Video: Dying Is Not as Bad as You Think – BBC

It’s time to break the taboo that exists around death, argues palliative care doctor and author Kathryn Mannix.

Watch video at You Tube (3:59 minutes) . . . . . . .

Open-topped BLTs with Spicy Sweetcorn Salsa

Ingredients

2 slices bread from a large seeded loaf, toasted
1 tablespoon reduced-calorie mayonnaise
50 g iceberg lettuce, roughly torn
4 rashers very lean dry-cured back bacon, grilled
4 tablespoons Spicy Sweetcorn Salsa (see recipe below)
freshly ground black pepper

Method

  1. Spread the toasted bread with the mayonnaise and divide the lettuce and bacon between the slices.
  2. Top with the salsa and finish off with a sprinkling of pepper.

Makes 2 servings.


Spicy Sweetcorn Salsa

Ingredients

250 g frozen sweetcorn kernels
1 tablespoon raw cane brown sugar
1 tablespoon sherry vinegar (or wine vinegar or cider vinegar)
125 g cherry tomatoes, quartered
2 large spring onions, finely chopped
1 red chili, deseeded and finely chopped
1 tablespoon freshly chopped parsley
1 tablespoon freshly chopped coriander

Method

  1. Cook the sweetcorn according to the pack instructions, then drain thoroughly.
  2. While it is still warm, add the sugar and vinegar and mix to dissolve the sugar. Leave to cool then stir in the remaining ingredients.
  3. This will keep in the fridge for 2-3 days.

Makes 24 tablespoons.

Source: GL diet made simple

Common Muscle Relaxant Could Pose Mental Dangers for Seniors

Dennis Thompson wrote . . . . . . . . .

A commonly prescribed muscle relaxant known as baclofen can leave older kidney patients so disoriented that they land in the hospital, a new study warns.

“It can present with acute stroke-like symptoms, even though it’s not a stroke,” said senior researcher Dr. Amit Garg, a professor of nephrology at Western University in Ontario, Canada. “It can present with dementia-like symptoms.”

About 1 in 25 people with low kidney function prescribed high doses of baclofen wound up being admitted to a hospital for severe confusion, according to a study of nearly 16,000 older Canadians with chronic kidney disease.

By comparison, only one in 500 kidney patients not prescribed baclofen wound up hospitalized for confusion.

“There was a pretty marked difference in risk,” Garg said, noting that these findings “highlight a potential risk associated with these drugs that hasn’t been fully appreciated.”

Other seniors might also face this risk, since kidney function often declines as people grow older, he added.

Baclofen is typically prescribed to people suffering muscle spasms, Garg said. Doctors hand out more than 8 million prescriptions of baclofen every year. It’s sold under a number of different brand names, including Lioresal, Gablofen and Kemstro.

The drug leaves the body when the kidneys filter it out of a person’s blood, Garg explained.

“If someone’s kidney function isn’t working very well, that means the drug is accumulating in the system,” he said.

Garg and other doctors had started noticing that kidney patients on baclofen sometimes became disoriented and dazed.

For example, nephrologist Dr. Holly Koncicki remembers some dialysis patients showing up with noticeably clouded mental capacity.

“Of those I can remember, they often presented with confusion or being very sleepy and lethargic,” said Koncicki, of the Icahn School of Medicine at Mount Sinai, in New York City.

In the Canadian study, Garg and his colleagues combed the medical literature and found 30 prior case reports linking baclofen to hitches in brain function, so they decided to more closely study this potential problem.

The researchers pulled health data on nearly 16,000 older Ontario residents with chronic kidney disease who had been prescribed baclofen between 2007 and 2018.

The investigators compared those patients’ hospitalizations for mental conditions against those from a group of almost 300,000 kidney patients who’d not been prescribed the drug.

Patients were at greatest risk of hospitalization for confusion if their kidney function was very impaired — 30% or less — and they had been prescribed a high dose of baclofen, more than 20 milligrams (mg) per day.

But even patients with kidney function as high as 60% had an increased risk of confusion when prescribed high doses of baclofen, the findings showed. About 1 in 5 older adults live with kidney function of less than 60%.

Kidney patients prescribed baclofen at 20 mg/day or higher had nearly 20 times the relative risk of being hospitalized for an altered mental state, compared with patients not taking the drug, the researchers found.

Doses lower than 20 mg/day were associated with a nearly sixfold increase in kidney patients’ risk of hospitalization.

The results were published online in the Journal of the American Medical Association, to coincide with a planned presentation at the American Society of Nephrology annual meeting, in Washington, D.C.

Koncicki, who was not involved with the study, said, “In our older patients with impaired kidney function, there should be cautious use of this medication.”

Garg added that the effect might be even more widespread than what was found in the study, which only considered people so severely affected that they landed in the hospital.

He said he’s concerned that many more people “might have more subtle changes in their thinking who we aren’t even picking up in this study.”

People already taking baclofen should keep taking the drug but ask their doctor about these possible mental side effects, Koncicki and Garg said.

Patients “should feel empowered to ask questions about the risks and benefits of medications,” Koncicki said, “and side effects to watch out for so they can make an informed decision about whether a medication is right for them.”

Dr. Teresa Murray Amato, director of geriatric emergency medicine at Northwell Health in New Hyde Park, N.Y., agreed.

“All patients should speak to their doctors regarding side effects of all medications,” Murray Amato said. “For patients over 65, make sure you understand your kidney function and ask about potential renal dosing on all medications. If you are on baclofen now, make sure you contact your health care provider so that you can have an expedited conversation.”

“Please seek emergency care if you or your family member is showing any signs of altered [mental activity] and you suspect medications may be involved,” Murray Amato said.

Regulatory agencies also might consider strengthening the drug warning for baclofen to include this potential effect, Garg said.

Source: HealthDay

Increased Exercise Over the Age of 60 Reduces Risk of Heart Disease and Stroke

People over the age of 60 should do more exercise not less in order to prevent heart disease and stroke, according to findings from a study of over 1.1 million elderly people published in the European Heart Journal [1] today (Friday).

The researchers in South Korea found that people who did less moderate or vigorous physical activity as they got older had as much as a 27% increased risk of heart and blood vessel problems, while those who increased their levels of activity had a reduced risk of cardiovascular disease of up to 11%.

The link between levels of physical activity and risk of cardiovascular disease in older people held true even for those with disabilities and chronic conditions such as high blood pressure, high cholesterol levels and type 2 diabetes.

Researchers, led by Mr Kyuwoong Kim, a PhD student at Seoul National University Graduate School Department of Biomedical Sciences in Seoul, under the supervision of Professor Sang Min Park, carried out the study in 1,119,925 men and women aged 60 years or older and who underwent two consecutive health checks provided by the Korean National Health Insurance Service (NIHS) from 2009 to 2010 and 2011 to 2012. The NIHS provides healthcare services for approximately 97% of the Korean population. The participants were followed up until December 2016.

At each health check the participants answered questions about their physical activity and lifestyle. The researchers calculated the amount of moderate exercise (e.g. 30 minutes or more a day of brisk walking, dancing, gardening) and vigorous exercise (e.g. 20 minutes or more a day of running, fast cycling, aerobic exercise) per week at each screening, and how it had changed during the two years between the screenings.

The researchers collected data on heart disease and stroke from January 2013 to December 2016. They adjusted their analyses to take account of socioeconomic factors, such as age and sex, other medical conditions and medication taken, and lifestyle behaviours, such as smoking and alcohol consumption.

The average age of the participants was 67 years and 47% were men. About two-thirds said they were physically inactive at both the first and second screening period. A higher proportion of women were physically inactive (78% and 77%) compared to men (67% and 66%) in both screening periods. Only 22% of inactive people increased their physical activity by the time of the second health check, and 54% of people who had been exercising five or more times a week at the time of the first screening had become inactive by the time of the second. During the follow-up period a total of 114,856 cases of heart disease or stroke occurred.

The researchers found that people who moved from being continuously inactive at the 2009-2010 health check to being moderately or vigorously active three to four times a week at the 2011-2012 health check had an 11% reduced risk of cardiovascular problems. Those who were moderately or vigorously active one or two times a week at the first check had a 10% reduced risk if they increased their activity to five or more times a week.

In contrast, those who were moderately or vigorously active more than five times a week at the first check and then became continuously inactive at the second check had a 27% increased risk of cardiovascular problems.

When the researchers looked specifically at people with disabilities and chronic conditions, they found that those who changed from being inactive to being moderately or vigorously active three to four times a week also reduced their risk of cardiovascular problems. People with a disability had a reduced risk of 16%, and those with diabetes, raised blood pressure or cholesterol levels had a reduced risk of between 4-7%.

Mr Kim said: “The most important message from this research is that older adults should increase or maintain their exercise frequency to prevent cardiovascular disease. Globally, this finding is of public health importance because the world’s population aged 60 years and older is expected to total two billion by 2050, which is an increase from 900 million in 2015 according to the World Health Organization. While older adults find it difficult to engage in regular physical activity as they age, our research suggests that it is necessary to be more physically active for cardiovascular health, and this is also true for people with disabilities and chronic health conditions.

“We believe that community-based programmes to encourage physical activity among older adults should be promoted by governments. Also, from a clinical perspective, physicians should ‘prescribe’ physical activity along with other recommended medical treatments for people with a high risk of cardiovascular disease.”

Although the size of the study is a strength, a limitation is that it was carried out in the Korean population and so the researchers cannot be certain their findings will apply to other populations due to differences in ethnicity and lifestyle. Other limitations include: physical activity was assessed by a self-reported survey, which is subject to bias; information was lacking on other types of physical activity, such as housework, and also muscle-strengthening activities; and the researchers were unable to assess the reasons why people changed their levels of physical activity because this was a study based on ‘real world’ data rather than data from an intervention study.

Source: European Society of Cardiology


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