Older Adults May Need Better Follow-up After Emergency Room Screenings for Suicide

JAGS graphicJournal of the American Geriatrics Society Research Summary

According to the World Health Organization, suicide rates for men over the age of 70 are higher than in any other group of people. In 2015, almost 8,000 older adults committed suicide in the U.S., and the proportion of suicides is higher among older adults than younger people. When older adults try to commit suicide, they are more likely to be successful compared to younger adults.  This is why suicide prevention strategies are especially important for older men and women.

Hospital emergency departments (EDs) are caring for an increasing number of people with mental health concerns, including thoughts or actions related to suicide attempts. For example, nearly half of the older adults who committed suicide had visited an ED in the year before their death. However, when healthcare providers see older adults in the ED, some may be too quick to assume that the warning signs for suicide are just a natural part of aging. As a result, many older adults may not get the help they need to address suicidal thoughts. These facts prompted a team of researchers to study older adults seen in EDs and the related risks for committing suicide. Their study was published in the Journal of the American Geriatrics Society. Continue reading

Some Frail Older Adults May Receive Potentially Inappropriate Medications When Admitted to Nursing Homes

JAGS graphicJournal of the American Geriatrics Society Research Summary

Medical experts know that older adults who have dementia or other mental health concerns that impact thinking or decision making should avoid certain “potentially inappropriate medications” (PIMs). PIMs can worsen confusion and raise the risks for falls, fractures, and even death, particularly for people with complex health needs.

PIMs may include treatments like:

  • Benzodiazepines (medications sometimes called “tranquilizers” and used to treat sleep problems, anxiety, or to relax muscles)
  • Antipsychotics (medications sometimes used to address mental health conditions)
  • H2-blockers (medications sometimes used to decrease the production of stomach acid)
  • Anticholinergics (medications that block a substance called acetylcholine, a “neurotransmitter” that transfers signals between certain cells to impact how your body functions. Anticholinergics have been used to treat several different conditions, including incontinence and chronic obstructive pulmonary disorder, or COPD).

A Canadian research team investigated how often healthcare providers prescribed PIMs to older adults living with dementia or other mental health concerns and who were being admitted to nursing homes. The research team examined records from more than 40,000 people with dementia or cognitive impairments who were over the age of 66 and had been admitted to nursing homes between 2011 and 2014. The team published their study in the Journal of the American Geriatrics Society.

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Mediterranean-Style Diets Linked to Better Brain Function in Older Adults

JAGS graphicJournal of the American Geriatrics Society Research Summary

Eating foods included in two healthy diets—the Mediterranean or the MIND diet—is linked to a lower risk for memory difficulties in older adults, according to a study published in the Journal of the American Geriatrics Society.

The Mediterranean diet is rich in fruits, vegetables, whole grains, beans, potatoes, nuts, olive oil and fish. Processed foods, fried and fast foods, snack foods, red meat, poultry and whole-fat dairy foods are infrequently eaten on the Mediterranean diet.

The MIND diet is a version of the Mediterranean diet that includes 15 types of foods. Ten are considered “brain-healthy:” green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, seafood, poultry, olive oil, and wine. Five are considered unhealthy: red meat, butter and stick margarine, cheese, pastries, sweets and fried/fast foods.

Researchers examined information from 5,907 older adults who participated in the Health and Retirement Study. The participants filled out questionnaires about their eating habits. Researchers then measured the participants’ cognitive abilities—mostly on their memory and attention skills. Continue reading

Should Your Primary Care Physician be a Generalist or a Specialist? New Study Sheds Light on Benefits vs Costs

JAGS graphicJournal of the American Geriatrics Society Research Summary

Your primary care provider (PCP) is usually your first medical contact when you’re ill. Beyond taking care of you when you’re sick, PCPs help coordinate your health care and make sure you’re up-to-date with your check-ups, tests, and immunizations.

Typically, PCPs are family medicine practitioners, general internists, pediatricians (for children) and geriatricians (for older adults). Some health plans, such as health maintenance organizations (HMOs), require you to choose a PCP whom you must see first before being referred to specialists when necessary. These PCPs play a special role in coordinating your care.

However, other plans—including traditional Medicare and most preferred provider organizations (or PPOs), don’t require you to see a PCP before seeking more specialized care. As a result, many people may see a specialist as their main doctor rather than a PCP who would act as “gatekeeper.” Continue reading

For Older Adults, Antibiotics May Not Be Appropriate Treatment for Some Urinary Tract Infections

JAGS graphicJournal of the American Geriatrics Society Research Summary

In a new research paper published in the Journal of the American Geriatrics Society, Thomas E. Finucane, MD, of the Johns Hopkins Geriatrics Center at Johns Hopkins in Baltimore, suggests that prescribing antibiotics for urinary tract infections (or “UTIs”) may often be avoided among older adults.

Here’s why:

  • “UTI” is a vague, overused diagnosis that may be applied to older adults who have no symptoms but may have bacteria in the urine and also may be experiencing confusion, falls, or other vague signs (including changes in the odor or color of urine). In most cases, antibiotics do not benefit these older people.
  • Researchers are coming to a new understanding about the kinds of bacteria, viruses, and other microorganisms that live in the human body naturally. We now know that everyone’s urine contains bacteria and viruses, for example. We also know that these microorganisms are usually helpful to overall well-being.
  • In some cases, antibiotic treatment can be harmful, especially for older adults.

Some groups of people do still benefit from antibiotic treatment of UTIs. These individual include:

  • People who are sick enough to require urgent antibiotic treatment regardless of findings in the urine.
  • People with invasive bacterial diseases, especially kidney infections.
  • Pregnant women and people about to have bladder or urinary tract surgery.

In his paper, Dr. Finucane says that microbiome studies—which examine the benefits and harms cause by the billions of organisms that naturally live in the human body—suggest that UTI treatment with antibiotics actually may be more harmful than we previously thought. If you think you have a UTI, or if you’re currently using an antibiotic to treat a UTI, it’s important to speak with a healthcare professional first before changing your care plan. Your doctor, nurse, or other provider can work with you to find a treatment plan that’s best for you.

This summary is from “Urinary Tract Infection: Requiem for a Heavyweight.” It appears online ahead of print in the March 2017 issue of the Journal of the American Geriatrics Society. The author is Thomas E. Finucane, MD, Co-director, Elder House Call Program, Johns Hopkins Bayview Medical Center and Professor of Medicine at Johns Hopkins Medicine.