Do self management programs work for older seniors?

Self-management programs are an effective means of improving the ability of older adults to carry out daily activities according to a study by van Het Bolscher-Niehuis MJ, den Ouden ME, de Vocht HM, Francke AL. Effects of self-management support programmes on activities of daily living of older adults: A systematic review published in the International Journal of Nursing Studies.

The researchers asked the following question, What are the effects of self-management support programs on the ability of older adults to perform important daily activities?

The reason for the study is that older adults living in the community often face health challenges that impair their ability to carry out important daily activities (e.g., eating, bathing, dressing). In addition, older adults living in the community are seldom given specific instruction on how to manage their own daily activities when dealing with chronic conditions and other health problems. So, a review was done to assess the effectiveness of self-management programs in improving the ability of older adults to carry out daily activities.

The researchers completed a detailed search of five electronic databases was conducted for studies published up to and including February 2016. Studies that focused on community-dwelling adults aged 65 years or older, self-management support programs, and outcomes relating to the performance of daily activities were included in the review.  They reviewed a total of 5,220 studies were identified in searches and decided to include 10 in the review after assessments for eligibility.

What the researchers found that self-management support programs may prevent or delay the decline the ability of older adults to perform daily activities. The authors reinforced the idea that effective self-management support interventions had a multi-component structure, contained disease-specific information, and included personalized instruction and feedback for older adults.

Conclusion

This review found that self-management support programs improve the ability of older adults to perform important daily tasks, such as eating and bathing. More evidence is required to identify whether self-management support programs should be taught in group or individual settings and whether they should be delivered with or without usual care programs.

We live in a time

We live in a time when politics are shaped by extremes, and chaos seems to unfold in a polarized world.

You probably won't believe this, but I'm as powerless as you when it comes to living other people's lives.

On the other hand, you are as powerful as I am when it comes to living your own life. 

You decide what's meant to be. You can have anything you want and everything is possible – whether you lean left or right, are on the top or bottom 1%, read the fake news, or dispense covfefe.

Don't give away your power waiting to see what happens to the rest of the world, when you can decide what will happen in yours.

Falls can be dangerous to your health

More than half of elderly patients (age 65 and older) who visited an emergency department because of injuries sustained in a fall suffered adverse events - including additional falls, hospitalization, and death - within 6 months. 

The results of a study examining how risk factors predict recurrent falls and adverse events were published online in Annals of Emergency Medicine.

This study shows an even higher rate of adverse events than previous studies have, patients taking psychiatric and/or sedative medications had even more adverse events. This is concerning because these types of drugs are commonly prescribed for elderly patients in the community and residential care settings.

Of patients who visited the emergency department for injuries sustained in a fall, 7.7 percent developed adverse events within 7 days, 21.4 percent developed adverse events within 30 days and 50.3 percent developed adverse events within 6 months. Within 6 months, 22.6 percent had at least one additional fall, 42.6 percent revisited the emergency department, 31.1 percent had subsequent hospitalization and 2.6 percent had died.

Risk factors associated with adverse events within 6 months of an emergency department visit for a fall included diabetes, polypharmacy (five or more medications), and psychiatric and/or sedative medications.

"Emergency physicians have a tremendous opportunity to reduce the very high adverse event rate among older emergency patients who have fallen. Fall guidelines exist and work needs to be done to increase their implementation in emergency departments so patients can be educated on how not to fall again once they have been discharged from the emergency department.

Prostate cancer: PSA screening does lower death risk, says review

A few days ago I posted about PSA screening for Prostrate Cancer which recommended against using this particular screen. The information came from the Canadian Task Force on Preventative Health. They do not recommend the PSA be used for screening for Prostate cancer. However, today I read a study that takes another position, so I thought I would share so you could make a more informed decision when you talk to your doctor about this test.

The PSA test is a blood test that is commonly used to detect possible prostate cancer. Elevated PSA levels may indicate the presence of prostate cancer, but can also be caused by other common non-cancer related conditions such as an enlarged prostate (also known as benign prostatic hyperplasia or BPH) or inflammation of the prostate gland (also known as prostatitis) due to an infection or other cause.

The study authors note that the guidelines for PSA screening were largely based on the results of two studies: the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO).

While results from the ERSPC suggested that PSA screening is linked to a reduction in prostate cancer-specific mortality, results from the PLCO showed that the screening offers no such benefit.

On reviewing these two studies with a mathematical model, however, the researchers found that they both demonstrated evidence of a significant reduction in prostate cancer death as a result of PSA screening.

For each study, the researchers compared the risk of prostate cancer death between men who did and did not undergo PSA screening.

Using their mathematical model, the team was able to account for differences in how each study was implemented, as well as any variations in practice settings.

When accounting for these differences, the researchers found that both studies showed that PSA screening is associated with a significant reduction in the risk of death from prostate cancer.

Based on these findings, the team suggests that current guidelines advising against screening for prostate cancer should undergo review.

However, each of is unique and I would recommend that you talk to your doctor about this test.

 2. Why does the CTFPHC recommend against PSA screening for prostate cancer?

The CTFPHC recommends against PSA screening because they found that the potential harms of screening outweigh the benefits.