Friday, July 20, 2012

Mental Illness and Health

People with serious mental illness – such as schizophrenia, bipolar disorder and disabling depression – are 2.6 times more likely to develop cancer than the general population, a new study by Johns Hopkins suggests.  The study’s findings raise questions about whether patients with serious mental illness are receiving appropriate cancer screenings and preventive care related to risk factors, such as smoking.

The increased risk is definitely there, but we’re not entirely sure why, says the study leader, an associate professor of medicine and psychiatry at the Johns Hopkins University School of Medicine. “Are these people getting screened? Are they being treated? Something’s going on.”

In a separate study, published online last month in the journal Injury Prevention, it was found that people with serious mental illness were nearly twice as likely to end up in a hospital’s emergency room or inpatient department suffering from an injury than the general population and about 4.5 times more likely to die from their injuries.

Roughly 5 percent of Americans have a serious mental illness, and this group is known to be two to three times more likely to die prematurely than those without disabling psychiatric problems. A small proportion of the higher risk, she says, can be attributed to the higher risks of suicide and homicide victimization in this population, but those factors do not account for most of the disparity. The top causes of death are cardiovascular disease and cancer, the same top causes of death for those without serious mental illness. Speculation is that this population is “falling through the cracks.”

In the first study, data from 3,317 people with schizophrenia and bipolar disorder were evaluated, determining whether they developed cancer between 1994 and 2004 and what type of cancer they had.  It was found that patients with schizophrenia, when compared to the general population, were more than 4.5 times more likely to develop lung cancer, 3.5 times more likely to develop colorectal cancer and nearly three times more likely to develop breast cancer. People with bipolar disorder experienced similarly high risk for lung, colorectal and breast cancer.    

One reason for the elevated risk of lung cancer could be smoking, which is more prevalent in people with serious mental illnesses. The professor also speculates that the breast cancer risk could be related to the fact that women with schizophrenia and bipolar disorder are less likely to have children, and childbearing is believed to reduce breast cancer risk. The colorectal cancer risk, she says, could be related to lifestyle issues, such as smoking, lack of physical activity and a diet lacking fruits and vegetables.

More study is needed on extent to which this population receives appropriate cancer screening and treatment. Mental health providers and primary care physicians must work together to promote screening as well as to reduce risk factors such as smoking among this group.

Friday, July 13, 2012

Challenges in Care

Up to a fifth of Americans over 65 years old have mental-health or substance-abuse conditions, according to a report released by the Institute of Medicine, an independent government-advisory group. According to this study, at least 5.6 million up to as many as 8 million older adults in America have one or more conditions, which present unique challenges for their care. And, the health-care system isn’t set up to adequately address their concerns.  With the number of adults age 65 and older projected to soar from 40.3 million in 2010 to 72.1 million by 2030, the aging of America holds profound consequences for the nation.

Substance abuse appears to be a growing problem among Baby Boomers, and there’s no reason to believe the trend will stop. Between 2002 and 2007, the percentage of people aged 50 to 59 nearly doubled to 9.4%, and non-medical use of prescription drugs also increased substantially to 4% from 2.2%.
Also, of particular concern are depression and dementia-related behavioral or psychiatric symptoms. Some of this may be brought on by the events more commonly experienced later in life, such as the death of loved ones.  Another factor in the looming increase in demand on the mental health-care system is simply a larger number of aging Americans.

However, older people are less likely to seek psychiatric treatment compared with younger ones, and the availability of services and professionals geared to treat this population is lacking, according to the report.
Many older people with mental-health problems also have physical ailments, so clinicians have to be especially careful to avoid unsafe drug interactions.

An older person’s goals for mental-health treatment also may be different than a younger patient’s. Instead of a total cure, an older individual may just want to function better while reducing the amount of needed medications.

For decades, policymakers have been warned that the nation’s health care workforce is ill-equipped to care for a rapidly growing and increasingly diverse population. In the specific disciplines of mental health and substance use, there have been similar warnings about serious workforce shortages, insufficient workforce diversity, and lack of basic competence and core knowledge in key areas.  An expert committee assessed the needs of this population and the workforce that serves it. The breadth and magnitude of inadequate workforce training and personnel shortages have grown to such proportions, says the committee, that no single approach can adequately address the issue. Overcoming these challenges will require focused and coordinated action by all.

Friday, July 6, 2012

Senses of smell, taste can change with age

This week, my blog discusses sensory changes that accompany aging – specifically the changes to taste and smell that come with aging.

In a recent study, the foods most often identified by taste and smell were: salt 89%, coffee 71%, tomato 69%, fish 59% and sugar 57%.  There is an indication that the senses of taste and smell decline significantly with age. If an individual is also having difficulty with their vision, they may be quite limited in their ability to identify foods, causing foods to have little appeal. Distinctive textures and temperatures, such as in ice cream or popcorn, can be important for the enjoyment of foods.

Poor nutrition can have serious consequences for elderly people, so it is important that they eat properly.  Tasteless foods make eating less enjoyable and bland, low salt or other diet restrictions can contribute to the undesirability of food.  A pleasant mealtime atmosphere and foods that are enjoyed in a social setting can make people feel more like eating.  Talking about food, the good taste and smell can make the food appear to taste better. Condiments and foods with strong flavors may also help to maintain interest in eating.

Poor sense of smell and taste may make it difficult to recognize spoiled foods or the smell of danger such as gas.  This is a potential hazard for the person who lives alone.  Older people with diminished smell and taste are encouraged to keep track of the age of foods in their refrigerators and check the pilot lights of gas stoves regularly.  Also, family members and friends can check these things whenever they visit.

I hope this bit of information has been helpful.  If you are looking after a parent, grandparent, friend, or elderly family member, please remember these tips that can help you compensate for the effects of diminished taste and smell on your loved one.