Coaching sessions can help seniors become more assertive during medical visits, suggests a new review of studies on methods to increase older patients’ involvement in their own healthcare.
“Elderly patients should ... have more of a say in not only treatment decisions, but they should also be supported during the whole consultation to make clear their needs and expectations about their healthcare,” said lead author Raymond Wetzels, a general practitioner at the Radboud University Nijmegen Medical Center in the Netherlands.
Even when coaching and handouts are provided to encourage elderly patients to play a more active role in their care, a majority may remain uninvolved in their doctor visits, one of the reviewed studies found. In this study, more than half of the patients had not identified specific issues to discuss before their visit to the doctor. Eighty percent did not bring a list of questions, problems or medications to the visit and asked no questions about their illness or tests or procedures. And 77 percent did nothing to prepare for their visits.
The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research.
Some elderly patients are reticent when dealing with doctors. It could be due to impaired hearing or vision, or dramatic environmental changes such as the loss of a spouse or moving to new living arrangements.
But there are other explanations, said Ming Tai-Seale, an associate professor at Texas A&M Health Science Center, who said that older patients “may be of the generation where they still see doctors as superior beings. They wouldn’t challenge their opinion. They may feel they are taking too much of the physician’s time.”
For patients unable to be assertive, face-to-face coaching sessions may help, according to one of the studies in the review.
There should be a balance, the reviewers concluded, between respecting a patient’s autonomy and stimulating active participation in healthcare.
Source: Health Behavior News Service
Overly Anxious and Driven People Prone to Irritable Bowel Syndrome
Overly anxious and driven people are susceptible to irritable bowel syndrome, usually known as IBS, indicates research published in the journal Gut.
The researchers studied 620 people who had confirmed gastroenteritis caused by a bacterial infection. None had had IBS before, or indeed any serious bowel disorder. Each participant completed a detailed questionnaire when their infection was confirmed. This included questions about mood, perceived stress levels, perfectionism and illness beliefs and behaviors.
They were then monitored three and six months later to see whether they had developed the typical symptoms of IBS, which include diarrhea and/or constipation, abdominal pain and bloating.
In all, 49 people had IBS at both time points. Women were more than twice as likely to have IBS as the men. Those with IBS were significantly more likely to have reported high levels of stress and anxiety and psychosomatic symptoms than those who did not develop the condition. They were also significantly more likely to be “driven,” carrying on regardless until they were forced to rest — a pattern of behavior that only worsens and prolongs the condition, say the authors.
Although not likely to be depressed, those with IBS were more likely to take a pessimistic view of illness.
IBS affects between 10 percent and 15 percent of adults in industrialized countries, but its exact cause is unknown. “Gastroenteritis may trigger the symptoms, but cognitions, behavior and emotions may help to prolong and maintain them over time,” conclude the authors, who suggest that cognitive behavioral therapy may be an effective treatment.
Source: British Medical Journal
Aspirin Reduces Esophageal Cancer Risk in Most-aggressive Form of Barrett’s Esophagus
SEATTLE — Researchers at Fred Hutchinson Cancer Research Center have found that people with the mostaggressive form of Barrett’s esophagus may benefit the most from preventive therapy with aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs). The researchers also identified a cluster of four known cancer biomarkers in people with Barrett’s that significantly increases their risk of developing esophageal cancer. These findings were published in the Feb. 27 issue of PLoS Medicine, a freely available online journal.
The researchers found that those with three or more of the cancer biomarkers upon enrollment in the study who also used aspirin or other NSAIDs had a 30 percent risk of esophageal cancer after 10 years, while those with the same biomarkers who did not use NSAIDs had a 79 percent risk of developing cancer within a decade of joining the study.
The researchers also found that Barrett’s patients whose esophageal tissue had no such biomarkers upon joining the study had a 12 percent risk of developing esophageal cancer after 10 years, while those with three or more of the abnormalities at baseline had a nearly 80 percent risk of developing such cancer within a decade.
Ultimately, the researchers hope, these biomarkers one day could be used in a clinical setting to identify which Barrett’s patients are most likely to develop esophageal cancer and therefore benefit from aggressive cancer surveillance via endoscopy and chemoprevention with aspirin and other NSAIDs.
Source: Fred Hutchinson Cancer Research Center
Restroom Access Act Provides Peace of Mind
Illinois is one of three states that have a law mandating access to employee restrooms for people with Crohn’s, colitis, irritable bowel syndrome, and related disorders. If a retail facility does not offer public restrooms, then any of these afflicted people can utilize the employee restroom facilities, as long as it is during regular business hours and getting to the restroom would not involve walking through a hazardous area.
Maryland and Michigan have similar laws, and a state representative in Austin, Texas, recently announced his intention to echo those laws in his own state. State Rep. Mark Strama (D-Austin), intends to file legislation in the new 2007 session that would make restrooms available not only to people with GI disorders, but also to pregnant women or people experiencing side effects from medications that require numerous trips to the bathroom.
As in Illinois, the legislation was proposed by children. In Illinois, a young girl of 14 was refused restroom access by an Old Navy employee, despite her obvious pain and discomfort. An ensuing “accident” caused her great embarrassment, and her mother contacted Illinois legislators in response.
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Nearly everyone knows someone who is aware of the location of every public restroom. Making non-public restrooms available to people with colostomy bags, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or other GI disorders is essential to maintaining their public dignity. Some states have cards that people can show to employees to prove they have been diagnosed with these disorders; other states will most likely imitate those efforts, and put their own laws in place.
Texas Rep. Strama, when queried about his proposed legislation, noted, “The Restroom Access Bill (House Bill 416) allows anyone who suffers from an eligible medical condition that requires immediate access to a toilet facility to be given access to employee-only restrooms in retail establishments.”
Eligible conditions stipulated by the bill include permanent conditions such as Crohn’s disease and ulcerative colitis, and temporary conditions such as pregnancy and urinary tract infections. “An employee of a retail establishment who refuses to provide a customer with access to an employee toilet facility will be committing a misdemeanor, punishable by a fine of not more than $100,” he adds.
Customers requesting use of these restrooms must provide the retail shop with evidence of their condition, such as a note from a physician on a prescription form, or an identification card issued by a nationally recognized organization or local health department.
“Assuming the Restroom Access Act is adopted into Texas law, I will work with the Texas Retailers Association to educate their membership on the implementation of the law,” says Strama. “In fact, the office of Illinois State Rep. Kathy Ryg, the legislative sponsor of the bill in that state, has worked closely with the Illinois Retailers Association to promote the importance of following the law to its membership.”
Awareness was stepped up during the holiday season, when many people who suffer from the aforementioned conditions fear leaving home to enjoy an experience most of us take for granted — shopping for presents for loved ones, Strama says. “I will work to do the same in Texas,” he adds.
There are more benefits than the obvious ones attached to this bill; those who suffer from IBD and other GI conditions struggle to attain a sense of normalcy, Strama points out. “Having access to a bathroom when away from home is an important part of establishing normalcy in their day-to-day lives,” he adds. Without that, “those afflicted with chronic illness like IBD are often forced to choose between staying home to ensure access, or to risk having an accident if access to a public restroom is unavailable. Providing freedom to those Texans is the most important benefit of this legislation. But many others who suffer from temporary conditions will also benefit from guaranteed access to toilet facilities in retail establishments.”
Strama is confident that the legislation will strike a chord with his fellow representatives. “When my fellow lawmakers hear the testimony of some of my youngest constituents who came to me with this legislation — including 10-year old Catherine Wicker — I’m confident that they will see the importance of this legislation. We should all be inspired by Catherine and other Texans like her who have had the courage to speak publicly about a difficult issue.”
Decades-Long Study Will Help Improve Surgery for Crohn’s Disease
Decades of painstaking research have yielded an in-depth look at the management of bowel stricture recurrence in patients who undergo surgery for Crohn’s disease.
Published in the journal Surgery, the study is the brainchild of Fabrizio Michelassi, professor of surgery at Weill Cornell Medical College and surgeon-in-chief at New York-Presbyterian Hospital/ Weill Cornell Medical Center in New York City.
Among other findings, the study supports the notion that strictureplasty — a bowel-sparing surgical procedure commonly used to correct Crohn’s-related strictures — is less likely to lead to stricture recurrence later on, compared to surgical excision (resection) of the stricture.
And, Michelassi says, “If a recurrence does occur after strictureplasty, it is likely to happen much later than after resection.” Recurrences after strictureplasty were also less likely to require a surgical excision of the affected area compared to recurrences after resection, he says.
The study also found that up to a third of recurrences occur away from the site of the original operation. Furthermore, the type and site of prior surgery appears to influence the pattern of recurrence, the researchers found.
Source: New York-Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College