Loneliness Might Be a Killer, but What’s the Best Way to Protect Against It?

Rita Rubin
JAMA. 2017;318(19):1853-1855.

Here is an excerpt:

“I think that it’s clearly a [health] risk factor,” first author Nancy Donovan, MD, said of loneliness. “Various types of psychosocial stress appear to be bad for the human body and brain and are clearly associated with lots of adverse health consequences.”

Though the findings overall are mixed, the best current evidence suggests that loneliness may cause adverse health effects by promoting inflammation, said Donovan, a geriatric psychiatrist at the Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital in Boston.

Loneliness might also be an early, relatively easy-to-detect marker for preclinical Alzheimer disease, suggests an article Donovan coauthored. She and her collaborators recently reported in JAMA Psychiatry that loneliness was associated with a higher cortical amyloid burden in 79 cognitively normal elderly adults. Cortical amyloid burden is being investigated as a potential biomarker for identifying asymptomatic adults with the greatest risk of Alzheimer disease. However, large-scale population screening for amyloid burden is unlikely to be practical.

Regardless of whether loneliness turns out to be a marker for preclinical Alzheimer disease, enough is known about its health effects that physicians need to be able to recognize it, Holt-Lunstad says.

“The cumulative evidence points to the benefit of including social factors in medical training and continuing education for health care professionals,” she and Brigham Young colleague Timothy Smith, PhD, wrote in an editorial.

The article is here.

Aging Doctors Face Greater Scrutiny

By Sandra G. Boodman
Originally published on December 10, 2012
Kaiser Health News in collaboration with The Washington Post

A distinguished vascular specialist in his 80s performs surgery, then goes on vacation, forgetting he has patients in the hospital; one subsequently dies because no doctor was overseeing his care. An internist who suffered a stroke gets lost going from one exam room to another in his own office. A beloved general surgeon with Alzheimer's disease continues to assist in operations because hospital officials don't have the heart to tell him to retire.

These real-life examples, provided by an expert who evaluates impaired physicians, exemplify an emotionally charged issue that is attracting the attention of patient safety experts and hospital administrators: how to ensure that older doctors are competent to treat patients.

About 42 percent of the nation's 1 million physicians are older than 55 and 21 percent are older than 65, according to the American Medical Association, up from 35 percent and 18 percent, respectively, in 2006. Their ranks are expected to increase as many work past the traditional retirement age of 65, for reasons both personal and financial.

Many older doctors remain sharp, their skills up-to-date and their judgment honed by years of experience. Peter Carmel, the AMA's immediate past president, a 75-year-old pediatric neurosurgeon in New Jersey, recently wrote about "going full tilt."

Unlike commercial airline pilots, who by law must undergo regular health screenings starting at age 40 and must retire at 65 -- or FBI agents, whose mandatory retirement age is 57 -- there are no such rules for doctors. Nor are any formal evaluations required to ensure the continued competence of physicians, many of whom trained decades ago. Most states require continuing education credits to retain a medical license, but, as Ann Weinacker, chief of the medical staff at Stanford Hospital and Clinics in California, observed, "you can sleep through a session, and if you sign your name, you'll get credit."

The entire article is here.

Geisinger no longer to hire job applicants who use tobacco products

CONTACT: Marcy Marshall: 570-271-8081
Dec. 28, 2011
FOR IMMEDIATE RELEASE

DANVILLE, Pa. – Starting Feb. 1, 2012, Geisinger will no longer hire job applicants who use tobacco products, including cigarettes, cigars, and chewing or smokeless tobacco.

“Geisinger is joining dozens of hospitals and medical organizations across the country that are encouraging healthier living, decreasing absenteeism and reducing health care costs by adopting strict policies that make smoking a reason to turn away job applicants,” said Richard Merkle, chief human resources officer, Geisinger Health System. “Non-nicotine hiring policies are legal in 20 states, including Pennsylvania.”

This policy also affects any applicants receiving offer letters as of Feb. 1. During the hiring process, all applicants – including those seeking full- and part-time positions, flex, volunteers, and students enrolled in Geisinger-based schools – will be tested for nicotine as part of the routine drug screening.

The test will include screening for cigarettes, smokeless tobacco, snuff, nicotine patches, nicotine gum and cigars. The test only detects active nicotine users, not those exposed to second-hand smoke.

“Applicants who test positive for nicotine use will be welcome to re-apply in six months provided they are nicotine free at that time,” Merkle said. “A listing of smoking cessation resources will be provided to any applicant who tests positive for nicotine.”

Current employees are not affected by this new policy, but are encouraged to take advantage of the tobacco cessation programs offered through Geisinger’s Employee Wellness program.

Geisinger currently has a no-tobacco-use policy that extends across all of its properties.

About Geisinger Health System

Geisinger is an integrated health services organization widely recognized for its innovative use of the electronic health record, and the development and implementation of innovative care models including ProvenHealth Navigator, an advanced medical home model, and ProvenCare program. The system serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania.

Many Don't Believe Their Obesity is Unhealthy

By Jenifer Goodwin
Health Daily Reporter
MedicineNet.com

Many overweight and obese patients seen in hospital emergency departments don't believe their weight poses a risk to their health, and many say doctors have never told them otherwise, a new study finds.

Researchers asked 450 randomly selected patients who were seen in the emergency department at Shands at the University of Florida two questions: Do you believe your present weight is damaging to your health, and has a doctor or other health professional ever told you that you are overweight?

Of those who reported that their weight was unhealthy, only 19% said they'd ever discussed it with a health care provider. And only 30% of those who reported being told by their health care provider that their weight was unhealthy agreed with that opinion, according to the study.

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Ryan recommends that patients leave the ER with referrals to dieticians and other weight-loss specialists, and that primary care doctors make sure to take the time to broach the issue with patients.

Gans agreed. Though emergency room physicians are pressed for time, when patients are sick and worried about their health may be an opportune moment to encourage changes.

"Unfortunately nothing happens until a patient becomes fearful," Gans said. "I see that all too often. I'll ask them, 'Do you need to wait until you have diabetes until you start to lose weight? Do you need to suffer a heart attack? And some people will actually say 'Yes.'"

The whole story can be read here.