Social Frailty

Social frailty is a corollary to physical frailty, a set of vulnerabilities (including weakness, exhaustion, unintentional weight loss, slowness, and low physical activity) shown to increase the risk of falls, disability, hospitalization, poor surgical outcomes, admission to a nursing home, and earlier death in older adults.

For seniors who want to think about their own social vulnerability, consider this five-item index, developed by researchers in Japan.

(1) Do you go out less frequently now than last year?

(2) Do you sometimes visit your friends?

(3) Do you feel you are helpful to friends or family?

(4) Do you live alone?

(5) Do you talk to someone every day?

Being ‘Socially Frail’ Comes With Health Risks for Older Adults — https://khn.org/news/article/socially-frail-older-adults-health-risks/

I passed the quiz.

New Prescription for the Chronically Ill

Fresh Produce Is an Increasingly Popular Prescription for Chronically Ill Patients

By Carly Graf March 23, 2023

When Mackenzie Sachs, a registered dietitian on the Blackfeet Reservation, in northwestern Montana, sees a patient experiencing high blood pressure, diabetes, or another chronic illness, her first thought isn’t necessarily to recommend medication.

Rather, if the patient doesn’t have easy access to fruit and vegetables, she’ll enroll the person in the FAST Blackfeet produce prescription program. FAST, which stands for Food Access and Sustainability Team, provides vouchers to people who are ill or have insecure food access to reduce their cost for healthy foods. Since 2021, Sachs has recommended a fruit-and-vegetable treatment plan to 84 patients. Increased consumption of vitamins, fiber, and minerals has improved those patients’ health, she said.

“The vouchers help me feel confident that the patients will be able to buy the foods I’m recommending they eat,” she said. “I know other dietitians don’t have that assurance.”

Sachs is one of a growing number of health providers across Montana who now have the option to write a different kind of prescription — not for pills, but for produce.

The Montana Produce Prescription Collaborative, or MTPRx, brings together several nonprofits and health care providers across Montana. Led by the Community Food & Agriculture Coalition, the initiative was recently awarded a federal grant of $500,000 to support Montana produce prescription programs throughout the state over the next three years, with the goal of reaching more than 200 people across 14 counties in the first year.

Participating partners screen patients for chronic health conditions and food access. Eligible patients receive prescriptions in the form of vouchers or coupons for fresh fruits and vegetables that can be redeemed at farmers markets, food banks, and stores. During the winter months, when many farmers markets close, MTPRx partners rely more heavily on stores, food banks, and nonprofit food organizations to get fruits and vegetables to patients.

The irony is that rural areas, where food is often grown, can also be food deserts for their residents. Katie Garfield, a researcher and clinical instructor with Harvard’s Food is Medicine project, said produce prescription programs in rural areas are less likely than others to have reliable access to produce through grocers or other retailers. A report from No Kid Hungry concluded 91% of the counties nationwide whose residents have the most difficulty accessing adequate and nutritious food are rural.

“Diet-related chronic illness is really an epidemic in the United States,” Garfield said. “Those high rates of chronic conditions are associated with huge human and economic costs. The idea of being able to bend the curve of diet-related chronic disease needs to be at the forefront of health care policy right now.”

Produce prescription programs have been around since the 1960s, when Dr. Jack Geiger opened a clinic in Mound Bayou, a small city in the Mississippi Delta. There, Dr. Geiger saw the need for “social medicine” to treat the chronic health conditions he saw, many the result of poverty. He prescribed food to families with malnourished children and paid for it out of the clinic’s pharmacy budget.

A study by the consulting firm DAISA Enterprises identified 108 produce prescription programs in the U.S., all partnered with health care facilities, that launched between 2010 and 2020, with 30% in the Northeast and 28% in the Midwest. Early results show the promise of integrating produce into a clinician-guided treatment plan, but the viability of the approach is less proven in rural communities such as many of those in Montana.

In Montana, 31,000 children do not have consistent access to food, according to the Montana Food Bank Network. Half of the state’s 56 counties are considered food deserts, where low-income residents must travel more than 10 miles to the nearest supermarket — which is one definition the U.S Department of Agriculture uses for low food access in a rural area.

Research shows long travel distances and lack of transportation are significant barriers to accessing healthy food.

“Living in an agriculturally rich community, it’s easy to assume everyone has access,” said Gretchen Boyer, executive director of Land to Hand Montana. The organization works with nearby health care system Logan Health to provide more than 100 people with regular produce allotments.

“Food and nutritional insecurity are rampant everywhere, and if you grow up in generational poverty you probably haven’t had access to fruits and vegetables at a regular rate your whole life,” Boyer said.

More than 9% of Montana adults have Type 2 diabetes and nearly 35% are pre-diabetic, according to Merry Hutton, regional director of community health investment for Providence, a health care provider that operates clinics throughout western Montana and is one of the MTPRx clinical partners.

Brittany Coburn, a family nurse practitioner at Logan Health, sees these conditions often in the population she serves, but she believes produce prescriptions have tremendous capacity to improve patients’ health.

“Real food matters and increasing fruits and veggies can reverse some forms of diabetes, eliminate elevated cholesterol, and impact blood pressure in a positive way,” she said.

Produce prescription programs have the potential to reduce the costs of treating chronic health conditions that overburden the broader health care system.

“If we treat food as part of health care treatment and prevention plans, we are going to get improved outcomes and reduced health care costs,” Garfield said. “If diet is driving health outcomes in the United States, then diet needs to be a centerpiece of health policy moving forward. Otherwise, it’s a missed opportunity.”

The question is, Do food prescription initiatives work? They typically lack the funding needed to foster long-term, sustainable change, and they often fail to track data that shows the relationship between increased produce consumption and improved health, according to a comprehensive survey of over 6,000 studies on such programs.

Data collection is key for MTPRx, and partners and health care providers track how participation in the program influences participants’ essential health indicators such as blood sugar, lipids, and cholesterol, organizers said.

“We really want to see these results and use them to make this more of a norm,” said Bridget McDonald, the MTPRx program director at CFAC. “We want to make the ‘food is medicine’ movement mainstream.”

Sachs acknowledged that “some conditions can’t usually be reversed,” which means some patients may need medication too.

However, MTPRx partners hope to make the case that produce prescriptions should be considered a viable clinical intervention on a larger scale.

“Together, we may be able to advocate for funding and policy change,” Sachs said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Popular keto diet may be linked to higher risk of heart disease, cardiac events

The study, presented over the weekend at the American College of Cardiology’s annual scientific session together with the World Congress of Cardiology, found that a keto-like diet may be associated with higher levels of “bad” cholesterol and twice the risk of cardiovascular events such as chest pain, blocked arteries requiring stenting, heart attacks and strokes.

The research team analyzed data from the UK Biobank, a large-scale database with health information from over half a million people living in the United Kingdom who were followed for at least 10 years. Upon enrollment in the biobank, participants completed a self-reported diet questionnaire and had blood drawn to check their cholesterol levels.

“Among the participants on an LCHF diet, we found that those with the highest levels of LDL cholesterol were at the highest risk for a cardiovascular event,” Dr. Iatan said. “Our findings suggest that people who are considering going on an LCHF diet should be aware that doing so could lead to an increase in their levels of LDL cholesterol. Before starting this dietary pattern, they should consult a health care provider. While on the diet, it is recommended they have their cholesterol levels monitored and should try to address other risk factors for heart disease or stroke, such as diabetes, high blood pressure, physical inactivity and smoking.”

Popular keto diet may be linked to higher risk of heart disease, cardiac events — https://www.med.ubc.ca/news/popular-keto-diet-may-be-linked-to-higher-risk-of-heart-disease-cardiac-events/

Outbreak Linked to Eyedrops

An alarming outbreak of extensively drug-resistant bacteria linked to eye drops has now sickened 68 people across 16 states, according to the latest update from the Centers for Disease Control and Prevention. At least 16 people have been hospitalized, eight have lost vision, and four have had their eyeballs surgically removed (enucleation). One person has died, which was reported earlier.

The VIM-GES-CRPA outbreak strain is rare and has never been seen in the US before. Health officials think it was brought into the country in contaminated eye drops manufactured by Global Pharma, a Chennai, India-based manufacturer. The products were sold under the brand names EzriCare Artificial Tears and Delsam Pharma’s Artificial Eye Ointment, which were available nationwide via Amazon, Walmart, and other retailers.

68 now sickened, 4 lose eyeballs in outbreak linked to eyedrops — https://arstechnica.com/science/2023/03/more-people-lose-eyeballs-in-outbreak-linked-to-eye-drops/

Yikes!

Another Troubling Trend

The SEARCH data demonstrate an increase in the youth population aged 0-19 diagnosed with type 1 or type 2 diabetes in five representative US centers. Between 2002 and 2018, the annual incidence rose by about 2% per year for type 1 diabetes and 5% per year for type 2 diabetes. The rates of increase for both types were greater among non-White than White youth.

Troubling Trend as Both Diabetes Types Rise Among US Youth – Medscape – Mar 08, 2023. – https://www.medscape.com/viewarticle/989327

Diet and lifestyle until proven otherwise.

2/3 Diet and Lifestyle, 1/3 Genetics

What can Okinawans tell us? Why does Ogimi and elsewhere on the island have a history of long life? That comes down to three main factors—diet, social practices, and genetics—explains Craig Willcox, a professor of public health and gerontology at Okinawa International University and a co-principal investigator of the Okinawa Centenarian Study, which has been investigating Okinawan longevity since 1975.“

About two-thirds of longevity is related to diet and way of life, the rest is genetics. Generally speaking, you need the genetic rocket booster if you want to get into the hundreds, not just a good diet,” Willcox says. “We haven’t looked into whether or not Okinawa has a genetic advantage over other parts of Japan, but longevity does run in families here.”

This island unlocked the secret to long life—and knows how to get through tough times — https://www.nationalgeographic.com/travel/article/uncover-the-secrets-of-longevity-in-this-japanese-village

Older Okinawans clinging to the islands’ traditionally healthful diet still boast the longest life expectancy in Japan, the country with the world’s longest-living people. But younger islanders, who grew up coveting the America they peeked at inside the bases here, began gobbling up hamburgers, fried chicken and pizzas as soon as their incomes permitted them to do so.

Urasoe Journal; On U.S. Fast Food, More Okinawans Grow Super-Sized — https://www.nytimes.com/2004/03/30/world/urasoe-journal-on-us-fast-food-more-okinawans-grow-super-sized.html

I need to go to the grocery store today.

  • Sweet potatoes
  • Bitter melon
  • Seaweed
  • Fish

Vitamin D and Dementia


Researchers at the University of Calgary’s Hotchkiss Brain Institute in Canada and the University of Exeter in the UK explored the relationship between vitamin D supplementation and dementia in more than 12,388 participants of the US National Alzheimer’s Coordinating Center, who had a mean age of 71 and were dementia-free when they signed up. Of the group, 37 per cent (4,637) took vitamin D supplements.

In the study, published in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, the team found that taking vitamin D was associated with living dementia-free for longer, and they also found 40 per cent fewer dementia diagnoses in the group who took supplements.

University of Exeter. “Taking vitamin D could help prevent dementia: Taking vitamin D supplements may help ward off dementia, according to a new, large-scale study..” ScienceDaily. http://www.sciencedaily.com/releases/2023/03/230301101511.htm (accessed March 1, 2023) — https://www.sciencedaily.com/releases/2023/03/230301101511.htm

Journal Reference:

Maryam Ghahremani, Eric E. Smith, Hung‐Yu Chen, Byron Creese, Zahra Goodarzi, Zahinoor Ismail. Vitamin D supplementation and incident dementia: Effects of sex, APOE , and baseline cognitive status. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 2023; 15 (1) DOI: 10.1002/dad2.12404