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 one who passionately builds brands for a living, it saddens me when I am forced to bear witness to the downward spiral of a once-strong brand.  The recent troubles faced by Tylenol and other huge brands from McNeil Consumer Healthcare bear witness to the fact that, while the identity of a brand can help bring a product to the heights of popularity, that same identity, when linked to negative events, can bring the product crashing down in the minds of consumers.

Tylenol has a long history of bumps in the road, starting with drug-tampering problems back in 1982, which resulted in the brand being held up as an example of what to do when disaster strikes your product.  Take responsibility.  Take Action.  Don’t make excuses.

The public was reassured by how the Tylenol scare was handled and sales eventually returned to the brand.  Tylenol came to mean a trusted and safe product once again.  And in a market with unimaginable generic competition, that trust went a long way toward making consumers feel like the branded choice was the right choice.

More recent troubles, however, cannot be blamed on nameless and faceless culprits who are threatening the safety of the American public.  This time the responsibility for manufacturing irregularities fall solidly in the lap of McNeil.  There is no denying that they must take responsibility, there is nowhere else to put it.  But the public is not so quick to forgive this time.

Part of the difference is that this time McNeil is truly to blame for the issue.  And the other part of the difference comes from how the world has changed in those intervening 28 years.  In the world of 1982, the news of the recall and corrective action came through formal channels and gossip about the problem was contained within neighborhoods.  In the world of 2010, news of the recall hit Twitter and Facebook long before it made the front pages of the newspaper or local news broadcasts.  Along with the immediacy of informing the public, McNeil was unable to control the message, and unprepared to deal with the fallout.  Their customer service resources were inadequate, their recall website not up to date, their response times were not up to snuff.

So now, in addition to being worried about the threat that recalled medications might hold for their families, people are angry that McNeil isn’t managing the situation as well as they could.  The brand is breaking.

As the process of restocking medicine cabinets with generic versions of McNeil’s recalled drugs is documented in minute detail via social media networks, more and more people see that generics offer safe, cost-effective alternatives to the branded drugs.  The more social proof that consumers see that the generics are just as effective, the more likely they will be to continue to eschew the branded products.  There is no upside of going back to Tylenol or Benedryl.  Those names are tainted with both the manufacturing issues (real or imagined, it makes no difference) and the customer service disappointments.

The bar for what consumers expect from a generic drug is much lower.  Does it work?  Does it cost less than the branded product?  Is it safe?  Customer service and advertising and image don’t enter into the equation for these purposes.

By dropping the ball so many times, McNeil is training consumers to be satisfied with a less impressive package.  It will be interesting to see if they are able to resolve and recover from this current crisis situation.  As surprised as I am to say this, my bets in this case are against the brand.

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!

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!

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

By Nancy Smith

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.

You knew it, and were just waiting for science to catch up. Coffee is good for you. For your brain. For your health. Overall, it’s the elixir of good health.

Scandinavian researchers followed the health of coffee consumers from middle to old age. The subjects were divided into three groups: low coffee drinker (0-2 cups), moderate (3-5), and heavy (more than 5 cups per day). 21 years later, 1,500 participants were examined for dementia and Alzheimer’s disease. They found that “Moderate coffee drinkers had a 65%-70% decreased risk of dementia and a 62%-64% decreased risk of Alzheimer’s compared with low coffee drinkers.” Low coffee drinkers also scored higher for depression. Coffee drinking has also been associated with lower risk of Type 2 diabetes.

What is it about coffee that has such a salubrious effect on the health? Caffeine? Not quite. Tea, also a highly caffeinated beverage, didn’t produce a similar pattern of mental health in its drinkers. Perhaps it’s something else in the coffee that does it. Whatever it is, you now have a better reason to hang out at the coffee machine at work.

by Lydia Yolen

Does your age shock you? Do you feel younger than your years describe? You’re not alone. A study of seniors found that, on average, men feel 13 years younger than they actually are, while women felt more like 7 years younger.

The gap between perceived and actual age narrowed during periods of ill health, and increased when the subject was happy and active.

Stay young; enjoy life.

by Ruth Folger Weiss

Add this to your  “it’s nice to know” file:

Physical warmth impacts on how we view other people and, creates a causal scenario where we then treat the other person in a warm or cold fashion.

To ascertain how temperature affects emotions, Lawrence Williams, PhD, assistant professor at the University of Colorado at Boulder, and John A. Bargh, PhD, professor of psychology at Yale University conducted a study on undergraduates.

Students were  casually asked to hold  a tester’s  cup of coffee for a moment prior to entering a room;  half the participants were asked to hold a cup of warm coffee and half were asked to hold a cup of iced coffee.

The students were   subsequently given a portfolio of information  on an unknown person described with words like intelligent, skillful, industrious, practical, and cautious. They were then asked to respond to a questionnaire evaluating the person’s personality. Interestingly, those who had held the warm coffee were much more likely to score the  “person in question”  as warmer than those who had held the iced coffee.

“It appears that the effect of physical temperature is not just on how we see others, it affects our own behavior as well,” Bargh says. “Physical warmth can make us see others as warmer people, but also cause us to be warmer — more generous and trusting .”

In the boardroom and in your social life, never underestimate the importance of  an outreached hand, especially when it’s a warm one!

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