Monday, October 4, 2021

Breakthrough in Alzheimer's Research?

My dear friend and colleague, Professor Feeley, sent me a link to this recent article, Likely cause of Alzheimer’s identified in new study.

Here's a brief bit of info about the study

[S]cientists in Australia have recently discovered an additional factor that may be responsible for the development of this neurodegenerative condition.

Lead study author Dr. John Mamo, Ph.D. — distinguished professor and director of the Curtin Health Innovation Research Institute at Curtin University in Perth, Australia — explained to Medical News Today the conclusion from the new research...

“This study,” he added, “shows that exaggerated abundance in blood of potentially toxic fat-protein complexes can damage microscopic brain blood vessels called capillaries and, thereafter, leak into the brain, causing inflammation and brain cell death.”

The findings were published here. This is the abstract from the article

Several lines of study suggest that peripheral metabolism of amyloid beta (Aß) is associated with risk for Alzheimer disease (AD). In blood, greater than 90% of Aß is complexed as an apolipoprotein, raising the possibility of a lipoprotein-mediated axis for AD risk. In this study, we report that genetic modification of C57BL/6J mice engineered to synthesise human Aß only in liver (hepatocyte-specific human amyloid (HSHA) strain) has marked neurodegeneration concomitant with capillary dysfunction, parenchymal extravasation of lipoprotein-Aß, and neurovascular inflammation. Moreover, the HSHA mice showed impaired performance in the passive avoidance test, suggesting impairment in hippocampal-dependent learning. Transmission electron microscopy shows marked neurovascular disruption in HSHA mice. This study provides causal evidence of a lipoprotein-Aß /capillary axis for onset and progression of a neurodegenerative process.

October 4, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International, Other, Science | Permalink

Friday, October 1, 2021

COVID 19 Impact on Older Adults

A couple of weeks ago, the Commonwealth Fund released a report,  The Impact of COVID-19 on Older Adults: Findings from the 2021 International Health Policy Survey of Older Adults. Here are the survey highlights:

  • Compared to their counterparts in the other survey countries, older adults in the U.S. have suffered the most economically from the COVID-19 pandemic, with more losing a job or using up all or most of their savings.
  • Latino/Hispanic and Black older adults in the U.S. have been far more likely than white older adults to experience significant negative economic consequences.
  • COVID vaccination rates for older adults were highest in countries where vaccines were most widely available when the survey was fielded. In the United Kingdom, nearly all older adults (97%) had already been vaccinated. The U.S. had the largest percentage of older adults who were not planning to get vaccinated.

The conclusion includes several steps for going forward "to reduce this burden on older Americans and to ensure that their health care needs are met":

Reducing care barriers... affordable access to care is increasingly a priority for policymakers and care delivery systems. Timely access to primary care is particularly important for older adults with multiple chronic conditions, because effective treatment requires coordination and follow-up plans....

Role of telemedicine...  countries clearly have an opportunity to improve care delivery to older adults through the expansion of virtual care services for those unable or resistant to receiving care in a clinician’s office....

Expanding vaccination ...  "[f]or older adults who said they were not planning to get vaccinated, limited trust in government to ensure vaccine safety and concerns with side effects were the most cited reasons. To increase uptake in this population, messaging campaigns should address their apprehension by engaging a wide range of voices, from clinicians and scientists to community members and local, state, and federal government agencies, to get the word out....

The full report is available here and the charts, here.

October 1, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Science | Permalink | Comments (0)

Monday, September 27, 2021

Why Monoclonal Antibodies Might Be Used in Assisted Living

Recently a friend noted with concern that she'd been advised that an elderly relative would be receiving "antibodies" in her assisted living community. The confusion was "if she has been fully vaccinated, and hasn't tested positive herself, why would she need "antibodies?"  Turns out there were new incidences of COVID-19 in her wing of older adults, many of them with multiple risks factors, and the staff was being proactive.   More than likely, what she was receiving was "monoclonal antibodies."  The question arose before the question of authorization of "booster" shots had been addressed by the FDA.

As explained in this WebMD Health News article, titled Monoclonal Antibodies vs. Vaccines vs. COVID-19, from August 2021, families with loved ones in communal settings may want to discuss monoclonal antibodies with the health care team: 

Can I help relatives in assisted living get it?

If you believe that a relative in a residential facility -- like a nursing home, assisted living facility, long-term care home, or prison -- has COVID-19 or has been exposed, the first thing you should do is have a conversation with the medical leadership at the facility.

 

[Michigan Department of Health and Human Services Division of EMS and Trauma Director, Dr. William Fales] has partnered Michigan-based paramedics with several nursing homes in the state to have monoclonal antibodies delivered to these facilities when there’s an outbreak. It’s also possible for long-term care pharmacies to get monoclonal antibodies to administer in-house. If the medical leadership doesn’t appear to be aware of the treatment, you can use the same websites to find the nearest infusion center and begin coordinating treatment with it.

 

It's a good idea, Fales says, to find out where monoclonal antibodies are offered in your area, and perhaps talk with your doctor or a high-risk loved one’s doctor about how to get them, to be prepared. The faster you can get the treatment, the more likely it will help.

September 27, 2021 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Science | Permalink | Comments (0)

Thursday, September 16, 2021

Friday's Public Hearing re Approval for Third Dose Covid-19 Boosters Can Be Viewed Online

The U.S. Food and Drug Administration hearing on Friday, September 17, 2021 to address the question of approval for "booster" doses of Covid-19 vaccines is scheduled to be "open" to the public through online portals.  The hearing begins at 8:30 a.m. Eastern time.

The FDA's website helpfully links to the submissions from the drug companies and other interested parties as well to the hearing portal.  In contrast to The Lancet article published earlier this week which takes the position that a booster vaccine dose is not "currently" indicated for most members of the public, Pfizer and Moderna each submitted materials to the FDA this week in support of administering third shots beginning six months after an individual's second shot. Pfizer is recommending a full-strength dose for its booster shot, while Moderna is recommending a dose that is 1/3 the level of its original doses.  It appears both companies are citing observational studies, clinical trials, and antibody tests in support of their recommendations, including studies in the U.S., Israel, and South Africa, and discuss histories of reactogenicity, adverse events, and risk/benefit assessments.  

Here's the useful FDA vaccine hearing webpage and links:  https://www.fda.gov/advisory-committees/advisory-committee-calendar/vaccines-and-related-biological-products-advisory-committee-september-17-2021-meeting-announcement#event-materials

September 16, 2021 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Wednesday, September 15, 2021

The Challenges of Federal Oversight for Medications or Food Supplements Targeting an Aging Public

I'm finding myself spending a lot of time reading and thinking about the Food and Drug Administration (FDA) and Federal Trade Commission (FTC).  Of course, public concerns about the efficacy of Covid-10 vaccines dominate the attention of many of us working on health-related legal concerns that affect older adults.  For example, I've been researching questions about the potential for FDA approved antibody tests for Covid-19 vaccines.  

But also intriguing is a report that a slow-moving FTC suit against developers and marketers of the dietary supplement known as Prevagen may be getting closer to a possible trial date in the Southern District of New York.  A dismissal of the 2017 law suit filed jointly by the FTC and the New York Attorney General was overturned in 2019 by the Second Circuit in a summary order, concluding that the "FTC and New York have made plausible allegations that Defendants] marketing campaign for Prevagen contained deceptive representations."  For more on this and other Prevagen-related suits, see the Washington Post's recent article Does the Supplement Prevagen Improve Memory? A Court Case is Asking that Question.

Plus, there are significant questions arising in the wake of the FDA's June 7, 2021  announcement of its "accelerated" approval of aducanumab for treatment of Alzheimer's Disease.  See e.g., Recently Approved Alzheimer Drug Raises Questions that May Never Be Answered (JAMA Network, July 21, 2021).

As noted in Dr. Jason Karlawish's important new book, The Problem of Alzheimer's: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It, the number of Alzheimer's patients in the U.S. will rise to an estimated 13.8 million by 2025.  The caregiver market alone is searching desperately for answers, and it can be very hard to make individual decisions about risks and benefits without trustworthy information.  This is a tough time for what we might call a pandemic crisis about "trust."   

September 15, 2021 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Science | Permalink | Comments (0)

Tuesday, September 14, 2021

Highlights from Touro Conference on Aging, Health, Equity, and the Law (9.13.21)

Touro College's Jacob Fuschberg Law Center hosted a fabulous half-day, interdisciplinary program on Aging, Health, Equity and the Law.  Among the highlights:

  • A perfect kickoff with opening remarks on the theme of the conference from Syracuse Law Professor Nina Kohn, who outlined the civil rights of older persons, reminding us of existing laws and the potential for legal reforms;
  •  A unique "property law" perspective on the importance of careful planning about ownership or rights of use, in order to maximize the safety and goals of the older person, provided by Professor Lior Strahilevitz from University of Chicago Law School;  
  • Several sessions formed the heart of the conference by taking on enormously difficult topics arising in the context of Covid-19 about access to health care, including what I found to be a fascinating perspective from Professor Barbara Pfeffer Billauer  from her recent work in Israel. She started with an interesting introduction of three specific pandemic responses she's identified in her research. She then focused on how "Policy Pariah-itizing" has had a negative effect on health care for older adults, with examples from Israel, Italy, and China.  I was also deeply impressed by the candid presentations of several direct care providers, including nursing care professionals Esperanza Sanchez and Nelda Godfrey, about the ethical issues and practical pressures they are experiencing; 
  • Illinois Law Professor Dick Kaplan offered  timely perspectives on incorporating cultural sensitivity in Elder Law Courses.  His slides had great context, drawing in part from an article he published about ten years ago at 40 Stetson Law Review 15;
  • Real world examples about tough end-of-life decisions involving family members and/or formally appointed surrogates, with Deirdre Lock and Tristan Sullivan-Wilson from the Weinberg Center for Elder Justice leading breakout groups for discussions.

I know I'm failing to mention other great sessions (there were simultaneous tracks and I was playing a bit of leap-frog).  But the good news is we can keep our eyes out for the Touro Law Review compilation of the articles from this conference, scheduled for Spring 2022 publication.  I know it was a big lift to pull off the conference in the middle of the fall semester.  Thank you!

September 14, 2021 in Advance Directives/End-of-Life, Books, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, International, Property Management, Science | Permalink

Sunday, September 12, 2021

Front Page on the Sunday NY Times: "Phony Diagnoses" Used in Drugging at Nursing Homes

In a front-page Sunday article, Phony Diagnoses Hide High Rates of Drugging at Nursing Homes, The New York Times adds a subtle but important focus in providing its latest reports of a well known issue, the use of chemical restraints, including antipsychotic medications, to control behavior for people in long-term care settings.  The patients have been getting "new" diagnoses of schizophrenia, thus attempting to justify the sedation associated with major antipsychotic medications, such as Haldol, despite the fact that such medications are contraindicated for dementia patients. From the article:

In 2005, the Food and Drug Administration required manufacturers to put a label on the drugs warning that they increased the risk of death for patients with dementia.

 

Seven years later, with antipsychotics still widely used, nursing homes were required to report to Medicare how many residents were getting the drugs. That data is posted online and becomes part of a facility’s “quality of resident care” score, one of three major categories that contribute to a home’s star rating.

 

The only catch: Antipsychotic prescriptions for residents with any of three uncommon conditions — schizophrenia, Tourette’s syndrome and Huntington’s disease — would not be included in a facility’s public tally. The theory was that since the drugs were approved to treat patients with those conditions, nursing homes shouldn’t be penalized.

 

The loophole was opened. Since 2012, the share of residents classified as having schizophrenia has gone up to 11 percent from less than 7 percent, records show.

 

The diagnoses rose even as nursing homes reported a decline in behaviors associated with the disorder. The number of residents experiencing delusions, for example, fell to 4 percent from 6 percent.

As the news article reports, the challenges of caring for individuals with dementia are enormous, and lack of adequate staffing is certainly a reason why families and facilities use and misuse drugs to control -- restrain -- them.  But, at the same time, as I have written about on this Blog several times (see here, for example), the problem is not "just" about staffing ratios.    

Special thanks to Laurel Terry, Dickinson Law Professor Emerita, for ensuring I saw this latest article.  

September 12, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Science | Permalink | Comments (0)

Tuesday, August 31, 2021

NPR Morning Edition: "Antibody Tests Should Not Be Your Go-To for Checking COVID Immunity

Apparently I'm not the only person asking about the proper role of antibody tests in determining safety protocols during this current phase of COVID-19 infections.  This morning on NPR's Morning Edition program, a strongly expressed piece discounted the value of current antibody tests.  At the heart of the story was the following:  

[Washington University School of Medicine Immunologist] Ali Ellebedy says that having detectable antibodies from a blood test six months after vaccination "only means that your immune system mounted a successful response then and that you have immune memory."

 

While scientists have generated a "ton of data" on which antibodies are best at neutralizing the virus, Ellebedy says, the available antibody tests are not designed to specifically pick up whether you have enough of these protective antibodies, especially in the face of evolving variants.

 

And don't forget the immune system is more than just antibodies, so even with low detectable levels in your blood, you're not defenseless. "Antibody tests — it's really probing just one part of your immune system," says Elitza Theel, who directs the Infectious Diseases Serology Laboratory at the Mayo Clinic.

The NPR piece poses the question of whether a person can "learn anything" from antibody testing.  The piece says "Yes, as long as you don't expect it to give you a straightforward answer for how well-protected you are from catching the virus."  

For more, I recommend reading or listening (3 minutes) to the NPR segment entitled "Antibody Tests Should Not Be Your Go-To For Checking COVID Immunity."  The segment suggests that "the identity of a blood test that can eventually give consumers a reliable indication of their immunity is not far-fetched."  Okay.  But as I suggest in my previous post on this topic, are there communities available for antibody testing to further the identification of "correlates of protection" that aren't being tapped currently?  Could college and university communities and long-term care communities become part of the development of a reliable tool?  

 

August 31, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Saturday, August 28, 2021

United Kingdom to Begin Offering Home-Finger-Prick Tests for Covid-19 Antibodies

Yesterday, I wrote here about what I'm hearing about use of antibody testing in some long-term care facilities in Pennsylvania.  The more I read about antibody testing for COVID-19, the more I'm surprised by the state of the science and the level of apparent uncertainty about appropriate uses for such tests. 

I've read published articles suggesting multiple explanations for why such tests have not been widely used as part of the response to COVID-19 and variant infections including:

  • Lack of availability of commercially-based testing products 
  • Lack of reliable testing products
  • Lack of FDA protocols to establish reliable tests
  • Disagreements (or lack of clarity) over what level of antibodies should be considered "protective"
  • Concern that any test results could be misused 
  • Lack of easily administered tests, especially tests that would not require medically-trained persons for blood draws

See, for example, these two articles by John Hopkins Center researchers:  Rachel M. West et al, Antibody (Serology) Tests for COVID-19: A Case Study (May 2021); Rachel West, et al, COVID-19 Antibody Tests: A Valuable Public Health Tool with Limited Relevance to Individuals (November 2020). 

As a non-scientist I can understand some of these concerns for the first half of this pandemic, where the issue was whether and to what extent actual infection would provide protection against reinfection. But, with almost 9 months of publicly administered vaccines, it is troubling to think that there could still be concerns about reliability of antibody testing following those vaccinations. Can an illness be called a "breakthrough" infection if the level of immunity wasn't being tested?  Or rather, if the immunity status couldn't be reliably detected?  

In any event, as I dig deeper, it seems that the U.K. is moving forward this month (August 2021) to "begin offering COVID-19 antibody testing to the general public...for the first time" via a home-administered finger-prick test.  From a Reuters report that leans on other media sources:

The government's new programme is intended to produce data on antibody protections for people following infection by different coronavirus variants, according to details of the programme published by multiple media outlets, including Sky News and BBC.

 

From Tuesday, anyone aged 18 or over in England, Wales, Northern Ireland and Scotland, will be able to opt in to the programme when receiving a PCR test, Sky News reported.

 

Participants, on testing positive for COVID-19, will be sent two finger-prick tests to complete at home to inform the UK Health Security Agency of the antibody response to different coronavirus variants, BBC reported.

Again, I find it odd that the U.K. goal -- at least so far as this report -- is to determine level of antibody protections following "infections" rather than "immunizations." Why not both? Why not especially the latter?   I'd still like to think that the U.S. can better prioritize the need for any and all protective actions, including booster shots, through intelligent use of antibody testing. 
 
One of my new (and exciting) colleagues, Penn State Dickinson Law Assistant Professor Sara Gerke, is the lead author on an article discussing appropriate safeguards for implementation of employment-based antibody testing.  See Covid-19 Antibody Testing as a Precondition for Employment: Ethical and Legal Considerations, published Summer 2021 in The Journal of Law, Medicine & Ethics. The analysis begins with a series of important research-assumptions.  The authors "assume that there is an antibody test for COVID-19 on the market that is accurate and reliable with high specificity and sensitivity." They acknowledge "FDA authorized tests meeting a reasonable threshold of accuracy and reliability" are essential to establish an ethical basis for their use.  
 
So much of COVID-19 testing is happening in an unusually public context, with new information generated every day. The intensity of a pandemic response certainly affects research and treatment priorities.  Nonetheless, the fact that some facilities are using antibody tests to facilitate care decisions seems significant.  Could certain residential institutions offer -- encourage? -- voluntary testing for COVID-19 antibodies, especially after the administration of the first doses, and  both before and after any booster doses?  Could colleges and universities, assisted living centers and nursing homes, all places where people are likely to live, work, and play together in close quarters around the clock, be uniquely good platforms for important data generation?   Could these locations be making better priority-based decisions about protective measures that both help their customers stay safe and provide better information for the public at large? 

August 28, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Friday, August 27, 2021

Are LTC Residents "Telling" Us that Antibody Testing is Important for Covid-19 Prioritization for Boosters?

In recent weeks, I've spoken to or read about residents of long-term care facilities being tested for Covid-19 antibodies.  Some residents, without being ill, are showing low (or even "no") levels of antibodies, despite having been fully inoculated in the spring of 2021.  This doesn't mean there was anything wrong with the original vaccinations, but it does suggest that at least for older persons, the immunity reduces over time.   As a result of these test results, the facilities are recommending that families support getting booster shots for their loved ones. That strikes me as using scientific data appropriately, to help prioritize next steps in fighting the troublesome developments with Covid-19. 

Why aren't other institutions, including universities, seeking similar information about antibodies or lack thereof?   Does it "matter" that a faculty member -- or a student -- or an administrator -- or a staff member -- was "fully vaccinated" in, for example, February 2021, if they aren't still "protected" in September 2021?  

Here's what I know so far:

  • My own health insurance company requires a "doctor's order" to permit an antibody test to be covered for reimbursement.
  • My local pharmacy advertised last spring that its onsite clinic would be offering antibody tests.  I learned recently, however, that it never actually set up that program.  The pharmacist I talked with didn't know why that decision was reversed.
  • My regular physician said I could sign up for a booster shot approximately 9 months from my last of the two-shot original vaccination, and said that therefore I didn't need an antibody test.
  • My insurance company asked whether I had a known exposure to Covid-19, implying that if the answer was yes, they would cover testing for a breakthrough-Covid infection, but not for antibody testing unless I had a doctor's order.

I realize one personal anecdote isn't evidence of much of anything.  But, is nursing home data already being generated that suggests antibody testing can supply relevant facts, perhaps facts that are "more" relevant than simply a history of immunization?     

 

August 27, 2021 in Consumer Information, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Monday, August 23, 2021

Nurse Robots?

There have been stories of late about shortages of nurses, for various reasons. For example, NPR reported, Hospitals Face A Shortage Of Nurses As COVID Cases Soar. So, then a dear friend and colleague of mine today sent me a link to this story: Meet Grace, the ultra-lifelike nurse robot.  Grace, developed by a robotic company in Hong Kong, is "a humanoid robot it hopes will revolutionize healthcare.... Designed as an assistant for doctors, Grace is equipped with sensors, including a thermal camera to detect a patient's temperature and pulse, to help doctors diagnose illness and deliver treatments....The android is a companion for patients, too. Specializing in senior care, Grace speaks three languages -- English, Mandarin, and Cantonese -- and can socialize and conduct talk therapy."  The company expects to start large scale production of this robot and another robot by year's end. The article notes that this robot is attended to assist, not supplant, health care providers.  There's an accompanying video, which includes a brief clip of the robot showing Tai Chi moves to the reporter.  The robot at one point responds that her specialization is in "senior care." I don't know what the cost will be of such a robot and what patient load it can handle. Plus, I'm not sure about the lack of human connections in caregiving.  We'll have to wait to see whether the robot is at least a partial solution to the caregiving and nursing shortages.

 

August 23, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, International, Science | Permalink | Comments (0)

Wednesday, August 18, 2021

When Do You Start To Get "Old"?

There was a bit of a buzz last week with the publication of a new study about metabolism.  What We Think We Know About Metabolism May Be Wrong explains the recent study: "[u]sing data from nearly 6,500 people, ranging in age from 8 days to 95 years, researchers discovered that there are four distinct periods of life, as far as metabolism goes. They also found that there are no real differences between the metabolic rates of men and women after controlling for other factors."

We probably only think about our metabolisms when we are trying to lose weight. But as the article explains, the implications are far beyond weight gain and loss.

Central to [the researchers'] findings was that metabolism differs for all people across four distinct stages of life.

  • There’s infancy, up until age 1, when calorie burning is at its peak, accelerating until it is 50 percent above the adult rate.

  • Then, from age 1 to about age 20, metabolism gradually slows by about 3 percent a year.

  • From age 20 to 60, it holds steady.

  • And, after age 60, it declines by about 0.7 percent a year.

For us in elder law, here  is the point: "And around age 60, no matter how young people look, they are changing in a fundamental way...'There is a myth of retaining youth, [one expert said] That’s not what the biology says. In and around age 60, things start to change. ... There is a time point when things are no longer as they used to be.'"

Thanks to Professor Naomi Cahn for sending the link to the article.

 

August 18, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Science, Statistics | Permalink | Comments (0)

Wednesday, August 4, 2021

Nursing Homes & Covid: Here We Go Again?

Another surge, another rise in COVID in SNFS? According to a recent article in the New York Times, Nursing Homes Confront New Covid Outbreaks Amid Calls for Staff Vaccination Mandates, the cases are rising.  Featuring one company, the article notes

The case count has ticked up again: It’s still below 100 among residents and staff, the company said, but includes many breakthrough cases of vaccinated residents testing positive. Then last week, two vaccinated residents died with Covid .... The company said it had pinpointed the cause of the spread there and at other of its facilities: The breakthroughs had happened in the same homes where unvaccinated staff were testing positive, seemingly carrying the virus into the home from the community.

The company recently announced it was requiring all staff to be vaccinated, the article notes.  As we all know, vaccine mandates are controversial.

Growing calls for vaccine mandates among health care workers have gained urgency but also met resistance in the nursing home industry, where some homes say it will cost them staff members in an industry already plagued with high turnover. Only about 60 percent of nursing home staff members are vaccinated, and some states report an even lower rate, with less than half inoculated, according to the most recent government data.

Staff immunization has been an issue in many states, especially as the highly contagious Delta variant races through regions with low vaccination rates. Some states and cities, not waiting for the nursing home industry, are imposing their own mandates for vaccinations on long-term care employees or operators may face penalties or additional testing requirements for unvaccinated staff.... 

Some states have reinstated visitation restrictions and the CDC is monitoring the number of cases. The article goes on to discuss in depth the issues surrounding a vaccine mandate, with some states requiring frequent testing in lieu of adopting a mandate.  Looks like we are going to be dealing with this through the end of 2021. I go over with my students a list of questions regarding choosing a nursing home. I'm adding "how many of your staff and residents are vaccinated again COVID" to the list. 

August 4, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other, Science | Permalink | Comments (1)

Monday, July 19, 2021

Heat Wave Impact on Elders

We have all heard about the shockingly high temperatures out west.  The full impact is yet to be determined, but it is a life-threatening event.   Most Oregon heat wave victims were elderly, had no central AC gave us some data about this tragedy.

preliminary report by Oregon’s ​Multnomah County found that a majority of the deaths reported during the record-breaking heat wave that began late last month were elderly men who lived alone and did not have central air conditioning....In Portland, which is in Multnomah County, from June 25 and June 28 the city reached triple-digits, even hitting a high of 116 degrees...The report examined deaths from June 28 through July 9. The Multnomah County Medical Examiner’s Office suspected hyperthermia in 71 deaths during this time. The report examined 54 cases where deaths were formally ruled as hyperthermia....Of those 54 deaths, 81.5 percent were ages 60 and older and 90 percent were white. The preliminary data states that 63 percent were males and 78 percent lived alone.... No one who died had central air.  (emphasis added)

With climate change, this isn't the first environmental tragedy, nor will it be the last.  

July 19, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Tuesday, June 8, 2021

In Search of the Abracadabra for Alzheimer's Medicines

I used to follow (and regularly blog about) new drugs in the pipeline for Alzheimer's treatment.  Then I realized that the drugs weren't making it to the market place.  While attending medical programs about R & D, I learned that it was going to be tough to find any magic treatments, much less "cures."

To it was interesting to read this week that for the first time in some 18 years,  the FDA has approved use of a new drug, with the marketing name  Aduhelm and the generic name Aducanumab  (kind of sounds like abracadabra, doesn't it?), manufactured by Biogen.   

Aduhelm is described by the FDA as an "amyloid beta-directed antibody," which was approved under an "accelerated approval pathway," to give "patients suffering from a serious disease earlier access to drugs when there is an expectation of clinical benefit despite some uncertainty about the clinical benefit of the drug." 

But there is a lot of sobering news accompanying this announcement:

First, the mechanism of delivery:  monthly intravenous infusions, which means a clinical visit lasting at least an hour per infusion.

Second, Biogen's own predictions about cost:  a "list price" predicted to average  $56,000 per year per patient!  Yikes.

Third, the critical response from a range of experts in relevant research, pharmacy and health fields about the approval process to date, indicating a history of interruptions in the clinical trials when preliminary results showed little to no evidence of clinical benefit. 

Fourth:  the need for assessment before the first infusion with an MRI, plus recommended follow up MRIs prior to the 7th and 12th infusions, to assess the potential for ARIA-H, which are amyloid-related abnormalities, also potentially associated with edema in the brain.

Here are some links (and I'll try to keep this list up-to-date as new info comes in):  

Draft Evidence Report dated 5/5/2021 from the Institute for Clinical and Economic Review on "Aducanumab for Alzheimer's Disease: Effectiveness and Value." 

Letter from American Geriatrics Society dated 6/2/2021 to FDA expressing concern about "premature" approval

STAT's commentary, dated June 7, 2021 on FAQs: What You Need to Know about the Alzheimer's Drug Aduhelm

New York Times, dated June 8, 2021:  FDA Approves Alzheimer's Drug Despite Fierce Debate Over Whether it Works

June 8, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Science, Statistics | Permalink | Comments (0)

Thursday, December 24, 2020

Hugs in Time for Christmas

A couple of days ago, the Washington Post ran an uplifting article about a hug room in a SNF.  After months of isolation, a ‘hug room’ lets Italian nursing home residents touch family for the first time tells us about "a 7-foot-tall piece of plexiglass, molded into a three-sided booth. It had four cutout holes, where protective sleeves would be added for arms. It was known, in the strange language of the pandemic, as a “hug room,” but it was less a room than a barrier: residents on one side, relatives on the other."  Although not as ideal as living in a COVID free world (or at least a vaccinated one), this "plexiglass represented the sort of modest step some nursing homes are now taking in a year when they have faced excruciating decisions about how protective to be and how best to reduce their risks."  The article references similar efforts taken by other SNFs.

A  little bit of good news, then, for Christmas.

PS: Florida announced that the second round of vaccines will go to those 70 and older, and Texas, to those 65+ and older.

PPS-remember to thank first responders, health care professionals and all who keep us safe and going through this trying time. Stay safe and stay healthy.

 

December 24, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International, Science | Permalink | Comments (0)

Monday, October 26, 2020

Weakened Memory Recall: Leading to Remembering?

Scientific American ran an article, Helping Alzheimer’s Patients Bring Back Memories Targeting recall processes could let people who are in the disease’s early stages access what they currently can’t remember.

People of all ages have moments when it feels like we’re on the edge of recalling something but can’t quite do it—where we parked our car or left our phone, for example, or what name goes with that familiar face. It’s extremely frustrating in the moment, but for most of us, we can usually remember if we try. For patients with Alzheimer’s, Huntington’s and many other dementia-causing diseases, however, memory loss is much more profound.

The article discusses two theories regarding memory loss: “one is that these patients can’t store new information properly in the brain; the other is that their ability to recall stored information has been weakened.”   The author discusses his research and how that led him to support the “weakened memory recall idea.”

The author uses great analogies to help the reader understand the science of the disease and the work. The author notes that there is a lot yet to know, “but what’s clear is that we need to take advantage of targeting recall to help treat patients in the near future.” 

Thanks to my colleague and friend, Professor Feeley, for sending me this article.

October 26, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Other, Science | Permalink | Comments (0)

Friday, October 23, 2020

Forgetting a Word Doesn't Mean Dementia

Ever find yourself saying, "what was their name again? It's on the tip of my tongue."  Then do you worry that you have dementia because you can't remember the word? The Washington Post tackled this in a recent article,  Dementia is more than occasionally forgetting a name or a word.

First, it is important to know that dementia cannot be diagnosed from afar or by someone who is not a doctor. A person needs a detailed doctor’s exam for a diagnosis. Sometimes, brain imaging is required.

And, forgetting an occasional word — or even where you put your keys — does not mean a person has dementia. There are different types of memory loss and they can have different causes, such as other medical conditions, falls or even medication, including herbals, supplements and anything over-the-counter.

There is normal age-related memory loss, and the article emphasizes that such memory loss is normal! Let’s distinguish from memory loss that is not normal---“forgetting the name of someone you see every day; forgetting how to get to a place you visit frequently; or having problems with your activities of daily living, like eating, dressing and hygiene….When you have troubles with memory — but they don’t interfere with your daily activities — this is called mild cognitive impairment. Your primary care doctor can diagnose it. But sometimes it gets worse, so your doctor should follow you closely if you have mild cognitive impairment.”

The article offers the CDC's  quick bullet-point list of warning signs for specific domains when forgetfulness is more than just normal age-related memory loss:

  • Memory.
  • Attention.
  • Communication.
  • Reasoning, judgment and problem solving.
  • Visual perception beyond typical age-related changes in vision.

Although Alzheimer’s is the dementia that most often comes to mind, the article reminds us that there are several types of dementia.  The article provides a good overview of the issues that arise from dementia and concludes with this thought-provoking observation:

But even more frightening is unrecognized or unacknowledged dementia. You must, openly and honestly, discuss changes you notice in your memory or thinking with your doctor. It’s the first step toward figuring out what is happening and making sure your health is the best it can be.

And, as with any disease or disease group, dementia is not a “character flaw,” and the term should not be used to criticize a person. Dementia is a serious medical diagnosis — ask those who have it, the loved ones who care for them or any of us who treat them.

October 23, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Wednesday, September 16, 2020

COVID and SNFs: Deaths Preventable?

The New York Times asked the hard question, whether COVID deaths in SNFs were preventable, in a recently published opinion from the editorial board. How Many of These 68,000 Deaths Could Have Been Avoided?

Around 40 percent of all coronavirus-related deaths in the United States have been among the staff and residents of nursing homes and other long-term care facilities — totaling some 68,000 people.

Those deaths were not inevitable. The novel coronavirus is adept at spreading in congregant living facilities, and older people face an increased risk of contracting and dying from it. But most of the nation’s nursing homes had months of warning about the coming threat: One of the first coronavirus outbreaks in the country was in a nursing home near Seattle, making it clear that such facilities ought to prepare.

The opinion discusses steps SNFs could have taken to reduce the chances of spread, the financial model for SNFs in the US. The opinion also discusses the reduction of oversight and notes

Every effort should be made to ensure that the bulk of the money that the government puts into this industry goes to patient care, not providers’ pockets. An investigation started by the House of Representatives into the nation’s largest for-profit homes is a meaningful step in this direction. The Justice Department should follow suit.

The opinion discusses the way SNFs get supplies for their PPEs, etc. as well as staffing shortages. The editors conclude with 3 recommendations

In the near term, lawmakers should provide for hazard pay for nursing home workers in the next relief package and should require all nursing homes to enact non-punitive sick-leave policies so that workers don’t infect colleagues or residents.

In the longer term, federal officials need to consider revising Medicaid reimbursement rates for long-term care so they support higher than minimum-wage salaries, and shifting reimbursement policies so at least some long-term care can be reimbursed with Medicare dollars.

Lawmakers and nursing home operators also would do well to consider a national initiative, perhaps involving student volunteers and internship programs, to recruit future workers to nursing home care. That work, which can be deeply rewarding, will remain urgently needed long after this crisis passes.

September 16, 2020 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Science | Permalink | Comments (0)

Friday, September 11, 2020

Legal Issues in Using AI for Caregiving

Computer Weekly recently addressed the legal issues that may occur when using technology for caregiving AI may be a solution to the social care crisis, but what are the legal concerns?,  looks at the caregiving situation in the U.K.  Building on the story from yesterday about the robot "Pepper" who can carry on conversations, the article highlights some legal issues, such as an individual's privacy. 

Consider this-the robot could report concerns about abuse, for example, "the technology might provide a report, supported by video evidence, to family members or those with the legal responsibility of care, such as attorneys or deputies, who can then review such material. It can easily become part of a care home contract to consent to such filming, although it is vital that this is handled in a sensitive manner and regularly deleted to ensure that a resident’s privacy is protected." The article notes concerns about "sensitive personal data." Would residents provide consent? Who would consent if a resident lacks capacity. As the article concludes, "[W]e must never forget who is at the heart of these considerations, and the legal framework needs to catch up with the technology to protect them and for it to have a viable chance of success."

Thanks to Professor Feeley for sending me this article.

September 11, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International, Other, Science | Permalink | Comments (0)