The number of Americans with clinically severe obesity is on the rise and this has extremely detrimental implications for the nation’s healthcare system. This is because highly obese patients have around twice as many chronic health conditions such as heart disease, diabetes and lung disease than do their averagely weighted counterparts. Although this is a well-established fact in the medical community there has been much debate regarding the best way to deal with this growing patient population. New evidence comprises a review of literature encompassing various types of weight loss programs, results from studies on effectiveness of bariatric surgery and identifies the recommendations regarding obesity and bariatric surgery case management programs.

In the primary practice setting disease management companies appear to be spending their time focusing on the general weight loss strategies such as diet and exercise. This is in contrast to larger national healthcare companies who tend to offer bariatric surgical services as a mainstay of treatment to those patients suffering from severe obesity. This means that case management programs within the healthcare systems, insurance companies and health management organizations are often faced with managing patients with severe obesity and, increasingly, these patients are requesting bariatric surgery. So what then is the most effective form of treatment for these individuals? and what should healthcare providers do when faced with these patients?

Research based evidence shows that severe obesity is a disease that is not very responsive to exercise, diet, or drug therapy and that in fact the best results come from those who undergo bariatric surgery. Surgical treatment has been shown to be more effective than drug treatment when it comes to weight loss. This extends to the fact that because bariatric surgery is more effective in providing weight loss it therefore has the greatest benefits for relief of secondary adverse medical conditions that tend to coincide with obesity. The number of Americans having weight loss surgery increased by 804% between 1998 and 2004, this seems to have sparked the recent development of obesity disease management and bariatric surgery case management programs.

Although this is still a very young field of surgery, it is exciting to know that there is an alternative for those who find other weight loss options and methods unachievable to reach their target weight. However bariatric surgery as with any operation is not without its risks and in fact extremely obese patients pose large challenges with regards to anesthesia due to their size and extra stress on their heart and lungs. It will also take them longer to recover post op and put them at higher risk of infection and other such complications as a result of generalized poor health. It is for this reason that there is simply no complete substitute for diet and exercise and in fact many hospitals require a certain amount of weight loss on the patient’s behalf prior to operation to show their commitment to losing weight. Expect to see lots more on this topic in the near future as bariatric surgery becomes more popular and our population as a whole gets more and more obese.

Now SSRI stands for selective serotonin reuptake inhibitor and in plain English what this means is that they work on receptors in your brain to keep the “happy particle” (serotonin) from being eliminated too quickly. As a result these medications have been proven to be very safe and effective antidepressants in recent years with the beneficial adjunct of lengthening ones time in the bedroom. Despite numerous studies the complete mechanism of action of SSRI’s in relation to PE is not fully understood, although what is known is that the type of SSRI used is important in the efficacy of the treatment. It has been shown that one of the SSRI family medications dopoxetine (priligy) is claimed to be particularly effective, compared to other SSRIs, when given acutely even as suddenly as after the first dose. This is exciting news as other SSRI’s used in the past are known to take a very long time to provide the patient with any clinical benefit.

The interesting thing about dopoxetine is that after large clinical trials for use as an antidepressant it failed because it doesn’t hang around in the body for as long i.e. it has the shortest half-life of all SSRI medications. However this has been shown to be favourable when it comes to the treatment of PE as it provides faster clinical benefits with fewer side effects than comparable SSRI’s. For example other SSRI’s take on average 3-4 weeks to show clinical benefit whereas clinical trials with dopoxetine showed that clinical benefit is achievable in 1 week.

Although it has been mentioned that the exact mechanism of SSRI action in PE is unknown, we can reasonably assume that in depression, clinical efficacy is generated by an adaptive change in the brain that stops serotonin from being eliminated as quickly as it would do in a patient not on SSRI treatment. If this is true it is easy to explain why all SSRI’s are not clinically equivalent and that is because they are not all used at the equivalent dosage to inhibit serotonin elimination to the same degree. Although this may be true for depression, studies have shown that simply raised levels of serotonin in the brain and not an adaptive change may bring about clinical benefits in PE. In other words if you take a medication that straight away raises the level of serotonin in your brain you will get clinical benefit in treating PE but not depression. This is because with depression you must wait for an adaptive change in the brain to occur whereas in PE it is simply enough to acutely raise the levels of serotonin.

As mentioned earlier dopoxetine has the shortest half-life and thus will have the quickest clinical effect because appropriate levels of serotonin will be reached within a short period of time. This is unlike the other SSRI medication that can take weeks to reach the effective level of medication in the body. The reason then that this is good for PE and not depression is simply due to the fact that a steady level of SSRI over a long time is best in managing depressive symptoms due to the required adaptive change in the brain. However in PE taking the medication (dopoxetine) prior to sexual intercourse and in turn raising that level of serotonin for that period of time and not at all times is best. So because of the ability of dopoxetine to raise the level of serotonin in ones brain acutely and not chronically it makes for a good PE treatment. This is also reassuring to the patient because taking dopoxetine “on demand” (1-3 hours prior to sex) will not alter the function of the serotonergic pathway in the same way as other SSRI’s as an adaptive change is not required by the brain in order to have an effective mechanism of clinical action.

Although clarity is required on the exact mechanism of action of these medications it can be said that the discovery of the beneficial effects of dopoxetine on PE is an exciting medical breakthrough. This medication known by the trade name of priligy as of the 10th of February 2010 was released for prescription only use in Sweden and Finland and is the first tablet form of medication of its kind.  It has been extensively evaluated in five randomised, placebo-controlled Phase III clinical trials involving more than 6,000 men with PE and their partners. As a result this is the most comprehensive not to mention the largest clinical trial to date re the use of drug therapy to treat PE. All going well it will hopefully be available in the US in the not too distant future.

Interestingly, even among elderly patients, research shows that, after going through emergency care, many of the individuals are able to resume their regular lives after they recover. However, more than half of people who are over sixty-five years of age generally get their needed emergency care from emergency rooms instead of specialty centers.

Many of these emergency facilities are not making any steps to change the care that they provide to seniors. However, the centers, which are making the changes, are doing so through construction improvements to the physical building, the purchase of upgraded equipment, and using advanced methods to keep up with elderly patients’ medical histories and records. The medical information is vital since it will contain information on how to handle the patient’s own medical problems. This history will include, not only current illnesses, but also past surgeries, diagnoses, medications, and procedures that the patient underwent. This information can be very helpful since many patients in emergency situations cannot tell the physician just what illnesses they have and what medications they take. Many patients are in severe pain, are under a great deal of stress, or are not cognizant, and they cannot convey pertinent information to their physician.

Another way to care for elderly in case of emergency situations, there is specialty equipment available, which can be a great aid. With one system, the patient wears a button, which they can press and be in immediate contact with an emergency-trained medical staff member. The system includes a small pendant, which must be worn around the neck all of the time since it will be readily available in any emergency situation.

Much of senior care has been pushed to the side and even neglected in the past, but steps are now being taken to make changes to this and emphasize the need for proper care. Unfortunately, the disregard has been going on for so long that it takes time to make proper changes. When we were younger, two or three decades ago, these elderly patients were caring for us. Do we not owe them something of the same? These seniors have been giving citizens and loving family, so the answer is yes, we owe them that much and more.

Everyone deserves proper medical and emergency care, whether they are elderly, children, or young adults. Many people prefer to ignore the fact that age has become a big factor in the type of emergency care that people are provided. However, we must recognize this in order to make the changes that will put the importance on the elderly that they deserve. It is already unfortunate that many elderly people go without the medicine they need because they cannot afford the high costs. It becomes even worse when they are treated without respect or proper care that anyone deserves.

In fact, dementia is actually a symptom of other problems, and it is not age specific. Sometimes, the effects of the mental disorder are able to be reversed with treatment. Often, though, the illness is not reversible and will slowly worsen.

Since the patients lose most of their memory, they often require constant care. Along with memory loss, the patients will also lose other cognitive function, and they may become unaware of their surroundings.

Many elderly people become fearful of dementia when they suffer common slips of the memory. Often, elderly people suffer from some memory loss, called by the professionals “senescent forgetfulness.” This type of problem is more of an aggravation than a serious issue.
Dementia will affect all of the person’s ability to think and understand the things around them.

When someone shows symptoms like memory loss, severe mood swings, confusion, and difficulty with speech, a physician should be consulted. The symptoms and causes of dementia can be treated and cared for once a physician has made the proper diagnosis.

A person suffering from dementia will need much care, and that need will increase over time. One of the well-know types of dementia is Alzheimer’s disease, which requires constant supervision. In most Alzheimer’s cases, the family cares for the patient in their own home.

Care for people suffering from dementia does not follow a certain pattern. While it may be frustrating, the caretaker should always treat the patient with respect and provide them patience. The caretaker will see major changes in the patient’s personality, but they are suffering and they are still the same person they were.

One way to help a person with dementia is to spend time working on the strengths that they still have, since this will give them something else upon which to focus. Remember that people with dementia still enjoy spending time with others socially.

Family and caregivers will need to remind themselves that each dementia patient’s experiences will be unique. A patient must be allowed to express themselves while the caretakers work to provide the best care for them.

It can be difficult, but one must remember that the memory loss can be detrimental for the patient. Because of the short-term memory loss, the patient should be watched over when doing anything potentially dangerous, like cooking.

While they may forget many things short-term, dementia patients will usually retain their long-term memory. Patients may become frustrated with changing situations.

Frustration and anger can happen quickly, so the caregiver should always be prepared. Memory games should never be employed with dementia patients. These games could lead to severe frustration or fear.

Dementia patients should be protected from dangerous situations. There should be no dangerous obstacles in the person’s house, garage, or yard. In addition, all areas should be well lit. Mirrors should be avoided since they can mislead a patient. If the dementia is severe enough, they may think the mirror is someone else and they will become frightened.

Family members should take the care of dementia patients very seriously even in the most stressful times.

More and more of the population are becoming elderly adults, so community centers become more important as to how they impact the health of seniors.

These centers allow elderly people to spend time with their peers and to take part in many activities. For the rest of the community, there is much to learn from the wisdom and experiences of the seniors. Although, physically they cannot, many seniors want to give something to their community.

Often, seniors can share personal, firsthand accounts of the stories that the youth learn in their school history class. The stories that the elderly can share give them a chance to enjoy spending time with others, while bringing history to reality for the children.

In order to provide for the social life of the seniors, these centers often provide shopping trips, bowling excursions, and even golfing days. From a healthcare perspective, the large group of seniors gathered together is a perfect opportunity to provide for their wellness needs. This can be accomplished through testing, screenings, and inoculations.

In addition, many community centers provide such as laundry services to help the elderly out. Another option that the community centers provides is a type of care during the day so that family members can go to work or do their errands while the senior is provided for.

After the community center comes something called the independent living center. Seniors who take part in this have to be able to care for themselves and keep up with their basic needs. After this is the assisted living facility, which provides independent living along with extra care and help with basic needs. Assisted living options provide medical services for 24-hours a day.

Not all of the independent living facilities are the same. This is because any location that caters to only seniors can be classified as one of these facilities. Additionally, many of these facilities include a community center since the seniors can keep up their social life with their peers.

These community centers are usually funded by the government in part, and they are open to seniors over 65, widowers over 50, and disabled people over the age of 18.

Interestingly, a Pennsylvania study points out that the chances for a senior to take part in their local community center greatly increase if they are received medical help or Medicare from the government.

In addition, studies have shown that seniors who do not go to a community center have higher needs emotionally and socially. These people generally do not have as much medical assistance and have lower needs financially.

The idea of the community center is quite young in the United States, so researchers continue to consider the positive impact of these centers on the senior’s quality of life.