What to know about pandemics

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A pandemic is an outbreak of global proportions. It happens when infection due to a bacterium or virus becomes capable of spreading widely and rapidly.

The disease behind a pandemic can cause severe illness and spread easily from one person to the next.

As of March 2020, the world is currently dealing with a global outbreak of COVID-19. On March 11, the World Health Organization (WHO)Trusted Source advised that this disease has the characteristics of a pandemic.

Many governments have now restricted free movement and placed populations under lockdown to limit the spread of the pandemic.

In this article, we discuss the difference between epidemics and pandemics, how pandemics start, and future concerns.

Pandemic or epidemic?

Share on PinterestDuring a pandemic, governments may restrict free movement and put populations under lockdown.

According to the WHO, a pandemic involves the worldwide spread of a new diseaseTrusted Source. While an epidemic remains limited to one city, region, or country, a pandemic spreads beyond national borders and possibly worldwide.

Authorities consider a disease to be an epidemic when the number of people with the infection is higher than the forecast number within a specific region.

If an infection becomes widespread in several countries at the same time, it may turn into a pandemic.

A new virus strain or subtype that easily transmits between humans can cause a pandemic. Bacteria that become resistantTrusted Source to antibiotic treatment may also be behind the rapid spread.

Sometimes, pandemics occur when new diseases develop the ability to spread rapidly, such as the Black Death, or bubonic plague.

Humans may have little or no immunity against a new virus. Often, a new virus cannot spread between animals and people. However, if the disease changes or mutates, it may start to spread easily, and a pandemic may result.

Seasonal influenza (flu) epidemics generally occur as a result of subtypes of a virus that is already circulating among people. Novel subtypes, on the other hand, generally cause pandemics. These subtypes will not previously have circulated among humans.

A pandemic affects a higher number of people and can be more deadly than an epidemic. It can also lead to more social disruption, economic loss, and general hardship on a wider scale.

The COVID-19 pandemic

Writing in March 2020, the current pandemic has had an unprecedented impact across the globe.

COVID-19 is a disease that develops due to infection with a type of coronavirus. The virus started causing infections in Wuhan, China, before spreading internationally.

On the recommendation of the WHO, more than one-third of the world’s population is on lockdown. Several countries — including the United States, United Kingdom, India, and China — have closed their borders, affecting global travel and industry.

People in many countries have also lost employment as a result of “nonessential” businesses closing to restrict the spread of the virus. Restaurants, gyms, religious buildings, parks, and offices have closed in many places.

A pandemic can also increase the pressure on healthcare systems by raising the demand for certain treatments.

People with severe COVID-19 symptoms use more ventilators and beds in intensive care. As a result, resources may be in short supply for others who need this equipment.

However, countries have put in place measures to counter this. For example, the U.S. government has requested that companies, including Ford and General Motors, start making respirators, ventilators, and face shields to meet increased demand.

Authorities hope that these emergency manufacturing measures and the restrictions of movement — which have a worldwide economic and social impact — will slow the spread of the disease.

Countries are collaborating on sourcing medical equipment and developing a vaccine, even though it may not be available for months or even years.

 

What is OCD?

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OCD is a mental health condition that involvesTrusted Source an obsession or compulsion, distressing actions, and repetitive thoughts. It can be challenging for a person with OCD to carry out routine tasks.

A person with OCD typically:

  • has thoughts, images, or urges that they feel unable to control
  • does not want to have these intrusive thoughts and feelings
  • experiences a significant amount of discomfort, possibly involving fear, disgust, doubt, or a conviction that things must be done in a certain way
  • spends a lot of time focusing on these obsessions and engaging in compulsions, which interferes with personal, social, and professional activities

Types

OCD can affect different people in different ways. It may involve:

Concern with checking

A person with OCD may feel the need to check repeatedly for problems. This might include:

  • checking taps, alarms, door locks, house lights, and appliances to prevent leaks, damage, or fire, for example
  • checking their body for signs of illness
  • confirming the authenticity of memories
  • repeatedly checking communication, such as e-mails, for fear of having made a mistake or offending the recipient

Fears of contamination

Some people with OCD feel a continual, overwhelming need to wash. They may fear that objects that they touch are contaminated.

This can lead to:

  • excessive toothbrushing or handwashing
  • repeatedly cleaning the bathroom, kitchen, and other rooms
  • avoiding crowds for fear of contracting germs

Some people experience a sense of contamination if they feel that someone has mistreated or criticized them. They may try to remove this feeling by washing.

Hoarding

This involves a person feeling unable to throw away used or useless possessions.

Intrusive thoughts

This involves feeling unable to prevent repetitious unwanted thoughts These may involve violence, including suicide or harming others.

The thoughts can cause intense distress, but the person is unlikely to act in a way that reflects this violence.

A person with this type of OCD may fear that they are a pedophile, even with no evidence to support this.

Symmetry and orderliness

A person with this type of OCD may feel that they need to arrange objects in a certain order to avoid discomfort or harm.

They may repeatedly rearrange the books on a shelf, for example.

Symptoms

OCD involvesTrusted Source obsessions, compulsions, or both. These can cause distress and interfere with the person’s ability to perform routine activities.

Below, learn more about obsessions and compulsions.

Obsessions

While everyone worries, in people with OCD, worries and anxiety can take over, making it hard to carry out everyday tasks.

Common topics of this anxiety include:

  • Contamination, by bodily fluids, germs, dirt, and other substances
  • Losing control, such as the fear of acting on an urge to self-harm or hurt others
  • Perfectionism, which may involve the fear of losing things or an intense focus on exactness or remembering things
  • Harm, including a fear of being responsible for a catastrophic event
  • Unwanted sexual thoughts, including thoughts about inappropriate activities
  • Religious or superstitious beliefs, such as a concern about offending God or stepping on cracks in the sidewalk

Compulsions

Not every repetitious behavior is a compulsion. Most people use repetitive behaviors, such as bedtime routines, to help them manage everyday life.

For a person with OCD, however, the need to perform repetitious behavior is intense, it occurs frequently, and it is time-consuming. The behavior may take on a ritualistic aspect.

Some examples include:

  • washing and cleaning, including handwashing
  • monitoring the body for symptoms
  • repeating routine activities, such as getting up from a chair
  • mental compulsions, such as repeatedly reviewing an event

OCD in children

The first signs of OCD oftenTrusted Source appear in adolescence, but they sometimes emerge in childhood.

Complications among young people, including children, with OCD include:

  • low self-esteem
  • disrupted routines
  • difficulty completing schoolwork
  • physical illness, due to stress, for example
  • trouble forming or maintaining friendships and other relationships

When OCD begins in childhood, it may be more commonTrusted Source in males than females. By adulthood, however, it affects males and females at equal rates.

 

Guidance for households with possible or confirmed coronavirus (COVID-19) infection

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1. What has changed

The self-isolation advice for people with coronavirus (COVID-19) has changed. It is now possible to end self-isolation after 5 full days if you have 2 negative LFD tests taken on consecutive days. The first LFD test should not be taken before the fifth day after your symptoms started (or the day your test was taken if you did not have symptoms). The self-isolation period remains 10 full days for those without negative results from 2 LFD tests taken a day apart.

2. Who this guidance is for

This guidance is for:

  • people with symptomsthat may be caused by COVID-19, including those who are waiting for a COVID-19 test result
  • people who have received a positive COVID-19 LFD or PCR test result (whether or not they have symptoms)
  • people who currently live in the same household as someone with COVID-19 symptoms, or with someone who has tested positive for COVID-19 by LFD or PCR test

In this guidance a household means:

  • one person living alone
  • a group of people (who may or may not be related) living at the same address and who share cooking facilities, bathrooms or toilets, or living areas – this may include students in boarding schools or halls of residence who share such facilities
  • a group of people who share a nomadic way of life for example those who live on Traveller sites, in vehicles or on canal boats

3. Symptoms

The main symptoms of COVID-19 are recent onset of any of the following:

  • a new continuous cough
  • a high temperature
  • a loss of, or change in, your normal sense of taste or smell (anosmia)

For most people, COVID-19 will be a mild illness. However, if you have any of the symptoms listed above, even if your symptoms are mild, stay at home and arrange to have a test. You do not need to take a PCR test if you have already taken an LFD test and the result was positive.

There are several other symptoms linked with COVID-19. These symptoms may have another cause and are not on their own a reason to have a COVID-19 PCR test. If you are concerned about your symptoms, seek medical advice.

If you have received one or more doses of COVID-19 vaccine and have any of the main symptoms of COVID-19 or have received a positive LFD or PCR test result, you should still follow this guidance. This is because it is still possible to get COVID-19 and spread it to others, even if you are vaccinated.

4. Tests for COVID-19

There are 2 main types of test currently being used to detect if someone has COVID-19:

  • polymerase chain reaction (PCR) tests
  • lateral flow device (LFD) antigen tests – also known as rapid lateral flow tests

4.1 PCR tests

PCR tests detect the RNA (ribonucleic acid, the genetic material) of a virus. It takes some time to get the results because PCR tests are usually processed in a laboratory.

PCR tests are the best way to diagnose COVID-19 infection in people who have symptoms and who also may require treatment. If you have any of the main symptoms of COVID-19, you should arrange to have a PCR test.

4.2 LFD tests

LFD tests detect proteins in the coronavirus and work in a similar way to a pregnancy test. They are reliable, simple and quick to use and are very good at identifying people who have high levels of coronavirus and are most likely to pass on infection to others. When rates of infection are high, it is very likely that people with a positive LFD test result have COVID-19.

LFD tests can be taken by people at home (self-reported tests) or under the supervision of a trained operator who processes the test, reads, and reports the result (assisted tests). LFD tests are mainly used in people who do not have symptoms of COVID-19. If you take an LFD test and the result is positive, you should report the result and follow this guidance.

You do not need to take a follow-up PCR test, unless:

  • you wish to claim the Test and Trace Support Payment– to claim the Test and Trace Support Payment, you must have tested positive for COVID-19 following a PCR test or an assisted LFD test
  • you have received an email or letterfrom the NHS because of a health condition that means you may be suitable for new COVID-19 treatments – if this applies to you and you develop any COVID-19 symptoms, you should use the PCR test kit that was sent to you in the post for this purpose; if you have not received a PCR test kit you can arrange to have a PCR test
  • you are taking LFD tests as part of research or surveillance programmes, and the programme asks you to take a follow-up PCR test
  • you have a positive day 2 LFD test result after you arrive in England

If your LFD test result is positive you may go on to develop symptoms in the next few days. If you develop any of the main symptoms of COVID-19 and you are concerned, or your symptoms are worsening, contact 111 or speak to your GP. In an emergency dial 999.

 

What to know about panic attacks and panic disorder

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A panic attack can happen when a person has high levels of anxiety. Anyone can have a panic attack. Sometimes, these attacks are a symptom of panic disorder. During a panic attack, a person may experience overwhelming emotions, including helplessness and fear. Physical symptoms can include a fast heartbeat, rapid breathing, sweating, and shaking. Panic attacks often happen in specific situations that trigger heightened stress. But some people experience them repeatedly, with no clear triggers. In this case, the person may have panic disorder.

However, panic attacks and panic disorder are both mental health issues that treatments can help manage.

Symptoms

A panic attack may be an isolated issue or a reoccurring symptom of panic disorder.

Regardless, an attack can be frightening, upsetting, and uncomfortable. The feelings are more intense than those of stress that people usually experience.

Panic attacks typically last 5–20 minutes, but the symptoms can linger for up to 1 hour.

According to the Anxiety and Depression Association of America, a panic attack involves at least four of the following symptoms:

People with panic attacks sometimes develop agoraphobia, which involves a fear of situations where help or an escape may be difficult to access.

The symptoms of a panic attack can resemble those of other medical conditions, including lung disorders, heart conditions, or thyroid problems.

Sometimes, a person having a panic attack seeks emergency medical care because they feel as if they are having a heart attack. Here, learn to tell the difference.

What is panic disorder?

Panic disorder is a mental health condition, and panic attacks are a symptom.

Many people experience at least one panic attack at some point, but people with panic disorder experience recurrent attacks.

The symptoms typically arise in early adulthood, around the ages of 18–25 years, but panic disorder can develop in children. It is twice as likely to occur in females as males.

Genetic and biological factors may increase the likelihood of having panic disorder, but scientists have yet to identify a link with any specific gene or chemical.

The disorder may develop when a person with certain genetic features faces environmental stresses. These include major life changes, such as having a first baby or leaving home. A history of physical or sexual abuse may also increase the risk.

Panic disorder may develop when a person who has experienced several panic attacks becomes afraid of having another one. This fear can cause them to withdraw from friends and family and refrain from going outside or visiting places where a panic attack may occur.

Panic disorder can severely limit a person’s quality of life, but effective treatments are available.

Causes

Anxiety is a natural response to stress, but if anxiety levels become too high, this can lead to panic.

When the brain receives warnings of danger, it alerts the adrenal gland to release adrenaline, which is sometimes called epinephrine or the “fight or flight” hormone.

A rush of adrenaline can quicken the heartbeat and raise blood pressure and the rate of breathing. These are all characteristics of a panic attack.

Risk factors

A number of issues can increase the likelihood of having panic attacks and panic disorder. These include:

Also, panic attacks can be a symptomTrusted Source of other conditions, such as:

Diagnosis

Using the guidelines in the DSM-5, a doctor may diagnose panic disorder if the person has:

  • frequent, unexpected panic attacks
  • had an ongoing fear of having a panic attack for at least 1 month
  • significantly changed their behavior due to this fear
  • no other condition, such as social phobia, and no use of medications or drugs that could account for the symptoms

Treatment

The most common treatments for panic disorder are medications and psychotherapy.

According to the APA, many people feel better when they understand what panic disorder is — and how common it is.

A person may benefit from cognitive behavioral therapy, sometimes shortened to CBT. It can help them identify triggers and new ways of facing difficult situations.

Another option is interoceptive exposure, which teaches a person to grow accustomed to the symptoms of a panic attack a safe environment. The aim is to reduce the fear of an attack and to break the symptoms down into manageable stages.

Meanwhile, relaxation techniques such as slow breathing and visualization can also help.

For some people, a doctor may also prescribe one or more of the following medicationsTrusted Source:

SSRIs and SNRIs are long-term treatments and can take several weeks to have an effect. Benzodiazepines can reduce symptoms more quickly, but there is a risk of dependence.

Some medications produce adverse effects. It is important that a doctor works with the person to find the best possible treatment.

 

 

 

 

 

Diet as a risk factor for dementia

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We hear so much from the media about what we should or should not eat. One day blueberries are the new so-called ‘superfood’ that will reduce our risk of developing dementia, the next it is the humble plum.

But what information can we rely on to be accurate? Can the food we eat really reduce our risk of developing dementia? If a person has dementia, can their diet or use of supplements influence how they experience dementia or its progression?

The brain requires a regular supply of nutrients in our diet to function and remain healthy. There is growing recognition that what we eat affects the way our brains work and our mental health, as well as our physical health.

Traditionally research undertaken to investigate the connection between diet, cognitive function and risk of dementia has primarily focused on the impact of individual nutrients on brain health. Those nutrients commonly researched include: vitamins B6, B12, C, E and folic acid, as well as omega 3 essential fatty acids. The outcome of such research has been inconclusive and thus guidelines to advise on specific nutrient intakes have not been developed. In this feature we’ll explore some of the ongoing research on this topic.

Healthy hearts mean healthy brains

We know that certain medical conditions such as high blood pressure, high cholesterol, diabetes and obesity can increase our risk of dementia. For some time these risk factors were commonly associated with vascular dementia. We now know that they are also associated with the development of Alzheimer’s disease.

Much of what we know now to be healthy for our heart is also healthy for our brain, so many of the dietary messages we have been encouraged to follow for a healthy heart will also apply to the health of our brains.

Salt

It is advisable to reduce our salt intake regardless of the type of dementia we are considering. A salt-rich diet can contribute to the risk of increasing our blood pressure, which in turn can increase the risk of stroke and vascular dementia.

About three-quarters of the salt we eat comes from processed foods such as bread, breakfast cereals, soup and sauces. So it is not just what you add yourself that makes the difference, but how the food itself is manufactured.

The Food Standards Agency recommends that we should aim to have no more than 6 grams of salt daily, which is approximately one level teaspoon.

Fats and oils

The significance of too much fat in the diet has been the topic of much conversation with regards to a healthy heart and vascular system. In particular saturated fat, commonly derived from animal fat (for example fat on meat, lard, butter or ghee) or trans fats (fats created during the hydrogenation of vegetable oils and often found in processed foods such as pastry or vegetable shortening) can elevate cholesterol levels in the body if eaten in significant quantities. A high saturated fat intake has also been implicated, along with other dietary factors, as increasing the risk of dementia.

Omega 3 and oily fish

Omega 3’s essential fatty acids have an important part to play in the structure of our brain cells, helping to maintain the health and functioning of our brain. Research undertaken as part of the Older People And n-3 Long-chain polyunsaturated fatty acid (OPAL) study supported the view that eating oily fish (or omega 3) is associated with better cognitive function in later life, but recommended further work to clarify the impact of these essential omega 3 oils on the brain.

We need omega 3 oils from food as they cannot be made efficiently by the body. Oily fish is a rich source of omega 3’s essential vitamins and minerals and it is recommended that we have at least one portion of oily fish a week. Guidelines vary though according to the individual – see the Food Standards Agency website, www.eatwell.gov.uk/healthydiet/fss/fats/ for further information. Omega 3 oils may also be found in vegetarian sources such as linseeds, rapeseed oil, walnuts and soya beans.

Antioxidants

Vitamins C and E, commonly found in fruit and vegetables, are examples of antioxidants – that is, substances that work against the negative effects of oxidation that occurs naturally in the body.

Vitamin E has been the subject of much research in relation to reducing the risk of dementia, with conflicting results. There are many other sources of antioxidants other than vitamins, for example in green tea, red wine and cocoa. Each of these has been the subject of studies and considered as a potential ‘superfood’ in protecting mind and body.

Research appears to demonstrate a link between antioxidants activity and dementia, but is not conclusive about which foods are guaranteed to help reduce the risk of dementia and how much we need.

It is generally considered that a diet rich in fruit and vegetables will provide us with a valuable source of antioxidants and be more beneficial than taking supplements alone. The Food Standards Agency recommends at least five portions of fruit and vegetables daily to help maintain a good intake of vital vitamins and antioxidants.

Folic acid, vitamin B6 and B12

Deficiencies in folic acid, vitamin B6 and vitamin B12 can cause an amino acid in our body, called homocysteine, to rise. Higher than normal levels are considered to be a risk factor for a number of disease states including cardiovascular disease and dementia, and are thought to contribute to poor cognition.

However, there are no guidelines to consuming supplements of B6, B12, or folic acid individually merely to reduce the risk of dementia (although these nutrients may be prescribed for actual deficiencies such as anaemia). Again the advice is to ensure that foods rich in B6, B12, and folate are present in the diet.

Can a Mediterranean-style diet help?

In recent years, research in the field of nutrition, cognitive function and dementia has built on what we know about the key nutrients involved in brain health. Subsequently this research has begun to focus more on dietary patterns or how combinations of specific nutrients can impact on cognitive function or reduce the risk of developing dementia, such as Alzheimer’s disease, and the process involved in developing this dementia.

The ‘Mediterranean-style diet’ has been popular for many years for helping to maintain a healthy heart and body. This style of eating is traditional to people living in the countries bordering the Mediterranean Sea. Generally such a diet is considered to be rich in fruits and vegetables, olive oil, cereals, legumes and fish, with small amounts of lean meat and moderate amounts of dairy foods. Overall this style of eating provides a diet rich in vitamins and antioxidants and low in saturated fats. This diet has been associated with reducing the risk of developing Alzheimer’s disease.

Conclusion

The impact of good nutrition on the health of our brains cannot be dismissed. We know that malnutrition affects physical and mental wellbeing: our brains need nutrients to work and remain healthy.

Diet and what we eat has an important role to play in adopting a healthy lifestyle which can help keep both our bodies and brains healthy. Eating a nutrient-rich diet, particularly one that has lots of fruits and vegetables, omega 3 oils, and low amounts of salt and saturated fats, will help to maintain the health of both our heart and brain.

Research in this field is ongoing and the hope is that this will provide us with more knowledge and understanding of how diet and nutrition impact on cognitive health and the risk of developing dementia.

 

The Risk assessment of Cancer surgery in elderly patients

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Senior patients with cancer are more frequently referred for possible surgical resection. Surgeons must ask: Do we know how to assist them? Do we understand their needs? Are we able to assess and predict operative risks? This review article focuses on such aspects and aims to assist surgical oncologists in the decision-making process.

Modern decision making is based on evidence. Unfortunately, there is often insufficient evidence guiding the choice of surgical options for senior patients with cancer.

It is generally believed that surgery is the most effective cancer-ablative therapy. However, complication rates, mortality, length of hospital stay, and intensive care unit admissions increase with patient age, which can offset oncologic advantages. Delay in cancer diagnosis can lead to a greater number of emergency presentations, and emergency surgery is associated with increased morbidity and mortality in this population. In the absence of clear guidelines and concerns about their ability to tolerate treatment, older patients are less likely to be offered standard cancer treatments that have been shown to improve survival. Nevertheless, high-profile centers have repeatedly demonstrated the feasibility of surgical treatment in this age group.

Poor understanding of frailty is, to a large degree, responsible for under-treatment. A particularly striking example of this is the nonsurgical treatment of older women with breast cancer. Only one in two older women have their cancer excised; too often, primary endocrine treatment is preferred. On the other hand, there can be overtreatment. When frailty is not identified, patients may be treated aggressively, resulting in poor oncologic outcomes, increased mortality, substandard quality of life, and high monetary costs. Alternative options should be discussed.

The decision of how to treat has to be thorough and honest. It should include the patient’s preferences, because older patients are keen to participate in the decision-making process. Patients should be informed of the advantages and disadvantages of a surgical procedure. Too often, for cases in which the operation is likely to be successful, practitioners forget to reassure the patient that the operation is feasible, perhaps slightly risky, but certainly worth undertaking and, most importantly, that the associated long-term prognosis is favorable. On the other hand, practitioners should not be swayed by a demanding family into offering an overwhelmingly risky operation to a frail patient who is unlikely to overcome multiple potential postoperative complications.

To guide these discussions, what is needed is clinical research that focuses not only on standard peri- and postoperative mortality and complication rates but also on longer-term outcomes and quality of life. Elderly patients who survive the first year after surgery have the same cancer-related survival as younger patients; therefore, decreased long-term survival in the elderly is mainly a result of differences in early mortality. The treatment of senior oncologic patients should focus on enhancing functional capacity preoperatively (prehabilitation), perioperative care, and 1-year outcomes after surgery.

SURGICAL CONSIDERATIONS IN THE OLDER ADULT WITH LUNG CANCER

Lung cancer is primarily a disease of the elderly. More than 65% of lung cancer patients are older than age 65 years when diagnosed.41 The percentage of patients with newly diagnosed lung cancer who are age ≥ 75 years is approximately 25%, and the percentage of patients age ≥ 75 years who die of lung cancer is approximately 30%. Thus, the average patient with lung cancer is paradigmatic of the issues involved in the treatment of any elderly patient with cancer, which may be framed as the following: How should an elderly patient with a cancer that, if left untreated, will likely cause his or her death be offered treatment with the lowest risk of operative morbidity and mortality that, at the same time, aims at the longest life expectancy, with acceptable functional status and quality of life?

The information needed to guide such difficult clinical decisions for the elderly patient with lung cancer remains incompletely collected. For example, the standard of care for patients of any age with resectable lung cancer has been anatomic lung lobectomy; the relative risks and efficacy of lesser resections (ie, segmentectomy) are being evaluated in clinical trials. In large randomized trials, lobectomy is associated with an operative mortality of 1.4%, and no increased risk was found to be associated with advanced age. However, this study and other smaller studies of elderly patients with lung cancer did not clearly characterize the population of patients considered for surgery. Some patients believed to have an increased perioperative risk, by use of unknown selection criteria, were referred for alternative ablative therapies such as radiation treatment.

It is possible that, in elderly patients who are not currently offered lobectomy, treatment with sublobar resection may have a better chance for cure with acceptable risks compared with nonsurgical ablative therapies. Conversely, some elderly patients undergoing lobectomy for lesions resectable by segmentectomy may not be offered a more extensive resection (and its benefits).

The effect of thoracic surgery on quality of life has been examined in only a few studies. They suggest that elderly patients experience a pattern of initial decrement followed by recovery similar to that seen in younger patients. Overall, patients with lung cancer have a baseline quality of life lower than that of their peers, and preoperative quality of life has been found to predict long-term survival after thoracic surgery.

Paralleling the efforts to preoperatively define patients at risk because of diminished quality of life has been the effort to define thoracic surgery patients at risk for postoperative complications because of frailty, disability, and multiple comorbidities. A geriatric preoperative assessment using these measures predicted both risk of postoperative institutionalization and 6-month survival.

Overall, intraoperative and postoperative management of patients undergoing lung cancer surgery has advanced considerably, such that the majority of patients can safely undergo effective surgery. The challenge now is to define the high-risk patient population, which will usually be a subgroup of the elderly.

Successful surgical treatment of the elderly patient therefore depends on a proactive, patient-centric, multidisciplinary program that involves a geriatrician and in which all stakeholders are committed to understanding the unique needs and expectations of the patients and their families.

In conclusion, surgery remains the best modality to treat solid tumors, regardless of patient age. Surgeons treating elderly patients with cancer should take into account that other factors, such as frailty, comorbidities, performance, and cognitive status, are important considerations when predicting outcomes. With adequate perioperative care, elderly patients can do as well in terms of morbidity and mortality as their younger counterparts. Therefore, if surgery is determined to be the appropriate treatment modality, patients should not be denied this option because of their age.

Emotional health for parents during pregnancy and after the birth

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What is emotional health?

Emotional health is a state of wellbeing. When you feel well and content, you are better able to cope with stress, maintain relationships and enjoy life.

Looking after your emotional health has benefits for both you and your baby.

Being active, feeling a sense of belonging and having a purpose in life are all good for emotional health and wellbeing. You will feel happier and better able to deal with problems and stress.

For more information and tips on how to be emotionally and mentally healthy, visit Act-Belong-Commit (external site).

Benefits of emotional health during pregnancy

When you are pregnant, your baby is exposed to everything you experience. This includes the sounds in the environment, the air you breathe, the food you eat and the emotions you feel.

When you feel happy and calm, it allows your baby to develop in a happy, calm environment. However, emotions like stress and anxiety can increase particular hormones in your body, which can affect your baby’s developing body and brain.

Benefits of emotional health after your baby is born

From birth, the interactions you have with your baby helps to shape the way he or she will think, feel and behave later in life. These interactions also help to form important emotional bonds between you and your child.

Good emotional health also helps to maintain positive relationships with your older children and other family. They can help support you and your partner through the challenges of adjusting to a new baby.

For information about connecting and bonding with your newborn, visit the Raising Children Network (external site).

What if I’m struggling with my emotions?

Often one or both parents experience difficult emotions during pregnancy, or after the birth of a child. You are not alone.

You might be feeling like hiding the fact you are struggling because you feel embarrassed or ashamed.

It is normal to have occasional negative thoughts, dreams or fleeting doubts.

Many things can make you feel this way including:

  • worries about the birth
  • lack of sleep
  • worries about how you’re coping as a parent.

There are things you can do to help yourself get through the more challenging aspects of parenthood. You can read about some common emotional problems in parents with new babies here.

Becoming a mum

Becoming a mum can mean your hopes and dreams have come true. You may love feeling your baby move inside. You may feel a sense of achievement in giving birth. You may love holding, touching, watching, smelling and playing with your baby. Some mums may not feel that overwhelming sense of love they were anticipating straight away.

Sometimes the happy emotions of motherhood are mixed up with feelings of loss, fear, worry, guilt and frustration. You might think:

  • What if I make too many mistakes?
  • Will people think I’m a bad mother?
  • What about my old life?

It is normal to ask yourself lots of questions when you’re going through a major life change, like having a baby.

Big changes in your life can leave you feeling overwhelmed, especially when things don’t happen the way you expected.

Becoming a dad

While women usually start preparing emotionally for parenthood during pregnancy, some fathers begin this process after the birth. As a result, the reality of fatherhood can be quite a shock. Even if you have been preparing throughout the pregnancy, some fathers can feel unprepared for the reality of having a newborn.

Some fathers can feel fierce, protective, overwhelming love for their child straight away, for others it may take a bit longer.

Fatherhood is just as challenging as motherhood, though not always for the same reasons. You might think:

  • I want to help with the baby, but I don’t know how.
  • It’s stressful managing work and family commitments.

You might also notice your relationship with your partner changes a lot too.

It’s normal to feel confused, stressed and out of your comfort zone when you have a new baby.

With any new or difficult situation, sometimes you are able to cope with the challenge, and sometimes you can feel overwhelmed. Fatherhood is no exception.

Just remember – there are plenty of things you can do to support yourself and your partner during this time.

If it is taking more than a couple of weeks to feel a connection with your baby, you should talk to a health professional. Read more about common emotional problems here

 

Impact on Anxiety and Depression of Caregivers

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In studies looking at post-traumatic stress disorder (PTSD) in caregivers and partners of people with cancer, 4% of caregivers experienced PTSD, and one third of partners experienced traumatic symptoms. Despite the significant psychological impact of caring, caregivers might not seek required treatment, with reporting that almost half of cancer caregivers who met diagnostic criteria for a psychiatric condition did not seek treatment for it.

Caregivers at increased risk of anxiety or depression:

  • Are predominantly younger and female.
  • Report lower socioeconomic status or education.
  • Live with the patient are the spouses, rather than the children, of the patient or report poor relationship quality with the patient.
  • Are unmarried or in shorter-term marriages.
  • Report high levels of unmet needs for supportive care.
  • Report comorbidities or more unhealthy behavior.
  • Use avoidant coping.
  • Feel less prepared for caregiving or confident in their abilities.
  • Are caring for patients that are older, are at a later disease stage, have symptoms, and report poorer physical functioning.
  • Have high caregiving demand and report higher intensity of care.
  • Report lower levels of social support.

Impact on Social Activities and Relationships

Several studies have reported that caregiving disrupts social connectedness and activities as caregivers’ energy and time are focused on the patient and their recovery. Almost half of caregivers have no time for themselves. The main concern here is that caregivers of people with cancer who have limited social networks and more restrictions in their daily activities are more likely to report caregiver burden.

The significant toll that a cancer diagnosis takes on a relationship is more and more understood. Even high-functioning couples may struggle to manage the stress and challenges of cancer, as well as changes in their relationships brought on by the cancer diagnosis. Such stress might lead to tension and conflict within the couple.

Despite the physical, social, and emotional burden of care, respite services are not well utilized by caregivers. Some patients and caregivers do not access specialist services because of the emotional difficulties in discussing death and dying.

Impact on Financial and Work Status

Caregiving creates a financial burden for family members, both in outright expenses and in lost income and benefits.

Caregiving also appears to reduce a person’s chance of being employed, and many caregivers are unable to work, need to take leave without pay, have fewer work hours, are in lower paid jobs, or work from home to manage the caregiver demands. Reduction in paid work also contributed to social isolation. Long-term financial impacts of caregiving include loss of savings for retirement.

POSITIVE IMPACT OF CARE GIVINGTop of Form

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While caregivers report experiencing surprise, shock, disbelief, anger, distress, fear, and depression in response to a cancer diagnosis, they also felt that caring for a person with cancer is an experience that can produce positive emotions. In one Australian study, 60% of caregivers were able to identify positive aspects of their role. When patients’ symptoms were minor, the time together was described very emotively as “precious time,” which allowed the exploration of emotions and expression of love for the patient. Happiness over quality time spent with the patient, the ability to explore and resolve issues, and feelings of value and self-worth have all been reported by caregivers. In addition, it has been suggested that caring for the patient may help caregivers to accept the death of the patient and work through their grief.

 

 

New ways of maintaining a healthy lifestyle in older age

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People who follow good health habits in their younger age tend to stay relatively more robust irrespective of their age. But it is never too late for a healthy lifestyle. Following good health habits can help elderly people to find ease in lifestyle. It could even prevent serious health issues.

In a research, it was analyzed that one could add extra five to eight years to their lifespan, by following a healthy lifestyle. Accepting the changes is the first part in acquiring stable health. With aging, there will be variations in blood pressure, heart conditions, and lesser immunity towards illness. These changes can affect both physically and emotionally. Leading a healthier life can boost both the physical and mental state. Healthy eating and regular physical activities are the primary solutions for good health at any age. But with more refined tips and a little more care, older adults can improve their living, leading a healthier lifestyle.

Through this article, let us discuss some valuable tips that could help seniors in achieving a healthier life and to live longer without struggles.

Regular health checkups

Health screenings play an essential role when it comes to old age. Screening should be done for a broad spectrum of diseases and health conditions such as cholesterol, blood pressure, diabetes, breast cancer, prostate cancer, heart disease, etc. Regular checkups can reduce the risk of severe illness and could improve health with proper medications and diet.

Regular eyesight, hearing and dental checkups

Older adults should have an eye test and get their prescription reviewed every year, as well as have their eyes screened for health issues such as glaucoma. Having the right pair of glasses can significantly diminish the prospect of falls. Hearing loss occurs commonly with aging, often due to exposure to loud noise. So hearing checkups should be done in a regular interval of time. Visiting the dentist once every six months could exclude the risk of cavities.

Maintaining healthy weight

Obesity and overweight can raise the risk of heart diseases, cholesterol, diabetes, and blood pressure. Hence it is imperative to manage a healthy weight, and this should be in accordance with the body mass index (BMI). Diet and exercise have a vital role in having a healthy weight. Individual medications should also be considered to balance the lifestyle.

Stay physically active

Even with conventional medications and better health, some people at their old age doesn’t convey much. It is always required to be active, and being active encompasses both mental activeness and physical activeness. Morning/Evening walks and exercise classes can aid in physical activeness. Mental activities could be hastened by having talking sessions with other people, including family members, younger people and people of the same age.

Sound sleep

Insomnia and frequent waking in the night are typical among older adults. There is nothing wrong with a nap in the midday to catch up on some snooze, but it’s vital to ensure the room is a calm, quiet and comfortable place for them to get as much sleep as they need. Afternoon naps could help seniors in being active, but frequent naps could result in tiredness.

Quit smoking

Smoking is harmful, and for older adults, the consequence is higher. Being old, it is troublesome to regulate the performance of the lungs, and with a constant obsession with smoking, the risk is double. It is always required to keep the lungs protected and hence smoking should be avoided.

 

 

The Risk assessment of Cancer surgery in elderly patients

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Senior patients with cancer are more frequently referred for possible surgical resection. Surgeons must ask: Do we know how to assist them? Do we understand their needs? Are we able to assess and predict operative risks? This review article focuses on such aspects and aims to assist surgical oncologists in the decision-making process.

Modern decision making is based on evidence. Unfortunately, there is often insufficient evidence guiding the choice of surgical options for senior patients with cancer.

It is generally believed that surgery is the most effective cancer-ablative therapy. However, complication rates, mortality, length of hospital stay, and intensive care unit admissions increase with patient age, which can offset oncologic advantages. Delay in cancer diagnosis can lead to a greater number of emergency presentations, and emergency surgery is associated with increased morbidity and mortality in this population. In the absence of clear guidelines and concerns about their ability to tolerate treatment, older patients are less likely to be offered standard cancer treatments that have been shown to improve survival. Nevertheless, high-profile centers have repeatedly demonstrated the feasibility of surgical treatment in this age group.

Poor understanding of frailty is, to a large degree, responsible for under-treatment. A particularly striking example of this is the nonsurgical treatment of older women with breast cancer. Only one in two older women have their cancer excised; too often, primary endocrine treatment is preferred. On the other hand, there can be overtreatment. When frailty is not identified, patients may be treated aggressively, resulting in poor oncologic outcomes, increased mortality, substandard quality of life, and high monetary costs. Alternative options should be discussed.

The decision of how to treat has to be thorough and honest. It should include the patient’s preferences, because older patients are keen to participate in the decision-making process. Patients should be informed of the advantages and disadvantages of a surgical procedure. Too often, for cases in which the operation is likely to be successful, practitioners forget to reassure the patient that the operation is feasible, perhaps slightly risky, but certainly worth undertaking and, most importantly, that the associated long-term prognosis is favorable. On the other hand, practitioners should not be swayed by a demanding family into offering an overwhelmingly risky operation to a frail patient who is unlikely to overcome multiple potential postoperative complications.

To guide these discussions, what is needed is clinical research that focuses not only on standard peri- and postoperative mortality and complication rates but also on longer-term outcomes and quality of life. Elderly patients who survive the first year after surgery have the same cancer-related survival as younger patients; therefore, decreased long-term survival in the elderly is mainly a result of differences in early mortality. The treatment of senior oncologic patients should focus on enhancing functional capacity preoperatively (prehabilitation), perioperative care, and 1-year outcomes after surgery.

SURGICAL CONSIDERATIONS IN THE OLDER ADULT WITH LUNG CANCER

Lung cancer is primarily a disease of the elderly. More than 65% of lung cancer patients are older than age 65 years when diagnosed.41 The percentage of patients with newly diagnosed lung cancer who are age ≥ 75 years is approximately 25%, and the percentage of patients age ≥ 75 years who die of lung cancer is approximately 30%. Thus, the average patient with lung cancer is paradigmatic of the issues involved in the treatment of any elderly patient with cancer, which may be framed as the following: How should an elderly patient with a cancer that, if left untreated, will likely cause his or her death be offered treatment with the lowest risk of operative morbidity and mortality that, at the same time, aims at the longest life expectancy, with acceptable functional status and quality of life?

The information needed to guide such difficult clinical decisions for the elderly patient with lung cancer remains incompletely collected. For example, the standard of care for patients of any age with resectable lung cancer has been anatomic lung lobectomy; the relative risks and efficacy of lesser resections (ie, segmentectomy) are being evaluated in clinical trials. In large randomized trials, lobectomy is associated with an operative mortality of 1.4%, and no increased risk was found to be associated with advanced age. However, this study and other smaller studies of elderly patients with lung cancer did not clearly characterize the population of patients considered for surgery. Some patients believed to have an increased perioperative risk, by use of unknown selection criteria, were referred for alternative ablative therapies such as radiation treatment.

It is possible that, in elderly patients who are not currently offered lobectomy, treatment with sublobar resection may have a better chance for cure with acceptable risks compared with nonsurgical ablative therapies. Conversely, some elderly patients undergoing lobectomy for lesions resectable by segmentectomy may not be offered a more extensive resection (and its benefits).

The effect of thoracic surgery on quality of life has been examined in only a few studies. They suggest that elderly patients experience a pattern of initial decrement followed by recovery similar to that seen in younger patients. Overall, patients with lung cancer have a baseline quality of life lower than that of their peers, and preoperative quality of life has been found to predict long-term survival after thoracic surgery.

Paralleling the efforts to preoperatively define patients at risk because of diminished quality of life has been the effort to define thoracic surgery patients at risk for postoperative complications because of frailty, disability, and multiple comorbidities. A geriatric preoperative assessment using these measures predicted both risk of postoperative institutionalization and 6-month survival.

Overall, intraoperative and postoperative management of patients undergoing lung cancer surgery has advanced considerably, such that the majority of patients can safely undergo effective surgery. The challenge now is to define the high-risk patient population, which will usually be a subgroup of the elderly.

Successful surgical treatment of the elderly patient therefore depends on a proactive, patient-centric, multidisciplinary program that involves a geriatrician and in which all stakeholders are committed to understanding the unique needs and expectations of the patients and their families.

In conclusion, surgery remains the best modality to treat solid tumors, regardless of patient age. Surgeons treating elderly patients with cancer should take into account that other factors, such as frailty, comorbidities, performance, and cognitive status, are important considerations when predicting outcomes. With adequate perioperative care, elderly patients can do as well in terms of morbidity and mortality as their younger counterparts. Therefore, if surgery is determined to be the appropriate treatment modality, patients should not be denied this option because of their age.