Will steroid injections for knee issues really help?

Posted on May 2017 by

There has been much debate how to deal with 'bad' knees.

And more and more aging boomers and their elderly paretns have knee issues of some kind.

But will steroid injections for knee issues really help?

Here is a current CTV News report that makes one wonder.

Read it here: http://www.ctvnews.ca/health/study-questions-steroid-injections-for-knee-arthritis-1.3424724

Antipsychotic medications are warranted, but being relied upon far too often in seniors with dementia

Antipsychotic medications are warranted, but are being relied upon far too often in seniors with dementia.

Here is a recent Globe and Mail article exploring this important issue: Read this on The Globe and Mail

Nursing home drama: wrong treatment

This is an email from a long time friend on the west coast. 

Her point is simple and poignent… a nursing home drama: wrong treatment.

Her challenge: how to help her failing fahter.

It's not pretty, and so many of us experience the same trauma. 

Please read on.

On Thursday, dad's geriatric psychiatrist contacted me to discuss his treatment. The facility is saying he is being aggressive, so they are looking at his meds to adjust. Less than a half hour later the doctor called me back asking if the facility had contacted me because they are indicating they will send him to emergency where he will essentially be sedated. The doctor doesn't agree with this and has him on the waiting list to get into the geriatric floor at the hospital. 

Dad is physically fine, he gets around and is busy. He tends to get into other people's rooms and moves everything around and tries to fix things. His eyesight is really bad, so he feels for things. One care aide at the home is calling this aggressive behaviour. He has had a couple of incidents, but they were because he was alone and could have been redirected, no one was hurt or even close to being hurt. Dad jokingly does a one two jab action, then laughs. It is a jest, not aggressive whatsoever. His main care aides say he is the least aggressive person, but busy and gets into things. The facility have told us we have to be there from the time he wakes until he goes to sleep or they will send him to emergency here he will be sedated and returned to the facility or he may not have anywhere to go. 

The home has a lack of staff and often there is often no LPN on his floor. If they are on breaks there is no one there. This is a dementia unit for high needs patients. They will move in temporary replacement staff that do not have dementia training, nor read the patients charts and make comments such as why are we even feeding these people.

They have lost his shoes, his dentures, his glasses, they don't shave him and I have to ask for him to be changed. They are supposed to contact us when incidents occur and they haven't.

It is appalling. I am putting in a formal complaint to the health authority, licensing board, and ministry. The disease is hard enough on its own without having to deal with the system. Not sure why I am sharing, except that I know you went through the disease part. This is not the norm as far as care, is it? I am working with the doctor and hopefully we can get him into a place that has adequate care. 

Maybe you need a follow up book on how to ensure your parent is being cared for?

Clearly, her father needs the right kind of care. 

He seems to need regular attention and care. And a way to vent his interets and energy.  It seems he's not violent or dangerous. But ongoing stimulation may be needed.

Bottom line: the system needs stronger checks and balances. It needs to be able to effectively understand and manage the needs to those who are suffering from various stages of dementia. 

 

Medications and the elderly: some good advice

Here is an excellent recent article in the Globe & Mail about medications and the elderly. Well worth the read and some reflection. 

THE QUESTION
My mother is in her 70s and suffers from a lot of health problems. I am very worried that she has been given too many different medications that are too strong for her. What should I do?


THE ANSWER
It’s possible that your mother may need all the drugs she is currently taking. But it’s also true that patients sometimes get prescribed drugs and remain on them when they are no longer required.
“Doctors are really good at starting medications, we are not so good at stopping them,” says Dr. Kimberly Wintemute, the primary care co-lead of Choosing Wisely Canada, an organization dedicated to reducing unnecessary medical treatments.
During a hospital stay, for instance, a patient might be given a sleeping pill or a heartburn drug and the prescription keeps getting renewed.
Over time, a patient can end up on a growing list of medications. About twothirds of seniors living in their own homes take five or more drugs, according to data collected by the Canadian Institute for Health Information. One-quarter of seniors are prescribed 10 or more medications.
Each new drug that’s added to the mix increases the risk of adverse side effects and medication interactions.
» The elderly are especially vulnerable to these problems. Not only do they tend to have more chronic conditions than younger people, but the aging process can also change the way the body handles medications.
For instance, the liver and kidneys – which play a key role in processing and excreting drugs – tend to work less efficiently as we age.
In fact, the liver can sometimes become overwhelmed trying to handle several drugs simultaneously. As a result, certain medications don’t get “activated” and essentially won’t work.
“Picture a bus and everyone is trying to get on at the same time – some people are not going to fit and will be left behind,” explains Dr. Cara Tannenbaum, co-director of the Canadian Deprescribing Network, a group that is trying to prevent the inappropriate use of medications.
Furthermore, as we age, we lose muscle mass which is replaced with fat and that can cause problems because some drugs are stored in fat tissue. This means medications can linger longer in the body and thereby exaggerate their effects, Wintemute says.
Another concern is the government approval process for new medications. Drugs are usually tested on relatively young people with just one medical condition – not elderly individuals with multiple ailments. “We don’t always know how a new drug is going to act in very old and very frail people,” says Dr. Debbie Elman, the lead physician for the Academic Family Health Team at Sunnybrook Health Sciences Centre.
Patients may suffer from a host of side effects and drug interactions including confusion, dizziness, fatigue, constipation, diarrhea, incontinence, weight loss, depression, agitation, anxiety as well as sexual dysfunction. It can be difficult to tell if a particular symptom is caused by a medication or if it represents a new medical ailment. A patient might be wrongly diagnosed with dementia or another medical condition even though a drug is really to blame.
So, what can be done to reduce the risks posed by multiple medications?
First and foremost, a patient should get all medications at the same pharmacy, Elman says.
She points out that patients are often treated by several medical specialists – and each one may be prescribing different medications. No single doctor may have a complete picture of what a patient is taking. However, when all prescriptions are picked up at the same drug store, the pharmacist can check for potentially hazardous drug combinations.
The pharmacist can also conduct a review of a patient’s medications and help determine if some may no longer be appropriate.
For a thorough assessment, the pharmacist will need to know if the patient is also taking any non-prescription drugs, herbal remedies or vitamin and mineral supplements. It’s important to keep in mind that so-called “natural” health products may interact with medications and either reduce or intensify their effects.
Tannenbaum says many patients don’t know why they are taking certain medications or what they do.
She suggests that patients, or their family members, should use the website medstopper.com to learn more about their medications. Simply type in the name of a drug and up pops a great deal of useful information, including if a certain medication might be particularly risky for seniors. Another website, deprescribing.org, provides guidance on how to wean off a medication that may be harmful or is no longer needed.
Of course, patients shouldn’t quit taking a drug without consulting their medical specialists or family doctor. But by first talking to a pharmacist and checking out the recommended websites, they can at least have an informed discussion with the physician responsible for their medical care, Tannenbaum says.


Paul Taylor is a patient navigation advisor at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. You can find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

Elderly parents may be taking wrong medications

 

This is an interesting and worrysome article about how many aging people are taking the wrong medicines: http://www.ctvnews.ca/health/more-than-400m-a-year-spent-in-canada-on-drugs-that-harm-seniors-study-1.2956741

If you haven't, it might be a good time to ensure your aging parents and loved ones are taking the right meds. Talkk with them; ask their pharmacists to go over what they take. And don't forget over the counter medicines and vitamins.

There’ll come the day they need us, and we’re not prepared.

Check out this site (cut and paste into your browser if you need to):
www.theguardian.com/commentisfree/2015/aug/02/nothing-prepares-you-daughter-ageing-parents-jackie-kay

It’s an excerpt from a new book in the Guardian, the United Kingdom-based daily. It’s about a daughter of two elder parents who need medical attention,and what that meant for a totally unprepared family. It’s a very good little read.

The lesson is the same-old, same-old: we need to prepare for the responsibilities that are on the horizon with all aging parents. There’ll come the day they need us, and we’re not prepared.

Protect aging parents and older loved ones: get a flu shot

You may not believe flu shots make a difference, or you may get the shot one year but not another. But if you have aging parents and other elderly loved ones, do them a favor: get the flu shot.

Ask your family physician or any health care professional about the importance of limiting the risk to the elderly that getting a flu shot gives. No question: given their ages and often their conditions, older loved ones are more vulnerable to catching a bad cold or flu from someone who has been infected.

That’s why as added protection for them, get a flu shot for you. Reduce the risk. And maybe even help yourself.

Will you go get a flu shot, knowing it can help keep aging parents and other loved ones at less risk?

 

Avoiding the risks of drug interactions in the elderly

    
One of the great miracles of modern medicine is the development of potent medications that can alter the natural history of what were only a few decades ago potentially fatal conditions or illnesses that resulted in long term disability and loss of function. But avoiding the risks of drug interations in the elderly has to be a priority for us all. When I was a medical student in Scotland, one of the most causes of admission to hospital and often death was acute heart failure as a consequence of rapid atrial fibrillation (very fast and irregular heart beat) as a consequences of previous rheumatic fever with the subsequent so-called rheumatic heart disease which affected the valves of the heart.


The steps required to save a patient from rapid death from heart failure during one of these episodes included treatment with morphine which was a powerful drug that decreased the terrible shortness of breath that was occurring as fluid built up in the lungs, digitalis which with luck would slow the rapid heart rate fast enough to prevent decline and death, oxygen, the use of tourniquets to decrease the return of blood from the lower limbs to the heart  and the removal of blood through phlebotomy (so-called bloodletting) which decreased the pressure of excessive fluid on the heart. 

With luck using these methods, within perhaps an hour or two, if the patient managed to struggle to withstand this overwhelming assault on their breathing and heart they might survive and then be treated with digitalis on a permanent basis to try and keep their heart rate slower and perhaps more regular. What did not exist yet were potent and easily administered diuretics to remove the excessive fluid from the lungs and thereby save the patient from what in essence was drowning in their own fluids.

One night while roaming the hospital wards with the young doctors which was always very exciting for medical students, a young woman came in with rapid atrial fibrillation and severe heart failure. We started with the usual treatment and then a senior resident arrived and wrote some words in a notebook while the nurse drew up a syringe full of fluid from a numbered box and vial. It was injected and within 10 minutes the patient was sitting in bed, breathing more easily and said in her thick Dundee dialect, “I feel much better thank you”. The bed was absolutely soaked with her urine. I had witnessed one of the miracles of modern drug therapy and that treatment with the diuretic called Lasix ® has saved millions of lives worldwide and is now standard treatment for all types of heart failure.
The story is dramatic and a reminder of the wonderful benefits of medications. But there is a flip-side to the story—that is even with the best of modern medications, there is always the potential for untoward side-effects that can be dangerous: many of these are in fact due not just to the intrinsic negative potential of the medication, but due to interactions with other medical conditions the person may have, for which the medication being used may cause a problem or interactions with other medications that may be necessary to treat other conditions.


The challenge for physicians and pharmacists in particular is to evaluate every combination of medications that a patient of theirs is taking and try and determine what potential interactions exist and if these present a potentially dangerous or harmful mixture of medications that the person’s body cannot tolerate. As a consequence of so many potent and often life- and health-promoting medications available and with the common occurrence of older people in particular having many chronic conditions, the pharmacy profession along with physicians and the pharmaceutical and software companies have created programs that highlight drug interactions at the time of prescription of a new drug and scan for problems for example during hospital admissions.


But the individual must also be on guard for drug interactions and take the best stops possible to avoid them. 
     1.    Know all of your loved one’s and your own medications both prescription and over-the-counter—including so-called “health products”. 
     2.    Keeping an up-to date list for doctors to see is a good practice. 
     3.    When choosing an over-the-counter product, always check with the pharmacist to make sure that your prescription medications will not interact with something you might want to try for a respiratory infection for example- many medications used for this purpose are not innocuous. 


The main protection from drug interactions is knowledge, awareness and prudence and then most important ask questions if you are not sure.

 

Lack of vitamin D could increase risk of dementia

A recent study indicates that the lack of vitamin D could increase the risk of dementia and Alzheimer's.

Read the CTV network media covereage on this here: http://www.ctvnews.ca/health/lack-of-vitamin-d-may-double-risk-of-dementia-alzheimer-s-disease-study-1.1948667#.U-KWsSYkKpY.gmail

Need for eldercare national policy pressed

This week, the Canadian Medical Association released survey findings showing a lot of Canadians are concerned about the quality of care now available for the elderly. And, the boomers are concerned about what to expect for themselves as they age. That's why the CMA is calling on the federal government to create a health care stratetgy for the aging and elderly.

Read the Globe & Mail article about it: http://www.cmaj.ca/site/earlyreleases/18aug14_CMA-wants-seniors-care-on-federal-agenda.xhtml