THURSDAY, March 4 (HealthDay News) -- Hospices that care for people who are dying often forget to turn off their implanted defibrillators, causing unnecessary discomfort, new research has found.

Only 20 percent of more than 400 hospices that responded to a survey indicated that they had a question on their admitting form that would identify people with defibrillators, and just 10 percent said it was their policy to discuss deactivating the devices, according to a report by physicians at the Mount Sinai School of Medicine in New York City, published March 2 in the Annals of Internal Medicine. The survey found that 97 percent of the hospices, though, had admitted people with implanted defibrillators.

A defibrillator delivers a shock to restore a normal heartbeat in people with rhythm abnormalities. "The purpose is to save a patient's life," said study author Dr. Nathan Goldstein, an assistant professor of geriatrics and palliative medicine at Mount Sinai. "There is a little burden, but mostly benefit. But there is no sense getting a shock when it is not going to fix their underlying condition."

Some hospice patients have compared the shock given by a defibrillator to being kicked or punched in the chest, Goldstein said.

He cited the case of a man who was dying of cancer and was shocked repeatedly by an implanted defibrillator. "That is very painful for the patient and upsetting for the patient and the family," Goldstein said.

A policy statement issued by the National Hospice and Palliative Care Organization said that all people with implanted defibrillators should be identified on admission to a hospice and that the option of deactivation "should be thoroughly explored with patients and their designated caregivers as soon as possible after admission."

The discussion should include an explanation that deactivation "does not constitute euthanasia nor physician-assisted suicide nor is it likely to hasten death," the statement said. If the device also acts as a pacemaker, that function can be maintained, it said.

"We put out this statement in 2008 because we knew that it was becoming an increasingly important issue in dealing with patients at the end of life," said Jon Radulovic, vice president for communications at the National Hospice and Palliative Care Organization. "We recognize that many hospices have a way to go to put a policy in place. The research out of Mount Sinai reminds us of how important this issue is. We now know that a lot of work needs to be done out there in the provider community in meeting the recommendation."

A conversation about turning off a defibrillator because the end of life is near is not easy to begin, Goldstein said, and many hospices "do not have a systematic way of having a conversation about the possibility of turning off defibrillators."

Family members who observe hospice patients being shocked report feelings of fear, worry and helplessness and have been shown to have increased rates of anxiety and depression, he said.

Goldstein's team has developed a model policy for managing implanted defibrillators in hospice settings. It includes an informed-consent discussion with the family and information on handling the device in an emergency.

"What is remarkable about Dr. Goldsteins study is what it uncovered," said Dr. Paul S. Mueller, director of the program in professionalism at the Mayo Clinic, who has done research on defibrillators in the end-of-life setting. "Here you have patients who have been admitted to the hospice program because they have terminal illnesses or will not live six months."

"The defibrillator is a life-preserving device. Is that kind of treatment consistent with a hospice program oriented toward end-of-life care? It would seem to be inconsistent with the goal of hospices," he added.

But one relatively bright point is that hospices that ask about defibrillators on admission are more likely to take steps to deactivate the devices, Mueller said.

More information

Learn about defibrillators   from the American Heart Association.

WEDNESDAY, March 3 (HealthDay News) -- High levels of a hormone called insulin-like growth factor 1 (IGF-1) are associated with an increased risk of cancer death in older men, a new study has found.

The findings, published in the March issue of the Journal of Clinical Endocrinology & Metabolism, suggest that IGF-1 may prove a useful biomarker for predicting cancer risk.

IGF-1, which is similar in structure to insulin, is regulated by growth hormone. Levels of growth hormone and IGF-1 decline as men and women age and this decrease is believed to be linked to health problems associated with old age. In an attempt to counter this, some people take supplemental growth hormone to elevate levels of IGF-1, according to background information in an Endocrine Society news release about the study.

"This is the first population-based study to show an association of higher IGF-1 levels with increased risk of a cancer-related death in older men," study corresponding author Gail Laughlin, of the University of California, San Diego, said in the news release. "Although the design of this study does not explicitly show that the higher IGF-1 levels caused the cancer death, it does encourage more study as well as a re-examination of the use of IGF-1 enhancing therapies as an anti-aging strategy."

The study included 633 men, aged 50 and older, whose IGF-1 levels were measured between 1988 and 1991. During 18 years of follow-up, men whose IGF-1 levels were above 100 nanograms per milliliter at the start of the study were nearly twice as likely to die of cancer as those with lower levels of the hormone.

"In this study, the increased risk of cancer death for older men with high levels of IGF-1 was not explained by differences in age, body size, lifestyle or cancer history," lead author Jacqueline Major said in the news release. "If these results are confirmed in other populations, these findings suggest that serum IGF-1 may have potential importance as a biomarker for prognostic testing."

More information

The U.S. National Cancer Institute has more about cancer risk factors.

TUESDAY, March 2 (HealthDay News) -- The humble sea squirt may offer a new way to test drugs to treat Alzheimer's disease, U.S. researchers say.

Sea squirts are marine organisms that have a hard outer tunic with a soft body inside. Adult sea squirts spend their lives attached to one spot on underwater structures such as the pilings of piers. They're simple creatures, but sea squirts share about 80 percent of their genes with humans, including the genes to develop the types of plaques that accumulate in the brains of Alzheimer's patients.

This led San Diego State University scientists to try to study Alzheimer's disease in sea squirts. They took a mutant protein found in human families with hereditary Alzheimer's disease and put it in immature, sea squirt tadpoles. This resulted in aggressive development of plaques in the tadpoles' brains in just one day, along with accompanying behavioral defects. However, these effects were reversed when the tadpoles were given an experimental drug designed to prevent plaque formation.

This is the first invertebrate creature found to be able to process the plaque-forming protein. Vertebrates take months or years to develop plaques after receiving the protein.

The findings suggest that sea squirts may offer an excellent model for testing new Alzheimer's drugs, the researcher said.

The study will be published in an upcoming issue of the journal Disease Models and Mechanisms.

More information

The U.S. National Institute on Aging has more about Alzheimer's disease.

TUESDAY, March 2 (HealthDay News) -- Elderly patients discharged from the hospital after a stay in the intensive care unit (ICU) have a high rate of death in the following three years, new research shows.

The risk of death is highest among patients who were on mechanical ventilation while in the ICU, according to the report published in the March 3 issue of the Journal of the American Medical Association.

U.S. researchers analyzed data on 35,308 Medicare patients (over age 65) who survived an ICU stay and were discharged from the hospital in 2003. After three years, the death rate for these patients was 39.5 percent, compared with 34.5 percent among elderly patients who'd been in hospital but not in the ICU (hospital controls), and 14.9 percent among elderly people in the general population.

Among the ICU survivors, the death rate was 57.6 percent for those who received mechanical ventilation and 38.3 percent for those who didn't receive mechanical ventilation. The much higher death rate among those who'd been on mechanical ventilation was primarily due to a large number of deaths that occurred in the first six months after discharge, Dr. Hannah Wunsch, of Columbia University Medical Center and New York-Presbyterian Hospital/Columbia in New York City, and colleagues reported.

The study also found that the six-month death rate for the 33 percent of ICU survivors and 26.4 percent of hospital controls discharged to a skilled-care facility was 24.1 percent, compared with 7.5 percent for ICU survivors and hospital controls discharged home.

"The magnitude of the post-discharge use of skilled-care facilities for both ICU survivors and hospital controls and the high long-term mortality for all of these patients call into question whether discharge to skilled-care facilities is merely a marker for higher severity of illness with appropriate delivery of care. These patients could have been discharged prematurely from acute care hospitals, and needed a higher level of care than they received," Wunsch and colleagues wrote.

"It also is possible that these patients could have had better outcomes if discharged home, but were not able to be sent there due to lack of sufficient support from family or friends to act as caregivers. These findings highlight the need for a much more detailed understanding of the long-term care needs of these patients," the researchers concluded.

There has been little research into the outcomes of elderly ICU survivors, Wunsch and colleagues noted.

"Patients older than 65 years now make up more than half of all ICU admissions," they wrote. "Information is needed to understand the patterns of mortality, morbidity and health-care resource use in the months and years that follow critical illness to allow for better targeting of follow-up care."

More information

The Society of Critical Care Medicine has more about critical care  .