806,000 hip and knee implants were performed in the US in 2007 – that’s double the amount done a decade earlier. However, a 2007 study demonstrates that 7% of Medicare patients who underwent a hip replacement required another replacement hip within seven and a half years.  That number, small as it sounds, translates into thousands of patients who eventually need a “do over”. A joint surgery involves risk, pain, convalescence, rehab and medical expenses; no one wants to go through that more than once if necessary.

A National Joint Replacement Registry helps reduce the rate of failed procedures by keeping a database of information that keys in surgeons to problematic implants, and provides insight as to how to avoid mess ups. According to Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn,  “Every country that has developed a registry has been able to reduce failure rates significantly.”  Sweden is one case in point.

The newly formed American Joint Replacement Registry is still in its nascent stage and has started collecting data. Its goal is to improve the quality, outcomes, and cost-effectiveness of total joint replacement (TJR) surgeries through the achievement of four objectives:

1. Establish an infrastructure and a uniform system for the collecting device information and monitoring outcomes of TJR throughout the U.S.;

2. Identify patients who may need follow-up evaluation thereby increasing patient safety;

3. Create real-time survivorship curve in order to detect poorly performing implants;

4. Establish a uniform system that can be used to define the epidemiology of TJR for outcomes research to improve the quality and outcomes of patient care.

Until we have access to solid facts from the U.S. Registry, there are some proactive steps you can take if you are in the market for a new joint.

– Go with a highly experienced surgeon in a busy hospital; don’t look for the best deal. Ask for recommendations. A 2004 study published in The Journal of Bone and Joint Surgery found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

A similar trend was documented with hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

– A joint replacement is not for everyone. Some arthritic problems are better served with medication, and surgery may be too risky for those who have uncontrolled high blood pressure or another serious chronic condition.

– Research the joint implant that your surgeon recommends. Find out how well it has performed in others and if there are known complications. Some implants are somewhat controversial and may cause tissue and bone damage; newer doesn’t necessarily mean better. If the hospital has its own registry, ask to review the data.

– Educate yourself as to what the surgery entails. The American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org is very helpful.

– Prepare your recovery in advance. Arrange for the necessary support upon your return home, and make sure you have all the help you need. It is crucial not to overexert yourself during your initial healing period.

An age old dilemma, – which is more powerful and important – brains or beauty?  Would you rather be hideously ugly and brilliant, or stunningly beautiful and unable to carry a conversation?

Of course none of us really wants to be either of those things.  We want to be brilliant and stunningly beautiful.  And rich.  And happy.  And living on an island with a cabana boy named Juan who fulfills our every desire…

Maybe that part is just me.

We have all been lead to believe that we should want it all and that we can get it all and if we don’t want and have it all, there is something wrong with us.  However, I now have some scientific proof that the choice between brains and beauty is more real than you may have thought!

In late April, the Wall Street Journal published an article, entitled “A Case for those Extra 10 Pounds”, that said that, while the recommendations are to control calories and make healthy diet choices, it seems that there is actually some benefit that comes from being 10-15 pounds overweight.  A little extra weight can lead to a lower risk of osteoporosis and even make you look younger.

Bring on the ice cream!

Just as I was really settling into my celebration of the joys of science, a new study came out that says that extra fat is linked to smaller brain volume, and potentially linked to Alzheimer’s Disease.  Lucky for me and my desire to continue to eat ice cream, it is unclear whether smaller brains lead to extra fat or vice versa.  I am pulling for the first one.  The idea of fat causing my brain to shrink is disturbing in more ways than one.

So extra fat causes Alzheimer’s, and too little fat causes osteoporosis.  A little extra fat will keep my face unlined and youthfully full, but may cause me to eventually forget my name. Am I willing to give up the ice cream to reduce the risk of dementia?

Is it wrong that I am not sure which way to go on this?

As we work with administrators to help navigate the world of Long Term Care it is hard not to be hyper-aware of our own mortality and the eventuality that we, too, are likely to reach a point where we will need some level of assistance in getting through the tasks of day-to-day living.  This awareness, combined with our mission to be a resource for those who serve the aging, means that our antennae are up for any news related to maintaining our bodies and minds well into our twilight years!

A New York Times review of the new book The Secret Life of the Grown-Up Brain caught my eye a week or so ago, and the author, Barbara Straunch, had some interesting insights to share relative to what middle-aged brains are actually good at, and how to keep our brains functioning well into the future.

• Our brains are still growing and developing far into adulthood.  Although we do have some compromises in short term memory (Where are my keys anyway? And what is your name?), the middle-aged brain is actually better in many ways than at any other point in our lives.

• Logic, creativity and social skills are all at a high point during those middle years.  Although you might not remember the name of the person to whom you are speaking, you will be an excellent judge of his character.

• We do not, as previously thought, actually lose brain cells as we age.

• Exercise and diet recommendations that benefit your heart are also likely to benefit the health of your brain.  Exercise in particular can actually help strengthen and grow your brain.  So get out there and start moving!

• Although there are benefits to making your brain work hard, crossword puzzles and learning a foreign language hold no particular magic powers in terms of maintaining the health of your brain.  Partaking in vigorous debates on subjects of interest can be just as helpful, so unless you just love the Sunday Times crossword puzzle, you can stop doing it!

• Meeting and engaging with people is healthy for your brain, and your mood!

It is so refreshing to hear that middle age is not necessarily the beginning of a slow slide into senility.  Staying engaged and active in life, both in terms of intellectual pursuits and social involvement, seems to be key to keeping your gray matter from graying.

I am hopeful that by maintaining an active life filled with fulfilling relationships, creative pursuits and lively conversation, I can remain one less consumer of Long Term Care services in New York!

I am admittedly not the trendiest girl around.  I don’t have designer shoes or a luxury car or get my hair blown out.  Actually, where I live getting your hair blown out means you drove with a window open, but I don’t do that much either.  The NYC crowd would have a field day with how un-cool I am with my suburban clothes and addiction to Dunkin’ Donuts iced coffee.  I am about as mainstream as they come, and for this I am generally unapologetic.  It’s who I am and I’m OK with that.

Although un-hip, I am quite interested in doing things to keep myself and my family healthy.  I try mightily to get my children to willingly eat vegetables. I don’t cook red meat. I choose fresh ingredients rather than food-in-a-box whenever possible.  I am embarking on an experiment to be a vegetarian, and I recently gave up caffeine for a month.  I am willing to try new things – within reason.

There was a recent article in the New York Times about the popularity of a fermented tea drink called kombucha.  Apparently this tea can do all kinds of magical things like re-growing hair, calming digestive issues and curing hangovers.  Those who drink it claim that it is quite delish.  Sounds good, right?  I’m in! I could be the first one in the suburbs to partake of this delightful elixir!  How do I get it?

This is where things get a little hairy for me.  Because kombucha is made by immersing a disk of bacteria into brewed tea and letting it sit, unrefrigerated, for up to two weeks.

A disk of bacteria.

In your tea.

On purpose.

I am so not down with that.

I understand the benefits of probiotics.  I eat yogurt (from the refrigerator, thank you very much).  But, I have to admit that I wouldn’t even drink the plain tea if it sat out for two weeks – and the introduction of the bacteria disk into the equation does nothing to improve the situation for me.

I suppose the nature of kombucha is essentially similar to beer.  Fermented substances in a drink are not that uncommon.  And yet, I can’t quite get my head around voluntarily introducing bacteria into a completely acceptable drink like tea.  I guess I don’t brew my own beer either, although I do enjoy drinking it.

There are packaged versions of kombucha available, including one made by Red Bull.  I am slightly more comfortable with the manufactured versions, mostly because I work under the assumption that beverage manufacturers are as terrified of being sued as I am of dying of kombucha poisoning.

I am a big sucker for slick marketing and putting anything, even something utterly disgusting, in a pretty bottle and giving it a fun name goes a long way to drawing my interest.  If I actually went out and purchased a Carpe Diem Kombucha, it would be an ultimate marking success for them.

Ooooo…pretty bottle….fancy name…who cares what’s in it?  I must have it!

I want to be cool and brave enough to jump on this bandwagon and give kombucha a try.  But the reality is that it’s probably beyond my capabilities to be that cool and brave.  And the Dunkin’ Donuts coffee is working just fine for me, thanks!

According to Jarett Berry, a cardiologist at University of Texas Southwestern Medical Center in Dallas, one must be vigilant about keeping physically active. Yes, in what they used to call “Middle Age.”  Wasn’t that the time we thought would be a little slower, a tad less “vigorous,” an entitlement to ease up a bit? Not if you want to hit 85 says the good Dr. “If you are fit in mid-life, you double your chance of surviving to 85.”

Dr. Berry’s findings, presented last week in San Francisco at the American Heart Association’s Annual Epidemiology and Prevention Conference, are based on an analysis of 1,765 men and women who had physical examinations performed during the 1970’s and 1980’s at the Cooper Institute, the Dallas-based birthplace of the aerobics movement. Put another way: If you’re not fit in your 50’s, your projected life span “is eight years shorter than if you are fit,” Dr. Berry says.

So regular exercise is the most cogent weapon we have to ward off illness and fight disease- as it results in lower blood pressure, healthier cholesterol, and lower blood sugar.

Rest assured… there is a silver lining to all this before you start jogging, digging ditches, or playing singles tennis:  Studies also indicate that exercise’s greatest impact occurs when individuals move from a sedentary lifestyle to embarking on regular moderate exercise regimens.

That’s encouraging. You go, Girl!

Stress is a part and parcel of our frenetic lives, but chronic stress is not what the doctor ordered. Too much stress hikes up your blood pressure, causes body inflammation and can result in heart problems.

So what do we do to slow down? Here are some ways to manage your stress.

• Be realistic about your goals and keep things simple. If you offer to host the annual family Holiday party, don’t go over the top and self cater the entire thing. Take-out side dishes and salads are great fill-ins.

• Express your thoughts in writing. Keeping a journal, blog or diary can be very therapeutic. And if you are not keen of the pen, try recording yourself via a digital voice or video recorder.

• Incorporate some form of exercise into your day and be consistent about it. You don’t have to run the marathon; take a walk with a friend, join the pool at the local Y or shoot some hoops with your kids.

• Massages are the ultimate relaxant. If you don’t believe me, try one for yourself. An aside, did you know that despite the gloomy economy – massage therapy has remained quite popular according to a recent survey from the American Massage Therapy Association?

• Find out if your workplace has any stress-fighting resources in place. Many Employee-Assistance Programs (EAP), wellness programs or health plans provide confidential personal stress-relief plans.

With the number of U.S. seniors with Alzheimer’s skyrocketing, much research is underway to determine how to stave off this mental deterioration, keeping people physically and mentally sound as they age.

A recent report in the December Journals of Gerontology: Medical Sciences found that older women who volunteered for Experience Corps – tutoring elementary school children, had increased brain activity in regions important to cognitive function after a period of six months.

What was exciting about these results, is that it shows a direct correlation between community-based programs and improved cognitive functions. Until now, much study has been done on the brain-boosting power of cognitive, physical and social leisure activities, but little was known about the effectiveness of community-based service.

“This finding is best captured by a personal observation from one of the volunteers, who stated that ‘it [Experience Corps] removed the cobwebs from my brain.” wrote Michelle C. Carlson, of Johns Hopkins Bloomberg School of Public Health.

The seventeen women enrolled in this study were low-income African-Americans with little education, aged 65 and older, and deemed high-risk for cognitive declines, based on a mental state evaluation. Eight of the women actually participated in the tutoring program in Baltimore elementary schools, while the other nine served as the control.

Via functional magnetic resonance imaging, researchers assessed neural activity in the brain prior to the volunteering experience, and again after six months. Based on the fMRI assessment, the women who actively participated in Experience Corps saw improvements in mental function compared with those in the control group.

There you have it, doing your civic duty and assisting others is highly rewarding to all participants. These meaningful activities seem to be more enriching than highly stimulating activities performed alone

There is a definite association between “covert coping” in the face of unfair treatment in the workplace. Men who tend to walk away from conflict at work could be setting themselves up for a myocardial infarction and cardiac death.

In a prospective study of Swedish workers, those who used “covert coping” techniques when they felt they had been unfairly treated were more likely to have an MI or die of ischemic heart disease. Constanze Leineweber, PhD, of Stockholm University in Sweden, and colleagues in the Journal of Epidemiology and Community Health, expanded on research indicating that covert coping – or walking away from a conflict and dealing with the anger “indirectly and introvertly” – increases cardiovascular risk factors. They cautioned that the study didn’t pin down a causal relationship between covert coping and cardiovascular disease. Instead, they said, it raises “an interesting hypothesis, which needs to be confirmed or refuted by future studies.” The researchers analyzed data from a long-running prospective cohort study in Stockholm, the Work, Lipids, and Fibrinogen study, dubbed WOLF for short.

Covert coping was measured by questionnaire, in which the participant was asked about how he or she dealt with unfair treatment from either a boss or a fellow worker. The questionnaire did not measure whether or not the participant experienced unfair treatment at work nor how often covert coping mechanisms were used.

The participants were asked whether they sometimes, often, seldom, or never:

Let things pass without saying anything
Walk away
Feel bad — developing a headache, for instance
Get into a bad temper at home

The results yielded a covert coping score that could range from 8 to 32; the researchers stratified covert coping as low if the score was 8 through 14, medium if it was 15 through 18, and high if it was 19 or more.

They also categorized immediate responses – to the first two options – as low, medium, or high.

Compared with those who had low covert coping scores, the researchers found:

When the unfair treatment came from a boss, those who sometimes or often walked away were three times as likely to have an MI or ischemic death. (The hazard ratio was 3.05, with a 95% confidence interval from 1.23 to 7.58.).

Letting things pass showed a nonsignificant trend to more cardiovascular outcomes for those who did so more often. When the unfair treatment came from a co-worker, the pattern was similar, except that those who said they seldom walked away also had a significant risk for cardiovascular outcomes. The hazard ratio for those who seldom walked away was 4.08, compared with 4.45 for those who said they did so sometimes or often. Both ratios were statistically significant. Neither of the delayed reactions had any association with cardiovascular outcomes – feeling bad or becoming ill-tempered at home – either for unfair treatment from a boss or a co-worker.

Future research, Leineweber and colleagues said, should look at “whether interventions designed to reduce covert coping would alter risk of myocardial infarction and cardiac death.”

Everyone knows that breakfast’s good for you. How good just became a little clearer. A team of British Researchers have pinpointed scientifically how your brain craves high calorie food when you skip your morning meal.

Utilizing MRI’s of the brain, they studied 20 healthy, thin people who went without breakfast that day. When those people were exposed to an array of food photos, both high and low fat, their brains become more active at the sight of the high-calorie options than when they saw low calorie foods. When this test was repeated on another day 90 minutes after they ate breakfast, there was no significant difference in their brain’s reaction to different caloric foods

Corresponding to the MRI findings, were ratings of appealing food pictures. After skipping breakfast, participants found calorie laden food choices to be much more tempting. After eating, however, the group did not show a strong preference for the high-calorie foods.

According to Tony Goldstone, MD, PhD, a consultant endocrinologist with the MRC Clinical Sciences Centre at Imperial College London, “Our results support the advice for eating a healthy breakfast as part of the dietary prevention and treatment of obesity, When people skip meals, especially breakfast, changes in brain activity in response to food may hinder weight loss and even promote weight gain.”

It starts with neglecting one’s hygiene, nutrition and medications, and can lead to death within the year. According to data compiled by the Chicago Health and Aging Project (CHAP), an older person’s risk of dying within the year increases six-fold when he or she starts to ignore his or her physical and medical needs.

The CHAP study took place from 1993-2005 in three Chicago neighborhoods and the 9,318 participants were ages 65 or older. Among that population there were 1,544 reported cases of self-neglect (mean age of 73.2 years old) and in the average follow-up within almost a year, there were 927 deaths (47.8%) in that group.

Elder abuse of any kind also generated a greater mortality rate, with a 61.6% death rate within an average of 2.7 years.

By the self neglect cases, the increased mortality rate wasn’t affected by whether or not the senior’s cognitive or physical functions were impaired. However by confirmed abuse cases there was a significant difference – increased mortality was not associated with elder abuse of high functioning seniors, demonstrating that this group was more likely to recognize abuse and seek help.

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