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.

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!

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!

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

The typical hospital fare such as jello, soggy sandwiches and tasteless chow that we’re all familiar with, seems to be a thing of the past. Think Machaca Steak with Sauce and Curried Banana Pierogi. Hospitals are now competing with the likes of five-star hotels and restaurants by installing sushi stations, organic salad bars and pizza ovens.

The National Society for Healthcare Foodservice Management recently launched an annual cooking competition. “We want to show the world that health-care food is so much different. It can be creative. It can dazzle,” said Betty Perez, a society board member and a hospital food administrator in New Jersey. “We have chefs that can compete with the best of them.”

However, hospital chefs must play by different rules than their glitzy restaurant counterparts. Their creative offerings must be in tune with doctors orders, as well as nutritionists and cost-sensitive food administrators.

600 calories, 20 grams of fat, and 1,000 milligrams of sodium were the max for each contest dish and the production cost per dish could not exceed $5.

So pass the Green Apple-Jicama Slaw and enjoy your stay.

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.

A new study, reported in the Aug. 15 issue of Journal of Clinical Sleep Medicine, finds that cognitive therapy has a beneficial effect on osteoarthritis patients and insomniacs – assisting them in their quest for a good night’s sleep.

Cognitive behavior therapy for insomnia or CBT-I,was given by an experienced clinical psychologist who taught participants cognitive restructuring techniques that helped change unrealistic beliefs and irrational fears regarding sleep or lack of it.

Handwritten sleep logs kept by participants documented their sleep patterns, and pain level was graded by the Short-Form McGill Pain Questionnaire (MPQ) and the Body Pain Subscale (SF-PAIN) question from the Medical Outcomes Study Short Form-36 Pain.

Results showed that after CBT-I treatement, patients were falling asleep faster than before, and remained sleeping approximately 37 minutes longer. CBT-I seems to be an effective tool for treatment of osteoarthritis in conjunction with other pain management techniques, and may also work well with other chronic pain conditions.

Wives who cared for husbands with dementia were nearly four times more likely to develop dementia than wives of men who didn’t have dementia, while husband caregivers in the same circumstances were almost 12 times more likely to develop the disease.

So what exactly is it that causes the risk of developing Alzheimer’s to skyrocket? You can’t catch it, can you? Researchers think the root cause is the stress that comes along with these caregiving situations.

Ralph Nixon, MD, PhD, a psychiatrist and Alzheimer’s disease expert at NYU and vice chairman of the Medical & Scientific Advisory Council at the Alzheimer’s Association feels that “the amount of stress involved in caring for a spouse with dementia is tremendous,and stress is a known risk factor for dementia.”

Healthy diet and exercise are key factors of good brain health, and both of these areas tend to falter when one is stressed out. It is critical that caregivers look after themselves properly, making sure to rest, to visit a doctor regularly and to maintain social ties.

Since men tend to rely on their wives to serve as the impetus for seeing the doctor and keeping up with friends and family, they are more apt than women caregivers to let these things slide when their spouse is cognitively impaired – thereby increasing their risk of high cholesterol, blood pressure and other conditions that can lead to dementia.

Advanced dementia is something that the average healthy person has a hard time imagining unless they are the caregiver of a loved one in that condition. Researchers in Boston recently documented the ravages of this incurable state on video. After showing this heartwrenching movie to adults over age 65, many had the same reaction; if they were faced with such serious loss of cognitive function they would not want their lives aggressively prolonged. The conclusion of researchers (published in the current BMJ journal) – people should make decisions about their future care while they are fully informed and healthy, and have them legally documented. Otherwise, once one reaches the point of incapacity, other will make those significant decisions for you, regardless of your wishes.

This footage underlines the importance of surrounding one’s self with devoted loved ones, especially in one’s old age. The knowledge that your family will sincerely and patiently see to your comfort, well-being and dignity provides one with the security to face the vulnerability of old age and its possible side effects head on.

VIDEO LINK
http://www.bmj.com/video/care_preferences_dementia.dtl

Today’s medical announcement would be astounding if it wasn’t almost intuitive; the results clearly demonstrate that lifestyle behaviors do contribute to stroke risk independently of the intermediate risk factors.

We are all aware that the following four behaviors are beneficial to one’s health. Physical activity, moderate alcohol consumption, no smoking, and the daily consumption of five or more servings of fruits and vegetables a day can only have a positive impact. The strength of that impact was recently bolstered by a defining EPIC (European Prospective Investigation of Cancer) study conducted in England.

20,040 men and women ages 40 to 79 had a physical exam and completed a detailed health and lifestyle questionnaire upon enrolling in the study. This data determined which participants smoked, drank, were physically active, and whether they ate their fruits and vegetables. The risk of stroke for those who did not practice any of the above mentioned behaviors increased twofold compared with individuals who adopted all four.

“These results provide further incentive and support for the notion that small differences in lifestyle can have a substantial potential impact on risk,” the authors concluded.