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Insomnia & Healthcare Use in Older Adults

Insomnia & Healthcare Use in Older Adults

Insomnia affects approxi­mately half of all older adults. Research suggests that insomnia may be underdetected and undertreated in clinical settings. While many older adults report difficulty sleeping, only about 10% are actually treated for a sleep disorder. In addition, older adults are high consumers of health services, with a substantial proportion of spending coming from hospitalizations, home healthcare services, and nursing home use. Focusing on Older Patients Previous studies have explored the relationship between insomnia and healthcare services use, but most have used clinical samples or focused on younger individuals. My colleagues and I, led by doctoral student Christopher Kaufmann, MHS, published a study in the Journal of Gerontology: Medical Sciences that examined the association between insomnia and the subsequent use of three different health services in a representative sample of middle-aged and older people. The study involved 14,355 participants in the Health and Retirement Study who were asked about their insomnia symptoms in 2006 and responded to questions about health service use 2 years later, including whether or not they had been hospitalized, used home healthcare, or used nursing home services. Specific insomnia symptoms included trouble falling asleep, waking during the night, waking early and not falling asleep again, and not feeling rested when wakening. We found that insomnia symptoms were associated with greater odds of subsequently using costly health services. Those with two or more insomnia symptoms were more likely to be hospitalized and to use home healthcare services. Even after accounting for common medical conditions and depressive symptoms, we observed an association between insomnia symptoms and use of any of the three health services assessed in...

Discrediting a Paper About Discredited Practices

According to a study in the Mayo Clinic Proceedings, 146 papers appearing in the New England Journal of Medicine over the first decade of this century contradicted medical practices previously thought to be effective. The paper’s findings were widely publicized. There was talk in the New York Times of inertia hindering change and allowing ineffective treatments to continue for years. The full text of the paper and a supplement containing a brief summary of all 146 discredited practices are available online. I decided to see for myself if any practices relating to general surgery were included in the paper and found 11. Two of them seemed highly debatable to me. Number 43 on the list was a comparison of open mesh to laparoscopic mesh inguinal hernia repair that appeared in NEJM on 4/29/04. This was the critique: “A laparoscopic approach to repair inguinal hernias with mesh was thought to have lower hernia recurrence rates and less post-operative pain. This multicenter, randomized trial in a VA population found that the laparoscopic approach led to a higher rate of complications and a higher rate of recurrences when repairing primary inguinal hernias.”  It definitively closed the door on laparoscopic inguinal hernia repair. Or did it? Follow-up letters to the editor pointed out that the laparoscopic recurrence rate of 10% in the VA study was much higher than in other reported series, and the size of the mesh (~8.0 cm) used in the laparoscopic cohort was much smaller than the 10 cm x 15 cm that most experts recommended. How has the VA paper affected surgeons’ choice of technique for hernia repair? A...
Making the Most of Social Media

Making the Most of Social Media

Surveys suggest that physicians use social media for personal use at nearly the same rate as the general population. However, when it comes to professional use—namely, the exchange of information and advice with other physicians and patients—physicians tend to be more apprehensive (Figure). With a boom in physician-review websites and an increasingly tech-savvy public, most physicians already have an online reputation that should not be ignored. Managing Online Persona “Many physicians are fearful of using social media because they believe what they say may be misconstrued,” says Enoch Choi, MD, a blogger and social media guru. “Others simply prefer to stay private. Unfortunately, there is plenty of information available online about most physicians, often including personal details, such as a home address or family members’ names.” A recent Pew Internet survey found that 44% of patients research their physicians online. Dr. Choi says physicians should keep this statistic in mind and actively manage their online personas so that the public finds the information they want found. “Flooding the internet with this information through social media engagement can bury personal details,” he says. “It can also limit inaccurate data and negative connotations that can be found among search engine results.” Examining the Social Media Options The various social media platforms (eg, Facebook, Twitter, LinkedIn, YouTube, and blogging) offer a multitude of benefits, but physicians should focus on their own goals and personalities, according to Dr. Choi. “Facebook is useful for word-of-mouth-type sharing with patients because many of them already use it. Facebook is a convenient tool for many reasons, including the fact that many family members and friends are on...
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