Long-Term Care Survey Alert

Looking to boost residents' immune response to the shingles vaccine and promote better physical functioning, pain relief and mental health? The Chinese exercise Tai Chi might be just the prescription you're looking for, according to a recent National Institutes of Health-funded study reported in a recent issue of the Journal of the American Geriatrics Society.

"One in five people who have had chickenpox will get shingles later in life, usually after age 50, and the risk increases as people get older," says NIA Director Richard J. Hodes, MD, in an NIH statement on the research. Hodes says more research is needed but the "study suggests that the Tai Chi intervention tested, in combination with immunization, may enhance protection of older adults from this painful condition."

Researchers conducted the randomized, controlled clinical trial on 112 healthy adults with an average age of 70. Participants were divided into two groups: Those who received 16 weeks of Tai Chi and a control group that received a comparable amount of health education weekly.

"Tai Chi alone was found to increase participants' immunity to varicella as much as the vaccine typically produces in 30- to 40-year-old adults," states the NIH. Tai Chi plus the vaccine boosted immunity by about 40 percent over the effect of the vaccine alone. The "Tai Chi group's rate of increase in immunity over the course of the 25-week study was double that of the health education (control) group." Participants in both groups showed similar immunity to the varicella virus at the beginning of the study.

Other perks: The Tai Chi group also reported significant improvements in pain, physical functioning, vitality and mental health. Both groups enjoyed a significant decrease in depressive symptoms.

More information about shingles is available from the NIA at www.niapublications.org/agepages/shingles.asp. More information on Tai Chi can be found at  www.nccam.nih.gov/health/taichi.

--The next time your resident is scheduled for a dilated eye exam, consider passing along this potentially sight-saving clinical information. Use of topical phenylephrine to dilate the pupils in patients with vaso-occlusive disease of the optic nerve can lead to worsening visual loss, according to a report by the University of Pittsburgh School of Medicine. Four patients ranging in age from 54 to 82 diagnosed with non-arteritic ischemic optic neuropathy suffered acute worsening of their vision after receiving the dilating drops, which have a vasoconstrictive effect.

The effect on patients' vision appeared in 45 minutes in one case and up to 12 hours later in others. One patient had ischemic optic neuropathy presumed to be due to lupus erythematosus. The other three patients had "classical risk factors" for optic nerve ischemia, such as "hyperptension, diabetes and a contralateral 'disk at risk'," according to an abstract of the study in a past issue of Seminars in Ophthalmology.

The authors conclude that "the routine practice of using phenylephrine to prepare patients for funduscopic assessment should be re-examined, particularly in patients with ischemic optic neuropathy."

--The OIG says a nursing facility can reward itself with its credit card reward programs, if it follows certain rules. A facility that uses a credit card in its name to purchase Medicare- and Medicaid-reimbursed items services can tap the card reward program (airline mileage, cash rebates, etc.) to buy more stuff for the nursing home--or reward staff for work performance. That's according to a recent HHS Office of Inspector General advisory opinion.

The stipulations: "Neither the credit card issuers nor their sponsors (or affiliates) will be health care entities or affiliated with the health care industry," states the OIG. And they can't be in a position to receive or influence referrals of items of services, adds the advisory. "The types of employees eligible to receive rewards include physicians, nurses, administrators, clerical workers, kitchen staff, and other employees" based on how they perform their duties.

Read the entire advisory opinion at http://oig.hhs.gov/fraud/docs/advisoryopinions/2007/AdvOpn07-03.pdf.