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Latest Senior News
Making Tomorrow's Health Care Decisions Today
NAPSA
When it comes to making decisions about the kind of health care they'll receive in the future, many Americans are willing to put off those decisions for as long as possible. That's especially true when it comes to crafting what's known as an advance directive. An advance directive is a document that names a person to be your spokesperson and who can describe how you want to be treated when you can no longer make your own health care decisions.
A recent poll from Harris Interactive commissioned by the American Bar Association shows that while more than three-quarters of Americans know they need to plan how they want to be cared for if they are incapacitated and unable to make health care decisions, fewer than one-third have actually appointed someone to act on their behalf. Many people are afraid to verbalize their wishes, fearing that putting their decisions about health care in writing makes the need for them more real, or fearing they will give another person control over their person or possessions. Giving up the right to make one's own decisions is just one of the prevailing myths about health care advance directives. The fact is that as long as a person is competent, he or she can revoke the directive or overrule a proxy's decision.
Another myth is that an advance directive always means "do not treat." The reality is that an advance directive expresses what a person wants and does not want. For one person, it may indicate continuing treatment against all odds. In another instance, it may indicate the person just wants to be made comfortable. Advance directives can take the form of a health care power of attorney or a health care proxy that names an individual to make decisions on a person's behalf; a living will that outlines specific actions caregivers should take during treatment; and a combination of the two, such as a document that addresses a person's medical, personal, emotional and spiritual needs.
A consumer kit from the American Bar Association's Commission on Law & Aging contains 10 tools that look at how to select a health care proxy, what to do after signing the advance directive, a guide for health care proxies and additional resources. To download a copy, visit http://www.abanet.org/aging/toolkit/home.html, or send your e-mail address to the American Bar Association, Commission on Law and Aging, 740 15th Street, N.W., Washington, DC 20005-1019.
Treatment-Resistant Depression Affects Millions of Americans Each Year
NAPSA
Millions of Americans with depression are able to successfully manage their condition with a combination of available therapies. However, according to an article in the Journal of Clinical Psychiatry, up to 35 percent of patients treated for depression may have a little-known condition called Treatment-Resistant Depression, or TRD.
"There are evolving definitions of TRD among the research community, but at this point, a TRD diagnosis is usually given to a patient with major depressive disorder who has failed two adequate trials of an antidepressant medication," said Dr. W. Clay Jackson, a primary care physician and assistant professor of clinical psychiatry at the University of Tennessee.
Depression Is a Highly Debilitating Disease
Not being able to find an effective treatment is a serious challenge for those who suffer from depression. There are many types of depression that can be difficult to treat, including major depressive disorder (MDD), bipolar depression and psychotic depression. MDD, the most common form of depression, is a highly debilitating disease. A 2007 article in The Lancet points out that the World Health Organization has concluded that it is the single most disabling medical condition. Furthermore, depression that is hard to treat is often more severe, more chronic and more disabling. In addition, treatment resistance increases the likelihood of physical symptoms in patients such as aches, pains, headache or GI disturbance.
TRD patients are also more likely to have attempted suicide at some point in their lives, says an article in the Journal of Psychiatric Research, as well as an article in the Journal of Clinical Psychiatry. In November 2006, the National Institute of Mental Health published the results of a study designed to evaluate depression treatments. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial was conducted over seven years and enrolled over 4,000 patients, states a report from the American Journal of Psychiatry.
"The main message from the STAR*D trial, the largest trial to date to look at various pharmacological treatments for resistant patients, was that after each successive treatment failure, recovery is less likely," said Jackson.
"The longer a patient has a depressive episode or the more severe the depression, the less likely remission will occur."
Dr. Jackson explained that the decreasing likelihood of recovery may result from neurological changes, including reduction of brain volume and function, as a result of depression.
Treatment Options Do Exist
Unfortunately, it often takes some time to find the right medication or nonmedical therapy. For the millions of people who suffer from TRD, other treatment options do exist. Augmenting or supplementing an antidepressant with another psychotropic medication (not originally intended to treat depression) can help some patients. Other options include cytochrome P450 genotyping testing (which checks for specific genes that affect how a person's body uses antidepressants), combining different classes of antidepressants (such as a selective serotonin reuptake inhibitor with a norepinephrine and dopamine reuptake inhibitor), increasing the dosage of a medication or trying a medication for a longer period. Patients may also benefit from psychotherapy, exercise or somatic interventions.
"TRD is far more common than most people realize," said Jackson. "Patients suffering from chronic depression may possibly have TRD and should seek help from their clinician."
"There are evolving definitions of TRD among the research community, but at this point, a TRD diagnosis is usually given to a patient with major depressive disorder who has failed two adequate trials of an antidepressant medication."
Watch Your Cholesterol
NAPSA
High blood cholesterol can cause heart trouble. But you can help control your cholesterol levels.
"Cholesterol has a variety of uses in the body that are very important," explains Dr. James Cleeman of the National Institutes of Health's (NIH) National Cholesterol Education Program, "but the body makes all it needs and we should keep the level of blood cholesterol down by making heart-healthy lifestyle changes."
The landmark Framingham Heart Study, funded by NIH, first showed that the higher your blood cholesterol, the greater your risk for heart disease-the No. 1 killer of Americans, both women and men. There are actually two forms of cholesterol in your blood: LDL and HDL. Too much LDL-the "bad" cholesterol-can build up in the walls of your arteries and form a waxy plaque. Higher levels of HDL-the "good" cholesterol-have been linked with a lower risk for heart disease.
"Where LDL cholesterol does its most harm," Cleeman says, "is in the walls of the arteries going to the heart-the coronary arteries."
Like any muscle, the heart needs a constant supply of oxygen and nutrients. When the coronary arteries become narrowed or clogged by plaque, blood flow to the heart is restricted. That causes coronary heart disease. If the blood supply is cut off, it results in a heart attack. Talk to your doctor to see if you're at increased risk for heart disease. The higher your risk, the lower your blood LDL cholesterol level should be. You can't control some risk factors, like age and genetics. But you can control what you eat and whether you are physically active.
The TLC program-short for Therapeutic Lifestyle Changes-can help you lower your LDL cholesterol level. It involves three things: changing your diet (by lowering how much saturated fat, trans fat and cholesterol you eat), doing more physical activity and controlling your weight. Learn more about TLC at http://www.nhlbi.nih.gov/ health/public/heart/chol/chol_tlc.htm. If lifestyle changes don't lower your LDL cholesterol enough, medication can help.
"Medication should be added to lifestyle changes," Cleeman says, "not substituted for them."
NIH's National Heart, Lung and Blood Institute recommends that everyone 20 and older have their blood cholesterol levels checked at least once every five years. Know your numbers. Then talk to your doctor about what you can do to lower your blood cholesterol and stay healthy.
Active Disease Management Of Rheumatoid Arthritis Patients
NAPSA
Chronic inflammation of bone joints. Swelling and stiffness. Difficulty with simple activities. These are just some of the symptoms people with the chronic autoimmune disease rheumatoid arthritis (RA) -one of the most serious and disabling forms of arthritis- battle every day.
Fortunately, for the 2.1 million Americans living with RA, active participation in disease management may be possible. Patients can be active in the quest to improve quality of life by working with their doctors on everything from ways to best maintain joint function to learning how to balance daily activities and anticipate flare-ups. In addition to the physical effects of RA, the emotional impact may be significant. Many patients experience stress and depression as a result of a decreased ability to function. According to new research from the Arthritis Foundation, psychological stress can worsen the disease by aggravating white blood cells that produce tumor necrosis factor (TNF), a protein that regulates autoimmune function in the body.
Some patients have found that engaging their health care providers to proactively seek solutions for dealing with both the physical and emotional effects of this disease is a good approach. Both as a result of increased communication between patients and their health care providers and the increased availability of drugs, trends indicate costs of RA treatments are going down. Even more, clinical studies continue to investigate potentially new treatments for RA patients.
New Research Under Way, Participants Needed
Clinical studies are now in progress to evaluate the safety and effectiveness of an investigational drug for the treatment of active RA. These studies, occurring at clinics throughout the country, are looking for participants who are 18 years of age or older and living with moderate to severe rheumatoid arthritis.
To find out more about RA clinical research studies being conducted nationwide, call toll-free (800) 668-9023.
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