Notes from the Elder Care Initiative
September
2005 Number 9
What's New
First Annual American Indian and Alaska Native Long Term Care Conference
November 16-17, 2005; Sheraton Old Town; Albuquerque, NM
Honoring Our Elders: Best Practices in Long Term Care
This Conference is intended to support the development of long term care systems and services for Elders throughout Indian Country. Participants will benefit from the experiences of successful program directors while learning from each other about how to create and develop sustainable programs, cultivate federal, state, and private resources, and respond to the unique long term care needs of their community. This 2 day conference and site visit are brought to you by federal agency, Tribal, Indian organization, and private nonprofit partners.
There is an abstract submission process for selection of promising practices in AIAN Long Term Care, with scholarships based on need available for programs selected to present at the conference.
For information about agenda, conference registration, and abstract submission, go to: www.aianlongtermcare.org <http://www.aianlongtermcare.org/>
Conferences and Training Opportunities
VA Palliative Care Course Available for Indian Health Clinical Staff
The VA Ann Arbor Geriatric Research, Education and Clinical Center (GRECC) and the University of Michigan Medical School invite Indian Health clinical staff to attend "Critical Clinical Issues in the Care of the Older Adult: Pain Management & Palliative Care" in Ann Arbor, Michigan on October 6-7, 2005. The program is designed for primary care physicians and providers (nurse practitioners and physician assistants), geriatricians, oncologists, and hospice and palliative care providers (physicians, nurses, social workers and chaplains). There are a limited number of slots reserved for Indian Health at the special VA registration fee of $150.00.
The conference brochure can be found at http://www.cme.med.umich.edu/events/pdf/U012215.pdf <http://www.cme.med.umich.edu/events/pdf/U012215.pdf>
For registration information, contact Dr. Bruce Finke at [log in to unmask] <mailto:[log in to unmask]> .
From the Literature
Walter LC, Covinsky KE. <http://www.ncbi.nlm.nih.gov.libproxy.unm.edu/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11386931&query_hl=1> Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001 Jun 6;285(21):2750-6.
Most cancers increase in incidence with age, while the benefit of screening for elders is diluted by competing mortality from age and chronic disease. How do we properly counsel elders about the benefits and risks of cancer screening in advanced age? In this article the authors suggest an interesting strategy for evaluating the value of screening for cancer in the elderly. They note that the likelihood of benefit from screening to detect cancer depends on several quantifiable factors, including the risk of death from the specific cancer, life expectancy, and screening factors (how well the screening test works). Based on this data, they calculate the number needed to screen (NNS) to prevent one cancer death at selected ages for the highest, middle, and lowest quartiles of life expectancy.
The results of this analysis can be quite striking. For women in the highest quartile of life expectancy at age 80 (vigorous, health octogenarians without chronic disease), 240 mammograms would be needed to prevent one death from breast cancer, comparing favorably to 226 mammograms needed to prevent a single death by breast cancer in women at age 50 in the lowest quartile of life expectancy. For men in the highest quartile of life expectancy at age 85 the benefits of colorectal cancer screening (NNS=554) are greater than for men in the lowest quartile of life expectancy at age 50 (NNS=630). Tables published in the paper outline these relationships in selected ages in very useful ways.
These findings match our clinical understanding that it is the overall health and vigor of the elder, not his or her age, that is important in these decisions and provide real information to bolster and clarify that understanding. The authors take pains to point out that the decision to screen or not screen, at any age, should be driven by the individual's health goals, values and preferences, informed by the best information we can offer.
It does no one any good (and can do significant harm) to urge cancer screening for frail elders who are unlikely to benefit. At the same time, we do a disservice to vigorous, health elders if we underestimate the possible benefit of screening based on age alone. The tables provided in this paper allow us give our elders real and specific information about the possible benefit of cancer screening to help them make their decisions.
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________________________________
From: Benjamin, Evan MD [mailto:[log in to unmask]]
Sent: Tue 9/13/2005 6:31 AM
To: Felten; Steve Winn; Steve Winn; [log in to unmask]; Lindenauer, Peter; Kudler, Neil; [log in to unmask]; [log in to unmask]; Dan Felten; Finke, Bruce; Hunter, Stanley; [log in to unmask]
Subject: See you Wed at Dan's
If we add authors to the bookgroup, does that mean we need to improve the level of the book discussion?
-----Original Message-----
From: Felten [mailto:[log in to unmask]]
Sent: Mon 9/12/2005 10:38 PM
To: Benjamin, Evan MD; Steve Winn; Steve Winn; [log in to unmask]; Lindenauer, Peter; Kudler, Neil; [log in to unmask]; [log in to unmask]; Dan Felten; Finke, Bruce; Hunter, Stanley; [log in to unmask]
Cc:
Subject: Re: Borrow
Guys, I was wondering whether we want to make Bob an honorary Book Group member, replete with a copy of Atticus signed by all present at Wednesday's group? Thought it might be a nice gesture.
Jim, any word on Bob's preferences for refreshments? Cigar and a pancake. Bong and a blintz? Let me know, otherwise it's the usual-beer, chips, wine and cheese for the girlies amongst us (just kidding-I'm a wine drinker too, in my more intimate, feminine moments), and soft drinks.
Later!!
----- Original Message -----
From: Benjamin, Evan MD <mailto:[log in to unmask]>
To: Benjamin, Evan MD <mailto:[log in to unmask]> ; Steve Winn <mailto:[log in to unmask]> ; Steve Winn <mailto:[log in to unmask]> ; [log in to unmask] ; Lindenauer, Peter <mailto:[log in to unmask]> ; Kudler, Neil <mailto:[log in to unmask]> ; [log in to unmask] ; [log in to unmask] ; Dan Felten <mailto:[log in to unmask]> ; Finke, Bruce <mailto:[log in to unmask]> ; Hunter, Stanley <mailto:[log in to unmask]> ; [log in to unmask] ; [log in to unmask]
Sent: Monday, August 22, 2005 1:45 PM
Subject: Borrow
Dan Felten has my copy of time traveler's wife - feel free to borrow it from him.
Guess we are on for the 14th of Sept for "Puff". Is the author coming?
- Evan
Please use this e-mail list as it is updated.
-----Original Message-----
From: Benjamin, Evan MD
Sent: Thursday, June 30, 2005 9:36 AM
To: Benjamin, Evan MD; 'Steve Winn'; 'Steve Winn'; [log in to unmask]; Lindenauer, Peter; Kudler, Neil; [log in to unmask]; [log in to unmask]; 'Dan Felten'; 'Finke, Bruce'; Hunter, Stanley; [log in to unmask]; [log in to unmask]
Subject: RE: Upcoming books and dates
Thanks for coming over last night - actually a pretty good discussion on a mixed book. I forgive her.
Who is here for August 31? or shall we move the group to Sept 7 or 14?
See you next month:
July 27: "The Time Traveller's Wife" by Niffenegger @ Steve Winn 's 66 S Main , Florence
Sept 7 : "Puff" by Flahrety @ Dan F 's
October 5: Jim Shinnick to choose (Jim choose soon!)
November 2: Paul Spector to choose
Dec : Kudler
Jan: Hirshman
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CONFIDENTIALITY NOTICE: This email communication and any attachments may
contain confidential and privileged information for the use of the
designated recipients named above. If you are not the intended recipient,
you are hereby notified that you have received this communication in error
and that any review, disclosure, dissemination, distribution or copying of
it or its contents is prohibited. If you have received this communication
in error, please reply to the sender immediately or by telephone at (413)
794-0000 and destroy all copies of this communication and any attachments.
For further information regarding Baystate Health System's privacy policy,
please visit our Internet web site at http://www.baystatehealth.com.
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