Posts Tagged ‘geriatrics’

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20% Discount on Vitamins, Eyeglasses and Diapers for Seniors

Saturday, July 10th, 2010

The newly signed Expanded Senior Citizens Act 0f 2010, RA 9994 includes discounts for vitamins, minerals, diapers, and essential medical supplies. This includes Calcium for osteoporosis, Iron tablets for anemia, and B complex for patients with neuropathy.

However, the DOH and FDA have clarified that discounted drug and medicine purchases, now extend to vitamins and minerals specifically prescribed by doctors for senior citizens for purposes of prevention, treatment, or diagnosis of a disease or illness. This excludes those classified as “food supplements with no approved therapeutic claim”.

This law also mandates that DOH is to provide free pneumoccocal and influenza vaccines to indigent senior citizens.

Moreover, the 20% discount also extends to the purchase of essential medical supplies, accessories or equipment like eyeglasses, dentures, hearing aids, walkers or wheelchairs, and even to geriatric diapers.

Wheelchair

Wheelchair

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Medical Profession Needs to Prepare for the Rapidly Growing Elderly Population

Thursday, June 17th, 2010

The Philippines needs to prepare for the burgeoning population of older persons. The population 60 years and above has grown at a very rapid rate, increasing from 3.2 million in 1990 to 4.6 million in 2000. By the year 2030, ten percent of our population will be composed of senior citizens. The National Institutes of Health (NIH) study “Status of Geriatric Education in Philippine Medical Schools” presented during the NIH Forum 17 June 2010, looked at how Geriatrics (the study of health and disease in old age) is taught in Philippine Medical Schools and the perception of graduating medical students on how well they can take care of old patients after receiving their MD diplomas.

The study revealed that most medical schools do have Geriatrics as part of a required course and 61% enjoy institutional support for developing said course. However, although 70% of the graduating medical students believe they are prepared to take care of the elderly in outpatient clinics and hospitals, only 61% of their teachers think they possess the necessary KAP (knowledge, attitude and practice) for such a job!

Some of the contributors to the lack in KAP of fresh graduates include the crowded medical course schedule and the lack of a curricular map of subjects that teach them how to take care of the elderly. Medical students learn the basics during the first three years of med school (classroom) but may not possess the skills in the final clinical years called internship (hospital exposure). The lack of clinical teachers and researchers were also identified as obstacles to the development of a good Geriatric program.

This study also contains recommendations as to how the situation can be rectified; how we can mold our future doctors into providing excellent and compassionate healthcare for the elderly. We can begin by increasing the number of doctors that are trained and dedicated to teaching, and by establishing a well mapped curriculum in Geriatrics. We also need to support researches that lead to improvement of the health and quality of life of the aging Filipino. The Association of Philippine Medical Colleges, DOH, DSWD, NIH and CHED can help lead this change.

About the NIH and Aging Study Group:

The National Institutes of Health (NIH) was created on January 26, 1996 by the UP Board of Regents as an institutional home of a network of various research and extension units specializing in health and socio-biomedical concerns. This thrust is consistent with the country’s vision of “Health for All”.

Currently, the NIH has various research institutes and active study groups that continue to develop and produce outputs that serve as vital guideposts in shaping national programs and policies. The Aging Study Group and the Committee on Aging and Degenerative Diseases (COMADD) has contributed greatly to current clinical and educational programs and policies on Aging. The vision of COMADD is “The Filipino elderly enjoying a healthy body, mind and spirit, being treated with dignity, and valued as a productive member of society, in a dynamic process unique to himself, and beginning a life of unlimited possibilities”.

Principal Investigator:
Shelley F. de la Vega, MD., MSc
Chair, Aging Study Group
Institute of Health Policy and Development Studies
UP Manila-NIH

Co-Investigators:
Jose Alvin Mojica, M.D., MHPEd
Chair, Department of Rehabilitation Medicine
Philippine General Hospital

Josephine Agapito, PhD
College of Arts and Sciences
UP Manila

Click here to view related post in Manila Bulletin Online

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Preventing Alzheimer’s Part 1: The NIH Consensus 2010

Tuesday, May 4th, 2010

Part 1: Supplements and Medicines for Alzheimer’s Prevention

Available scientific evidence is inadequate to conclude that any known preventive strategies are effective. This conclusion is based on a review of published literature of randomized, controlled trials (RCTs), the most rigorous, highest quality evidence.

Summary of Detailed Interventions:
1. Vitamins, Nutrients, and Dietary Supplements.
Vitamin E – no evidence that this factor altered the onset of the Alzheimer’s disease.

Gingko biloba – A recent, large long-term RCT showed no reduction in the incidence of Alzheimer’s disease, leading to the conclusion that there is not sufficient evidence to support the efficacy of gingko biloba.

2. Medications
Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) – this class of drugs is not effective in preventing Alzheimer’s disease.

Anti-hypertensive medications – negative with insufficient evidence for protection against Alzheimer’s disease.

NSAIDs—rofecoxib, naproxen, and celecoxib—suggest an increased incidence of Alzheimer’s disease with treatment.

Conjugated equine estrogen, one combined with methyl progesterone – suggest an increased incidence of dementia (including Alzheimer’s disease) with treatment.

Together, these trials suggest that no known medication can be said to reliably delay the onset of Alzheimer’s disease.

Source: NIH State-of-the-Science Conference:
Preventing Alzheimer’s Disease and Cognitive Decline
April 26–28, 2010

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Tips to Reduce Clutter and Hoarding

Sunday, March 28th, 2010

Hoarding

Some people will hoard or save numerous items, including dirty clothes, food, and papers. Losing a meaningful role in life, work, friends, family, and a good memory can have an impact on a person’s need to hoard and or to “keep things safe”. Hoarding in this population is oftentimes triggered by the fear of being robbed.

When working with persons who have dementia, it is essential that you keep their safety in mind. Order, routine and simplicity are most helpful. A house or room that is relatively uncluttered is the ideal environment.

Ten Tips to Consider

1. Let go of ideal notions of cleanliness. Your patient may value items that appear to you as worthless. Parting with their belongings (even used paper cups) can cause severe emotional distress.

2. Ask your patient if they can donate or sell their belongings to charity.

3. Focus on fall prevention. Create pathways free of debris, loose cords or slippery rugs. Some frail patients hold onto furniture or other items while moving through the room; preserve their “props” until other assistive devices (canes, walkers) can be introduced.

4. Focus on fire prevention. Red flags include newspapers stored on top of or inside a hazardous area.

5. Be creative and negotiate. Consider photographing belongings, as this may help the patient part with things and preserve memories.

6. Begin by reorganizing a small corner of a room, a single table, or just a section of the table.

7. Have a friend or relative present during a major cleanout, preferably one who already has a supportive relationship with the patient. Clean-outs can be overwhelming to people with severe hoarding behavior. Have a back-up plan in case emergency psychiatric services are needed.

8. Discuss how to safeguard valuables in the cleaning process. Have a written contract. Agree on what to do with valuables that turn up, such as money, jewelry, or collectibles.

9. Consider relocating an individual to a new room if the clutter is the result of physical or mental frailty. A new environment can provide a fresh start and enable the patient to receive needed services sooner.

10. Plan for on-going maintenance and supervision to maintain a decluttered environment.

Adapted From: Weill Medical College of Cornell University

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Protect Seniors from Heat Stress

Tuesday, March 9th, 2010

Heat exhaustion is a form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids.

Warning signs vary but may include the following:

* Heavy sweating
* Paleness
* Muscle Cramps
* Tiredness
* Weakness
* Dizziness
* Headache
* Nausea or vomiting
* Fainting
* Skin: may be cool and moist
* Pulse rate: fast and weak
* Breathing: fast and shallow

To protect yourself from heat stress and heat stroke, follow these tips:

# Drink cool, nonalcoholic beverages. (If your doctor generally limits the amount of fluid you drink or has you on water pills ex. furosemide or hydrochlorothiazide, ask him how much you should drink when the weather is hot. Also, avoid extremely cold liquids because they can cause cramps.)
# Rest.
# Take a cool shower, bath, or sponge bath.
# If possible, seek an air-conditioned environment. (If you don’t have air conditioning, consider visiting an air-conditioned shopping mall or public building to cool off.)
# Wear lightweight clothing.
# If possible, remain indoors in the heat of the day.
# Do not engage in strenuous activities.

seniors swim
If you are living with or taking care of an older person

* Visit older adults at risk at least twice a day and watch them for signs of heat exhaustion or heat stroke.

* Encourage them to increase their fluid intake by drinking cool, nonalcoholic beverages regardless of their activity level.

Warning: If their doctor generally limits the amount of fluid they drink or they are on water pills, they will need to ask their doctor how much they should drink while the weather is hot.

* Take them to air-conditioned locations if they have transportation problems.

If You Don’t Have Air Conditioning:
• Take a cool shower, bath or sponge bath.
• Create cross-ventilation by opening windows on two sides of your house.
• Keep windows open at night.
• Keep curtains, shades or blinds drawn during the hottest part of the day.
• Cover windows when they are in direct sunlight.
• Electric fans may help, but when the temperature reaches the high 90s, fans won’t prevent heat-related illness.
• Go somewhere that’s air-conditioned like the shopping mall, the movies, the library, a senior center or a friend’s house. If you don’t have a car or no longer drive, ask a friend or relative to drive you. If necessary, take a taxi. Don’t stand outside waiting for a bus.

More heat stroke and heat stress information from the CDC link: Centers for Disease Control and Prevention USA

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Pandemic Flu H1N1 Vaccination 2010

Saturday, February 20th, 2010

The flu pandemic is not over.
The 2009 AH1N1 influenza virus continues to be the dominant influenza virus in circulation in the world. Based on historical data, pandemics are characterized by several successive waves, potentially more impactful (e.g. 1968 pandemic). Compared with seasonal flu, the proportion of severe / deadly cases in previously healthy and young subjects is substantially higher. Although fewer older persons were infected with the pandemic AH1N1 virus, paradoxically, infected older people will experience the highest rates of severe disease and death of any age group. Vaccination of older persons is therefore a priority.

Because it is the dominant circulating strain, the WHO recommends that the pandemic H1N1 strain should be incorporated into the seasonal flu vaccine for 2010. Keiji Fukuda, MD, MPH, special adviser to the WHO director-general on pandemic influenza, stressed that the recommendation does not indicate that the pandemic is over.

Although fewer older persons were infected with the pandemic AH1N1 virus, paradoxically, infected older people will experience the highest rates of severe disease and death of any age group. Vaccination of older persons is therefore a priority.

“The recommendation to put the pandemic virus in the upcoming vaccine really means that this has been a dominant virus, and it is expected that it will continue to be a very significant virus circulating around the world,” Fukuda said.

The WHO Recommendation for the Composition of the 2010 Southern Hemisphere (SH) Vaccine is:
— an A/California/7/2009 (H1N1)-like virus, the pandemic strain
— an A/Perth/16/2009 (H3N2)-like virus;
— a B/Brisbane/60/2008-like virus.

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2010 Clinical Guideline for Fall Prevention

Monday, February 1st, 2010

Excerpts from the American and British Geriatric Societies Clinical Practice Guideline 2010:

Prevention of Falls in Older Persons

Summary of Recommendations

SCREENING AND ASSESSMENT

1. All older individuals should be asked whether they have fallen (in the past year).
2. An older person who reports a fall should be asked about the
frequency and circumstances of the fall(s).
3. Older individuals should be asked if they experience difficulties with walking or balance.
4. Older persons who present for medical attention because of a fall, report recurrent falls in the past year, or report difficulties in walking or balance (with or without activity curtailment) should
have a multifactorial fall risk assessment.

Photo of the 4-step balance assessment demo at the Training of Trainors program, COMADD and Palo SHS:

TOT 4 steps group

The multifactorial fall risk assessment should include the following:

Focused History
1. History of falls: Detailed description of the circumstances of the fall(s), frequency, symptoms at time of fall,
injuries, other consequences
2. Medication review: All prescribed and over-the-counter medications with dosages
3. History of relevant risk factors: Acute or chronic medical problems, (e.g., osteoporosis, urinary incontinence, cardiovascular disease)

Physical Examinations
Functional Assessment
Environmental Assessment

Details are available at the AGS Website

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Longevity and Wellness Postgraduate Course

Sunday, December 6th, 2009

The Department of Internal Medicine, Section of Geriatrics and the Wellness Center of The Medical City Ortigas recently hosted a successful Postgraduate Course The Fountain of Wellness and Longevity.
The course included topics on healthy aging, preventive geriatrics, cancer screening, boosting the immune system, coffee and the heart, and graceful aging. The President of the Hong Kong Geriatrics Society, Dr. Bernard Kong, delivered a talk on Pneumonia in the Elderly. Postgrad Group Photo with Kong 2
The next day, TMC residents presented a case of pneumonia in the elderly. The case conference was moderated by Dr. Josephine Ramos (TMC Pulmonologist). Guest geriatricians Dr. Bernard Kong (HK) and Dr. Philip Poi (Malaysia) graciously joined the discussion.
Tmc Res With Kong 09

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PSGM Fellowship Night 09

Saturday, December 5th, 2009

Philippine Society of Geriatric Medicine PSGM enjoyed a night of 80’s culture and fun at The Hyatt Hotel and Casino, Manila.

PSGM Fellows Winning MJ Dance

PSGM Fellows Winning MJ Dance

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Geriatrics in the PDI News

Monday, November 30th, 2009

Mr Michael Tan, writes about Geriatrics and care of older Filipinos in a recent article in the PDI.

Click for here the complete article Philippine Daily Inquirer PDI (10.28.09).

Excerpts below:

Geriatrics is also about developing more autonomy or independence for the elderly. That includes encouraging the elderly to set their own goals for health. This is where problems often arise. Non-geriatricians tend to keep patients passive: take this medicine, don’t take that food, stay in bed. Unfortunately for the elderly people, that passive role often leads to a further deterioration of their health. This is worsened by Filipino cultural norms that also emphasize passivity and dependence for the elderly.

Less is more

Geriatricians want their patients to be active whenever possible. When it comes to medicines, less is more for geriatricians because of more risks of side effects, and of drugs interacting with each other. Again, this sometimes runs counter to local culture: our elderly sometimes boast that they are taking 10 pills a day.

We will need more geriatricians who have both the biomedical skills and cultural competence or sensitivity to care for our elderly. Moreover, geriatricians could play another important role of training caregivers, friends and relatives, somewhat like para-geriatricians. I know The Medical City offers such training workshops from time to time.

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