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Joint Assets: An Osteoarthritis Update

The aching, swollen, stiff joints associated with osteoarthritis (OA) have long been considered a “wear and tear” condition, associated with aging. It was thought that cartilage, the smooth connective tissue on the end of bones that cushion the joints, simply breaks down over a lifetime of walking, exercising and moving. New research shows that it is a disease of the entire joint that also causes bony changes of the joints, deterioration of tendons and ligaments and inflammation of the synovium (lining of the joint). While more prevalent in people over 50, OA can show up in younger patients, especially those who’ve experienced a joint injury such as a torn ACL or meniscus. The promising news is that according to the Arthritis Foundation, “OA is not an inevitable aging disease” and the Cleveland Clinic notes: “Age is a contributing factor, although not all older adults develop osteoarthritis and for those who do, not all develop associated pain.”

Still, currently OA is by far the most prevalent form of arthritis, affecting more than 32.5 million Americans, and primarily targeting knees, hips, hands and spine. A variety of factors contribute to the development of OA, including congenital joint deformity, family history, previous joint injury, and years of physically demanding work or contact sports. However, reducing risk is possible with attention to these modifiable factors:

  • Obesity adds stress and pressure to joints. Consider that your knees bear a force equivalent to three to six times your body weight with each step, so a lighter weight relieves the burden considerably – losing one pound takes 3 pounds off the knees.
  • Lifestyle. Being physically active is crucial, as a sedentary lifestyle and obesity are associated with a higher risk of OA. While sports such as football, baseball and soccer may pose a risk because of their impact on joints, most types of regular or moderate exercise can be safely done.

Living with Osteoarthritis

Unfortunately, there is no cure for OA, and managing symptoms such as joint stiffness, tenderness, swelling, and popping or crackling can become increasingly difficult over time. While seeking a pill to alleviate discomfort is a natural reaction, consider trying alternative solutions to help break the cycle of chronic pain.

“The longer the brain processes pain, the more hypersensitive it becomes to pain,” explains Rachel Welbel, MD, a physiatrist who is extensively trained in physical medicine and rehabilitation and sports medicine. “The brain, now constantly on high alert, may respond to non-painful sensations as if they are painful. Poor diets and stress can increase chemicals in the brain that reinforce this response, prolonging the pain cycle.”

Reflecting a more holistic and multi-faceted approach to managing pain, she says: “Opioids are almost never the answer.” Instead, she recommends lifestyle modifications, treatments and medications that help tackle pain in a variety of ways.

Lifestyle Modifications, Treatments and Medications for Osteoarthritis

Weight management. Obesity is not only a leading risk factor for OA, but adds to the pain for those with the condition. Body fat produces proteins called cytokines that cause inflammation, and in the joints, can alter the function of cartilage cells. Shedding even a few pounds can make a difference: losing just 10% of your body weight can cut arthritis pain in half, and losing another 20% can reduce the pain by an additional 25% or more, and may slow or even halt progression of the disease.

Exercise and movement. “Exercise is key to living well with OA,” says Welbel. “While resting aching joints may bring temporary relief, lack of movement ultimately leads to more discomfort. The focus is not on weight loss but on minimizing pain and maximizing strength.” Plan on 150 minutes of light to moderate exercise each week. She recommends working with a physical therapist who can analyze your joint biomechanics and suggest exercises to strengthen muscles and improve range of motion while reducing stiffness and pain. “In addition, exercise is a natural mood elevator,” says Welbel. “Walk, swim, or try mindfulness-based, stress-reducing exercise such as yoga and tai chi.”

Anti-inflammatory diet. Increasing consumption of fruits, vegetables, whole grains, legumes and fish, while reducing consumption of red and processed meats, refined grains, and sugar-containing beverages and foods, may play an important role in reducing pain associated with inflammation from OA, says Welbel. Try incorporating into your diet fatty fish; herbs and spices such as garlic, turmeric and cinnamon; yogurt and other fermented foods; and healthy fats such as avocados, extra virgin olive oil and walnuts.

Supportive devices. A cane or walker can help lighten the load on your joints, decrease pain, and reduce your risk of falling. Intermittent use of a knee brace may be helpful for added stability, especially if walking on uneven surfaces. Foot orthotics such as arch supports and metatarsal pads may reduce foot pain.

Medications. Over-the-counter (OTC) pain relievers like acetaminophen (Tylenol) may help joint pain and stiffness for some. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also used to relieve pain, including OTC medications such as Advil or Aleve, or Celebrex, a prescription medication with a somewhat lower risk of ulcers and upper gastrointestinal bleeding than other NSAIDs. Topical NSAIDS such as Aspercreme and other creams or patches containing ingredients such as capsaicin, menthol or lidocaine can help.

Injections. Corticosteroids injections may provide temporary relief for acute flare-up of OA pain in knees and finger joints, but effectiveness can vary, and you must wait at least 3 to 6 months to repeat an injection in a specific joint if needed. Viscosupplementation involves injection of a gel-like substance containing hyaluronic acid, which acts as a lubricant in the fluid between bony surfaces and is decreased in OA joints. Research results for significant pain reduction or improved function are not yet convincing, but there appear to be a number of patients with mild to moderate knee OA who report symptom relief.

Supplements. Research results are mixed, but we note some of the more well-known supplements with the caution that these are not recommended to be used alone as treatments for OA. Glucosamine and chondroitin sulfate, naturally occurring compounds found in healthy cartilage, may help reduce joint pain and stiffness, and have been available in the U.S. and Europe for several decades. Other supplements such as tart cherry and turmeric may help reduce OA symptoms for some.

Other promising but not yet proven treatments. Platelet-rich plasma (PRP) injections and stem cell therapy have been used to treat pain of mild to moderate knee OA, but evidence of effectiveness is mixed, and these are still considered experimental. Elements of Eastern medicine, including herbs and acupuncture, may help control OA symptoms, but have not yet been confirmed in large clinical studies.

A Generation of Joint Replacements

When diet and exercise modifications, supportive devices, medications and injections no longer sufficiently ease the pain of OA, a hip or knee replacement may be recommended. The number of people opting for this surgery increases each year, now totaling more than 790,000 knee and 450,000 hip replacements annually.

The implants, made of plastic, metal or ceramic, are traditionally kept in place with bone cement, which is gradually being replaced by newer cementless and porous titanium systems to improve bone fixation and durability. Also on the rise is computer-assisted surgery to increase placement accuracy of the prosthetic components, and patient-specific implants using 3D printing technology. The combination of modern materials and advanced surgical techniques have extended the durability of most implants to 20 years, a marked improvement over the previous standard of 10 to 15 years.

Recovery time has also changed for the better. With rehabilitation to regain strength and motion, normal activities can usually be resumed within weeks to months. Most importantly, the majority of patients are highly satisfied with the results, reporting minimal to no pain and significantly improved function and quality of life. However, outcomes can vary and potential complications should be discussed before proceeding.

Additional breakthroughs may be on the horizon: researchers at Duke University start trials this spring of a hydrogel-based cartilage substitute that may prove more durable than natural cartilage…stay tuned!

Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.

Sources: Arthritis Foundation, AAOS, Orthoworld, Cleveland Clinic, National Academy of Medicine (formerly Institute of Medicine), UpToDate, US Department of Agriculture, American College of Rheumatology.

 

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Bone Up: What Is Osteoporosis?

Except for dedicated thespians, saying “break a leg” is most definitely not a harbinger of good luck. More than 10 million Americans are living with osteoporosis, a condition of low bone mass that results in increased risk of bone fracture, sometimes even from a minor fall or pressure from a big hug. Over 1.5 million osteoporotic fractures occur annually, and 1/3 of women and 1/5 of men over 50 will experience an osteoporotic bone fracture in their lifetime. The good news is that reliable diagnostic testing and treatments are available, which we share below.

Who’s at Risk for Osteoporosis?

Osteoporosis is sometimes referred to as a “silent disease” because it is painless unless a fracture occurs, so people often are unaware they have it until that happens. Post-menopausal women are at highest risk, in part due to the decline in estrogen levels. Estrogen, and to an even greater extent, testosterone, are hormones that help ward off osteoporosis, which is why it is not as common in men. Others at risk include those with autoimmune diseases such as rheumatoid arthritis and celiac disease, those with high parathyroid or thyroid levels and certain other chronic diseases.

Medications including corticosteroids, proton pump inhibitors and certain antidepressants and anti-seizure medications may increase risk of bone thinning. Inherited factors may affect risk, such as race (more common in Caucasians and Asians), body shape and size (smaller/thinner individuals more at risk) and family history of osteoporosis. Physical activity level and diet play a role, placing those who are sedentary and/or have a diet low in calcium at higher risk. Cigarette smoking and higher alcohol intake are also risk factors.

How Osteoporosis is Diagnosed

A bone density measurement test is the best way to diagnose osteoporosis, using the DEXA (dual energy x-ray absorptiometry) scan of hip and spine. The severity of decrease in bone mass is determined by your T-score: Between -1.0 and -2.5 is defined as osteopenia, when bones are weaker than normal, while -2.5 or less indicates osteoporosis.

Osteoporosis Medications

A number of medications are available to treat osteoporosis.

  • Bisphosphonates to slow the breakdown and removal of bone are typically tried first. Fosamax, used most, is a weekly pill often taken for 5 years followed by a “drug holiday.” The IV bisphosphonate Reclast is generally continued for three years.
  • Evista is a daily pill for post-menopausal osteoporosis that protects against bone loss and also reduces the risk of breast cancer in high-risk women.
  • Prolia is injected every 6 months to slow breakdown and removal of bone and help increase bone density. It should not be discontinued once started or must be followed by another medication if stopped.
  • Evenity is injected once a month for a year to increase new bone and reduce breakdown and removal of bone.
  • Forteo and Tymlos are drugs that help build bone for people at high risk of fracture. These are injected daily for two years.

Managing Osteoporosis

Peak bone mass is achieved by age 25-30 years, but at any age, a healthy lifestyle can aid in strengthening bones. Focus on eating a balanced diet rich in vitamin D and calcium (see sidebar), and remember that exposing the body to natural sunlight increases production of vitamin D. Eliminating tobacco use and limiting alcohol is strongly recommended to promote maximum absorption of calcium and vitamin D. Taking fall prevention measures is crucial: consider that 95% of hip fractures are caused by falls.

Aim for 30 minutes of weight-bearing and muscle strengthening exercises on most days:

  • Walk or run on level ground or a treadmill
  • Dance
  • Climb stairs
  • Lift weights without straining your back
  • Sit-to-stand exercises: start with an elevated seat height, and progress to a lower chair as you get stronger
  • Strengthen thighs: stand against a wall and slide down into a slight knee bend, hold for 10 seconds and repeat a few times
  • Tai Chi: combines slow movements, breathing exercises, and meditation

Nourishment Know-How for Bone Health

For optimal bone health, a daily intake of 1200-1500 mg of calcium and 400-800 IU (international units) of Vitamin D is recommended for adults. In many cases, supplementation may be appropriate.

Selected sources with calcium and/or Vitamin D:

  • Dairy products
  • Calcium- and vitamin D-fortified foods and beverages (soy or almond milks, cereals, cheese)
  • Dark green, leafy vegetables
  • Fish such as salmon, trout, mackerel, tuna, sardines
  • Egg yolks
  • Sesame or chia seeds, figs, almonds

Fall Prevention Measures for Those with Osteoporosis Include:

  • Avoid ladders, step-stools and roof work
  • Eliminate tripping hazards like throw rugs, obstacles or cords on the floor
  • Be careful around pets and leashes
  • Use good lighting, night lights, update glasses and eye care to optimize vision
  • Stay fit with regular strengthening and balance exercises
  • Wear non-slip shoes
  • Install handrails and grab bars in the bathroom

Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.

Sources: Arthritis Foundation, AAOS, Orthoworld, Cleveland Clinic, National Academy of Medicine (formerly Institute of Medicine), UpToDate, US Department of Agriculture, American College of Rheumatology.

 

 

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The Future of Aging

The First Hundred Years: Healthy Longevity May Ultimately Define the Future

Humankind has eternally searched for the fabled fountain of youth. While we suspect that a magical elixir to turn back time may never be discovered, in 2023 we are coming ever closer to a more achievable goal: using scientific breakthroughs to slow the process of aging and therefore prolong our healthspan. As the number of Americans celebrating their 90th, 95th and even 100th birthdays continues to rise, aging research has radically shifted from efforts to extend the lifespan to enhancing function and years lived independently. Countless studies, encompassing everything from launching stem cells into space to investigating the genetics of “super agers”, are underway. Below we explore some of the newest thinking and exciting breakthroughs to come with nationally recognized expert George Kuchel, MD, whose decades of successful research both at the bench and in clinical settings have contributed to shaping a new vision of how we age.

“We can’t reach old age by another man’s road. My habits protect my life but they would assassinate you.” – Mark Twain, 1905

Individuality in Aging

“We used to look at older adults as if they were all the same, with everyone becoming old the day they retired at 65,” says Dr. Kuchel, director of the UConn Center on Aging, which was established in 1985, making it one of the first multidisciplinary centers focused on improving the lives of older adults through research, education and clinical care. “While aging is inevitable and a normal part of the lifespan process, there’s tremendous heterogeneity, or variability, in how each of us ages. When we study the rate at which individuals age in terms of physical and cognitive function, frailty, disability, and disease development, we find increasing heterogeneity with age. Therefore, rather than focusing on averages typically culled from observational studies of older people compared to younger people, we are focusing on the differences within those averages.”

Geroscience and Aging Adults

Better understanding the uniqueness of each individual as they age has inspired Dr Kuchel and his colleagues to spearhead the burgeoning new field of Precision Gerontology. The overarching goal is to develop treatments for older patients that are more effective in promoting health and independence by being more precise and targeted. Adding exponentially to this knowledge base is the field of Geroscience, which seeks to delay the onset and progression of different chronic diseases by targeting the shared biological mechanisms that make aging a major risk factor and driver of common chronic conditions and diseases of older people.

“Many older people have multiple ongoing chronic conditions, and see different physicians for each,” says Kuchel. “However, as geriatricians and concierge medicine physicians were among the first to recognize, looking at the whole patient is essential. Geroscience transforms the ‘one disease at a time’ approach by studying the role of biological aging in enabling all these conditions.”

The 2021 launch of the NIA Older Americans Independence “Pepper” Center at UConn, one of only 15 National Institutes of Health (NIH)-funded centers across the country dedicated to enhancing function and independence in older adults through research, has significantly advanced the scope of studies at the university. According to Kuchel, “We are combining evidence-based geriatric care with more individualized treatments involving emerging interventions designed to delay the onset of chronic diseases by targeting biological aging. Our work moves us closer to the mission of extending the healthspan of greater numbers of individuals.”

Studies Related to Healthy Aging and Longevity

Promising studies under the microscope at UConn and other prominent research institutions include:

Can chronic diseases be delayed by targeting aging?

A geroscience-based trial to test the effectiveness of diabetes drug metformin in slowing the onset of chronic diseases in older adults is slated to be announced in 2023. The randomized, six-year TAME (Targeting Aging with Metformin) trial, led by the American Federation for Aging Research, will engage over 3,000 individuals nationwide between the ages of 65 and 79 to test if those taking metformin experience decreased or delayed onset or progression of age-related diseases such as cardiovascular disease, cancer and dementia.

Dr. Kuchel believes that conducting the trial will prove revolutionary. “Metformin has an excellent safety profile, proven over more than six decades,” he says, “and uniquely among other oral hypoglycemics, it appears to have a broad effect on many aspects of aging.” By collecting and analyzing trial participants’ serum, plasma, blood, urine and stool for varied biomarkers, the study will also provide information about a person’s risk of developing a disease, and lay a solid foundation for future biomarker discovery and validation as well as accelerating the pace of geroscience research.

Worth noting: In earlier stages is the study of rapamycin, an immunosuppressant currently used in high doses in transplant patients. However, when used in much lower doses the drug promotes longevity and reduces age-related disease in animal models, while it improves influenza vaccine responses in community-dwelling older adults.

Senolytics

This entirely new class of drugs may one day be used to halt cellular senescence, a hallmark of aging. As cells age and lose their ability to divide, they secrete molecules that trigger inflammation and cause much of the damage seen in osteoporosis, arthritis, diabetes, sarcopenia, cardiovascular disease and cancers. In numerous animal trials, use of senolytic drugs such as fisetin to selectively eliminate and clear senescent cells from the body were shown to significantly improve function. Multiple placebo-controlled, double-blind studies with older patients are planned or underway through the National Institute of Aging Translational Geroscience Network and elsewhere.

Inside the microbiome

This topic of intense interest continues to build an impressive body of research, including a recently completed collaboration between UConn Center on Aging and Julia Oh, PhD, at the Jackson Laboratory for Genomic Medicine on the same campus. This study showed the presence of an altered microbiome (the millions of microbes living in our gut, mouth, skin and elsewhere) in nursing home residents. Importantly, the changes were specific to frailty rather than biological age, and linked to bacteria associated with severe infections and antibiotic resistance. Going forward, in keeping with a focus on Precision Gerontology, clinical approaches may be used to identify individuals with high risk for severe infections and to explore treatments for restoring the microbiome to a state characteristic of younger or less frail individuals.

Personalized influenza vaccines

Another example of Precision Gerontology research is underway with Duyu Ucar, PhD, at the Jackson Laboratory and the Icahn School of Medicine at Mount Sinai, studying adults aged 65 and older over the next three influenza seasons to pinpoint the age-related immune alterations that reduce influenza vaccine effectiveness. “We know the body’s ability to produce a robust immune response after receiving the flu shot decreases with age, and we’ll be testing whether next-generation influenza vaccines, including mRNA-based ones, can help boost these immune responses. Understanding the factors that predict good responses to each vaccine will allow us to ultimately personalize our recommendations,” explains Kuchel.

“This is truly a time of meaningful change and ongoing advances in the field of aging,” says Kuchel. “Each day we uncover new answers to the question that has inspired our research from the start: ‘How can we add life to our years?’”

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Studying the Secrets of Super Agers

The growing group of people able to enjoy 100 years of life may well be one of the most remarkable achievements of the 21st century. A generation ago, the number of centenarians worldwide was just 110,000; today they are 600,000 strong. Notably, a sizable segment of this long-lived group, aptly called Super Agers, reach 100 in good health with no age-related disease or disability. Are they the fortunate recipients of outstanding genes, followers of a particularly healthy lifestyle, or a combination of both?

Definitive answers may start to emerge sooner than we had imagined possible, thanks to the SuperAgers Family Study, called one of the most ambitious ever conducted, with the goal to uncover and understand the genetic and biological mysteries of exceptional longevity and healthy aging. The initiative, spearheaded by the American Federation for Aging Research (AFAR) and Albert Einstein College of Medicine, in collaboration with https://www.bumc.bu.edu/busm Boston University School of Medicine, will recruit 10,000 people over age 95 to collect their DNA samples and health histories, as well as their children’s.

“Super Agers show us that chronic disease is not an inevitable part of aging, and that an extended period of good health can accompany a long lifespan,” says Sofiya Milman, MD, principal investigator of the study and director of Human Longevity Studies at Einstein’s Institute for Aging Research.

While previous research has attempted to pinpoint the distinctive characteristics of people living well in their ninth and tenth decades, the enrollment of 10,000 participants in SuperAgers will represent the largest cohort ever studied. The extensive numbers are essential to obtaining meaningful data that can benefit many in the future, according to Milman.

“We believe longevity may be linked to rare genetic variants found in less than five percent of the population, making it a challenge to amass ample genetic evidence,” explains Milman. “The enormous data bank being built in our SuperAgers study will enable us to identify these genes, understand their biological pathways and explore how to duplicate their functions.”

Milman aims to achieve full enrollment over the next two to three years, with results from the first phase available in 2024. “SuperAgers will significantly accelerate our research by providing us with a treasure trove of data on not just genetics, but biological and behavioral factors that affect aging and its related diseases. Ultimately, this will help us develop, trial and fast-track new therapies to extend a healthy old age,” she says.

In the meantime, adhering to a nutritionally balanced diet, exercising, getting sufficient sleep, managing stress and eliminating tobacco are all well advised. “A healthy lifestyle alone may not be enough to guarantee you reach 100,” admits Milman, “but all evidence points to the fact that it will extend your healthy lifespan.”

SuperAgers Sign-Up

Interested in being part of the SuperAgers family study?

Individuals who have passed their 95th birthday, as well as children of those individuals, are invited to enroll online at http://www.superagersstudy.org and complete a health history, family history and demographic profile. Those eligible will receive a biospecimen collection kit in the mail and are asked to return it in a postpaid envelope to the Albert Einstein College of Medicine, which will store and process each participant’s DNA. Please note that participants may choose to receive results regarding their ancestry or family origins. The SuperAgers biobank holding the DNA records, and all the related data, will be protected and maintained at Einstein in compliance with federal medical privacy law (HIPAA).

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Dementia and Alzheimer’s: Updates from a Leading Geriatrician

Senior Moments Or Something More?

As Baby Boomers continue the inexorable journey deep into their senior years, preserving cognitive function understandably tops the list of worries. While Alzheimer’s Disease and related dementias are seen in just 5% of people over 65, that number jumps to 30% for people age 85 and over. Questions abound: is forgetting a name a sign of normal aging or an indicator of a more serious memory disorder? Are any nutritional supplements or pharmaceutical treatments available that are proven to stave off memory loss? Most importantly, what steps can be taken to modify individual risk?

To better understand how to identify and manage dementia and Alzheimer’s disease, we asked one of the country’s leading experts, R. Sean Morrison, MD, for his informed perspective on this growing concern for seniors, their families and caregivers. A practicing geriatrician, palliative medicine physician and health researcher for almost three decades, Dr. Morrison has earned numerous awards and recognition for his work, and currently serves as the Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and as Director of the Hertzberg Palliative Care Institute.

Is memory loss an inevitable, natural sign of aging?

Dr. Morrison: The good news is that not all cognitive functions decline with age. The ability to maintain attention, language comprehension, usage, and vocabulary does not decrease. Knowledge learned years ago like how to ride a bike, or brush your teeth, also stays intact. Additionally, when you learn something new and can remember it, you won’t forget it any more rapidly than when you were younger.

The not so good news is that it will take greater effort to learn those new things; more attention, repetition and use of memory-enhancing strategies will be needed. The ability to multitask is also diminished, as processing information takes longer and reaction times are slower. People may experience poorer performance when working under time pressure, and find it more difficult to manipulate information in the brain, such as calculating a tip in a restaurant or figuring out a route to travel from one place to another.

How do you distinguish between a “senior moment” lapse in memory and a sign of Alzheimer’s disease?

Dr. Morrison: So many people experience that temporary inability to remember a name. But if you are able to recall things with a cue or can pick it out from a list of possibilities, that’s evidence of a problem with retrieval but not with storage. You can be reassured that it doesn’t indicate Alzheimer’s disease but a “senior moment” because the information has been successfully stored in your memory.

Is routine screening for dementia recommended in older adults?

Dr. Morrison: The U.S. Preventive Services Task Force does not recommend for or against routine screening, saying no interventions are proven to have a significant effect in people with earlier detected cognitive impairment. However, it is required as part of Medicare’s yearly assessments, and most primary care physicians consider dementia screenings an essential part of their annual wellness exam.

What types of screening tests do you recommend?

Dr. Morrison: At least a dozen tests are available, each with their own benefits and drawbacks. I recommend the following for their ease of use and proven sensitivity and specificity in diagnosing cognitive impairment:

  • Mini-Cog is a quick, three-minute evaluation. Patients are asked to repeat three words, draw a clock with hands at a specific time, and then recall the initial three words.
  • Memory Impairment Screen assesses free and cued word recall. Patients are read four unrelated words from four categories (e.g. Red Cross, saucer, checkers, telegram) and after a few minutes of diversion, asked to recall the words in 20 seconds, either with no prompting or cued by category.
  • Animal Fluency Test. Patients are asked to name as many animals as possible in a 60-second period.

Are there any risk factors for dementia and Alzheimer’s disease that can be controlled by patients?

Dr. Morrison: Quite a few risk factors are modifiable with lifestyle changes and non-pharmaceutical treatments. These include:

  • Address hearing and visual impairments, with eyeglasses, hearing aids and other assistance
  • Prevent and manage hypertension and diabetes
  • Maintain a healthy weight
  • Stop smoking
  • Seek treatment for depression
  • Prioritize regular exercise and physical activity
  • Avoid social isolation
  • Explore cognitive training

The best advice I can give to people in their 50s to 70s looking to prevent or delay progression of dementia and Alzheimer’s disease: exercise, exercise, exercise and rigorously control your blood pressure.

How are the symptoms frequently experienced by people with dementia – sleep disturbance, mood disorders, agitation – best addressed?

Dr. Morrison: There are a number of non-pharmaceutical interventions that have proven effective. Use adaptive clothing and assistive devices to help eliminate distress around bathing and dressing. Create a reassuring familiar structure to the day with a regular routine and activities. Optimize the sleep environment with a comfortable temperature, the right amount of light, a warm milky drink and a bath or shower before bed; avoid stimulating medications, drinks containing caffeine and alcohol, and exercise too close to bedtime. Pharmaceutical treatments can also be considered, including antidepressants to improve cognition and ameliorate agitation and aggression, and melatonin and melatonin antagonists to help with sleep disorders. Of note: medications such as benzodiazepines (BZD), non-BZD hypnotics, mood stabilizers and antipsychotics are no longer routinely recommended as side effects can outweigh possible benefits.

Are there any benefits to nutritional supplements or appetite stimulants?

Dr. Morrison: Nutritional supplements can help with weight gain in patients with anorexia or cachexia (‘wasting’ syndrome) but have no meaningful impact on survival. And while appetite stimulants such as cannabinoids and steroids are often given to help patients with dementia, there is no consistent data regarding their safety and efficacy.

What medications are available to treat or stop the progression of dementia?

Dr. Morrison: Until last year, only four medications were approved for treatment of dementia and Alzheimer’s disease, showing only a minimal to modest improvement in cognition. In 2021 a fifth drug was launched – aducanumab – a monoclonal antibody designed to reduce amyloid protein in the brain. Its fast-track approval was quite controversial as the clinical benefits of the drug were not proven during trials, which were stopped early as a result, and some severe side effects were observed. Interestingly, some researchers are now rethinking the idea that targeting amyloid protein plaques will eliminate Alzheimer’s disease, and instead exploring Alzheimer’s as a disease of inflammation. This could be the next fascinating line of research.

How a Memory is Made

Memory begins to form by giving attention to the information received through your senses. Anything that interferes with your ability to pay attention, such as hearing impairment, will affect the formation of a sensory memory. Successful integration of sensory memories into your working memory enables you to temporarily store, organize and manipulate information. These memories are then encoded into long-term memory and finally put into permanent storage.

 

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Nourish Body, Brain and Heart with the MIND Diet

Mindful Eating for Your Brain

Harkening back to ancient civilizations, the concept of food as medicine represents one of today’s most cutting-edge approaches to prevention and disease management. Inspired by the intricate connection of mind and body wellness, a small, special group of diets have made their way into the mainstream offering benefits far beyond short-term weight loss. Among them are DASH (Dietary Approaches to Stop Hypertension), a low-sodium diet that encourages consumption of foods rich in nutrients such as potassium and calcium and magnesium; the Mediterranean diet for heart health, emphasizing fish, fruits, and vegetables, with olive oil as the main source of fat; and combining both, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, which shows real promise in helping its adherents preserve cognition and reduce the risk of dementia.

Launched in 2015 by researchers at Rush University Medical Center, the MIND diet encourages selecting foods from categories that include leafy greens and vegetables, legumes, fish and seafood, poultry, nuts and berries, while limiting high fat, high sugar and processed foods. Longitudinal observational studies showed the rewards of shifting to this healthier way of eating, with a 53% reduction in the risk of dementia for seniors who rigorously followed the diet, and somewhat surprisingly, a 35% risk reduction even for those who followed it only moderately well.

“This is my favorite feature,” says Jennifer Ventrelle, MS, RD, lead dietitian for the MIND Diet Intervention to Prevent Alzheimer’s Disease at Rush, “you don’t have to be perfect! It’s not necessary to eat from every preferred category to achieve your goals.”

Although it’s not intended as a reducing diet, Ventrelle says people who follow it naturally lose weight by focusing on the preferred categories of foods. “It’s too difficult for many people to consider banishing all sweets or giving up red meat forever, so we haven’t eliminated these foods but allow them with limited frequency and close attention to portion sizes,” she explains.

Additional research pointed to a host of other benefits associated with eating MINDfully for older adults: slower cognitive decline and progression of Parkinsonian signs in aging, and reduced risk of functional disability, depressive symptoms, metabolic syndrome, cardiovascular disease and all-cause mortality. “The literature continues to grow, with new studies that point to the key role diet plays in preventing cognitive decline,” says Puja Agarwal, PhD, nutritional epidemiologist and assistant professor of internal medicine at Rush.

But it is the gold-standard randomized controlled trial begun several years ago by Rush and Harvard School of Public Health that may ultimately establish a causal relationship between diet and dementia. More than 600 participants at higher risk for Alzheimer’s disease – overweight, suboptimal diets and a history of dementia in the family – were enrolled in the study designed to directly measure whether following the MIND diet versus a low-fat diet can prevent neurodegenerative ills – results are expected by the end of 2022. According to Agarwal, who is fully aware of its significance at a time when more than 6 million people in the U.S. are living with Alzheimer’s disease, a number expected to double in the coming decades. “We don’t have a cure for these diseases, so prevention strategies are essential. We’re hoping for intervention trial results for the effect of MIND diet in protecting the brain to further establish the role of diet in healthy aging.”

What a day of meals on the MIND diet might include*:

BREAKFAST
Greek Yogurt Parfait: ½ cup whole grain, high fiber cereal, ½ cup berries, ½ cup low-fat Greek yogurt, 2 tbsps (raw, unsalted) walnuts, almonds or pecans.

LUNCH
Whole Wheat Turkey Wrap: 1 tortilla wrap + 3-5 oz turkey breast lunchmeat or carved white meat + 1 slice reduced fat cheese + lettuce, tomato and veggies of choice.

3-Bean Salad: Mixture of kidney beans, black beans, chickpeas, red onions + 1 tbsp extra-virgin olive oil + 1 tsp balsamic vinegar + Italian seasoning mix such as oregano, parsley, basil, etc.

SNACK
Mediterranean Rice Cake: 1 whole grain rice cake spread with 2 tbsps hummus topped with cucumber slices, tomato slices + fresh lemon juice.

DINNER
Baked Salmon over Spinach and Grains with Asparagus

  • 3-5 oz salmon filet topped with fresh or dried dill or parsley + a squeeze of fresh lemon juice baked on top of 1 cup baby spinach leaves
  • 8 asparagus spears topped with ½ tbsp extra-virgin olive oil + fresh lemon juice + zest
  • 1 cup cooked whole grain such as brown rice, quinoa, or bulgur mixed with ½ tbsp. extra-virgin olive oil

DESSERT
1 oz of dark chocolate (at least 75% cocoa) and ½ cup frozen berries

*Please consult with your physician to determine if these foods are appropriate for you.

The post Nourish Body, Brain and Heart with the MIND Diet appeared first on Specialdocs Consultants.

Why Patients Are Choosing Concierge Medicine

You studied medicine and became a doctor because you enjoy helping people. You went into practice and work long hours because your patients need you. When you see a problem, you want to fix it.

However, what if the problem isn’t with your patients’ health but with your practice’s fee-for-service business model? Don’t you want to make healthcare work better and more efficiently for everyone?

The types of business model that physicians primarily use for their patient practices are:

  1. Private practice: Physicians own their practices and — in addition to treating patients — are responsible for managing (or outsourcing the management of) office duties. Doctors in private practice can take on as many or as few patients as they like, but the hours and responsibilities are often greater. Forty-nine percent of physicians worked in a private practice in 2020, which is a decrease from 54% of physicians in 2018.
  2. Group practice: Two or more doctors within the same practice provide medical services. They share practice responsibilities and office staff and divide the income among them.
  3. Hospital-based: Physicians are employees of a hospital or multi-hospital system. The hospital also employs the office staff and manages the responsibilities of the practice. As employees, physicians in a hospital-based system have less control over what hours and days they work and the number of patients they see each day.

In a medical practice that is often overworked and inefficient, challenges to patient care might include:

  • Long wait times (weeks or months) for patients to see doctors
  • Acute health issues developing into chronic conditions if patients can’t be seen in a timely fashion
  • Overburdened emergency departments being used as primary care facilities
  • Nursing, tech and administration shortages due to stressed and overworked medical and office staff

What can be done about these issues? How can healthcare be done differently? Welcome to concierge medicine.

What Is Concierge Medicine?

In a concierge practice, physicians are paid a monthly or annual retainer by their patients. In return, concierge doctors make time in their schedules to see and treat their patients for regular wellness visits or in situations when more immediate care is warranted.

During a concierge appointment, more time can be spent with each patient, enabling more thorough examinations and consultations. Concierge visits are typically more personalized, with a greater emphasis placed on wellness and illness prevention.

There are many benefits of concierge medicine, including:

  • Shorter wait times: With same-day or next day appointments, patients can see doctors sooner, making conditions and symptoms more manageable. This can also improve patient satisfaction, as they can receive medical attention more quickly, rather than wait for appointment openings for weeks or months.
  • Less reliance on emergency rooms: Time spent in the waiting room for wellness visits is typically shorter. As a result, people are more likely to see their primary care physician rather than turn to the emergency room.
  • Better patient care: Office visits are often less rushed, so physicians can ask more questions to learn more about their patients’ physical health and mental wellbeing. Additionally, patient visits can include health coaching and other preventive measures.
  • More flexibility: Virtual consultations between physicians and patients are available. Plus, patients’ adult dependent children between the ages 18-26 might also qualify for the concierge plan, sometimes with additional, lower membership fees.
  • A network of caregivers: Concierge doctors can typically refer patients to specialists and admit patients to hospitals, allowing them to give their patients the care they need when they need it.

Patients and dedicated staff deserve better and more efficient healthcare than the current fee-for-service business model. That is why more physicians and patients are choosing concierge medicine.

The post Why Patients Are Choosing Concierge Medicine appeared first on Specialdocs Consultants.

What Is Concierge Medicine?

As a relatively new and unfamiliar form of healthcare, concierge medicine is gaining popularity due to its notable benefits for doctors and patients. So, what is concierge medicine?

Concierge medicine refers to an innovative, membership-based model where patients pay an annual, bi-annual or monthly fee to join a physician’s practice. In this approach, physicians typically see a fraction of the patients they did under a fee-for-service model. This allows doctors to spend more time with their patients, leading to enhanced care and improved outcomes.

To help physicians and their patients gain a better understanding, below is a list of common questions and answers on the process and the benefits of concierge medicine.

Frequently Asked Questions

How does concierge medicine work?

Concierge medicine works similarly to paying a retainer for an attorney. Rather than charging by the hour, an attorney on retainer provides legal services for a flat fee. In this healthcare model, a person receives medical care for a flat fee instead of paying for each visit and service. Also like having a lawyer on retainer, this allows a patient to call or see her or his doctor whenever needed. Concierge medicine is often referred to as being retainer-based.

What is a concierge doctor?

A concierge doctor is a trained physician who has chosen to form or join a concierge medical practice. This type of private practice limits the doctor’s patient load, allowing her or him to provide more direct access and personalized care. The doctor receives the same amount of education, training and licensing as a doctor in traditional settings. Concierge doctors are sometimes referred to as a direct primary care (DPC) or personalized medical service providers.

How do concierge doctors work?

Concierge doctors can do everything that primary care physicians can, such as conducting annual physical exams, preventive screenings and administering lab tests. Additionally, they can refer their patients to a specialist included in the practice at no charge. As these services are covered by the flat-rate, subscription-based payment structure, an individual with a condition requiring frequent visits may find this model to be more cost-effective in the long run.

What is concierge service in healthcare?

Concierge medicine revolves around quick and easy access. Shorter wait times, more individualized care and even house calls are offered to make this form of healthcare beneficial for those who can afford the retainer. Such fee-for-care concierge services can be modified to fit the patient’s needs and budget. Major medical issues, such as surgery, are not included and still require insurance coverage.

What is a concierge medical practice?

In a concierge medical practice, a physician tends to be more independent and uninhibited by some insurance regulations. The practice is then able to offer a higher quality of care than they might otherwise be able to at a fee-for-service practice. Without the excessive number of patients, scheduling conflicts, administrative burdens and performance pressures that are common at a traditional primary care practice, physicians in a concierge medical practice report higher patient satisfaction as well as feeling more satisfied.

Additional Resources

If you have more questions, please refer to this informative page on the pros and cons of becoming a concierge doctor.

Click here to learn what a relationship with Specialdocs Consultants has to offer.

The post What Is Concierge Medicine? appeared first on Specialdocs Consultants.

How Long Does It Take To Convert To A Concierge Medical Practice?

Just as every medical practice is unique, so too is the process involved with converting to a concierge medical practice. This makes it virtually impossible to answer the question, “How long does it take to convert to a concierge medical practice?”

It is impossible to provide an exact conversion time because there isn’t a one-size-fits-all answer. Some smaller medical practices may be able to fully convert from an independent physician association to concierge medicine in a few months, while other, larger practices may need more time.

Understanding the process involved with converting to a concierge medical practice can help you get a better idea of how long it may take. Continue reading to learn why it is difficult answer, “How long does it take to transition to a concierge medical practice?”

The Evaluation Process

The concierge business model isn’t right for every medical practice. To make sure becoming a concierge doctor is right for you, you will first have to go through an evaluation process.

The evaluation process takes an in-depth look into your medical practice to determine if concierge medicine is right for you and your patients. The evaluation process looks at everything from your personal goals as a physician and the dynamics of your practice to the demographics of current and future patients.

What the Evaluation Process Looks Like for Physicians?

The evaluation process will vary from physician to physician and practice to practice. Some physicians will need to go through every step of the evaluation process before beginning the transition to concierge medicine, while others will only need to complete a few steps.

Some examples of what occurs during the evaluation process include:

  • Meeting with a qualified concierge MD consulting service to start the conversation about making the transition from the traditional medical model to the concierge model
  • Conducting a practice survey to determine how patients and staff feel about the possible switch to a concierge doctor
  • Running a preliminary assessment to determine if your practice is a good fit for concierge medicine
  • Conducting a financial analysis to determine what type of concierge model allows you to reach your financial goals and meet overhead costs
  • Conducting a patient panel to determine what type of services you need to offer to meet the needs of your patients
  • Scheduling an appointment for a concierge MD consultant to visit your practice
  • Finalizing any consulting agreements and documentation

Once the evaluation process is complete, you can begin the transition to becoming a concierge doctor.

What Occurs During the Transition Phase?

Several things will happen at once while you are converting your practice from a traditional model to a concierge model.

Some of the things that you will be doing during the transition phase include:

  • Working to create a unified message that all staff and caregivers can use when communicating to patients about the upcoming transition
  • Actively communicating with patients about the upcoming conversion and educating them about the process
  • Answering any questions that existing patients may have about the conversion to concierge medicine
  • Developing an active marketing strategy that can help you grow your existing practice by informing and educating potential new patients about concierge medicine
  • Creating an active strategy to retain as many existing patients as possible

It may seem like a lot to do, but by completing these steps, you improve your chances of successfully converting to a concierge medical practice.

Work With a Consulting Firm to Transition to a Concierge Practice

Working with a trusted consulting firm that has a proven track record of helping physicians convert to a concierge model should improve your chances of having a smooth and successful transition. Established in 2002, Specialdocs Consultants has helped physicians across the country transition from a fee-for-service model to a concierge model.

Want to get started? Contact Specialdocs to schedule an appointment with a medical consultant. Our medical consultants are available to help you explore your options, learn more about concierge medicine and determine if this business model is right for you.

Call us or fill out our online form to get connected with a medical consultant.

The post How Long Does It Take To Convert To A Concierge Medical Practice? appeared first on Specialdocs Consultants.

Benefits Of Concierge Medicine

When looking for a doctor, it’s easy to be overwhelmed by all your options. In addition to physicians who operate under the traditional insurance structure, you may have heard of those who offer their services as a concierge practice.

If you’re unfamiliar with this term, don’t let that deter you from joining. Although it may be different from what you’re used to experiencing from your current doctor, the benefits of concierge medicine are well worth it. Read on to learn more about what this model of care can do for you.

What Is Concierge Medicine?

Under the standard system, doctors receive reimbursement for their services from patients’ medical insurance providers, rather than from the patients themselves. This comes with a lot of tedious paperwork as well as uncertainty when it comes to whether certain treatments will be covered. In a concierge practice, people subscribe to a physician’s services by paying a retainer fee, usually monthly. This means they pay their doctors directly, without insurance providers serving as middlemen.

What Are the Benefits of a Concierge Doctor?

If you choose to join a concierge practice, you’ll notice some significant differences between your experience there and what you had before with your previous provider.

Here are a few examples of the advantages this framework provides for you:

  • Personalized care: Without so much red tape taking your doctor’s time and energy, he or she will be able to devote more attention to you and your needs. Concierge practices also allow physicians to carry a much smaller patient base, so your physician can give you the care you deserve. You won’t be hustled out the door to keep the line moving through the waiting room. You’ll have a chance to build a real rapport with your doctor so he or she can put your mind at ease and get to know you as a person, not just a number.
  • More treatment options: One of the most frustrating aspects about working with insurance companies is that they’re focused on preserving their bottom line, not necessarily your health. This means they might prevent your doctor from exploring all available options. Under the concierge model, however, there are no such restrictions. You can rest assured that your physician won’t be handcuffed by an insurer.
  • Fewer complications: When cutting the insurance companies out of your care, receiving treatment from your doctor becomes much simpler and less stressful. You won’t have to worry about whether the services you receive will be covered, nor will you have to spend hours on the phone being bounced from department to department. Everything remains between you and your doctor, with nothing standing in the way of you getting what you need and being treated the way you deserve to be.

As the recognized leaders in helping practices transition to the concierge model, Specialdocs Consultants knows how to help improve the way people receive care and how their physicians deliver it.

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