By Richard P. Holm, MD
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In the U.S., there are almost five million people with mild to moderate dementia, and studies show that about 70 percent are at home, either alone or with a caregiver, often a spouse. If people with mild to moderate dementia can stay home safely, this would save Medicare and Medicaid a great deal of taxpayer money. More importantly, this would provide those people affected with dementia their preferred environment. Indeed, it is important to allow all people the chance to stay at home whenever possible.
 
A 2013 Johns Hopkins report studied more than 250 people with dementia living at home and found that 99 percent of the demented and 97 percent of their caregivers had at least one unmet need. The foremost unmet need was defined by safety issues such as poor lighting in walkways which increased the risk of falling. Other needs that were not being met in this study included not performing regular exercise, poor follow-up with health care providers, not having prepared legal and estate planning and not receiving help with medications and some activities of daily living. Researchers found that those with lower income, with depression and with borderline rather than severe dysfunction had significantly more unmet needs.
 
When there were at-home caregivers for these folks with early dementia, the caregivers were often not aware of these deficiencies. In addition, the needs of the caregivers were often ignored or unrecognized. Remarkably, at-home caregiver stress and depression were some of the strongest predictors for an earlier move of the person with dementia to the nursing home.
 
Methods to enhance a person’s chance of staying at home are not difficult. Preparation for legal issues and estate planning should be done early and BEFORE the loss of memory. Other methods include providing raised toilet seats, grab bars in the bath and bedroom, properly tacked down carpets, good nighttime lighting in walkways and proper day and nighttime footwear. Researchers also advise providing enhanced support for caregivers with education about community support available such as social services, occupational therapy and caregiver support groups. In addition, screening and treatment of any caregivers’ depression, should be provided. This would go a long way in helping people stay at home as they age.
 
Bottom line: Most of us, and our families, are not prepared for the possibility of dementia as we age. If we prepare, we greatly improve our chances for staying at home.
 
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By Richard P. Holm, MD
 
We have all had to deal with bullies throughout our lives, and I have had my share. One fall day, coming home from school, I saw two guys from my third-grade class beating up on a smaller kid and was moved to step in to help. I was chagrined but not surprised when the victim ran home, and I became the new target. The beating I took that day was minimal, however, the sense that I did the right thing by standing up against bullies has propped up my self-worth my whole lifetime.
 
Bullies and abuse are everywhere. While in medical school, I was in an Atlanta emergency room when a woman came in with a broken nose and other broken bones and bruises that were explained away as the result of a fall, when we knew full well the injuries were inflicted by her spouse. Since coming to this prairie town 38 years ago, I have seen several cases of parents who physically and emotionally abused their children, and of adult children who physically and emotionally abused their parents. I remember numerous cases where women came into my office, explained their husbands were physically beating them, and despite my recommendations to escape and seek shelter, they stayed married to the scoundrels.
 
The American Psychiatric Association defines domestic violence and abuse as control by one person over another in any relationship. Control is the operative word. The means of this control can result from physical, sexual, emotional and economic abuse, including threats of isolation.
 
The number of American troops killed in Afghanistan and Iraq from 2001 through 2012 was greater than 6,000, and the number of American women murdered by male partners during that time was about 12,000. The Center for Disease Control estimates that in the U.S., one out of every four women and one out of every seven men will have experienced severe physical violence from a bully in their lifetimes.
 
The National Coalition for the Homeless estimates ten million children are exposed to domestic violence every year, and that people exposed to such hostility as children are three to four times more likely to become abusive or be abused than people raised in families without it.
 
Sometimes it’s right to stand up to a bully, and when there is danger, it’s right to escape and get help. And it’s always right to save your children from a lifetime of abuse by not allowing it in your family.
 
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By Richard P. Holm, MD

It is miraculous to consider how much access and exposure we have to information through our computers, televisions, radios and newspapers. Unfortunately, we need to be on guard because too much of this buzz can be false information.

In an October 2017 article, the Pew Research Center found 43 percent of people in 2016 received their news from Facebook listening for information that aligned with their world view (not necessarily with facts). Pew also found 23 percent had shared, by intention or accident, untrue political messages on social media. We need to be more critical of all sources of information around us. Almost as malignant as fake news are advertisements that pretend to be factually based.

Of course, marketing (sales) can be good and important as it moves commerce, and I’m not saying industry doesn’t sponsor credible scientific research. However, marketing can be harmful when selling a weight-loss program that gives false hope, when peddling virility pills that are ineffective or when pushing an outrageously expensive drug that should be used only after first-line medicines are tried. Advertisements can and should be based on truth, but my cynical side sees the words “truth in advertising” as an oxymoron, like “seriously funny,” “awfully good” or “found missing.” Indeed, marketing motives can be as different from evidence-based science as corn syrup is to leafy green vegetables.

It has been our desire and goal at Healing Words Foundation to find and help spread health information that is not influenced by marketing or sales. What is known today as Prairie Doc® media started in the 1980s with newspaper articles, expanding in the 1990s with a local talk AM-radio show, in 2003 with a television show and in 2010 with social media. Prairie Doc® has been made possible with the help of volunteer physicians and experts, South Dakota State University and its students, our paid and voluntary Prairie Doc® production staff, our Foundation Board of Directors and, most importantly, the unrestricted underwriting of organizations and individuals like you. We feel blessed to have such wonderful talents and gifts allowing us to bring our unbiased and credible public health information to the people.

The mission statement of the Healing Words Foundation and all Prairie Doc® programming is enhancing health and diminishing suffering by communicating useful information, based on honest science, provided in a respectful and compassionate manner.

This is a call for all of us to be careful and critical. We don't have to be influenced by fake news but rather need to choose our sources of information carefully. Let this be a time of truth.
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By Richard P. Holm, MD

We take a lot of things for granted. With the advent of antibiotics in the 1930s and 40s, we saw a true change in longevity and a reduction in premature death from infectious diseases. Now we are seeing deaths from bacteria which are resistant to every antibiotic and it’s not just the sick and decrepit who are affected. Recent studies show many more people are dying in the U.S. from antibiotic resistant bacteria than from AIDS. It’s a real crisis resulting from too much of a good thing.

Resistance is due to excessive and over-use of antibiotics, which are often incorrectly seen as the cure for whatever ails us. The most glaring example is when antibiotics are given for what is obviously the common cold, making absolutely no difference in the course of the illness. Often, I hear from the patient, “Why not start an antibiotic to keep this viral bronchitis from turning into pneumonia?” To that question I usually answer, “You are correct, when bacterial pneumonia occurs, it often follows a common cold, but studies show antibiotics don’t prevent the occurrence of that pneumonia following the cold. Rather, it becomes a pneumonia resistant to treatment.”

So why are we over-using antibiotics? Most experts say it is from patient or parent expectation. One study showed that if the doctor perceives the parents expect antibiotics for their children, 65 percent of the time the doctor will prescribe antibiotics. Conversely, when parents do not indicate an expectation for antibiotics, even when the children are similarly ill, the doctor prescribes them only 12 percent of the time. Ultimately the doctor is responsible but too often yields to pressure to provide unnecessary treatment.

Another reason for growing antibiotic resistance has resulted from use of antibiotics in animal and poultry feed which boosts animal growth and profits. In the U.S. antibiotics are now limited for use only when a veterinarian prescribes them, but similar limits are not in effect in India and other countries. Also, veterinarians are prescribing the newer broader spectrum antibiotics only for the care of sick individual animals, not the entire herd. These new moves are a start, but closer monitoring of usage needs to occur. The good news is that in countries where efforts to use fewer antibiotics are successful, within a few years, antibiotics become effective again.

Based upon current science, rather than expecting an antibiotic from the doctor, it’s in our best interest to discuss options and use antibiotics only when they are necessary. We can also benefit by taking time to read food labels carefully, choosing antibiotic-free products.

Let’s not take antibiotics for granted. By avoiding the overuse of antibiotics, we can save ourselves from a real crisis.
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