Caregivers of Alzheimer's patients suffer, sometimes to death

It's common to hear about diseases like Alzheimer's drastically affecting the lives of those who have it, often causing severe struggles and hardships. What you may not hear much about is how caregivers of people with Alzheimer's can also suffer deeply and greatly.

Jim Crabtree was actually relieved to find out that his wife and mother had been shot and killed by his father who then shot and killed himself, Linda Carroll of NBC News reports. (Today show photo: Crabtree with his wife, Rita)

"Crabtree had been struggling" to care for his 62-year old wife, who had been diagnosed with Alzheimer's six years before, and his elderly parents: a father with dementia and a mother with crippling arthritis.

Crabtree said he felt stretched thin with the responsibility of caring for his family and that by killing them, his father actually got rid of the burdens they caused him all at once, Carroll reports.

"Although rare, there are other murder-suicide cases involving caregivers and their charges. It’s a sign of how stressful the job is," Linda Ercoli, director of geriatric psychology at the Semel Institute at the University of California, Los Angeles said in the story.

The Alzheimer's Association has created a test for caregivers to check their stress levels. 

Carroll describes how caregivers' emotions can range from helplessness to anger when they don't understand that certain annoying behaviors by their ill patients could be symptoms of the disease. Because of high emotions that can arise in a home with Alzheimer's patients, Ercoli explains that violence isn't uncommon. Studies have found that 5 percent of caregivers have been violent with their patients and 16 percent of patients have been violent with their caregivers.

Caregivers at first get a certain satisfaction from taking care of others, but as the disease progresses, they tend to suffer from deep depression, anxiety or other disorders, Ercoli explains. Also, Carroll adds, caregivers sometimes face the risk of becoming physically sick themselves. 

Experts say that caregivers should reach out more to each other for support. “People don’t say, ‘I survived Alzheimer’s’,” Crabtree said. “We are the survivors. I survived caregiving.”

UK researcher calls for change in state law to allow syringe exchange program to curb hepatitis C epidemic in Eastern Ky.

Despite the benefits associated with syringe- or needle-exchange programs in preventing the spread of hepatitis C, Kentucky law still prohibits them, and a researcher from the University of Kentucky is calling upon policymakers to help curb this public health threat in Eastern Kentucky.

Syringe exchange programs were first created 30 years ago in response to the AIDS epidemic, and they are an important component of a comprehensive disease prevention strategy, says the Center for Disease Control and Prevention. Yet, Kentucky law prohibits them even though federally funded programs have successfully reduced disease transmission.

A recent study of 500 Appalachian drug users found that nearly two-thirds of them were infected with hepatitis C, reports Stu Johnson of WEKU News. Transmission of the disease in rural Appalachian communities is predominantly due to injection drug use, but community opposition and legal restrictions are barriers to establishing exchange programs.

UK epidemiologist Jennifer Havens would like to see a change in the state law to establish syringe exchange programs in Kentucky. She says these programs don't encourage drug use, which has in the past been an incorrect perception that can inhibit exchange adoption, says the CDC. The programs can instead reduce disease transmission.

“I don’t think anyone walking by the program, the syringe service program, is going to say, `I’m going to start doing drugs today because there’s a syringe service program.’ All it does is allow folks who are already injecting a safer way, a safer source of syringes and potentially program that they wouldn’t otherwise be able to access,” Havens told Johnson.

Haven's previous research, which examined individual and network factors among Appalachian drug users, found an association between injection of prescription opioids and hepatitis C. The study concluded that efforts preventing drug users' transition to injection, especially among prescription opioid users, may curb transmission of the disease. 

One public health tool that has successfully reduced disease transmission in other states is the creation of a syringe exchange program, says the CDC. In addition to asking for a policy change, Havens is calling for federal funding to establish syringe exchange programs in an area of Kentucky particularly impacted by the disease: the eastern region.

“In talking to a lot of the leaders in Eastern Kentucky, I haven’t necessarily approached this issue in particular, but they are at their breaking point with regard to what do we do about this epidemic, so I think, actually at the end of the day, a syringe service program would probably be fairly welcome,” Havens told Johnson.

Beyond reducing the spread of hepatitis C, syringe exchanges can also bring abusers into drug treatment programs, says Havens. The programs are reported to effectively link hard to reach drug users with prevention services, such as screening and drug abuse/ recovery programs, says the CDC. 

Courier-Journal runs comprehensive list of questions and answers about health insurance exchange set to open Oct. 1

http://www.courier-journal.com/apps/pbcs.dll/article?AID=2013309070050

Webinar Tuesday from 12:30 to 1:30 p.m. Eastern Time will look at rates and plan offerings in state health-insurance exchanges

The second in a series of webinars for journalists covering the Patient Protection and Affordable Care Act will be held Tuesday from 12:30 to 1:30 p.m. ET. This one will look at insurance rates and plan offerings in the new state-based marketplaces known as health benefits exchanges.

The co-directors of the Kaiser Family Foundation's program for the study of health reform and private insurance, Senior Vice President Larry Levitt and Vice President Gary Claxton, will give a brief presentation on the early reports of rates, how and why they vary, and what consumers would pay after taking tax credits into account. They will also answer journalists' questions about the new insurance market rules taking effect in 2014, and how to interpret insurance rates.

Journalists who want to register for the webinar can RSVP by clicking here. Shortly after registering, each participant will receive a confirmation email that contains information about how to join the webinar. If you are unable to attend the second webinar, but would like to receive all future updates on the series, please email your name and media affiliation to acawebinars@kff.org.

During the webinar series, participants are welcome to continue the conversation on Twitter with the hashtag #ACA101KFF. Archived video from the first webinar, "What Do Consumers Need to Know About Health Reform's Changes," is available on the foundation website. For more information, contact Victoria Chao at 650-854-9400 or the email address above.

State health-insurance exchange plans to make smokers pay 40 percent more for coverage; varied interests, observers object

By Molly Burchett
Kentucky Health News

Supporters of the Patient Protection and Affordable Care Act have touted its goal to provide health insurance to all Americans without discrimination, such as prohibiting insurers from denying coverage due to pre-existing conditions. But it allows them to charge smokers more for it, and the officials running Kentucky's health-insurance exchange plan to do just that.

When Kynect, the state's online insurance exchange, opens Oct. 1, smokers can expect to pay up to a 40 percent surcharge, not far from the 50 percent limit in the law. That has brought objections from a wide range of observers, including tobacco companies and anti-cancer activists, saying it may be well-intended but is unfair and may backfire.

"Ranked No. 1 in adult smoking and cancer deaths, Kentucky should be doing all it can to bring tobacco users under the care of medical professionals. Yet some Kentucky smokers — perhaps many — will still be unable to afford health insurance, even after historic reforms take effect next year," says a recent Lexington Herald-Leader editorial. In 2011, the last year for which figures are available, 29 percent of adult Kentuckians smoked, and that does not include those who use smokeless tobacco.

UPDATE, Sept. 11: The state Department of Insurance says the 40 percent is a ceiling, and some companies are charging less, but 40 percent is the most common tobacco surcharge on health insurance policies sold in Kentucky. "There are health care costs associated with tobacco use," spokeswoman Ronda Sloan said. "With no tobacco use surcharge, insurers would have raised rates for everyone to offset those costs. . . . Plans will provide benefits for tobacco use cessation."

Seven states (California, Connecticut, Massachusetts, New Jersey, New York, Rhode Island and Vermont) and the District of Columbia will not charge smokers higher premiums. Connecticut voted against a smoking surcharge for individual policies, saying higher individual rates would disproportionately penalize poor people who tend to smoke.

Surchage critics in Kentucky agree. "This penalty is being applied to the working poor and medically indigent," writes Dr. Kevin Kavanagh, chairman of Health Watch USA, in a Herald-Leader op-ed. "Tobacco use is inversely related to education and income. In Kentucky, 48 percent of adults without a high school diploma smoke. These are the working poor."

Since most smokers tend to have lower incomes, the surcharge could discourage them from signing up for coverage at all because they can't afford it, restricting health care access for those that need it most, critics say. Although people with incomes up to four times the federal poverty level will get premium subsidies on the exchanges, the tobacco surcharge will be added to the final rate, reports Sarah Kliff of The Washington Post.

"The smoker's premium alone will account for 24 percent to 29 percent of his salary not counting deductibles and co-pays," Kavanagh writes. "This policy clearly blocks insurability for the low-income worker." Cigarette makers say the policy amounts to discrimination against smokers, reports Kliff.

The surcharge makes sense from a strictly actuarial perspective, and is supported by the insurance industry because smokers have much higher health costs, reports WebMD Health News. Kentucky's health costs attributable to smoking add up to about $1.5 billion a year, and smoking-caused productivity losses total $2.3 billion a year, says the Centers for Disease Control and Prevention.

Read more here: http://www.kentucky.com/2013/09/08/2810231/pricing-smokers-out-of-health.html#storylink=cpy

However, punitive measures like higher premiums have not been proven to reduce smoking, say health organizations opposing the surcharge, such as the American Cancer Society and American Lung Associaton. In addition to being ineffective, higher premiums for smokers could make health insurance coverage unaffordable, leaving tobacco users without coverage for smoking-cessation programs, or any other type of coverage that Obamacare has sought to provide.

"From the longer-term perspective on how to improve people's health and contain medical costs, the tobacco penalty is a policy disaster," says the Sept. 8 Herald-Leader editorial. The Cancer Society says states would see greater public health and economic benefits from increased tobacco taxes, implementation of strong smoke-free laws and the funding prevention efforts, rather than penalizing smokers.

In closing, Kavanagh poses an important question: "Wouldn't it be better to provide these individuals access to the health care system where tobacco withdrawal could be encouraged and assisted and preventative care for other ailments can be provided?" (Read more)

Teen use of e-cigarettes doubles in past year but may equal nicotine patches in helping smokers to quit or cut back

E-cigarettes use battery-operated products that turn nicotine
and other chemicals into vapor to be inhaled by the user.

Electronic cigarettes, or e-cigarettes, may actually benefit smokers who want to quit by helping them smoke fewer cigarettes and doing as good a job as nicotine patches to help them quit the habit, says a new study.

The report is the first of its kind to shine a potentially positive light on the public-health debate about e-cigarettes, which are not yet regulated by the Food and Drug Administration and have generated concern from U.S. health officials and public health experts; the Centers for Disease Control says they are addictive and could be dangerous.

However, Chris Bullen of the University of Auckland in New Zealand and colleagues recruited 657 participants who wanted to quit smoking for a study, finding that e-cigarettes were just as effective as nicotine patches in doing this, reports Maggie Fox of NBC News.

“While our results don’t show any clear-cut differences between e-cigarettes and patches in terms of quit success after six months, it certainly seems that e-cigarettes were more effective in helping smokers who didn’t quit to cut down,” Bullen said.

The study, which was published in the British medical journal The Lancet, found that 57 percent of volunteers given real e-cigarettes were smoking half as many cigarettes a day as before, compared to 41 percent of those who got patches.

The study's findings also show that participants were more enthusiastic about using e-cigarettes as a means of quitting, compared to patches, suggesting that the product may have greater consumer acceptability, Dr. Cheryl Healton, president and CEO of the anti-tobacco Legacy Foundation, told NBC News.

E-cigarettes are already becoming more popular among young consumers. The CDC and FDA released a report on Thursday showing that the number of high school students who have tried them in the past year has doubled - to an estimated 1.78 million or 10 percent of middle and high school students. This trend raises concerns among public health professionals.
 
CDC researchers worry that e-cigarettes might be a gateway to conventional tobacco products, but it's not known whether e-cigarettes may lead young people to try cigarettes or other tobacco products, which are known to cause disease and lead to premature death, says the FDA. It's also unknown whether e-cigarettes are safe or how much nicotine or other potentially harmful chemicals are being inhaled during their use, says the FDA website.

Nicotine itself may also be harmful, said Dr. Tim McAfee, director of the CDC Office on Smoking and Health. “We are particularly concerned about adolescents being exposed to nicotine in any form because it has the potential to impact their brain development.”

Another unknown is whether e-cigarette use has potential benefits, says the FDA, but this new study suggests two: helping smokers to quit or lessen smoking. The study's authors do agree with public health advocates, saying that additional research is needed to study long-term e-cigarette use and "to clearly establish their overall benefits and harms at both individual and population levels."

Webinars to be held Thursday, Sept. 12, for small businesses to help them plan for implementation of the Affordable Care Act

What will the Patient Protection and Affordable Care Act mean for Kentucky's small businesses? A webinar Thursday, Sept. 12 is designed to address such questions about the federal health-care reform law, often called Obamacare.

The webinar will be presented twice, at 11:30 a.m. and 3:30 p.m. ET. Its topics will include tax credits available to businesses and tax-exempt non-profits, an update on the Kentucky health-insurance exchange, the concept of shared responsibility, efforts to contain costs, planning for implementation of the law, a checklist for getting ready, and tools and resources available for small businesses.

The webinar will conclude with a question-and-answer period with the presenter, Mary Huttlinger, outreach manager for Small Business Majority, a national organization focused on public-policy concerns of small businesses. The webinar is sponsored by Kentucky Voices for Health. To register for the 11:30 ET webinar, click here. For the 3:30 session, click here.