “So what ends up happening is that the ambulance brings them back to us and we have to house them until our staff can help them get the utilities turned on.  We have a community in need.”

Within 30 days of discharge, 25 percent of Medicare patients with heart failure are readmitted to the hospital.  The Patient Protection and Affordable Care Act (ACA) has ruled that beginning next October, Medicare will fine hospitals whose patients who have had heart attacks, heart failure or pneumonia return to the hospital too soon.  By 2014, hospitals with high readmission rates can potentially lose up to three percent of their Medicare reimbursements.

Medicare has set aside funds so hospitals can more effectively plan patients’ post-discharge care.  According to Patrick Conway, Medicare’s chief medical officer, some funds will be targeted to hospitals that serve significant numbers of poorer people.  “We especially are concerned about safety-net hospitals that take care of a high portion of patients in poverty and racial and ethnic minorities,” he said.  At the same time, his agency is committed to the readmission penalties, in part because it is the law and because it believes the penalties will persuade hospitals to be certain that patients get the follow-up care they need.

Some hospital administrators are concerned that the new policy is too harsh.  “In essence, they are penalizing those hospitals and areas that need the most help and the most money to address these issues because we have the sickest, most noncompliant and vulnerable patient population,” said Guy Alton, chief financial officer at St. Bernard.  According to Abellera, St. Bernard’s heart failure patients usually have more than one serious conditions, such as kidney failure, hypertension and diabetes.  “A patient does not come here for heart failure alone,” he said.  “They have no less than six or seven diagnoses — we’ve had many with more than that.”

Dr. Ashish Jha, in the latest New England Journal of Medicine, makes the case that readmissions aren’t the best gauge of unnecessary care — even though they’re a natural target for budget-cutters.  The Harvard University professor points out that many hospitals with the highest readmission rates serve the poorest areas with the biggest health problems.  “Readmissions are caused by what hospitals do, who the patients are, and what’s happening in the community,” he says. “You want hospitals to fix the things they can, but you don’t want to punish them for taking care of poor people, and you don’t want to punish them for being located in a poor area.”

Two of the most frequent reasons for hospital readmissions are medication errors and failure to see a physician – both of which could be reduced if patients were supervised through home care visits following discharge.

Foreclosure Is Hazardous to Your Health

Monday, November 14th, 2011

Falling behind on mortgage payments harms more than just finances; the stress and strain can negatively impact physical and psychological health.  In 2009, 2.2 percent of all American homes — more than 2.8 million — were in some stage of delinquency.  Researchers examined data collected in 2006 and 2008 on nearly 2,500 Americans who took part in the Health and Retirement Study, a nationally representative sample of Americans aged 50 and older.  The data included information about general health, psychological health, income and whether the person had fallen behind on paying their mortgage.  People who were behind between 2006 and 2008 reported more depressive symptoms, increased food insecurity and were more likely to not take prescription medications as prescribed because of the cost.

“People are making unhealthy trade-offs when they’re trying to make their mortgage,” said Dawn Alley, an assistant professor of epidemiology and public health at the University of Maryland School of Medicine.  “We think it’s a very serious issue.”  The study was published in the American Journal of Public Health.

Nearly 32 percent of people who were having difficulty paying their mortgages didn’t take medications as prescribed because of costs, compared to the five percent who were able to make their mortgage payments.  “Depression, not taking medications and not spending enough money on nutritious food can exacerbate conditions you already have,” Alley said.

Nearly one-third of the people who were mortgage-delinquent reported fair or poor health compared to 19 percent who were able to pay their mortgages on time.  “The rise in mortgage defaults may have important public health implications that could ultimately prove costly to affected individuals, employers, the healthcare system, and society,” according to the study’s authors.

More than a quarter of people in mortgage default or foreclosure are over 50,” Alley said. For an older person with chronic conditions like diabetes or hypertension, the types of health problems we saw are short-term consequences of falling behind on a mortgage that could have long-run implications for that person’s health,” Alley said.

“This study has pinpointed an issue that until now has been somewhat under the radar, but which threatens to become a major public health crisis if not addressed,” said E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.  “Through research such as this, faculty epidemiologists and public health specialists provide valuable information and perspectives that are useful for government and private policy makers as they work to meet the health and economic needs of Americans.”

This study was co-sponsored by the National Institutes of Health and was conducted with support, resources and use of facilities from the Philadelphia Veterans Affairs Medical Center.

Another study by Janet Currie of Princeton University and Erdal Tekin of Georgia State University shows a direct relation between foreclosure rates and the health of residents in Arizona, California, Florida and New Jersey.  The researchers concluded in a paper published by the National Bureau of Economic Research that an increase of 100 foreclosures related to a 7.2 percent increase in emergency room visits and hospitalizations for hypertension, and an 8.1 percent increase for diabetes, among people in the 20 to 49 age group.

Writing in the Wall Street Journal, S. Mitra Kalita says that “Each rise of 100 foreclosures was also associated with 12 percent more visits related to anxiety in the same age category.  And the same rise in foreclosures was associated with 39 percent more visits for suicide attempts among the same group, though this still represents a small number of patients, the researchers say.  Teasing out cause and effect can be delicate, and correlation doesn’t necessarily mean foreclosures directly cause health problems.  Financial duress, among other issues, could lead to health problems — and cause foreclosures, too.  The economists didn’t find similar patterns with diseases such as cancer or elective surgeries such as hip replacement, leading them to conclude that areas with high foreclosures are seeing mostly an increase of stress-related ailments.”

New Study Cites Setbacks in Women’s Health Issues

Tuesday, December 28th, 2010

More American women are binge drinking and not being screened for potentially deadly diseases such as cervical cancer, according to a new study  by the National Women’s Law Center and the Oregon Health and Science University.   Additionally, greater numbers of women are obese, diabetic and hypertensive than just a few years ago; even more alarming is the fact that more women are testing positive for Chlamydia, a sexually transmitted disease (STD) that can cause infertility.

The report presents a grim picture and gave the United States an “Unsatisfactory” grade and numerous Fs on specific goals created by the federal government’s Healthy People 2010 initiative. “The takeaway message is that we’re really not where we should be,” said Dr. Michelle Berlin, an associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine and associate director of the Center for Women’s Health.  http://www.ohsu.edu/xd/health/services/women/ “We’ve had 10 years of doing this report card, and you would hope the needle would have moved more than it has.”

Although screening rates for colorectal cancer and high cholesterol have improved since the 2007 report card, just 78 percent of women aged 18 to 64 are being tested for cervical cancer, a drop from the 84.8 percent reported in 2007.  The Healthy People 2010 objective is 90 percent.  Another growing problem is obesity, which impacts 24 percent of women.  According to Dr. Berlin, 25 percent of women are sedentary and participate in very limited physical activity; a majority do not eat the recommended five daily fruits and vegetables.

The amount of binge drinking was especially surprising to the researchers, with more than 10 percent of women saying they had five or more drinks on at least one occasion in the previous month.  “This is very concerning, especially when we think about what other things can happen when people engage in binge drinking:  there are more sexual-assault problems, they’re more likely to acquire an STD, and more likely to have accidents while driving,” Dr. Berlin said.