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Hospice use and ‘unwanted care’ on rise

Though the percentage of seniors who died within three days of beginning hospice care nearly doubled between 2000 and 2009, the proportion of dying seniors in intensive care also rose, according to research co-authored by Joan Teno MS’90, professor of health services policy and practice in the Public Health Program. The study was published today in the Journal of the American Medical Association.

Teno and her team of researchers examined the Medicare records of more than 840,000 people over 66 years of age who died between 2000 and 2009, according to a University press release. They found that while health care designed to alleviate suffering and make patients more comfortable has become more popular over the last decade, many seniors still undergo “aggressive” treatment, leading to multiple hospitalizations and stays in intensive care units.

“Poor communication leading to unwanted care is an epidemic in many systems,” said co-author David Goodman, Dartmouth professor and director of the Center for Health Policy Research, in the press release. “The patterns of care observed in this study reflect needlessly painful experiences suffered by many patients.”

Healthcare providers may pursue more aggressive treatments to garner reimbursements for service fees from Medicare, Teno said in the release.

“We need a system where doctors and hospitals are paid for delivering high-quality, patient-centered care that understands the dying patient’s needs and expectations and develops a care plan that honors them,” she added.


Human activity erodes Cape Cod

Seventy years of human activity have led to the erosion of Cape Cod’s sea banks, according to a study led by Tyler Coverdale ’10 published in Frontiers in Ecology and the Environment last month.

Coverdale and other researchers involved in the study analyzed aerial pictures of Cape Cod’s marshes dating from the 1930s to the 2000s to determine how disruptions to the shore’s natural ecology have snowballed over time, according to a University press release.

In the 1930s, people sought to decrease the area’s mosquito population by digging ditches to drain the marshes. Though not destructive at the time, the ditches let water flow through, allowing a new type of grass to grow and a different species of grass-eating crab — the Sesarma crab — to thrive.

This did not become an issue until decades later, when development on Cape Cod spurred an increase in recreational fishing. Fishermen have been capturing the crab’s main predators, enabling the new species to “roam unchecked,” according to the press release.

The crabs’ eating has destroyed the marshes, according to the release.

Coverdale’s image analysis found that the marshes without the trenches and fishing infrastructure have fared better.


Transposable elements expressed in aging cells

As a cell ages, its ability to temper the harmful effects of transposable elements — floating strands of DNA — weakens. Lowered control over these strands may be one reason why an individual’s health declines as he or she ages, according to a study led by University researchers published in the online edition of the journal Aging Cell last month.

Transposable DNA elements can increase an organism’s genetic diversity, but they can also disrupt normal cell functioning, according to a University press release. Cells work to confine these strands of DNA to prevent them from being expressed into proteins.

“We barely seem to be winning this high-stakes warfare, given that these molecular parasites make up 40 percent of our genome,” said John Sedivy, professor of medical science and study senior author.

The researchers found that chromatin — the combination of DNA and protein that lives in cells and plays a key role in trapping and controlling transposable elements — changes as cells age.

In young, healthy cells, chromatin structures are more open around DNA parts that need to be expressed into proteins, and they remain closed around transposable elements that could cause harm. But the researchers observed that in older cells, once-open chromatin became more closed and once-closed chromatin became more open. This leads to increased expression of transposable elements, according to the press release.

It is unclear how much damage the transposable elements cause when expressed, Sedivy said in the press release. “Is the transposition really bad for the organism, or is it something that happens so late that by that point the organism has already accumulated so much age-associated damage?” he asked in the release.

Sedivy said scientists should still consider “coming up with an existing drug therapy” to combat the expression of transposable elements.


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