Thursday, December 28, 2006

Communication tips for doctors

"As baby boomers increase in age, the face of the American population will change dramatically. By the year 2030, a projected 71 million Americans will be age 65 or older, an increase of more than 200 percent from the year 2000, according to the U.S. Census Bureau. It's estimated that some 6,000 people turn age 65 every day and, by 2012, 10,000 people will turn age 65 every day."

This is the opening paragraph of an article in the Family Practice Management journal, Sept. 2006. As you and/or your parents age, you might be getting less face time with your doctor. The article suggests tips for the doctors, but it also alerts us patients to the problems.

Here's the summary, but stop and read the whole article.

1. Allow extra time for older patients.

2. Minimize visual and auditory distractions.

3. Sit face to face with the patient.

4. Don't underestimate the power of eye contact.

5. Listen without interrupting the patient.

6. Speak slowly, clearly and loudly.

7. Use short, simple words and sentences.

8. Stick to one topic at a time.

9. Simplify and write down your instructions.

10. Use charts, models and pictures to illustrate your message.

11. Frequently summarize the most important points.

12. Give the patient a chance to ask questions.

13. Schedule older patients earlier in the day.

14. Greet them as they arrive at the practice.

15. Seat them in a quiet, comfortable area.

16. Make signs, forms and brochures easy to read.

17. Be prepared to escort elderly patients from room to room.

18. Check on them if they've been waiting in the exam room.

19. Use touch to keep the patient relaxed and focused.

20. Say goodbye, to end the visit on a positive note.

Saturday, December 16, 2006

Keep your eye on your eyes

"About 41% to 46% of adults aged 50 years and older have not had a dilated eye examination and 30% to 35% have not visited an eye-care professional during the past year, according to data from 5 states that participated in the new CDC Behavioral Risk Factor Surveillance System (BRFSS) vision module during 2005.

The study also found that whereas annual dilated eye examinations are recommended for patients with diabetes and individuals aged 65 years and older, 44% of those aged 60 to 69 years and 32% of those aged 70 to 79 years had not been tested in the preceding 12 months.

Moreover, approximately 50% of those who had not visited an eye-care professional during the preceding year said that they had no reason to go. Twenty percent cited cost/insurance as the cause. The apparent lack of concern regarding the need for preventive eye care remains a major public health concern, according to the CDC."

Reported at Medscape.com from this CDC report.

Sunday, December 10, 2006

Do you take low dose aspirin?

Many people take low dose aspirin daily. I was born with an extra circuit in my heart which over the years caused atrial fibrillation. It was ablated (zapped) a few years ago, I was on medication for awhile, and now I just take a 81 mg aspirin once a day (a blood thinner). A-fib puts you at risk for a stroke.

I noticed an article in the Berkeley Wellness Letter on, "Should Your Aspirin Wear a Coat." I guess I thought a coated aspirin would be better, but according to this article, that's not necessarily true. It depends on why you're taking it. The coating can prevent quick pain relief. In my case, it doesn't matter if it takes an hour or so longer to work, so you need to always check with your doctor before starting any regular use of aspirin.

The article points out some things about aspirin I didn't know. Go to the archive of UC Berkeley Wellness Letter, and click on December 2006.

Saturday, December 09, 2006

Age and Beauty

In a very interesting Washington Post article that claims we are hard wired in our perception of beauty, David Von Drehle concludes with an epilogue about age.

"Our era is sexually candid but chronologically dishonest. A recent ad for anti-wrinkle cream in a major fashion magazine employed a model who appeared to be in her teens. Countless ads for men's underwear feature slim bodies, taut as a Renaissance Saint Sebastian. The skivvies, bulging like a one-pound bag toting a two-pound puppy, shout all man. But the inevitably hairless bodies whisper still boy. The most widely circulated magazine in the country is published by the AARP; its standard cover image is a movie star or other celebrity who has managed, with the help of a stylist and modern technology, to look 20 years younger than the truth.

If today's Americans are uniquely obsessed, it's not with beauty, but with youth. The aging baby boomers who have shaped so much popular culture for such a dreadfully long time are now pondering age spots, varicose veins, worry lines and droopy breasts. Vogue's August effort was titled "The Age Issue," but it could have been called "The Fear of Age Issue." Along with the article on cosmetic surgery for feet, ("I will always feel young as long as I can wear heels"), the magazine promoted human growth hormone for "an ageless body," detailed the merits of vascular surgery for younger-looking legs ("the bruises have faded almost completely within two weeks") and explained why a 48-year-old woman decided to get braces on her teeth -- for the second time.

"How sad it is!" lamented the handsome young Dorian Gray. "I shall grow old, and horrible, and dreadful. But this picture will remain always young. It will never be older than this particular day in June." As Oscar Wilde knew, an aging person's obsession with looking young has less to do with beauty than with the realization that beauty dies.

Time waits for no one, no matter how many sets of braces one wears. The struggle to preserve the physical bloom, whether through single-minded obsession or through artifice, is a fight that can never be won, for human beings are made of flesh, not stone."

Friday, December 08, 2006

Mediterranean Diet and the Risk for Alzheimer's Disease

You've probably seen reports or summaries of this article by Nikolaos Scarmeas, MD and others, which appeared in the June 2006 Annals of Neurology (2006;59:9212-921). I can't think of another health problem that is more distressing to contemplate as we age than Alzheimer's Disease. The Mediterrean Diet is characterized by high intake of vegetables, legumes, fruits and cereals, unsaturated fatty acids (mostly in olive oil), and moderate high intake of fish, with low to moderate intake of dairy products (cheese or yogurt), and low intake of meat and poultry, plus wine during meals.

When you think about it, our own mothers didn't think there was any single miracle food--at least not back in the 40s and 50s. The fad diets started later. I'm not sure my mother ever said, "Eat all the colors," but that was the implication. We always had meat, potatoes, vegetables and fruit, with a light dessert, and the snacking was kept very simple. We had fresh fruits and vegetables when they were in season in northern Illinois, and home canned when they weren't. Potatoes, lettuce, peas, corn, beets, etc. came from the garden beside our house. Eggs and milk were purchased locally.

From reading this article it would seem we get too caught up in focusing on a single nutrient or eating plan and forget the big picture. They decided to study dietary patterns of a region or people rather than a self-selected group that volunteered to change their eating patterns. For instance, if I decide to try the "Mediterranean Diet" living in Columbus, OH, the results will be biased toward someone who's had other health benefits, or detriments. We don't really know how it would have affected me differently if I were 20 years younger, or if I'd never had HRT.

The researchers' conclusions after doing a community based study of 2,258 nondemented individuals in NY (details how they found them in the article): "Higher adherence to the MeDi was associated with significantly lower risk for development of AD." It's a very interesting study that deserves more attention and further research.

There is a follow up study reported in the October issue of the same journal