ElderWeb

A new plan to help low-income elderly in Massachusetts with the cost of prescription drugs started in April of this year. This plan covers all premiums and deductibles for people age 65 or older who are at or below 188% of the Federal Poverty Level (FPL). People between 188% and 200% of the FPL are eligible for coverage, but will pay premiums and deductibles, based on their income.

Researchers have never been sure of the cause of arthritis pain, since cartilage that is affected has no nerve endings, but a new study points to one possible cause. Researchers led by Dr. David T. Felson of Boston University School of Medicine in Massachusetts studied 401 people with knee osteoarthritis, some who had knee pain, and some who did not, to see if they could find a common thread among those with pain.

Bone marrow lesions were found in 78% of those with painful knees compared with 30% of persons with no knee pain. Large lesions were present almost exclusively in persons with knee pain, and after adjustment for severity of radiographic disease, effusion, age, and sex, lesions and large lesions remained associated with the occurrence of knee pain. They concluded that bone marrow lesions on MRI are strongly associated with the presence of pain in knee osteoarthritis.

The study was funded by Bayer Corporation, the Arthritis Foundation and the National Institutes of Health, and is published in the April 3 issue of Annuls of Internal Medicine.

The Massachusetts Health Care Task Force has issued an interim report which makes recommendations for dealing with the nursing home crisis in that state. They point out that 25% of the nursing homes in the state are owned by corporations in bankruptcy, all of them large companies which are not based in Massachusetts. People in Massachusetts use nursing homes at a higher rate than the national average, and Massachusetts nursing homes have a larger proportion of Medicaid residents than the national average, both factors that have contributed to the crisis.

The task force points out that the option of waiting to see how this will play out is not a viable option. So many nursing homes in the state are in bankruptcy that if they all closed and forced their residents to find a new place to stay, there would not be enough empty beds in the state to accept them. Having nursing home residents return to the community is not an option either, both because of the level of care that they need and because few community-based services accept Medicaid as payment. Medicaid is responsible for the cost of care of 70% of the residents in the state.

The task force also blanched at the idea of bailing out the nursing homes. They expressed concern the revenue from rate increases would not be used for patient care, or even used to benefit the local facility in any way, but would instead be routed back to the main office located out of state, and used to pay off debt or settle bankruptcy issues.

Instead, the task force recommends some targeted interim assistance, coupled with a more comprehensive analysis and revision of the long term care system in Massachusetts. They are especially interested in developing ways to help nursing homes find and pay for sufficient staff, since staffing problems have been a big contributor to the current problems.

The Massachusetts Department of Aging has posted a list of new aging-related legislation and events in Massachusetts. The latest bills enacted include:

- The nation's first insurance-based prescription drug program for elders and people with qualified disabilities, which sets monthly premiums, annual deductibles and co-payments based on a member's annual household income, and fully subsidizes certain premiums and deductibles for very low income persons.

- An expansion of the Supportive Housing program from 15 sites to 27, to serve about 4,000 elders with "assisted living-like" services such as 24-hour care, housekeeping and meals.

- An additional $1.1 million to investigate and remedy incidences of elder abuse, neglect and financial exploitation, and support the Money Management Program's efforts to help elders manage their personal finances and retain financial independence.

- An increase of $4.4 million for the statewide Home Care Program, to preserve independence for 39,000 elders each month.

More than half of medication-related injuries in nursing homes may have been preventable, according to a Massachusetts nursing home study, titled "Incidence and Preventability of Adverse Drug Events in the Nursing Home Setting." The study was published in the August 1 issue of the American Journal of Medicine, and was conducted by Jerry H. Gurwitz, M.D., of the Meyers Primary Care Institute, a joint initiative of the University of Massachusetts Medical School and the Fallon Healthcare System in Worcester, Massachusetts.

Of the total adverse drug events identified in the study, one was fatal, 6% were life-threatening, 38% were serious and 56% were significant. Psychoactive drugs (antipsychotics, antidepressants, sedatives and hypnotics) and anticoagulants were the most common medications associated with preventable adverse drug events, and lead to oversedation, confusion, hallucinations, delirium, falls and bleeds.

The authors stated that if the study's findings are generalizable, an average-sized U.S. nursing home (106 beds) will have at least 24 adverse drugs events and eight "near misses" per year, and at least 350,000 adverse drug events occur every year, and more than half of those are preventable. The authors consider these estimates to be conservative.

The authors recommend implementation of enhanced surveillance and reporting systems for adverse drug events and medication errors, continued educational efforts relating to optimal use of drug therapies in the frail elderly patient population, and systems-based prevention strategies to prevent ordering and monitoring errors in drug therapy.

Clot-dissolving drugs given to heart attack victims don't help patients over age 75, and may actually increase the risk of death, according to a study published in the current issue of Circulation, the Journal of the American Heart Association. The researchers found that patients over 75 who were given the clot-busters were nearly 40% more likely to die within 30 days of treatment than patients who did not get the drugs. In an editorial, Harvard Medical School's Dr. John Ayanian said the findings support the use of angioplasty over thrombolytic therapy in the elderly.

A new study published in Nature Medicine reports on progress in the development of a painless method of drawing blood for diabetics. Robert Langer at Massachusetts Institute of Technology has created an appliance which can do these painless procedures. Low frequency ultrasound opens pores through which the fluid is drawn and tested for glucose, after which the pores close up again. He says more testing is needed, but hopes such a device could be available on the market within 3 to 5 years. Another non-invasive device, the GlucoWatch, is awaiting FDA approval. It uses electricity to pull fluid through the skin and measure glucose.

Harvard's Joint Center for Housing Studies has published a new report, "Housing America's Seniors," based on a two year study. This report concludes that the housing industry will need to react to the growing need for home modifications and expanded housing choices as the population ages. The study found that about 10% of older Americans live in age-restricted communities, and only about 1/3 of that segment live in communities that provide some sort of care or assistance. Another 10% of older people either move in with someone else, or have someone else move in with them as a way of receiving care assistance. The report concluded that only about half of seniors with disabilities have the home modifications they need. Interestingly, the report also found that most seniors lock in housing decisions before they turn 65, so they will need good information to understand their options and plan accordingly.

The National Institutes of Health announced results of a study that found that the combination of following the DASH (Dietary Approaches to Stop Hypertension) diet with reduced sodium levels reduced blood pressure more than either the DASH diet or lower sodium intake alone. National Heart Lung and Blood Institute Director Dr. Claude Lenfant said that "These results challenge Americans to eat the DASH diet and to reduce sodium consumption and the food industry to reduce sodium levels in foods. Meeting this challenge, along with other lifestyle changes, could prevent the rise of blood pressure with age and allow patients to control their hypertension with fewer or even no drugs."

"The combination of eating the DASH diet at a lower sodium level is a significant effect ? equal to or greater than the result you would expect from treatment with a single hypertension medication," says Dr. Frank Sacks, chair of the DASH-Sodium Steering Committee and Associate Professor of Medicine at Brigham and Women's Hospital and Harvard Medical School. "However, the long-term health benefits of the low sodium DASH diet will depend on whether the American public is willing to make long-lasting dietary changes, including choosing lower sodium foods, and whether the food industry makes available a greater number of lower sodium food products," adds Dr. Sacks.

The findings were published in the January 4 issue of the New England Journal of Medicine.