The Ultimate in Low-Tech Care

I haven’t lost interest in the convoluted intersection between world-changing information technologies and real human beings, especially within healthcare, my chosen profession.  I plan to keep on discussing these issues in this blog.  But it’s time to pivot from writing mostly about information technology in healthcare to addressing a broader range of medical issues and maybe some non-medical ones too.
I started my medical writing career in 1976 with a weekly column for the Yuma (Colorado) Pioneer.  I called it “Healthy and Wise.”  This literary effort was a way to extend my reach in educating my community about health and illness, which I have always considered to be on a par with diagnosing and treating illness.  “Healthy and Wise” has followed me to newspapers in Ripon, Wisconsin and in Greeley, Holyoke and Brush, Colorado.  For 16 years I produced commentaries that were audio equivalents of “Healthy and Wise” for KUNC, a Colorado public radio station.  
As you can see, my desire to inform is nothing new.  Blogging is yet another way to do it, as well as to stay faithful to my decision in second grade to be a writer when I grew up.  (N.B. I am a writer.  It’s just never been my day job.)  
This time I’d like to talk for a change about a couple of medical studies that are about as far from technology as you can get.  They describe the healing that can come with simple human activities like movement and companionship, in this case with respect to dementia and delirium.
- Marc Ringel, MD

Association of Physical Activity Level With Risk of Dementia in a Nationwide Cohort in Korea

JAMA Open Network

An article entitled, “Association of Physical Activity Level With Risk of Dementia in a Nationwide Cohort in Korea,” published last December in the online medical journal, JAMA Open Network, reported on 62,286 patients 65 years or older, never before diagnosed with dementia, who had received health checkups under the auspices of Korean National Health Insurance.  The patients were followed for five years.  Each person’s exercise quantity was estimated, based on self-report of intensity, duration and frequency, and assigned a single number of MET-minutes per week.  MET is a standard measure of energy expenditure.  A sleeping person dissipates 1 MET, 2 sitting, 4 walking slowly, 5 slow dancing, 6 jogging slowly, and 8 METs running uphill.

Over the course of 42 months of follow-up 3757 people (6%) developed dementia.  Not surprisingly, the more MET-minutes per week a person reported the less their likelihood of developing dementia.  The good news is that at low levels of activity, 500 MET-minutes per week, dementia risk decreased almost 20%.  That’s the equivalent of 25 minutes 5 times a week of slow walking, mopping or golfing with a cart.  At 100 MET-minutes per week--40 minutes five times a week of normal walking, slow dancing or raking leaves--risk is reduced further by another 10%.  After that the curve of decreasing risk flattens out, which means it doesn’t take heroic levels of exercise to get near maximum protection from dementia.

Every activity counts, including housework, gardening and just plain walking.  You can save breathing heavily for romance, which is also good for your health.  (That’s another topic.)  One caveat.  You could make the case that the people who were more active were healthier in the first place.  So maybe the protective effect of exercise for dementia is less than this study indicates.  But staying active is good for you any way you slice it.  To quote my Great-Aunt Elke, “It vudn’t hoit!”

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Outcomes of a Delirium Prevention Program in Older Persons After Elective Surgery

JAMA Surgery

The other report I wish to discuss, entitled “Outcomes of a Delirium Prevention Program in Older Persons After Elective Surgery,” appeared in the December 2021 issue of JAMA Surgery.  In dementia, though mental impairment may wax and wane it still is longstanding and overall pretty constant.  Delirium, on the other hand, is defined as acute mental impairment usually caused by a reversible insult to the brain.  Surgery and anesthesia are well known culprits, especially in the elderly who start out with less reserve in every body system, including the central nervous system.  Patients who experience post-operative delirium overall have significantly worse recovery, including new dementia or worsening of pre-existing mental impairment.

1470 German patients age 70 and older who were scheduled for elective orthopedic, abdominal or cardiac surgery were enrolled in this study.  Above and beyond the usual care that the participants of the control group received, patients in the intervention group also got an extensive orientation to the clock, calendar and bathroom in their hospital room.  Staff made sure their hearing aids worked and even cleaned their eyeglasses.   Close attention was paid to moving about in bed and, for those who were able, to walking.  Mental stimulation was supplied by Sudoku, other games and reading the newspaper.  Music, warm drinks, acupressure and relaxation exercises helped them chill when they needed to.  Staff were assigned to accompany these patients during meals, trips for laboratory and x-ray studies, in post-operative recovery, and even on the way to the operating room.

The only electronic devices to be found in the whole program were hearing aids, audio players and clocks.  Simple no-tech interventions reduced the incidence of post-operative delirium by nearly 40% in the abdominal and orthopedic surgery groups (but not in cardiac surgery patients, perhaps because heart surgery is that much bigger of a stress on the system)

View Article

Here’s the take-home.  A large part of caring for ourselves at home and for patients in the hospital depends on good old TLC.  No matter how smart it may be, a machine will never be the sole solution to keeping myself active at home nor to keeping my marbles when I do need surgery.  It takes people to do that.

February 1, 2022
 in the
Written by
Marc Ringel, MD

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