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ALL ABOUT AGING: Putting Medical Tests to the Test

Much of the excess cost and waste in health care can be attributed to unnecessary tests and procedures. By some estimates, as much as 30 percent of all health care spending is considered wasteful.

Patients play a role in this process by requesting tests and procedures they have heard or read about or because their friends had one. Doctors often find it difficult to resist these requests and may be driven to order tests out of fear of being sued – the practice of defensive medicine.

Inappropriate testing is not only wasteful but also can lead to harm when false-positive results lead to further testing and procedures that carry risk. For example, a benign-looking finding on a chest X-ray can lead to additional radiation exposure or invasive procedures that sometimes cause complications.

This month, the American Board of Internal Medicine and nine subspecialty groups published a list of 45 commonly used procedures that should be re-evaluated by physicians and patients because there is little or no evidence to support their use and some evidence of potential harm. Examples include cardiac-stress tests in patients without symptoms and pre-operative chest X-rays in patients without histories of lung problems.

Other examples include brain imaging for common headache and X-rays for general low-back pain. These lists are meant to publicize the problem of excessive testing and serve as guidelines for patients and physicians. Individual circumstances should determine which tests are really indicated.

When you see your doctor, remember that when it comes to testing, more is not better. There are risks associated with unnecessary testing. The results of any test should have the potential to improve your care and subsequent health, and test results obtained by subspecialists should be routinely shared with your primary physician to limit duplication and wasteful spending.

There are very few “routine tests.” EKGs, chest X-rays and most laboratory tests are not useful for prevention or health maintenance. Tests and procedures should be done with specific goals in mind and when the benefits outweigh the risks involved.

Things to remember

Work with your doctor to make sure any tests being ordered are supported by evidence-based recommendations. Careful attention to appropriate use of medical tests and procedures will help us get more “bang for the buck” from our health care dollars and promote better health in the bargain.

Dr. James Davis is a board-certified geriatrician with the highly ranked UCLA Geriatrics Program in Santa Monica and Westwood. For more information, call (310) 319-4371.

ALL ABOUT AGING: Q & A on High Blood Pressure

May is “High Blood Pressure Education Month,” which aims to raise awareness of this medical condition also known as hypertension. Below are some of the more common questions that I hear from my patients, along with my answers.

Q: “If my blood pressure is only high in the doctor’s office, or only sometimes, do I still need to treat it?”

A: Yes. Also called “white-coat hypertension,” stress-related high blood pressure requires treatment. Stress occurs daily in all of our lives, and none of us can predict, control or prevent it. When our bodies are stressed, our blood pressure naturally goes up. When we have high blood pressure, it goes up higher than it should (>140/90). We want to treat patients who have white-coat hypertension so their blood pressure does not get dangerously high under stress.

Uncontrolled high blood pressure can lead to eye and kidney disease, strokes and heart attacks. Complications of untreated hypertension include death. It is vitally important to treat high blood pressure, even if it is not always high. Blood pressure naturally goes up and down. However, we want the highs to remain within the normal range. There are some exceptions to this rule, including a few conditions that require a slightly elevated blood pressure for stable health. Ask your doctor about your target blood pressure.

Q: “Can I just try to lose weight and avoid salt, instead of taking blood pressure medication?”

A: Generally, if your blood pressure is high enough to warrant treatment, you will need to take medication to control it. If you are overweight, then losing weight is important because it will improve your overall health and mobility. It may also help lower your blood pressure in the long run or prevent you from taking more medications as you get older. However, losing weight is probably not enough to control high blood pressure. Also, if you consume a lot of salt, you should cut down anyway for better health. Doing so may help lower your blood pressure, but probably not enough to avoid medications.

Q: “If I start medication for blood pressure, will I have to take it forever?”

A: Chances are, yes. But this is not a bad thing! Many people commonly view taking medication as a “bad thing” or a sign of failure. They often think they are not better unless they can eliminate the high blood pressure entirely – and the need for medications. I often try to reframe my patients’ views on medication by reminding them that high blood pressure affects the majority of us as we age. Our arteries harden over time, causing increased resistance against the flow of blood and, ultimately, high blood pressure. It’s much better to know and treat it, than to not know or ignore it. The good news is that there are many medications – most with no or minimal side effects – that can effectively control blood pressure and prevent its secondary effects such as strokes and heart attacks.

Q: “Why do I have to take more than one medication for high blood pressure?”

A: Different medications work in different ways to control blood pressure. Therefore, one medication may help a little, but needs another medication to make it work more effectively. It is not uncommon to need several medications, working together to lower your blood pressure.

Finally, here are some key lifestyle changes to consider for healthy blood pressure:

  • Have your blood pressure checked regularly.
  • Take prescribed blood pressure medications as directed.
  • Quit smoking.
  • Eat a healthy diet rich in fruits and vegetables and low in sodium.
  • Maintain a normal body weight based on body-mass index (BMI) guidelines.
  • Get or stay active by taking brisk walks daily.

Dr. Sonja Rosen, board-certified in both geriatrics and internal medicine, is a geriatrician with the highly regarded UCLA Geriatrics Program in Santa Monica. She is also medical director of the Geriatrics Unit at UCLA’s new Santa Monica campus. Call (310) 319-4371 for more information.

Medscape Examines Alzheimer’s Research

Medscape reported March 15 on a study that identified the intracellular mechanisms regulated by vitamin D3 that may help the body clear the brain of amyloid beta, the main component of plaques associated with Alzheimer's disease. Dr. Milan Fiala, a researcher at the David Geffen School of Medicine at UCLA and the Veterans Affairs Greater Los Angeles Healthcare System, was quoted.

Ronald Reagan’s Daughter Talks About Alzheimer’s Support Group She Co-Leads

KCBS-Channel 2 reported March 15 on the Ronald Reagan UCLA Medical Center’s new Alzheimer’s and Dementia Care program, which was spearheaded by Patti Davis, daughter of former President Reagan. Davis and Dr. David Reuben, chief of geriatrics, were interviewed.

Click here to view the full story.

ALL ABOUT AGING: Sleep Matters for Better Health

Daylight Saving Time begins March 11to make the most of sunlight during the warm summer months. However, springing forward one hour can disrupt our sleep patterns.

As we grow older, we may notice that our sleep schedule is not what it was. What changes are considered a normal part of aging and which are not? Here is some helpful information about getting a better night’s sleep.

While adults on average need seven to nine hours of sleep per night, older and younger adults’ quality of sleep differs. Older adults experience more light sleep, less deep sleep and more awakenings.

Sleep is vital for good health. Studies have shown that sleep deprivation can lead to cognitive problems and difficulty in daily functioning.

There are many types of sleep disorders. Insomnia, the most common one, is difficulty falling or staying asleep. Circadian-rhythm (also known as sleep-wake cycle) sleep disorders involve going to bed or waking up too early or too late. Hypersomnia is sleeping too much.

If you have sleep problems, tell your doctor. He or she may conduct tests to determine the cause. For example, sleep apnea causes poor sleep and daytime tiredness. Sometimes anxiety can make it difficult to fall or stay asleep, while depression can lead to waking up too early.

Depending on the cause, there are steps you can take. Your doctor may recommend behavioral changes and/or medications.

Sleep difficulties are not a normal part of aging! Here are some suggestions for getting more restful sleep:

  • Maintain a regular schedule. Establish consistent sleep and wake times.
  • Keep your bedroom dark and quiet for sleeping.
  • Use the bedroom only for sleep. Don’t watch TV, use a laptop/tablet or eat meals in bed.
  • Talk with your doctor about adjusting the times you take any stimulating medications.
  • Exercise regularly but not right before going to bed. Daily exercise can help your body, mind and sleep. Consider taking walks in your neighborhood or visiting your local gym.
  • Be careful about napping. If you must nap, limit it to less than one hour and earlier in the day.
  • Avoid caffeine, especially in the afternoon and evening. Caffeine can stay in the body for several hours, disrupting sleep at night.
  • Watch your alcohol consumption, too. While it can make you feel sleepy initially, it interferes with deeper sleep.
  • Eat your last big meal of the day and limit drinking liquids a few hours before bedtime.
  • Avoid going to bed upset. Try to take care of your problems during the day and let go of what remains at night.

Follow these simple steps for a good night’s sleep and a healthier life!

Dr. Alia Tuqan is a geriatrician with the highly regarded UCLA Geriatrics Program in Santa Monica. For more information, call (310) 319-4371