Disease Management Update
Volume IV, No. 35
December 27, 2007

Dear Healthcare Intelligence Network Client,

According to the American Heart Association, stroke is the third largest cause of death and a leading cause of serious and long-term disability in the United States. This week's Disease Management Update takes a look at factors that may reduce as well as increase one's risk of stroke.

Visit HIN's blog to read about some neurological problems that could be predictors of a stroke.

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

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at:

Table of Contents

  1. Good Physical Function After Age 40 Tied to Reduced Risk of Stroke
  2. Disease Management Q&A: Geriatric Depression Scale and Mini Mental Status Exams
  3. HealthSounds Podcast: Managing Transitions to Care for the Frail Elderly
  4. Cholesterol-lowering Drugs May Increase Risk of Hemorrhagic Stroke
  5. Survey of the Month: Healthcare Consumerism
  6. Caregiver Education and Support Programs Provide Positive Impact

1. Good Physical Function After Age 40 Tied to Reduced Risk of Stroke

People who have good physical function after the age of 40 may lower their risk of stroke by as much as 50 percent compared to people who are not able to climb stairs, kneel, bend, or lift as well, according to the medical journal of the American Academy of Neurology.

For the study, researchers examined 13,615 men and women from 1993 to 1997 who were between the ages of 40 and 79 and had not suffered a stroke, heart attack or cancer. Participants were then asked to complete a self-reported test on their physical function 18 months later that looked at how well they were able to climb stairs, carry groceries, kneel, bend and lift. Researchers monitored how many strokes were suffered in this group through 2005.

The study found that people who scored in the top quartile on the physical function test had a 50-percent lower risk of stroke than those with the lowest test scores. This finding remained unchanged after adjusting for age, sex, body mass index, high blood pressure, cholesterol, smoking, diabetes, physical activity, social class, alcohol consumption and respiratory function. The study also found that for every increase of 10 points on the test, men had a reduced risk of stroke by 19 percent and women had a 29 percent lower stroke risk.

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 expert is Gregg Lehman, Ph.D., president and chief executive officer of INSPIRIS at time of contribution and current president and CEO of Minneapolis-based Health Fitness Corp.

Question: How do you conduct your geriatric depression scale and mini mental status exams on the frail elderly? Is it telephonic? 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. Itís 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 details 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: Managing Transitions to Care for the Frail Elderly

In this week's disease management podcast, Dr. John Charde and Laurie Russell explore how to create effective care management approaches for the frail elderly. Dr. Charde, Enhanced Care Initiatives' vice president of strategic development, describes how Enhanced Care Initiatives varied programs "touch" the frail elderly, while Russell, senior director of health solutions for XLHealth, details how her organization's "Ask Your Doctor" report empowers members with the language to address medical conditions during a doctor visit.

To listen to this complimentary HIN podcast, please visit:

4. Cholesterol-lowering Drugs May Increase Risk of Hemorrhagic Stroke

People taking cholesterol-lowering drugs such as atorvastatin after a stroke may be at an increased risk of hemorrhagic stroke — or bleeding in the brain — a risk not found in patients taking statins who have never had a stroke. But researchers caution the risk must be balanced against the much larger overall benefit of the statin in reducing the total risk of a second stroke and other cardiovascular events when making treatment decisions.

The study consisted of a trial of 4,731 people who were within one to six months of having had a stroke or transient ischemic attack, or mini-stroke, and with no history of heart disease. Half of the participants received atorvastatin and half received a placebo. The participants were then followed for an average of four and a half years.

Overall, treatment was associated with a 16-percent reduction in total stroke as well as significant reductions in coronary heart events. However, secondary analysis found that the overall reduction in stroke included an increase in the risk of brain hemorrhage. Of those people randomized to atorvastatin, the study found 2.3 percent experienced a hemorrhagic stroke during the study compared to 1.4 percent of those taking placebo. The study also found there was a 21-percent reduction in ischemic stroke, a more common type of stroke involving a block in the blood supply to the brain, among people taking atorvastatin.

To learn more about this study's findings, please visit:

5. Survey of the Month: Healthcare Consumerism

Complete our survey on healthcare consumerism efforts by December 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. Caregiver Education and Support Programs Provide Positive Impact

According to statistics by the Family Caregiver Alliance, approximately 52 million informal and family caregivers provide care to an adult that is ill or disabled in the United States. The majority of caregivers are 35 to 64 years old, and an estimated 60 percent are also working outside the home. A proactive approach to this growing dilemma through caregiver education and support programs allows employers to provide an invaluable benefit, while increasing employee loyalty and productivity.

To download this complimentary white paper, please visit:
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