Jet Lag-Like Sleep Disruptions Spur Alzheimer’s Memory, Learning Loss

Results suggest greater emphasis on managing slumber habits of people with AD risk

Newswise, October 29, 2015 — Chemical changes in brain cells caused by disturbances in the body’s day-night cycle may be a key underlying cause of the learning and memory loss associated with Alzheimer’s disease, according to a University of California, Irvine study.

The research on mice, led by UCI biomedical engineering professor Gregory Brewer, provides the first evidence that circadian rhythm-altering sleep disruptions similar to jet lag promote memory problems and chemical alterations in the brain.

Clinical application of this finding may lead to more emphasis on managing the sleep habits of people at risk for Alzheimer’s disease and those with mild cognitive impairment. Study results appear online in the Journal of Alzheimer’s Disease.

People with Alzheimer’s often have problems with sleeping or may experience changes in their slumber schedule. Scientists do not completely understand why these disturbances occur.

“The issue is whether poor sleep accelerates the development of Alzheimer’s disease or vice versa,” said Brewer, who’s affiliated with UCI’s Institute for Memory Impairments and Neurological Disorders. “It’s a chicken-or-egg dilemma, but our research points to disruption of sleep as the accelerator of memory loss.”

In order to examine the link between learning and memory and circadian disturbances, his team altered normal light-dark patterns with an eight-hour shortening of the dark period every three days for young mouse models of Alzheimer’s disease and normal mice.

The resulting jet lag greatly reduced activity in both sets of mice, and the researchers found that in water maze tests, the AD mouse models had significant learning impairments absent in the AD mouse models not exposed to light-dark variations and in normal mice with jet lag.

In follow-up tissue studies, they saw that jet lag caused a decrease in glutathione levels in the brain cells of all the mice. But these levels were much lower in the AD mouse models and corresponded to poor performance in the water maze tests. Glutathione is a major antioxidant that helps prevent damage to essential cellular components.

Glutathione deficiencies produce redox changes in brain cells. Redox reactions involve the transfer of electrons, which leads to alterations in the oxidation state of atoms and may affect brain metabolism and inflammation.

Brewer pointed to the accelerated oxidative stress as a vital component in Alzheimer’s-related learning and memory loss and noted that potential drug treatments could target these changes in redox reactions.

“This study suggests that clinicians and caregivers should add good sleep habits to regular exercise and a healthy diet to maximize good memory,” he said.

Kelsey LeVault and Shelley Tischkau of the Southern Illinois University School of Medicine contributed to the research, which received support from the National Institutes of Health (grant R01 AG032431).

About the University of California, Irvine: Currently celebrating its 50th anniversary, UCI is the youngest member of the prestigious Association of American Universities. The campus has produced three Nobel laureates and is known for its academic achievement, premier research, innovation and anteater mascot.

Led by Chancellor Howard Gillman, UCI has more than 30,000 students and offers 192 degree programs. It’s located in one of the world’s safest and most economically vibrant communities and is Orange County’s second-largest employer, contributing $4.8 billion annually to the local economy. For more on UCI, visit www.uci.edu.

Media access: Radio programs/stations may, for a fee, use an on-campus ISDN line to interview UC Irvine faculty and experts, subject to availability and university approval. For more UC Irvine news, visit news.uci.edu..

Memory Complaints in Older Women May Signal Thinking Problems Decades Later

Newswise, October 29, 2015– New research suggests that older women who complain of memory problems may be at higher risk for experiencing diagnosed memory and thinking impairment decades later.

The study is published in the October 28, 2015, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“These memory complaints may be a very early symptom of a gradual disease process such as Alzheimer’s disease,” said study author Allison Kaup, PhD, with the San Francisco VA Medical Center and University of California San Francisco.

“Other studies have shown this association, however, our study followed women for longer than most other studies, following these women over the course of nearly 20 years.”

Kaup said the memory complaints were enough to be noticeable to the women, but not significant enough to show up on a standard test.

For the study, 1,107 dementia-free women with an average age of 70 were asked several times over 18 years the same question: “Do you feel you have more problems with memory than most?”

At the end of the study, women completed tests of thinking abilities to diagnose whether they had memory or thinking impairment. Other important factors such as years of education, depression, high blood pressure, diabetes, stroke and heart disease were considered.

A total of 89 women, or 8 percent, complained of memory problems at the start of the study.

They were 70 percent more likely to develop a diagnosis of memory or thinking impairment during the study than women who did not have any memory complaints, with 53 percent of those with complaints developing a diagnosis compared to 38 percent of those with no memory complaints.

Women who had memory complaints 10 years before the end of the study were 90 percent more likely to develop a diagnosis than those with no memory complaints at 10 years prior.

Women who had memory complaints four years before the end of the study were three times more likely to develop a diagnosis than women with no memory complaints four years prior.

“Our findings, though modest, provide further evidence that memory complaints in aging deserve close attention as a possible early warning sign of future thinking and memory problems, even several years in advance,” said Kaup.

She noted that since the study involved only European-American women, the findings cannot be generalized to men and other racial or ethnic groups.

The study was supported by National Institutes of Health, the National Institute on Aging, the U.S. Department of Veterans Affairs, the San Francisco Veterans Affairs Medical Center and the Department of Veterans Affairs Sierra-Pacific Mental Illness Research, Education, and Clinical Center.

To learn more about cognition, please visit http://www.aan.com/patients.

The American Academy of Neurology, an association of more than 28,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine,

multiple sclerosis, brain injury, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

Are Hospitals Telling Patients About Charity Care Options? New Study Finds Room for Improvement

As Affordable Care Act requirements take full effect next year, patients with

no insurance or big bills should ask about available help, U-M team says

Newswise,October 29, 2015 — If you don’t have health insurance, or your insurance coverage still leaves you with big bills, hospitals are supposed to let you know if you qualify for free or reduced-price care, and to charge you fairly even if you don’t.

That is, if they want to keep their tax-free nonprofit status under the Affordable Care Act’s new Section 501(r) rules.

But a new study from the University of Michigan Institute for Healthcare Policy and Innovation finds many nonprofit hospitals have room to improve.

Writing in the October 29 issue of the New England Journal of Medicine, the researchers report results from their review of Internal Revenue Service forms submitted by more than 1,800 nonprofit hospitals nationally. They looked at records for 2012, the first year hospitals had to comply with the ACA’s requirements and the most recent year for which data were available.

A mixed bag of findings

IHPI post-doctoral fellow Sayeh Nikpay, Ph.D., MPH and IHPI director John Z. Ayanian, M.D., MPP, call hospitals’ performance “far from perfect”. Their key findings:

• Nearly all (94 percent) of the hospitals reported having a written charity care and emergency care policies, to guide them on deciding which patients could get free or reduced-price care. Though the ACA doesn’t tell hospitals which patients to offer discounts to, or how generous to be, it does say they must have such policies and make them known.

• Only 29 percent of the hospitals reported they had begun charging uninsured and under-insured patients the same rate that they charged private insurers or Medicare. Such rates are often far lower than the “chargemaster” rates hospitals set as the starting point for negotiating with insurers about how much they will actually accept.

• Only 42 percent of the hospitals reported they were notifying patients about their potential eligibility for charity care before attempting to collect unpaid medical bills. The ACA requires such notifications to give patients a chance to apply to get some or all of their costs written off.

• One in five hospitals had not yet stopped using extraordinary debt-collection steps when patients failed to pay their medical bills. Such steps, such as reporting patients to credit agencies in ways that can damage their credit scores, placing liens on their property or garnishing their wages, are now banned.

• Hospitals in states that have not expanded Medicaid reported having less generous charity care policies, and were less likely to have a policy about notifying patients of charity care options before they left the hospital. In general, patients have to be poorer to get free or discounted care in these states than in states that have expanded Medicaid.

• Only 11 percent of hospitals reported having conducted a community health needs assessment in the past three years as of 2012. Such assessments, to identify pressing health issues in the population they serve, don’t necessarily affect charity care.

Playing by the rules?

Nonprofit hospitals are exempt from paying most taxes, which was valued at $24.6 billion in 2011. In return, they must justify their nonprofit status to the IRS each year by showing how much care they write off for those who cannot pay.

When Congress wrote the ACA, they sought to use the tax tools available to them to reduce hospitals’ use of aggressive methods to pursue payment, and perhaps to prevent individual bankruptcies or credit score damage caused by medical bills.

Though hospitals had to report for tax year 2012, the federal government did not issue final language about exactly how to comply and penalties for non-compliance until 2014. Nikpay and Ayanian will continue to study the issue as new IRS data become available. They are already working on 2013 data.

“Hospitals are generally complying with the part of the rules that require they establish charity care policies and publicize them, but this may not impact the amount of charity care they provide,” says Nikpay, who is also a visiting scholar at the University of California, Berkeley. “So far, it appears many aren’t complying with the part of the rules that could increase their charity care.”

Ayanian, a professor at the U-M Medical School with joint appointments in public policy and public health, says physicians and patients should familiarize themselves with policies at their hospitals.

“Financial protection for patients is an under-recognized component of the ACA, and it’s important that hospitals are required to have policies, that they disclose these policies, and that they enable people to apply for help in a timely way,” he says.

“This will be most important for patients living in states that have not expanded Medicaid to cover people with lower incomes. Hospitals in those states will likely experience additional demand for charity care because they now need to publicize their charity care policies and comply with other IRS provisions.”

With these added requirements, hospitals may start to pull back on how generous they make their charity care policies – and Section 501(r) of the ACA does not set standards for that, Nikpay notes.

As more Americans enroll in insurance plans that have high deductibles, they may find they need to ask for financial relief after a hospital stay. Even a single person earning $40,000 a year, or a family of four with an income of $80,000, might qualify for discounted care from many hospitals.

Aged Care Market is Expected to be a Key Growth Area for Healthcare

Publisher's Note:  While this story features Technological growth in the European market of care for the aged, the potential of having an impact in the United States cannot be ignored as the world's population ages and in light of the continually growing impact of technology on all our lives and occupations.

LONDON, October 28, 2015--PRNewswire/ -- By 2020 22% of the world's population will be of or above 60 years. In order to encourage independent living, IT service providers need to support the development of smart homes and communities that leverage technology-based solutions for the aged. 

High adoption of remote monitoring devices, which are useful for personal physicians, nurses and family, will help all senior citizens who prefer to stay in their own homes. Information and communication technology (ICT)-based assistive technologies, including computer-based or other electronic communication aids, object locators and reminder systems, will also gain traction. Further, robots as a support system will emerge as an excellent aged care model.

New analysis from Frost & Sullivan, expects healthcare to be among the top industries for ICT providers in Europe, yielding an estimated €71.57 billion in 2019. IT services will constitute a large proportion of healthcare spending in this sector.

For complimentary access to more information on this research, please visit: http://owl.li/THOqy

The aged population's requirement for specialised medical technology will create strong long-termopportunities for wireless network, IT service and software solution providers. Thus, these service providers are making concerted efforts towards developing and implementing technologies that support independent ageing and aged care.

"Wearable devices are increasingly becoming an integral part of senior citizens' lifestyle," said Frost & Sullivan Information & Communication Technologies Senior Research Analyst Shuba Ramkumar.

"While it is true that a wearable device or global positioning system (GPS) tracker does not in itself provide better care, it can facilitate remote monitoring of senior citizens and help prevent major accidents. For example, it can prevent a patient with memory loss or dementia from going outside and endangering themselves."

However, seamless connectivity, irrespective of whether it is low/high bandwidth or short/long range, is important for the accurate functioning of the aged care ecosystem.

Even the smooth operation and integration of assisted living technologies in the healthcare sector is dependent on the resolution of connectivity, data privacy and regulation issues.

Currently, the need to certify some ICT devices for deployment and restrictions on the use of data collected by devices prove to be major obstacles for the end-user market. Nevertheless, development of stringent data security regulations and partnership with healthcare technology companies can help overcome some of these challenges.

"IT service providers must collaborate with large private and public aged care providers to design and deploy solutions that integrate with the healthcare system," noted Ramkumar.

"For residential care communities, they should also provide end-to-end Internet of Things platforms to enable communication between smart devices for monitoring patient activity. These solutions are necessary to integrate home/residential care systems with the central healthcare system to facilitate automated healthcare delivery."

Seasonal Flu Questions/Answers and Tips

Symptoms

Influenza (the flu) typically starts with a headache, chills and cough. Those are quickly followed by fever, loss of appetite, muscle aches and fatigue, running nose, sneezing, watery eyes and sore throat. Nausea, vomiting and diarrhoea may also occur, especially in children.

Most people will have uncomplicated influenza and recover from within a week or ten days, but some are at greater risk of developing more severe complications such as pneumonia.

Who is Most at Risk

Some people are more likely to get seriously ill if they catch the flu, including:

• Children and adults (including pregnant women) with chronic medical conditions, such as cancer, cardiac disorders, asthma, and morbid obesity (people with a body mass index greater than 40);
• Residents of nursing homes and other chronic care facilities;
• People 65 years of age and older;
• Healthy children under 5 years of age;
• Aboriginal Peoples; and
• Healthy pregnant women, at any stage of pregnancy.

How to Avoid Getting the Flu

The seasonal flu vaccine is safe and effective and remains the best protection against flu viruses. Everyone over the age of six months is encouraged to get the vaccine.

Receiving the flu vaccine is especially important for those who are more likely to get seriously ill or suffer complications if they catch the flu. Getting the flu shot every year is important because the vaccine is reformulated annually. Flu viruses are constantly changing and your immunity levels following vaccination decrease over time, which is why a flu vaccine is needed each year. Flu vaccine is made up of the flu strains that research suggests will cause the most illness in the upcoming flu season.  The flu vaccine remains the best way to protect yourself and your loved ones from the flu.

It's also important to remember that the flu vaccine protects against three or four flu strains (depending on the type of vaccine you receive), so even when there is a less than ideal match or lower effectiveness against one strain, the vaccine  can provide protection against the remaining two or three strains.

In addition to getting the flu shot, you can protect yourself and your family from infection during flu season by taking the following steps:

• Clean your hands frequently;
• Cough and sneeze into your arm, not your hand. If you use a tissue, dispose of it as soon as possible and wash your hands;
• If you get sick, stay home;
• Keep your hands away from your face;
• Keep common surface areas - for example, doorknobs, light switches, telephones and keyboards - clean and disinfected; and
• Eat healthy foods and stay physically active to keep your immune system strong.

If you are elderly and at high-risk of complications or if you are severely ill with the flu, consult a health care professional regarding the potential use of antiviral drugs to help manage the flu. It is important that antiviral drugs be started as early as possible after you get sick.

The flu vaccine is also highly recommended for:

• Those in close contact with individuals at high-risk for complications (e.g. healthcare workers, household members, and those providing childcare to children up to five years of age);
• Those who provide services within closed or relatively closed environments to persons at high risk (e.g. crew on a ship);
• People who provide essential community services including emergency medical responders such as paramedics, police and firefighters; and
• People in direct contact during culling operations with poultry infected with avian influenza.

Boomers put health at Risk

United States birth rate (births per 1000 population). The red segment from 1946 to 1964 is the postwar baby boom, with birth rates starting to drop around 1960.[

October 27, 2015--(BUSINESS WIRE)--Baby boomers believe in the value of prevention, but many of America’s most influential generation are taking a reactive, and sometimes risky, approach when it comes to managing their health, as revealed by the first MDVIP Boomer Health Survey released today.

Boomers may be living longer, but not necessarily healthier. 

New @MDVIP survey results are in. #BoomerHealth

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The national survey of 1,049 baby boomers, conducted by the independent market research firm Ipsos Public ^1]Affairs on behalf of MDVIP, shows that while 94 percent of boomers believe preventive care is an important part of staying healthy, three out of four say they should be doing more to better manage their health (74 percent). 

Half of boomers (46 percent) say they don’t exercise regularly, and more than a third say they don’t eat healthy (35 percent) or get sufficient sleep (37 percent, 7 to 8 hours of sleep a night).

More than 75 million baby boomers – those born between 1946 and 1964 – are now living in the United States. This aging population is expected to live longer than their parents’ generation, but with higher rates of chronic illness which can lead to diminished quality of life in their later years. MDVIP commissioned the research to better understand boomers’ perceptions and concerns related to their current health, and how primary care experiences are influencing their overall well-being.

Reactive Mindset: The Waiting Game

What would motivate boomers to get on a healthier track? Though 73 percent of those surveyed report suffering from a chronic health condition, almost half (43 percent) are playing the “waiting game,” saying it would take an unexpected, life-threatening diagnosis for them to invest more in staying healthy. 

Additionally, 14 percent say a friend or family member’s health scare would be an impetus for change. 

Other motivators are having an expert create a clear plan tailored to helping them achieve their health goals (28 percent), and having a strong support system of friends, family and mentors to encourage them (25 percent). About 17 percent claim nothing would motivate them, believing they have little control over their future health.

“The survey findings show that boomers have a greater health consciousness than previous generations, but also expose the discrepancies between what boomers know they should be doing to stay healthy versus the reality,” said Dr. Bernard Kaminetsky, Medical Director and a founding physician for MDVIP. 

“A health scare or serious illness is frequently the first wake-up call for people, but many chronic conditions plaguing boomers today – from diabetes to cardiovascular disease – are often preventable. This is where good primary care plays a key role, by helping patients identify their risk factors early and influencing the necessary lifestyle changes in order to mitigate, and even prevent, disease.”

The Pains of Primary Care

The gap between boomer beliefs and behavior may be linked to shortcomings in primary care, with nearly half of the respondents (45 percent) reporting frustrations with their primary care experience. The findings revealed:

• The top three frustrations about visiting their primary care physician are waiting while in the office to see the doctor (32 percent), the limited time they actually have with the doctor (26 percent) and trying to get an appointment (18 percent).
• 31 percent report that they typically spend more time sitting in the waiting room than they actually spend with their doctor, and 28 percent say that they spend more time getting their car oil changed than they do with their doctor.
• 30 percent have had to track down their doctor’s office to get test results.
• 23 percent say their doctor isn’t available when they need him/her.
• Many boomers feel their doctor doesn’t really know them, with 31 percent doubting their doctor would recognize them on the street.
• More than a third (36 percent) have taken action as a result of these frustrations, including 27 percent who have changed or have thought about changing their primary care doctor.
• For most boomers, the actual experience of visiting their primary care doctor is a chore: 45 percent compare it to grocery shopping, 11 percent to airport security and 10 percent to waiting in line at Disney. Only a quarter (25 percent) say their actual experience is like talking with a trusted advisor.
• 18 percent compare conversations with their doctor to talking to a boss who is running late.
• When asked what they would most value in their primary care doctor, 62 percent say visits that don’t feel hurried and last as long as needed; 50 percent want a physician with a kind and compassionate bedside manner; and 39 percent want a physician who focuses more on prevention and wellness, not just treating them when they’re sick.

“These insights highlight the increasing challenges of traditional, volume-based medicine that are driving more consumers to look for healthcare alternatives,” said Bret Jorgensen, Chairman and CEO of MDVIP. 

“Many people want and need a close relationship with their doctor, who knows them well, customizes a plan to optimize their overall health, and has the ability to intervene and coach along the way. This is the cornerstone of the MDVIP model, which was launched 15 years ago to provide patients with more personalized, proactive care. Data shows that patients who are actively engaged in their health and have better relationships with their doctor are achieving improved outcomes and better management of chronic conditions.”

Better Health Outcomes

Hospitalizations are the largest cost drivers to the healthcare system. The American Journal of Managed Care published astudy that showed dramatic reductions in hospitalizations for MDVIP Medicare and commercially insured patients, as well as lower hospital readmission rates. MDVIP members also report satisfaction scores that are nearly 40 percent higher than traditional primary care practices.

About the Survey

The MDVIP Boomer Health Survey was conducted August 25 – 31, 2015, via an online interview, in English, by Ipsos Public Affairs, a non-partisan, objective, survey-based research firm. The sample was composed of 1,049 U.S. adults between the ages of 51 and 69 who have a primary care doctor or have seen a primary care doctor in the past five years. 

An additional group of 407 boomers were interviewed in the New York metro area. Statistical margins of error are not applicable to online polls. All sample surveys and polls may be subject to other sources of error, including, but not limited to, coverage error and measurement error. 

Where figures do not sum to 100, this is due to the effects of rounding. The precision of Ipsos online polls is measured using a credibility interval. In this case, the poll has a credibility interval of plus or minus 3.4 percentage points for all respondents. For more information about Ipsos online polling methodology, please visit http://goo.gl/yJBkuf.

About MDVIP

MDVIP, Inc. is the national leader in affordable personalized healthcare offered by over 830 affiliated primary care physicians across the United States who are committed to empowering people to take charge of their health. 

MDVIP physicians limit the size of their practices in order to invest the time needed to provide highly individualized service and attention, including a comprehensive preventive care program and customized wellness plan. Published outcomes comparing MDVIP members to patients in traditional primary care practices include lower hospitalization rates, which yield significant cost savings to patients, employers, insurers and the healthcare system. 

Celebrating its 15th anniversary this year, MDVIP was founded in 2000 and is headquartered in Boca Raton, Florida. For more information, visit www.MDVIP.com, www.facebook.com/MDVIP, @mdvip on Twitter or http://www.mdvip.com/press.

Americans Deserve Better: Leading Obesity Groups Call for FDA Regulation of Dietary Supplements Sold as Medicinal or Curative

To protect consumers, research, treatment and patient groups propose regulatory reforms, offer tips for healthcare providers

Newswise, October 27, 2015-- On the heels of a new study tying dietary supplements to more than 23,000 emergency room visits each year, four leading obesity research, treatment and prevention groups issue a joint scientific statement recommending dietary supplements for weight loss claiming curative or medicinal qualities be subject to review and approval by the United States Food and Drug Administration (FDA). 

To do so, the groups call for the reform of the 1994 Dietary Supplement Health and Education Act (DSHEA), providing FDA and the Federal Trade Commission (FTC) the increased regulatory authority and funding to protect the public from false claims of safety and efficacy of dietary supplements.

The statement reads:

All publicly available dietary supplements sold or advertised for weight loss should have randomized, double blinded, placebo-controlled studies of sufficient duration to support both safety and claimed efficacy. These randomized controlled trials should be of appropriate magnitude and rigor. If a dietary supplement is marketed as curative or medicinal it should be categorized as a drug and subject to enforcement by FDA."

“While we acknowledge that there may be effective dietary supplements on the market, there is a clear need for long-term data showing the benefits, safety and effectiveness for these unregulated treatments claiming weight management,” said Steven R. Smith, MD, The Obesity Society (TOS) past-president and Chief Scientific Officer at Florida Hospital, Orlando.

Today, 30% of U.S. adults report using a dietary supplement for weight loss, contributing to the nearly $2 billion a year spent on these products. 

Many dietary supplements have no evidence to support the weight-loss claims made on labels and in advertising. According to the paper, the harm can go far beyond financial losses, including: 1) exposure to unsafe ingredients including drugs removed from the market or compounds not adequately studied in humans; 2) exposure to products tainted with prescription drugs, and; 3) deleterious response to products that may include increased blood pressure, cardiac arrhythmias, stroke, seizure and even death.

In 2013, the American Medical Association joined the many other leading organizations in recognizing obesity as a disease, including the National Institutes of Health (1998), the Social Security Administration (1999), the Centers for Medicare and Medicaid Services (2004), The Obesity Society (2008) and the American Association for Clinical Endocrinology (2012). 

While weight loss is recognized as a treatment for obesity, according to FDA, dietary supplements should not make claims that their products will “diagnose, treat, cure or prevent any disease.” Legally, only FDA-approved drugs can make those claims.

However, under the current DSHEA, dietary supplement companies are not required to provide pre-market data for the safety and claimed efficacy, or evidence that label claims are not false or misleading to consumers.

“The current regulatory approach to protect Americans from the harms of dietary supplements is simply not working,” continued Dr. Smith. 

“Inaction should not be an option in response to the 23,000 people each year who find themselves in emergency rooms as a result of unregulated, unsafe and ineffective products. Americans deserve better and we’ve come together to propose a solution.”

Even for consumers struggling with their weight who seemingly do not experience direct harm from the purchase of dietary supplements, the groups say, “misleading and unsubstantiated claims detract consumers from evidenced-based interventions and treatments, such as FDA-approved medications, metabolic and bariatric surgery, and commercial intensive lifestyle intervention programs with proven safety and efficacy.”

In addition to the regulatory recommendations, the groups proposed steps to help healthcare providers address the dangers with patients:
• Be aware of the lack of credible evidence for efficacy and safety of many supplements promoted for the purpose of weight loss.
• Query patients who desire to accomplish weight loss regarding their use of dietary supplements for this purpose.
• Advise patients who desire to accomplish weight loss of the limited evidence supporting the efficacy and safety of many supplements and the lack of oversight by government agencies regarding the claims made about such supplements.
• Be educated on the DSHEA and the roles of FDA and FTC in safety and claims monitoring of supplements promoted for the purpose of weight loss.
• Avoid engaging in entrepreneurial activities in which they may directly profit from the prescribing of non-FDA approved weight-loss remedies where both safety and efficacy have not been proven.

TOS’s Advocacy and Public Affairs Committees led the development of the statement over a six-month period, adhering to a rigorous, scientific process and review of existing peer-reviewed research. In addition to TOS, signatories include the Obesity Action Coalition, the Obesity Medicine Association, and the Academy of Nutrition and Dietetics.

Dietary supplement use, as well as proven treatments for obesity and weight loss, will be discussed in several sessions at the upcoming ObesityWeek conference, taking place at the Los Angeles Convention Center in Los Angeles, CA, Nov. 2-6, 2015.

Read the full statement here.

About The Obesity Society

The Obesity Society (TOS) is the leading professional society dedicated to better understanding, preventing and treating obesity. Through research, education and advocacy, TOS is committed to improving the lives of those affected by the disease. For more information visit: www.Obesity.org. Connect with us on social media: Facebook, Twitter and LinkedIn. Find TOS disclosures here.

About ObesityWeek 2015

ObesityWeek is the premier, international event focused on the basic science, clinical application, prevention and treatment of obesity. TOS hosts its Annual Meeting at the world’s pre-eminent conference on obesity, ObesityWeek 2015, Nov. 2-6, at the Los Angeles Convention Center in Los Angeles, California. For the third year, attendees will unveil exciting new research, discuss emerging treatment and prevention options, and network and present. Connect and share with ObesityWeek by using the hashtag #OW2015.

Too Much, Too Late: Doctors Should Cut Back on Some Medications in Seniors, Two Studies Sugges

Overtreatment for blood pressure & blood sugar can be dangerous for some

Newswise, October 27, 2015— Anyone who takes medicine to get their blood sugar or blood pressure down – or both – knows their doctor prescribed it to help them.

But what if stopping, or at least cutting back on, such drugs could help even more?

In some older people, that may be the safer route. But two new studies published in JAMA Internal Medicine suggest doctors and patients should work together to backpedal such treatment more often.

In people in their 70s and older, very low blood pressures and sugar levels can actually raise the risk of dizzy spells, confusion, falls and even death. The consequences can be dangerous.

In recent years, experts have started to suggest that doctors ease up on how aggressively they treat such patients for high blood pressure or diabetes -- especially if they have other conditions that limit their life expectancy.

Dialing back

To see if such efforts to encourage doctors to de-intensify treatment are working, a team of researchers from the University of Michigan Medical School and VA Ann Arbor Healthcare System studied the issue from two sides: patient records and a survey of primary care providers. They focused on patients over 70 with diabetes who had their blood sugar and pressure well under control using medication.

In all, only one in four of nearly 400,000 older patients who could have been eligible to ease up on their multiple blood pressure or blood sugar medicines actually had their dosage changed. 

Even those with the lowest readings, or the fewest years left to live, had only a slightly greater chance as other patients of having their treatment de-intensified.

Meanwhile, only about half of the nearly 600 doctors, nurse practitioners and physician assistants surveyed said they would de-intensify the treatment of a hypothetical 77-year-old man with diabetes and ultra-low sugar levels that put him at risk of a low-sugar crisis called hypoglycemia.

Many providers said they worried that decreasing medications for a patient like this might lead to harm, and that decreasing medications might make their clinical “report cards” look worse. Some even worried about their legal liability.

“As physicians, we want to make sure patients get the care they need, but we should also avoid care that might harm them,” says Eve Kerr, M.D., MPH, an author on both studies and director of the VA Center for Clinical Management Research. “If something is not likely to benefit them, but is likely to cause other problems, then we should pull back,” she adds. 

“We were surprised to find that this is not yet happening despite guidelines to aid providers in determining who qualifies for de-intensification.”

In both cases, the researchers looked at care in the VA system – which is actively trying to encourage de-intensification of blood sugar-reducing treatment in its oldest patients nationwide.

Kerr and her colleagues, based at the VA CCMR and the U-M Institute for Healthcare Policy and Innovation, note that their study data come from just before the VA’s efforts to reduce overtreatment started. 

They’re already doing follow-up studies to see if things change over time, and to study how often de-intensification happens in the non-VA senior population.

But in the meantime, they note, older patients with diabetes and high blood pressure – and the adult children who often assist with their care – should talk to their care teams about whether de-intensification is right for them.

Long-term gain, short-term pain

Jeremy Sussman, M.D., M.S., lead author of the study that used medical records, notes that the reasons why doctors prescribe medication to help people get their blood pressure and diabetes under control mostly focus on the long term.

Controlling these factors for years can help people cut their risk of problems that result from too-high blood pressure or sugar levels, like stroke, heart attack, blindness, nerve damage, amputation and kidney failure.

“Every guideline for physicians has detailed guidance for prescribing and stepping up or adding drugs to control these risk factors, and somewhere toward the end it says ‘personalize treatment for older people’,” says Sussman, an assistant professor of general internal medicine. 

“But nowhere do they say actually stop medication in the oldest patients to avoid hypoglycemia or too-low blood pressure.”

If a patient has been on medication for diabetes or blood pressure for many years, and is now in their late 70s or older, they may have gotten many long-term benefits from keeping their levels in control. 

But because their chance of a dangerous blood sugar or blood pressure dip goes up with age, the short-term risk starts to balance out any long-term gain they could still get.

“Physicians are used to thinking about when to start medications, and if a patient isn’t complaining and appears to be doing fine, stopping medications may not be first thing on their mind,” says Tanner Caverly, M.D., MPH, clinical lecturer and lead author on the survey of primary care providers.

 “As we get more precise evidence about the degree of benefit and harm from using these medications, it’s showing us that we need to dial back in some patients.”

It can be hard for an older person to recognize the signs of too-low blood sugar, such as confusion and combativeness, or of too-low blood pressure, such as dizziness. Meanwhile, keeping up with taking multiple medications, and checking blood sugar daily or even more often, can be a struggle for the oldest patients. 

De-intensifying their treatment can often be a relief.

In addition to Sussman and Kerr, the medical records study’s authors include senior author Timothy Hofer, M.D., M.S., Sameer Saini, M.D., MS, Rob Holleman, MPH, Mandi Klamerus, MPH, Lillian Min, M.D., and Sandeep Vijan, M.D., M.S. In addition to Caverly and Kerr, the survey research was conducted by Angela Fagerlin, Ph.D., Brian Zikmund-Fisher, Ph.D., Susan Kirsh, M.D., MPH, Jeffrey Kullgren, M.D., M.S., MPH and Katherine Prenovost, Ph.D. Funding for the work came from the Veterans Health Administration. REFERENCES: JAMA Internal Medicine, doi:10.1001/jamainternmed.2015.5110 and doi:10.1001/jamainternmed.2015.5950

Care More Expensive for Dementia Patients and Families in Last Years of Life

Newswise, October 27, 2015-- The cost of care over the last five years of life for patients with dementia is significantly higher than for patients who die from heart disease, cancer, or other causes, according to a study led by researchers at the Icahn School of Medicine at Mount Sinai, Dartmouth College and University of California, Los Angeles, and published online today in the journal Annals of Internal Medicine. The study was funded by the National Institute on Aging.

In addition to higher total end-of-life costs, the study found that out-of-pocket spending for patients with dementia was 81 percent higher than for those who died from other causes. The burden of this spending, measured as the proportion of household wealth devoted to out-of-pocket costs, was particularly high for dementia patients who were black, had less than a high school education, or were unmarried or widowed women.

This is the first national study which looks at total costs (patient and family expenses, as well as Medicare and Medicaid expenditures) over the last five years of life for those with dementia in comparison to those without, according to the study authors.

It also estimated the cost of family caregiving for patients with dementia, which is defined as a decline in mental ability severe enough to interfere with daily life. Symptoms can include memory loss, as well as declines in language, problem-solving and other cognitive skills. People with Alzheimer’s Disease represent the majority of dementia cases.

“Our study shows that all households, regardless of disease, face substantial financial risks during the last years of life; however, households of those with dementia face an even greater burden of costs, particularly with regard to out-of-pocket expenses and the costs of caregiving,” said Amy Kelley, MD, Associate Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai and lead author of the study.

“Many costs related to daily care for patients with dementia are not covered by health insurance, and these care needs--from supervision, to bathing and feeding--may span several years.”

While Medicare provides nearly universal coverage for U.S. adults over age 65, it does not cover health-related expenses most valuable to those with chronic diseases or a life-limiting illness, such as homecare services, equipment and non-rehabilitative nursing home care. People living with dementia often face many years of progressive functional decline and require long-term, supportive care.

Researchers analyzed data from 1,702 Medicare beneficiaries, aged 70 years or older, who died between 2005 and 2010. The group was then subdivided into four main categories: individuals with high probability of dementia, and individuals who died of heart disease, cancer, or other causes. Findings indicated the average total cost for deceased patients with dementia was $287,038 in the last five years of life. This was significantly higher than for those who died of heart disease ($175,136), cancer ($173,383), or other causes ($197,286).

“The families of patients with dementia have more expenses than other families, and the financial burden is greatest among families that may be least able to manage it,” said Dr. Kelley. “The discussion of healthcare reform must include the significant uninsured care needs of older adults with dementia and examine ways to mitigate the financial risk currently faced by Medicare beneficiaries.”

The study was supported by the National Institute on Aging. The study’s data was supplied by the Health and Retirement Study (HRS), a national sample of U.S. adults age 50 linked to Medicare claims. The HRS includes detailed information on out-of-pocket spending and total Medicare spending, as well as information about insurance coverage, socioeconomic status, health and cognitive status, and cause of death.

Collaborators of the study include researchers from the Geriatric Research Education and Clinical Centers at the James J Peters VA Medical Center, the University of California Los Angeles Department of Economics, Dartmouth College Department of Economics and The Dartmouth Institute for Health Policy and Clinical Practice at the Dartmouth Medical School.

About the Mount Sinai Health System


The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—.from community-based facilities to tertiary and quaternary care.

The System includes approximately 6,100 primary and specialty care physicians; 12 minority-owned free-standing ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. Seven departments at The Mount Sinai Hospital and one at the New York Eye and Ear Infirmary (NYEE) ranked nationally in the top 25 in the 2015-2016 “Best Hospitals” issue of U.S. News & World Report. Mount Sinai’s Kravis Children’s Hospital also is ranked in seven out of ten pediatric specialties by U.S. News & World Report.

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