HCR -- Binge Drinking and Other Challenges

By John Ballard

?According to the CDC about one in six adults binges on alcohol. 
The number of drinks averages eight.
The average frequency is weekly.

Binge drinking -- defined as at least four drinks in one sitting for women and five drinks for men -- carries substantial risks and high costs. It accounts for more than half of the estimated 80,000 annual deaths and three-quarters of the $223.5 billion in economic costs tied to excessive alcohol use.

In addition, it is associated with a greater risk of a multitude of problems, including car crashes, violence, suicide, hypertension, acute MI, sexually transmitted diseases, unintended pregnancy, fetal alcohol syndrome, and sudden infant death syndrome (SIDS).

Details at the link. 
I could type reams of commentary but the reader can furnish his own. Anyone who thinks this is not seriously related to the health care debate, public health, politics and the economy is advised not to help any children with coloring books, especially the kind involving connecting the dots.  

?The death of a loved one increases the risk of heart attack for survivors. 

Among a cohort of 1,985 people, the rate of myocardial infarction was more than 21 times higher than normal within 24 hours of losing a loved one, reported Murray A. Mittleman, MD, DrPH, from Beth Israel Deaconess Medical Center in Boston, and colleagues

The absolute risk of experiencing an MI within a week of a significant loss was higher for those already at a high 10-year risk of MI: one per 320 versus one per 1,394 for those with a low 10-year risk, according to the study published online in Circulation: Journal of the American Heart Association.

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During the first week of bereavement, the risk was almost six times higher than normal. Although the risk declined each day after the death, it remained significantly elevated for at least one month following the loss.

Researchers found that men were more sensitive to negative health consequences from bereavement than women and younger people, more so than older bereaved people, which is consistent with other findings, they said.

A number of psychological stressors are associated with bereavement including anger, anxiety, and depression. In addition, those mourning the loss of a loved one could have reduced appetite, reduced sleep, and inadequate medication compliance.

"Caretakers, healthcare providers, and the bereaved themselves need to recognize they are in a period of heightened risk in the days and weeks after hearing of someone close dying," Mittleman said in a statement.

?Educate patients when it comes to cancer screening tests

This is old news for regular readers, but repetition and reminders are never a mistake. Like so much important information this has no money-making advocates so the only way to spread the word is word-of-mouth. 

• women in their 40s do not appear to benefit from mammograms 


• women ages 50 to 74 should consider having them every two years instead of yearly


• also recommended that routine colonoscopy not be done for screening purposes in patients older than 75. 


• This year it was recommended that pap smears begin at age 21 and be conducted at least every three years 


• P.S.A. tests for prostate cancer detection not be performed on a routine basis.

?How can we train more geriatricians?

I have a 90-year-old father and an 86-year-old mother who are still living independently but are very frail. Thirty years ago, when I graduated from medical school, they were sprightly at ages 60 and 56. Back then, I didn�t appreciate the importance of geriatrics. Boy, I do now.

I have learned some valuable lessons while helping to manage their care.

A great doctor knows what not to do as well as what to do. My parents are lucky to have a great internist who has been their physician for 35 years. He knows the importance of not doing everything. He has tried to find the right balance between intervention and observation. Not everything needs to be fixed.

Avoiding hospital stays is critical. After age 85, people don�t get better when they are admitted to the hospital; they get worse. They get loss of muscle strength from prolonged bed rest with no PT, pressure sores, new confusing medications, and antibiotic destruction of their gut flora that results in embarrassing diarrhea. I tell my dad that he is like a shark: �If you are not moving, you are dying.� Continued activity is the key to independence. Until nine months ago, even though he is blind, my dad walked on his treadmill for 20 minutes a day. Although only 1.2 miles an hour, he was moving.

Nurses in most community hospitals don�t really know how to care for elderly people. Seeing an untouched meal tray, they say, �I guess you weren�t hungry,� and take it away. It doesn�t occur to them that elderly people often can�t hear or see well enough to navigate the complexities of feeding themselves when hospitalized. My family makes sure one of us is parked in my father�s room most of the day; we schedule family members to be present at every meal to help my father eat.

Medicare is a fabulous safety net that allows many older people to age in place in their homes. It provides hospital beds, lifts, oxygen concentrators, and weekly home health nurse visits. This is why my parents have been able to stay independent.

There are angels out there. There is a wonderful lady who comes in three times a day to help bathe and feed my father. She has no formal training, but she could teach nursing students how to prevent pressure sores. She cares for a number of older people and keeps them engaged and connected. Her assistance and expertise are priceless.

So how does this relate to the geriatrician workforce challenges we are facing in academic medicine?

We should focus on older students. Because their own parents are probably close to needing geriatric care, it�s easier for them to �get it.�

We need a fast-track retraining program in geriatrics for licensed physicians. I appreciate trained geriatricians so much more now than I did 30 years ago, when I opted to specialize in anesthesiology. Retraining could provide a way for experienced physicians to add to their qualifications and give back to society.

We need a residency/fellowship experience that is community-based and patient-centric. We must teach practitioners to help seniors age in place and create networks of community care.

Academic medicine has a wonderful opportunity to develop a commitment outside of our acute-care facilities, leveraging provider training programs and population-based research to create a sustainable pipeline of geriatricians.

This was written by a doctor and published in a doctor-oriented forum. In just the last few hours the comments thread is already getting negative feedback. I want to say something supportive and encouraging but when a level of professional cynicism is apparent toward a colleague, there is no reason to imagine anything said by a layman would carry any weight. 

Perhaps the relentless drone of the GOP primary candidates is getting on my nerves but I'm having a hard time feeling optimistic about the future of health care. Every item in today's list is a bleeding sore in "the world's best medical care" and I  haven't heard a word from any candidate suggesting we address any of them. The last thirty or forty years have resulted in record profits for drug and device companies, a flourishing private insurance industry, somethig like a trillion dollars in student debt (owed, of course, to the Education Industrial Complex) and spreading homelessness and poverty. We are witnessing a train wreck of historic proportions and all I hear is the ghost of Ronald Reagan prating about big government, too much regulation and high taxes. 

I'm thinking about resuming smoking and learning how to binge drink.