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Aging, Medical Apps, Stanford News, Technology

Stanford Letter Project, which helps users have end-of-life discussions, now available for mobile devices

Stanford Letter Project, which helps users have end-of-life discussions, now available for mobile devices

Stanford_LetterFor many of us, the topic of how we want to spend our final days rarely comes up in discussions with our family members or doctors. And a big reason why is that we think of reflecting on how we want to die as highly emotional and unpleasant.

But there are some compelling reasons to take the time to clarify what matters to you most in your waning days of life: It can reduce stress on your loved ones and help your physician provide a better quality of care.

Earlier this year, VJ Periyakoil, MD, director of palliative care education and training at Stanford, launched the Stanford Letter Project, a campaign to empower all adults to take the initiative to talk to their doctor about what matters most to them at life’s end.

Recently, Periyakoil released mobile app versions of the Stanford Letter Project for both the iPhone and Android. The apps, which offer templates comprised of simple questions aimed at getting the end-of-life conversation rolling, are free and can be downloaded from the iTunes and Google Play stores. Templates are available in Spanish, English, Italian, Taglog, Russian and Hindi.

As Periyakoil explained in a recent 1:2:1 podcast, “2.6 million Americans die every year, and very few of them get to talk to their doctor about their end of life wishes.” She urges every adult to tell their doctors about how they want to spend their last days; she suggests engaging in end-of-life discussions each time you reach a milestone in your life such as getting married, having a baby or being diagnosed with a chronic illness.

Previously: How would you like to die? Tell your doctor in a letter, Stanford doctor on a mission to empower patients to talk about end-of-life issues, Medicare to pay for end-of-life conversations with patients and “Everybody dies – just discuss it and agree on what you want

Aging, Events, Medicine and Society, Medicine X, Stanford News

Living long and living well: A conversation on longevity at Medicine X

Living long and living well: A conversation on longevity at Medicine X


There were big-time laughs, and the expected misty eye or two, at today’s Medicine X session on aging and longevity. Natrice Rese, a retired personal support worker, began the conversation with a moving ePatient Ignite! talk about how life for many older adults is less than “golden.” She told the audience how difficult time spent in a nursing home or care facility can be: “So many people wait to be fed, wait to be dressed, wait to be undressed, wait to be taken outside… When you’re dependent on care from others, your life is reduced to a waiting game.”

Her mother found herself in one such place at the age of 85, and Rese recalled how her mom pulled her aside one day and said, “Don’t come near these places – it’s not good here.” Her mother was in the throes of Alzheimer’s and unable to offer further details, but “her words stay with me today,” Rese somberly told the audience.

Rese said her mom’s comments ultimately reinforced her desire to work to make sure older adults feel appreciated and are able to “create memories that matter.”

Fellow panelist Barbara Beskind is certainly doing that – and more. The 91-year-old former occupational therapist made headlines when she landed a job at Silicon Valley design firm IDEO. Appearing at the conference alongside Dennis Boyle, a partner and founding member of the firm, she goes to the office every Thursday and is now working on a variety of projects related to aging – including a redesigned walker.

Younger designers “can’t put themselves in the shoes of the elderly,” Beskind told USA Today earlier this year. “People who design for the elderly think they need jeweled pill boxes or pink canes. We need functional equipment.”

“I admire you,” Rese told Beskind during a panel discussion, after hearing about Beskind’s contributions. “You shouldn’t be one of a few – you should be one of many.”

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Aging, Medicine and Society, Mental Health, Patient Care

Stanford longevity design winner brings dementia place setting into production

Stanford longevity design winner brings dementia place setting into production

eatwellprimaryHelping people live not just longer but better lives is the goal of Stanford’s Center on Longevity, and last year it held a Design Challenge to scope out great ideas for doing so. The winner of that competition is no longer just a design; Eatwell is moving into production.

Eatwell, a place setting for those with cognitive and motor impairments from dementia, features subtle alterations to the colors, textures, weight, and shape of traditional dishes and cutlery. For example, bright colors make food more appetizing, and blue surfaces make it less likely that users will confuse their food with the dish. Slanted bottoms help keep food together and make it easier to scoop, and weighted bottoms with skid-resistant texture make spills less likely. There are even placemat attachments for a napkin to catch drips.

I recently corresponded with Eatwell’s designer, Sha Yao, via email while she was in Asia overseeing the manufacturing of her innovative product. The 20 design features of the 9-piece set emerged from a four-year research process involving one-on-one observation and volunteering in adult day care centers. “Along the way,” Yao told me, “I had many opportunities to come in contact with people who work with people with Alzheimer’s. I did more than a hundred mock-ups and asked my target users to give me feedback.”

Yao was surprised by the number of things caregivers have to be aware of. “Our loved ones may have visual impairment, and they may have depth perception problems with gripping things in front of them. Simple tasks can become difficult for them and I didn’t even know that before I did research on it and watched them struggle to eat.”

Although Yao has worked on a variety of products while completing her MFA in industrial design, this is the first project she developed from an idea to mass-production. Her impetus was a close connection with her grandmother, who took care of Yao and her sister as children while their parents worked.

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Aging, In the News, Infectious Disease, Public Health, Research

Does the flu vaccine really help the elderly?

EM_of_influenza_virusMost years, senior citizens are among the groups hit hardest by flu, which is why doctors recommend all people over 65 get vaccinated. But accurately measuring how well the vaccine does at preventing severe disease and deaths isn’t as straightforward as it is in younger populations.

A lot of factors complicate getting accurate information on the number of flu cases among older adults and the vaccine’s role at preventing them, and some have argued that current estimates of the flu vaccine’s effectiveness are overblown because they don’t account for such factors. For example, sometimes patients are left unvaccinated because they are already medically frail and struggling with a lot of other health issues. So simply counting the number of deaths among unvaccinated patients versus vaccinated patients might not paint an accurate picture.

Last month, a study led by Vincent Mor, PhD, of Brown University, looked a little closer at the vaccine to assess its effectiveness. The research team analyzed 10 years of Medicare claims for nursing home residents, taking advantage of a built-in variation.

Because the flu virus changes over time, the vaccine has to be updated every year to fight against the strains that are circulating that year. Some years, the vaccine matches what’s circulating better than other years. (Last year, in the 2014-2015 season, the vaccine strain didn’t match the flu viruses infecting people very well.)

If the vaccine isn’t effective in elderly patients, then we shouldn’t see any difference in flu cases from year to year. But Mor and his colleagues found that the better the vaccine strain matched the circulating viruses, the better the vaccine was at protecting elderly nursing home residents. They argue that this indicates that the vaccine protects people living in nursing homes from serious outcomes associated with influenza infection.

This isn’t an approach we can take with other types of vaccines. It’s only possible because the flu vaccine changes from year to year. “What we’ve used is the randomness of the match,” Mor said in a statement. “Ours is the first study to, we think, come up with an unbiased approach.”

Though this study probably won’t settle the controversy about how well the vaccine works in older people, it does offer a different way to look at the question. A variety of other novel approaches are probably what it will take to get a handle on this hard-to-understand aspect of influenza.

Previously: Science Friday-style podcast explains work toward a universal flu vaccine, Study: Pregnancy causes surprising changes in how the immune system responds to the flu and Gut bacteria may influence effectiveness of flu vaccine
Photo by Cynthia Goldsmith

Aging, Global Health, In the News, Public Health, Research

As life expectancy rises worldwide, many are living longer with illness and disability

10812180384_18496a55f3_zGood news: Average life expectancy has continued to climb over the past two decades. The downside is that those extra years are often marked by chronic disease or disability, according to a new analysis published in the Lancet.

In the study, an international team of researchers examined fatal and nonfatal health loss across countries in an effort to help direct global-health policies to improve longevity and quality of life regardless of where a person lives.

HealthDay reports:

The analysis of data from 188 countries found that life expectancy for both sexes increased from just over 65 years in 1990 to 71.5 years in 2013, while healthy life expectancy rose from almost 57 years to slightly more than 62 years.

“The world has made great progress in health, but now the challenge is to invest in finding more effective ways of preventing or treating the major causes of illness and disability,” study author Theo Vos, a professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, said in a journal news release.

The rise in overall life expectancy is due to significant declines in illness and death caused by HIV/AIDS and malaria, the researchers said, along with major advances in combating infectious diseases, nutritional deficiencies, and mother and baby health problems.

Earlier this year, Laura Carstensen, PhD, director of the Stanford Center on Longevity, spoke at the Big Data in Biomedicine conference about modern society’s gains in life expectancy and called it an “unprecedented” time in history. During her presentation, she presented data on the current aging population and what aging might look like in the future.

Previously: A look at aging and longevity in this “unprecedented” time in history, “Are we there yet?” Exploring the promise, and the hype, of longevity research and Living loooooooonger: A conversation on longevity
Photo by jennie-o

Aging, Podcasts, Public Health, Research, Stanford News

Stanford doctor on a mission to empower patients to talk about end-of-life issues

Stanford doctor on a mission to empower patients to talk about end-of-life issues

Each year, about 2.6 million people die in America. Although past research has shown that 7 out of 10 of us prefer to die at home, an estimated 70 percent of people die in the hospital, nursing home or long-term care facility. The disconnect between where people die and how they would prefer to spend their final days often happens because loved ones and doctors don’t know their end-of-life wishes. Only 20 to 30 percent of Americans have completed advanced directives.

It’s not easy to talk about death, and the terminology used in advance directives can be confusing. I remember having to complete the form with my husband shortly before the birth of my first child. Despite having been in a relationship for 12 year, we had never discussed end-of-life issues. Imagining the scenarios that might lead to either of us being in a life-threatening situation was an extremely emotional exercise — especially as we awaited our son’s arrival. Did we want doctors to use every intervention possible to save our life? What if it meant sacrificing our quality of life? Did we want to be on life support? If so, how long?

We eventually turned to a friend, who was also a physician, to help us sort through the process. But we didn’t talk to our own primary care doctors and, to this day, our doctors have never asked us if we have an advance directive or about our end-of-life preferences. And this isn’t unusual. Recent research from VJ Periyakoil, MD, director of Stanford’s Palliative Care Education and Training, shows that most doctors struggle to talk with patients about what’s important to them in their final days, particularly if the patient’s ethnicity is different than their own.

In the latest 1:2:1 podcast, Periyakoil discusses her study findings and why it’s critical for all adults to complete an advance directive and initiate a conversation about their end-of-life wishes with their doctor and family. To get these conversations started and help patients navigate the emotionally-charged process, she launched the Stanford Letter Project, which provides templates in a range of languages asking patients simple questions about how they want to die.

Listen to the full podcast to learn more about the project and hear from Stanford Letter Project users about how they want to spend their final days.

Previously: How would you like to die? Tell your doctor in a letterIn honor of National Healthcare Decisions Day: A reminder for patients to address end-of-life issues, Study: Doctors would choose less aggressive end-of-life care for themselves and On a mission to transform end-of-life care

Aging, Research, Sleep

Having trouble sleeping? Research suggests spending more time outdoors

Having trouble sleeping? Research suggests spending more time outdoors


Raise your hand if you didn’t sleep well last night. Findings published in the latest issue of Preventive Medicine show that increasing the amount of time you spend outdoors can improve sleep quality, particularly for men and people over the age of 65.

To better understand the relationship between insufficient sleep and outdoor space, researchers analyzed data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, which surveyed of more than 250,000 adults in the United States. This information was paired with data from a U.S. Department of Agriculture index that scores the country’s geographical areas for natural amenities, using hours of sunlight, an important factor in regulating a person’s circadian rhythm, and temperature. According to a release:

For men, the relationship between sleep and exposure to green space was much stronger than for women. And males and females 65 and over found nature to be a potent sleep aid, [Diana Grigsby-Toussaint, PhD, said.]

Grigsby-Toussaint noted that living near green landscapes is associated with higher levels of physical activity and that exercise in turn predicts beneficial sleep patterns.

The finding should be a boon for people who are having trouble sleeping as they age. “If there is a way for persons over 65 to spend time in nature, it would improve the quality of their sleep—and their quality of life—if they did so,” Grigsby-Toussaint said.

Researchers added that the findings underscored the importance of preserving nature and providing safe access to nature in urban development.

Previously: Green roofs are not just good for the environment, they boost productivity, study shows, Nature is good for you, right? and Out-of-office autoreply: Reaping the benefits of nature
Photo by Garry Knight

Addiction, Aging, Chronic Disease, Pain

National survey reveals extent of Americans living with pain

National survey reveals extent of Americans living with pain


Yesterday, the NIH announced a new analysis of data that examined how much pain people in America suffer. The findings, published in The Journal of Pain, were based on data from the 2012 National Health Interview Survey (NHIS), an annual survey that asks a random sample of U.S. residents a wide variety of questions about their health.

The survey results are staggering: More than half of the adults in the country (126 million) had some kind of pain, minor to severe, in the three months before the survey. About 25 million had pain every day for that time frame and about 40 million suffer from severe pain. Those with the worst pain were also most likely to have worse health in general, use more health services and have more disabilities.

The survey also looked at complementary medicine approaches people take to dealing with their pain. Natural dietary supplements topped the list, followed by deep breathing and physical exercise such as yoga, tai chi or qi gong.

Joseph Briggs, director of the National Center for Complementary and Integrative Health was quoted in an article about the new study in the Washington Post:

The number of people who suffer from severe and lasting pain is striking. . . This analysis adds valuable new scope to our understanding of pain … It may help shape future research, development and targeting of effective pain interventions, including complementary health approaches.

Another topic the WaPo article touched on, which we’ve written about here at Scope, is the link between chronic pain and prescription painkiller abuse:

The prevalence of chronic pain in America also lies at the root of an ongoing epidemic of prescription painkiller abuse. Since 1999, according to the Centers for Disease Control and Prevention, the amount of painkillers such as oxycodone and hydrocodone sold in the United States has nearly quadrupled.

Here at Stanford, the Division of Pain Medicine is sponsoring a free back pain education day on Saturday September 13. You can find out more details here.

Previously: Assessing the opioid overdose epidemicChronic pain: Getting your head around itFinding relief from lower back pain and Stanford researchers address the complexities of chronic pain
Photo by Steven Depolo

Aging, Ask Stanford Med, Chronic Disease, Neuroscience, Women's Health

Exploring Alzheimer’s toll on women

Exploring Alzheimer’s toll on women

Julianne Moore AlzheimersIn last year’s “Still Alice,” Julianne Moore’s portrays a woman beset by early-onset Alzheimer’s Disease. It’s fitting that the academy-award winning film (Moore garnered a Best Actress award for her role) about Alzheimer’s features a woman as the central character because the illness disproportionately affects women.

The BeWell@Stanford blog recently featured a Q&A with Stanford neurologist and Alzheimer’s researcher Michael Greicius, MD, MPH about Alzheimer’s and women. The piece covers the effects of the disease, but I was intrigued to read about the challenges for caregivers of people with the disease (who are also disproportionately women):

Most of the caregivers of people with Alzheimer’s Disease are women. Do you have any advice for them in terms of how they can take care of themselves while taking care of a loved one with the disease?

This gets to the damned-if-you-do, damned-if-you-don’t aspect of AD and women. On the one hand, women are more likely to develop AD; on the other hand, they are also more likely to find themselves as the primary caregiver for someone with AD. It is now well known that caring for someone with AD has a powerful, negative impact on physical and emotional well-being. Particularly as the disease progresses and patients require more care, there is a large physical toll taken when, for example, having to lift patients out of a chair or off the toilet or out of bed. Sleep becomes fractured for the patient. which means it becomes fractured for the caregiver.

Some of the questions also dealt with the fact that despite the recent advances in Alzheimer’s research, we still don’t completely understand how the disease works or how it can be prevented:

What can we do to reduce our risk for developing the disease?

We do not know of anything that definitely reduces a person’s risk of developing Alzheimer’s, although there is strong data to suggest that regular aerobic exercise and a heart-smart diet will reduce risk. Head trauma is an important risk factor for AD and another type of dementia, so minimizing exposure to head trauma can also reduce risk of AD. Numerous companies make explicit or implicit claims about their “nutraceutical” or vitamin or “brain-training” software being able to stave off AD. None of these claims are true and most, if not all, of these purveyors are modern-day snake-oil salesmen and saleswomen.

But Greicius is optimistic and pointed out that Stanford recently became an NIH-sponsored Alzheimer’s Disease Research Center, which means we can build upon Stanford’s past “ground-breaking Alzheimer’s research.”

Previously: Are iron, and the scavenger cells that eat it, critical links to Alzheimer’s?Alzheimer’s forum with Rep. Jackie Speier spurs conversation, activismScience Friday explores women’s heightened risk for Alzheimer’s and The toll of Alzheimer’s on caretakers
Photo by Maria Morri

Aging, Health Costs, Health Policy, Patient Care

A look back at Medicare’s 50 years

Hand in HandOn Friday, KQED’s Forum offered a look at Medicare and Medicaid to mark the programs’ 50-year anniversary. Stanford health policy researcher Laurence Baker, PhD, participated in the discussion, which covered issues such as how the programs drive the way prices for care are negotiated with medical providers, how the large population of Baby Boomers will affect the system, and how reimbursement rates affect the kind of care Medicare and Medicaid patients receive.

The panel also discussed the gaps in coverage — services like dental care are not covered by Medicare — and the challenges they create. Medicare coverage has grown from the narrow set of conditions it first covered, and Baker thinks the conditions are right to begin a new national conversation about expanding coverage:

One of the things that’s really ripe for discussion is how this country is going to handle the long-term care issues. Medicare’s got to be at the center of that. And it almost feels like the time is coming that we’re going to have to think about that much more seriously.

And when host Mina Kim asked Baker the question that’s on a lot of people’s mind — Is Medicare sustainable for the long term? — Baker noted:

The program is pretty important; it’s clearly something the country values across the political spectrum. Lots of people want to see it sustained. It may not be a pretty process. It might not be fun to watch the politics of how we work all this out, but there are lots of ways to keep the program solvent, so I’m optimistic.

Previously: Competition keeps health-care costs low, Stanford study findsWhat’s the going rate? Examining variations in private payments to physiciansCheck the map – medical procedure rates vary widely across CaliforniaMedicare payment reform shown to cut costs and improve patient care and KQED health program focuses on baby boomers and the future of Medicare
Photo by Garry Knight

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