Posts tagged with "JAMA Surgery"

No bones about it: Slip-and-fall injuries up among seniors who walk dogs to stay active

March 8, 2019

Nothing is more likely to get a senior citizen out of the house for a walk and some fresh air than attending to the needs of his or her dog (and best friend). What’s more, taking Rover for a ramble offers an opportunity to socialize with nearby neighbors and pet owners, especially if the weather is good.

So it seems to be a win-win situation on both sides of the leash. Or is it?

While walking a dog provides older Americans with a valuable outlet for regular, physical activity, findings of a Penn Medicine study indicate that fractures related to these walks more than doubled between 2004 and 2017 in patients 65 and older.

The study — published on March 6 in JAMA Surgery—established that, in this population, 78% of the fractures occurred in women, with hip and upper extremity breaks being the most common.

The rise in injuries in this population is a result of two trends, the researchers say: increased pet ownership and a greater emphasis, in recent years, on physical activity at older ages.

“Dog walking, which has repeatedly demonstrated social, emotional and physical health benefits, is a popular and frequently recommended activity for many older Americans seeking new ways to stay active,” said the study’s lead author Kevin Pirruccio, a second-year medical student in the Perelman School of Medicine at the University of Pennsylvania. “This study highlights that while there are undoubtedly pros to dog walking, patients’ risks for falls must be factored into lifestyle recommendations in an effort to minimize such injuries.”

The study team, which included senior author Jaimo Ahn, an associate professor of Orthopaedic Surgery, and Yeo Myoung Yoon, a research assistant at Penn, reviewed all fractures in the 65-and-older population related to “pet products” in the National Electronic Injury Surveillance System database of the United States Consumer Product Safety Commission. The entries the team found— stretching across roughly 100 participating hospitals’ emergency departments—corresponded to 32,624 cases in the United States, overall.

Fracture injuries linked to walking leashed dogs were found to have increased significantly from 1,671 cases in 2004 to 4,396 in 2017—a 163% increase. About half of the injuries were related to people’s upper extremities; fractures of the wrist, upper arm, finger and shoulder were the most common in that category.

Specifically, seniors fractured their hip most often, accounting for 17% of the injuries in the database. This is particularly concerning as mortality rates related to hip fractures in the in patients over 65 are close to 30%. Why hip injuries among older people can be so deadly has to do with the possibility of setting off a domino-effect of factors that relate to poorer health, such as a sudden lack of mobility and activity.

While the numbers are sobering, the researchers believe that their count of dog walking injuries may actually be low. The study only examined reported fractures and those who went to an emergency room. Debilitating tendon or muscle damage and those who may refuse or seek out other avenues of care were not included in the study.

The researchers don’t want to keep seniors from walking dogs or owning them. But they hope their study and others that build off of it provide grounds for deeper considerations about the risks everyone faces as they grow older.

Research contact: Francis.Otto@pennmedicine.upenn.edu

Medicaid expansion linked to better, more timely surgical care

February 16, 2018

The  Affordable Care Act’s Medicaid expansion has been linked to better access to surgery—and higher-quality surgical care, at that—according to findings of a study  of 300,000 patients nationwide by Harvard T.H. Chan School of Public Health released online in the January 24 edition of JAMA Surgery.

“What was most striking was that we saw significant improvements in the treatment of surgical conditions fairly quickly, less than two years after states expanded Medicaid coverage,” said lead author Andrew Loehrer, who conducted the study as a research fellow at Harvard Chan School.

Previous studies have examined the impact of the expansion of Medicaid by the ACA (also known as Obamacare) on a range of outcomes in medical areas such as  primary care, prescription medication use, and self-reported health— generally finding favorable results. But this is the first study showing similar benefits for serious conditions requiring surgery.

The researchers looked at five years’ worth of data from patients across 42 U.S. states who were admitted to hospitals for one of five common surgical conditions: appendicitis, cholecystitis, diverticulitis, peripheral artery disease (PAD), or aortic aneurysm. They analyzed trends in insurance coverage, timeliness of surgical care, and care outcomes—both before the ACA’s Medicaid expansion (2010-13) and after (2014-15)—comparing 27 states that chose to expand their Medicaid programs with 15 that chose not to expand.

The study found that Medicaid expansion was associated with:

  • A 7.5-percentage-point decrease in the probability of patients being uninsured;
  • An 8.6-percentage-point increased probability of patients having Medicaid;
  • A 1.8-percentage-point increase in the probability of patients seeking care earlier, before their surgical conditions became complicated; and
  • A 2.6-percentage-point increase in patients’ probability of receiving optimal care

They speculated that the ACA’s Medicaid expansion led patients with surgical conditions to seek treatment before complications set in. Being treated for these conditions earlier makes it more likely that they will have better health outcomes, the authors said.

“The fate of the ACA and Medicaid remain … a key policy debate,” said senior author Benjamin Sommers, associate professor of Health Policy and Economics at Harvard Chan School. “As policymakers continue to discuss major changes to the ACA, and the Trump administration advances reforms that could lead to fewer people covered by Medicaid, our findings provide important new evidence that Medicaid expansion is improving the quality of care for serious conditions affecting tens of thousands of Americans every year.”

Research contact: mhdwyer@hsph.harvard.edu