HIV Over 50

More effective medications are helping AIDS patients live into their 60s. A surprising number of people are becoming infected during their “golden years.”

Sixty-two-year-old Jane got HIV 12 years ago when she began dating after her divorce. “Look at this face, this old, wrinkled face,” says Jane. “This is another face of HIV.” Rather than feeling sorry for herself, Jane says the disease gave her life a new purpose. “We must understand this virus, and we must all understand that everyone is at risk.”

The National Institute on aging says 11 percent of all new AIDS cases are in people over age 50. In fact, groups that are middle-aged and elderly have undergone more of an increase than those under 40.

Jane says, “A favorite comment of mine was in a letter from a middle school girl. She started off by saying, ‘Dear Jane, well I never knew anyone over 50 could have sex.'” Yet they are, and the most common cause of HIV among the elderly is sexual activity.

“The older adult is fighting not only the stigma of HIV, but the stigma of age,” says Jane. Unfortunately, older people’s infections are often undiagnosed by doctors because HIV’s symptoms can be seen as signs of normal aging — fatigue, confusion and loss of appetite.

“Older persons are perhaps more reluctant to talk about their sex lives, and physicians and service providers are reluctant to ask them,” says Jane. She hopes to educate and destroy the stereotypes. So far it’s working.

Doctors say you can never be too safe when it comes to AIDS. The virus does not discriminate and can affect every age, gender and social class.

A Kinder, Gentler Death

Seven out of ten Americans say they want to die at home, yet 75 percent die in medical institutions. Nearly half of Americans die in pain, surrounded and treated by strangers.

These are statistics that might make us want to push the thought of death further back in our minds. “Medical Care of the Soul” places death in front of our eyes, ringing in our ears, and on the tips of our tongue.

By acting as a guidebook to dying well, this collection of thoughts, observations, recommendations and suggestions allows the reader to think about death, their own death, or a loved one’s death. It encourages us to realize that there is a way to explore the emotions and situations that will arise. The book is a recognition of the soul and how doctors, families and patients should consider the soul when making end of life decisions. From worksheets that include “Five wishes for (your name here)” to a sample of Power of Attorney for Health Care Decisions, Bruce Bartlow, M.D., introduces us to the unfamiliar, the unknown, and the unavoidable.

For 30 years, Dr. Bartlow tried to “save” patients. Until he realized that by prolonging patients lives, he might be doing just the opposite. He says, “Our patients are often destroyed by the technological brilliance we heap upon them.” In these modern times death is considered to be a loss and failure. As a solution, Dr. Bartlow asks us all to listen to ourselves and think about the possibilities of healing and being healed. We read through different scenarios and how critical care physicians might address these situations with the patient, our families, and us. We learn how to first recognize, then express our desires. Dr. Bartlow points out that years ago death was accepted, ever present and honored. Now technology “the slayer of the soul” has entered the picture. “Between 1947 and 1952 science snatched death from the grasp of fate and faith,” he writes.

Dr. Bartlow hopes “that haunted aching will be resolved when we realize that we will be healed not by defeating death but by honoring life so deeply that each moment draws us closer to its mysteries.” He asks us to see the death not as a loss but as the “last, loudest call to discover what we came here to do.” Death has always been a mystery but Dr. Bartlow shares his vast and insightful inspiration in helping us to achieve a good death. “Medical Care for the Soul” is like night swimming; slipping into a calm body of water, surrounded by dark, warm uncertainty. I have never felt more at ease with the subject.

Treatment for Late-Life Depression

New research suggests that a collaborative intervention program called Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) is more beneficial for the treatment of depression in seniors than usual depression care.

According to researchers, “Major depression and dysthymic disorder [chronic mild depression] affect between 5 percent and 10 percent of older adults.” Depression suffered by seniors, called late-life depression, is usually chronic, linked to functional damage, and responsible for a reduced quality of life. Seniors who suffer from late-life depression are also at a higher risk for medical illnesses and suicide. When seniors try to seek help for their depression, they often go to general medical services, which do not generally help seniors stick to a treatment or help them to continue further on with treatments.

In the study, researchers gathered 1,801 adults age 60 or older, who suffered from major depression, a dysthymic disorder, or both. Of the participants, 906 received treatment through IMPACT and 895 received help through usual medical services. A depression care manager was available to help the IMPACT group. The caregiver had the support of a psychiatrist and primary care physicians who offered education, anti-depressant medication, or psychotherapy to the seniors if needed. The other group was encouraged to used the available resources provided by the usual medical care service.

By one year, 45 percent of the IMPACT participants had a 50 percent decrease in their depression. Only 19 percent of the other group had a decrease in their depression. The IMPACT patients also reported more contentment with their treatment, reduction of functional loss and an improved quality of life. Researchers conclude, “The IMPACT model, a collaborative, stepped care management intervention for late-life depression, appears to be feasible and significantly more effective than usual care in a wide range of primary care practices.”

Preventing Stroke

Some risk factors for stroke — age, gender, race, family history — are not controllable. But even if you fall into a higher-risk category, there are still things you can do to reduce your chances of stroke.

According to the National Stroke Association, 80% of all strokes are preventable. The NSA offers a list of guidelines including these, for reducing your risk:

If you smoke, quit. Smoking doubles your risk of stroke.

If you drink alcohol, do so in moderation. Limit alcoholic beverages to 2/day.

Exercise. As little as 30 minutes of walking each day offers many benefits; find an exercise buddy to keep you motivated.

Eat a reduced-sodium, reduced-fat diet. Focus on vegetables, fruit, whole grains, and lean proteins; keep added salt and fat to a minimum.

Know the symptoms. Remember, act FAST — look for drooping of face when smiling, difficulty raising arms above the head, and slurring or other speech difficulties — and get treatment as quickly as possible, because time is of the essence.

Ask your doctor about medical tests for atrial fibrillation, circulation problems, or diabetes and to evaluate and monitor your blood pressure as well as cholesterol levels.

Hospitalizations After Hip Fractures

Hip fracture patients who are discharged from the hospital before they have fully stabilized stand a much higher risk of dying — even if they are discharged to another health care facility.

According to researchers publishing in the Archives of Internal Medicine, patients suffering from even one unresolved medical issue, such as a fever, breathing problem, infection, incontinence, or eating problem, have a 360-percent higher mortality rate and a 60-percent greater chance of being readmitted to the hospital.

Hip fractures are a major cause of death and disability among the elderly. About 350,000 people have the fractures every year, and medical complications are high. Despite the risks, however, doctors are under increasing pressure to reduce the number of days these patients stay in the hospital. Average stays for hip fracture patients have declined from about 20 days in 1981 to just 6.5 days in 1999.

In this study, investigators from Mount Sinai School of Medicine reviewed 559 cases of hip fracture patients from four hospitals in the New York area. All were treated and discharged in 1997 and 1998. Nearly 17 percent of the patients were found to have one or more “acute medical issues” and about 40 percent had one or more “new impairment” prior to discharge, which put them at higher risk for death and subsequent readmission to the hospital. The higher death rates and hospital readmission rates were seen in patients regardless if they were discharged to their homes or to a rehabilitation hospital or skilled nursing facility.

The authors believe these findings suggest a need for doctors to more carefully factor in the presence of unresolved medical issues when deciding when a hip fracture patient is ready to be discharged from the hospital. They also believe physicians need to work more closely with post-acute care facilities to ensure any unresolved medical issues are adequately addressed in the new setting.

A link between the brain and the heart

Have you noticed an older friend or relative feeling a little down lately? A link between the brain and the heart may shed some light on why the elderly suffer depression.

Eighty-five-year-old Margaret Hawkins always enjoyed life. After she lost her husband and two close friends, however, depression set in. “It’s something in your chest around your heart, and you think it’s anxiety,” says Margaret.

Duke psychiatrist Dr. Ranga Krishnan says Margaret is one of many older Americans who is suffering small, almost undetectable strokes inside her brain. “They were not identified as strokes clinically before because they did not affect motor movements,” says Dr. Krishnan. “In other words, they didn’t produce paralysis.”

These mini-strokes occur when blood vessels cut off blood flow to the areas of the brain which affect mood. The result is depression.

Dr. Krishnan is studying more than 200 patients like Margaret and has discovered none fit the profile for depression. Yet they all have classic signs of heart disease like a history of diabetes, high blood pressure and clogged arteries.

Dr. Krishnan says, “It just tells you, don’t treat depression just like a symptom. Don’t just give it a medicine and forget about the underlying medical problems that may be leading towards it.”

He also says medicines that help the heart may help the mind. So patients like Margaret take vitamin E and an aspirin a day.

Margaret Hawkins, “I’m not a depressed person. I’m a pretty happy person, and everybody I see now talks about how good I look.”

Researchers hope studying patients like Margaret will help them refine treatment for others. They believe vascular depression is so common, it could account for as much as 30 to 40 percent of all depression in people over the age of 65.