Disease Management Update
Volume IV, No. 38
January 17, 2008

Dear Healthcare Intelligence Network Client,

This week's Disease Management Update focuses on cognitive problems in older patients. A new study links sleep apnea with cognitive impairment, while another suggests that older patients who undergo non-emergent surgeries are at greater risk for developing cognitive problems.

Visit HIN's blog to read about what CMS is doing to make it easier for seniors to be diagnosed and treated for sleep apnea.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

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Table of Contents

  1. Sleep Apnea Linked to Cognitive Impairment in Older Women
  2. Disease Management Q&A: Geriatric Depression Scale and Mini Mental Status Exams
  3. HealthSounds Podcast: Improving Medicare Disease Management
  4. Older Surgical Patients at Greater Risk for Developing Cognitive Problems
  5. Survey of the Month: Medical Homes Use To Manage Chronic Conditions
  6. Baby Boomers’ Impact on Healthcare

1. Sleep Apnea Linked to Cognitive Impairment in Older Women

Older women with sleep-disordered breathing (SDB) — the restriction or interruption of breathing during sleep — are more likely to show cognitive impairment than women without SDB, according to a study led by researchers at the San Francisco VA Medical Center (SFVAMC) and University of California, San Francisco. The association is even stronger in women with at least one copy of the APOE e4 gene, which is considered a risk factor for Alzheimer’s disease as well as SDB.

Using standard cognitive tests, the researchers measured the cognitive abilities of 448 women with a mean age of 82.8 years. They collected one night’s worth of sleep data on the women using polysomnography, a method of measuring multiple domains of sleep-related physiologic responses. The greater the severity of apnea or hypopnea in a study subject, the greater the likelihood the subject tested as cognitively impaired.

According to lead author Adam P. Spira, Ph.D., a geriatrics researcher at SFVAMC, the study does not demonstrate a cause-and-effect relationship between SDB and cognitive impairment, but simply an association. He notes that even if there is a cause-and-effect relationship, the exact mechanism by which SDB might contribute to cognitive impairment is unknown. “However, low blood oxygen that might be associated with cessations or reductions in respiration could lead to neuronal damage,” he says.

To learn more about this study, please visit:

2. Disease Management Q&A: Geriatric Depression Scale and Mini Mental Status Exams

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts is Gregg Lehman, Ph.D., president and chief executive officer, Health Fitness Corporation and member of the board of directors for INSPIRIS, Inc.

Question: How do you conduct your geriatric depression scale and mini mental status exams on the frail elderly? Is it telephonic? And when depression is diagnosed, what steps are taken to address it?

Response: (Gregg Lehman) In many cases we work with the attending physician. When we do our assessment and identify depression, for example, we evaluate the patient, the degree of impairment and the medications. It’s important to determine if the medications are appropriate. This is a coordinated effort between the physician and the nurse practitioner.

The evaluation is conducted on site at the bedside. This frail elderly population often does not have a telephone in their room because of their high levels of dementia or cognitive impairment. In many cases, we can only do the evaluation face to face.

For more information on coordinating care transitions for the elderly, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Improving Medicare Disease Management

In this week's Disease Management Podcast, Blake Andersen, president, Chronic Care Group, Health Sciences Institute, outlines the critical success factors in delivering improved senior care. Pamela Fromelt, vice president of government programs, LifeMasters Inc., illustrates how important the face-to-face approach is in serving Medicare patients. Dr. Randall Krakauer, national medical director, retiree markets, Aetna, describes how preventing avoidable admissions in the Medicare population can have an impact on costs, mortality and morbidity. Andersen, Fromelt and Krakauer described how disease management programs can serve the needs of Medicare beneficiaries with chronic conditions to improve their health status, while reducing spending on these conditions.

To listen to this complimentary HIN podcast, please visit:

4. Older Surgical Patients at Greater Risk for Developing Cognitive Problems

Patients over the age of 60 who have elective surgeries such as joint replacements, hysterectomies and other non-emergency, inpatient procedures, are at an increased risk for long-term cognitive problems, according to a new study led by Duke University Medical Center researchers. The study also found that elderly patients who developed these postoperative cognitive problems were more likely to die in the first year after surgery.

The study found that many of the young, middle-aged and elderly patients experienced postoperative cognitive dysfunction (POCD) at the time they left the hospital. But three months later, those aged 60 and older were more than twice as likely to exhibit POCD. Those with POCD at both the time of hospital discharge and three months after surgery also were more likely to die within the first year after surgery, Monk said.

"We have known that patients undergoing heart surgery are at risk for cognitive dysfunction — problems with memory, concentration, processing of information — but the effects of non-cardiac surgeries on brain function are not as well understood," said Terri Monk, M.D., an anesthesiologist at Duke and the Durham Veterans Affairs Medical Center, and lead investigator on the study. "Our study found that increasing age put patients in this population at greater risk for cognitive problems and this is significant because the elderly are the fastest growing segment of the population. We know that half of all people 65 and older will have at least one surgery in their lifetime."

To see more of this survey's results, please visit:

5. Survey of the Month: Medical Homes Use To Manage Chronic Conditions

Complete our survey on medical homes use by January 31, and you'll get a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Baby Boomers’ Impact on Healthcare

Baby boomers have practically achieved cult status. As the first of the post-World War II generation turns 60 this year, the media has been recounting their preferences in everything from music to parenting to lifestyles. Boomers are depicted as an educated, financially secure bunch, redefining retirement as they care for aging parents and launch second careers. Job-wise, they’re having the last laugh: employers who shunned the older worker 20 years ago now recast work schedules and job descriptions to woo boomers back to work. But the picture wouldn’t be complete without some sobering statistics, particularly when it comes to the healthcare needs of boomers.

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