ElderWeb

Researchers at Mayo Clinic in Jacksonville, Fla., are recruiting siblings who have suffered a stroke for a new study. Researchers believe inheritance of specific stroke risk genes may explain why stroke tends to run in families. Dr. Thomas Brott, a Mayo Clinic neurologist, is one of the investigators for the multicenter, nationwide study called ?Siblings With Ischemic Stroke Study? or SWISS. The investigators, supported by a grant from the National Institute of Neurological Disorders and Stroke, hope to enroll at least 300 pairs of siblings into the study over the next few years. To qualify for the study, a person has to have had an ischemic stroke within the preceding six months, and he or she must have a living sibling who has also had a stroke in the past. Both must be willing to provide a blood sample and release their medical records to the study investigators who will keep all genetic, demographic and medical information confidential and anonymous.

Those interested who think they may qualify for the study should contact Kristin Cornwell, study coordinator, at the Mayo Physician Alliance for Clinical Trials, by calling 1-800-541-5815, or via e-mail sent to cornwell.kristin@mayo.edu.

The Mayo Clinic reports results of a new study, led by David Knopman, M.D, which links diabetes and high blood pressure in adults age 40-70 to a decline in mental ability. He said, "While the participants in the study may not have noticed any decline in their mental ability, the decline was statistically significant.""

The study also compared the results between two age groups: those under age 58 and those age 58 and older. Diabetes was associated with greater cognitive decline in both age groups when participants who have diabetes were compared to participants without the disease. High blood pressure, however, was found to be associated with greater cognitive decline in only the age 58 and older group of participants.

The researchers suggested that interventions aimed at hypertension or diabetes that begin before age 60 might lessen the burden of cognitive impairment in later life. Dr. Knopman said, "The results point to the fact that there are things some people may be able to do during middle age to help preserve our mental abilities later in life."

In a special article, done for the Mayo Clinic Cancer Center Quality of Life Working Group and published in the Mayo Clinic Proceedings, authors note that physicians as a group may prolong the end-of-life suffering with aggressive approaches to "cure" the patients? underlying disease rather than acknowledging that the time has come to provide the patient with palliative care services. But the physician can help alleviate the suffering of a patient by orchestrating a multidimensional approach to helping ensure the quality of life at the end.

The authors point out that the death process has changed over the years. Before the 1900s, most Americans died at home surrounded by their loved ones. Now, as many as 60% will die in hospitals, and about 25% will die in healthcare-related facilities such as nursing homes. The role of the physician has had an ever-expanding role in the manner which people die with so many Americans dying in hospitals and other health care facilities.

"With modern medicine emphasizing genetic manipulations, high technology, and cure at all costs, we often neglect what was once the most sacred aspect of being a physician: alleviating suffering," the authors write. "Therefore, we contend that the approach to a person dying in the hospital must change from simply postponing death to focusing medical interventions on maintaining quality of life to the end."

The Mayo Clinic authors conclude their article: "We believe that the principles that have been so successful in improving the quality of life for hospice patients must be adopted in hospitals and related facilities such as nursing homes so that suffering can be relieved where the vast majority of Americans continue to die."

Members of the Minnesota Long Term Care Task Force have agreed on a tentative plan to present to the Legislature when it convenes next month. The plan calls for more home-based and assisted-living care, such as apartment buildings with built-in nursing and social services, and efforts to attract more workers by upgrading jobs and raising wages.

The task force was formed in May 2000 to address the emerging issues in long-term care in Minnesota. The task force members included 12 legislators, six senators and six representatives, named by the leadership in the Senate and House, with bipartisan representation. Members also included three commissioners of state agencies most involved in long-term care issues: the Minnesota Department of Human Services, Minnesota Department of Health and the Minnesota Health Finance Agency.

The task force is charged with drafting legislation needed to reform the long term care system in Minnesota, and they have agreed to consider legislation that would restructure the system that now depends on highly skilled nursing-home care to include more home-based and assisted-living care, provide better consumer information so older people and their loved ones can more easily make informed decisions, and address the worker shortage in a way that would attract qualified people to an upgraded profession.

Governor Jesse Ventura's budget goal is to hold overall spending increases to 5 percent, so the task force's $113 million plan wouldn't work without cutting other programs, although it does fit Ventura's vision for the state, because it encourages independent living and self-sufficiency. The $113 million plan would include:

* $91 million for cost-of-living wages for all long-term-care providers.
* $43 million for increased services for the elderly who otherwise would end up in nursing homes.
* $5.6 million to expand consumer information.
* $4.4 million to build up the market for long-term-care insurance.

The plan also would help nursing homes close or convert to other types of care, make respite care available for home caregivers on a sliding-fee scale, and make state regulations more flexible. The ideas contained in the plan were drawn from comments during meetings of dozens of older people and their families, nursing-home administrators and employees, and other public officials.

A report published by Mayo Clinic physicians in the November edition of Mayo Clinic Proceedings states there is insufficient data to conclude that soy isoflavones are an acceptable alternative to estrogen for hormone replacement in postmenopausal women.

The Mayo physicians studied available literature in response to recent interest in the use of natural products like soy proteins for their potential estrogen-like effects. Soybeans are a staple in the diet of East Asian countries. In areas with soy-enriched diets, there appear to be lower incidences of hormone-dependent diseases such as breast and ovarian cancer and coronary artery disease. The theory is that soy phytoestrogens, specifically isoflavones, are partly responsible for this protection, so there has been intense interest in the isoflavones as substitutes for estrogen for postmenopausal women.

The authors of the Mayo Clinic report looked at various studies about isoflavones and the effects they have on coronary artery disease, breast cancer prevention, bone loss, the central nervous system, the endometrium, hormonal effects, attenuation of hot flashes and the skin. They determined that it is premature to draw definitive conclusions regarding the use of isoflavones as an alternative to estrogen for hormone replacement in postmenopausal women. Appropriate dosage studies with the widely available isolated isoflavones have not been done and long-term benefits of isoflavones with regard to fracture prevention, prevention of hormone-dependent cancers, attenuation of memory loss, and prevention of cardiovascular disease are currently unknown. Randomized, placebo-controlled clinical trials are necessary to address these important issues.

Mayo Clinic Proceedings is a peer-reviewed and indexed general/internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 120,000 nationally and internationally.

Garvan C. Kane, MD, AND James J. Lipsky, MD reviewed literature on drug-grapefruit juice interactions in the Mayo Clinic Proceedings. They suggested that more research needs to be done in this area, since numerous studies show such interactions, and many older people drink grapefruit juice at breakfast time, when they are taking these medications.

The Minnesota Board on Aging has created an online benefits questionnaire. The "Public Program Counselor" asks a series of questions to determine potential eligibility for public programs. The questionnaire contains about 30 to 50 questions and takes approximately 10 minutes. The responses are processed and a report is generated listing the potential benefit programs available. The report contains program descriptions, local contact information, and the required materials to apply for the programs. The agency emphasizes that these results are only estimates of program eligibility, and that the potential beneficiary should apply to the agencies listed in the program details to get a final determination of eligibility.

Almost everyone making grandfather clocks at the Kuempel Chime Clock Works and Studio Inc. is a grandfather himself. Kuempel is an Excelsior, Minnesota firm where the average employee age is 72 1/2. Since 1916 the firm has hired older workers, nearly all retired, to handcraft their timepieces. "They're reliable, like clockwork," says John Swon, 58 the firm's CEO. "It's a great use of a tremendous resource. I think we give people a real reason to get up in the morning, to get excited about what they do, to interact with people, to work on something that means something."

Kuempel sells ready-to-assemble kits and hand-crafted clocks that range from wall clocks for $995 to $7,000 grandfather clocks. They report that sales have increased dramatically since the company's Web site was launched 4 1/2 years ago.

Schedules are flexible and the older staff works an average of about 20 hours a week, and can go home any time after about 3 p.m. to catch an early bird dinner, go fishing, or visit with friends and family. The older, part time, workers are supervised by 40 year old full time employees, providing an interesting variation on the usual dynamic where older workers supervise younger ones.