Notes from the Elder Care Initiative
March
2005 Number 3
What's New
Joining Together to Share Palliative Care Knowledge and Resources, the national team training in palliative and end-of-life care, Anchorage, Alaska. Alaska Native Tribal Health Consortium (ANTHC) will be hosting the IHS team training this year in conjunction with an Alaska state-wide training. This will allow for a larger gathering with nationally renowned faculty and excellent materials, while still maintaining the AIAN focus. This conference will again provide "palliative care 101", a basic training in palliative and end-of-life care for teams and individuals from across Indian country with a special focus on program development. One team from each IHS Area will be fully funded. Area Chief Medical Officers are "nominating individuals and teams for supported for this training; if interested contact your Area CMO. Deadline for nomination in an Area sponsored team is April 1. In addition to Area sponsored teams, individuals are welcome. For more information contact: Bruce Finke (413-584-0790 or [log in to unmask] <mailto:[log in to unmask]> ) or Kay Branch (907-729-3922 or [log in to unmask]).
Pearls from the Literature
U.S. Preventive Services Task Force. Screening for abdominal aortic aneurysm: Recommendation statement. Ann Intern Med 205 Feb1; 142:198-202.
Fleming C et al. Screening for abdominal aortic aneurysm: A best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2005 Feb 1; 142:203-11.
http://www.ahrq.gov/clinic/uspstf/uspsaneu.htm <http://www.ahrq.gov/clinic/uspstf/uspsaneu.htm>
The USPSTF recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 who have ever smoked. Rating: B Recommendation <http://www.ahrq.gov/clinic/3rduspstf/ratings.htm#brec> .
Abdominal aortic aneurysm (AAA) rupture is a catastrophic event, with only 10-25% of persons surviving to hospital discharge. Studies published over the past decade led the USPSTF to revisit its recommendation regarding screening for AAA. A meta-analysis of four large randomized controlled trials of a single ultrasound screening showed a reduction of up to 43% in AAA related mortality in men age 65-74 years. These trials took place in England, Denmark, and Australia. In these trials those with aortas greater than 3.0cm and less than 5.0cm were followed closely and those 5.0cm and larger were referred to vascular surgery. In other studies open repair of aneurysms 5.5cm and greater provide a 43% reduction in aneurysm associated mortality. No significant reduction in AAA related mortality could be shown in women, and the authors point out that AAA rupture in women is more rare than in men and occurs, on average, 10 years later than in men. No reduction in AAA related mortality could be shown in men aged 74-84, likely because of competing causes of mortality. Smoking is a potent risk factor for AAA. An estimated 500 men age 65-74 who have ever smoked would need to be screened to prevent one death from AAA rupture over a five year period as compared to 1783 persons who have never smoked.
Does this recommendation apply to our patients? Dr. James Galloway, IHS Cardiologist and Director of the Native American Cardiology Program says: " I cannot think of any reasons why this should not apply for our folks and with the evidence of increased CVD and atherosclerosis in our population over other populations, I would feel strongly that this recommendation be maintained in our system as well....".
This recommendation has been added to the IHS Preventive Care Guidelines for the Elderly, recently updated and available at http://www.ihs.gov/MedicalPrograms/ElderCare/index.asp <http://www.ihs.gov/MedicalPrograms/ElderCare/index.asp>
Conferences and Training Opportunities
June 16-18: NMGEC Geriatric Summer Institute, Albuquerque, NM. A Shoulder to Lean on: Supportive Care for the Frail Elder. This conference will focus on care of the elder receiving long term care, home and community based and institutional. As always, the NMGEC Summer Geriatric Institute has a special focus on the care of Native elders. Scholarships are available for Indian health professionals. For information contact: Darlene Franklin at [log in to unmask] <mailto:[log in to unmask]> or at 505-272-4934.
April 5-7: VHA Care Coordination and Telehealth Leadership Forum, Salt Lake City, UT. This is a forum for care coordination and telehealth in the Veterans Health Administration. There will be focused breakouts on diabetes care, home care, mental health, and rehabilitative care. Slots are reserved for Indian health personnel to attend so that we can:
* Establish clinical specialty and VISN-specific relationships with VHA staff;
* Become involved with VHA telehealth special interest groups;
* Project plan with VHA staff on specific projects and collaborations.
For information, contact Mark Carroll, MD at 928-214-3920 or [log in to unmask] <mailto:[log in to unmask]>
To subscribe to this monthly email newsletter subscribe to the Eldercare listserve. Instructions: http://www.ihs.gov/GeneralWeb/HelpCenter/Helpdesk/index.cfm?module=list&option=list&newquery=1
Bruce Finke, MD
IHS Elder Care Initiative
[log in to unmask]
413-584-0790 615-417-4915 (cell)
<mailto:[log in to unmask]>
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