Age-related diseases: prevention - diagnosis - treatment

The panel "Age-Related Diseases - Prevention - Diagnosis - Treatment" began and ended with a discussion of how much we are losing, as a society, as a health care system, due to the fact that Poles (and Polish women) are still reaching for tobacco products. Dr. Malgorzata Czajkowska-Malinowska, national consultant in lung diseases and president of the Polish Lung Association, stressed that lung cancer is the main killer among cancers, but the patient profile has changed somewhat. When, relatively recently, lung cancer mainly affected and killed men, now there are more and more women among patients. This is the result of a "revolution in customs": on the one hand, there was no shortage of very successful anti-smoking campaigns in the 1990s, which prompted primarily men to quit smoking; on the other hand, the percentage of female smokers is rising among women, and the number of those who die of lung cancer after years of smoking is also increasing.

Smoking also influences the development of COPD - once even considered a male disease, but now "equality" is advancing in it as well. But it is also not indifferent from the point of view of other lung diseases that can develop in senior age, such as pulmonary fibrosis or interstitial pneumonia. From the point of view of the health of seniors, an extremely important role is played by pneumococcal vaccination, for which, as the specialist stressed, possible chronic lung diseases are not a contraindication, on the contrary. Equally important, however, for those who reach for tobacco products, is to stop smoking. - Smoking is worth ending at all times, at any age. Also when we have already become ill. With COPD or lung cancer, continuing to smoke increases the risk of complications or cancer recurrence, she reminded.

There is no doubt that one of the key challenges in the area of diseases manifested in senior age is their early diagnosis. Prof. Bożena Walewska-Zielecka, NIZP PZH - PIB, Medicover Scientific Council urged that this should not be equated with prevention. - Of course, it is all very well to detect the disease in advance, but prevention starts earlier. It's about a healthy lifestyle from an early age," she stressed, expressing regret that health education will be introduced into schools as an optional subject. - We will continue to have an uneducated society.

The expert recalled that both longevity and prolongation of years lived in health to a great extent - for the vast majority of people - depend on individual decisions and literally "lie in our hands," and the obstacle to improving indicators is the public's health illiteracy. However, much can be done with concrete interventions. As an example, she cited a program implemented by Medicover, which included overweight and obese people - for a year, without the intervention of a dietician, they were motivated to exercise regularly, thanks to which not only weight reduction was achieved, but, above all, there was a marked improvement in the body's test results.

Professor Artur Mamcarz, head of the Third Department of Internal Medicine and Cardiology at the Faculty of Medicine of the Warsaw Medical University, Faculty of Medicine of the University of Warsaw, drew attention to another aspect related to performing tests. As he said, the message itself, the mere knowledge that one has elevated cholesterol or an abnormal blood pressure value, is not enough. It is necessary for the patient to adhere to therapeutic recommendations - whether in terms of changes in lifestyle or taking medications, which, the expert admitted, is a big problem in chronic diseases, especially those that are not accompanied by troublesome symptoms. - This is our role, the role of doctors, to talk to the patient in such a way, to formulate messages in such a way that the patient understands and believes why he should take these drugs. That the goal, for example, is not to lower blood pressure values, but to prolong life in good quality health, without the complications of high blood pressure," he stressed, recalling that the annual cost of non-adherence in chronic diseases across the EU is estimated at 200 billion euros. Non-adherence to medical recommendations also consumes approx. 200,000 deaths annually. According to the expert, there is a need to eliminate communication errors on the part of medical professionals. - So that people take medicine and not listen to charlatans, who at the moment are attacking not only vaccinations, but also statins, for example. Someone who acts to the detriment of public health should face legal consequences," he concluded.

In turn, Prof. Leszek Czupryniak, head of the Department of Diabetology and Internal Diseases at the Warsaw Medical University, called for consistency and coherence in declarations and decisions. - Smoking should be banned. The state cannot behave like a pimp who profits from the sale of tobacco and then spends billions on treating cancer, cardiovascular diseases, he pointed out. According to the expert, who has been saying for years that tobacco smugglers should be punished decisively - showily even - and farmers who make their living from tobacco production should be offered a favorable alternative, he stressed that without such a change we will not solve the problems with the incidence of a large part of civilization diseases, one of the leading risk factors of which is smoking. As he stressed, medicine has already conclusively proven that smoking is harmful, any discussion on this topic is unnecessary.

Prof. Czupryniak, however, focused primarily on the issue of diabetes treatment. In his opinion, in recent years, thanks to the spread of glycemic monitoring systems, we can talk about a real revolution in the treatment or management of this disease. - Monitoring glucose levels with a glucometer can be compared to driving a car around the clock with your eyes closed and opening them only four times during that time, he explained to conference participants. Modern monitoring systems, which transmit information to the patient's smartphone and from there to the cloud, making it accessible to the doctor, mean that the eyes remain open all the time, that is - there is control, control, over the disease. - I myself consult patients daily by email thanks to this solution. Patients themselves can modify their behavior. The alignment of the disease is definitely improved. Knowledge of the disease is power over the disease," he stressed, adding that at the moment diabetologists are seeking reimbursement for glycemic monitoring systems for all patients with type two diabetes who are treated with insulin, regardless of how many doses per day they have to take.

- I also urge patients with newly diagnosed diabetes who are not being treated with insulin to set up such a system at their own expense, if only for a short time, for a month. You have to pay a few hundred zlotys, but it instantly gives you knowledge of how behaviors, choices, affect sugar levels. How important it is what and how much we eat, how much physical activity," he explained. At the moment, about 100,000 people are using the reimbursed systems, which has helped, Prof. Czupryniak stressed, to significantly reduce cases of severe hypoglycemia associated with ambulance calls and hospitalizations. Thus, the relatively high costs also mean savings for the system, with the biggest benefit being keeping patients in good health despite their illness.

Prof. Piotr Jankowski, head of the Department of Internal Medicine and Gerontocardiology, deputy director of the Medical Center for Postgraduate Education and Prof. W. Orlowski Hospital in Warsaw, even went a step further, stating that he recommends even short-term use of glycemic monitoring systems to patients who do not have diabetes, but are at risk of it or suffer from cardiovascular disease. - This allows you to see for yourself and see the effect on your body of your own daily choices. This is an element of education that very quickly influences behavior change and prevents the development of diseases directly dependent on unhealthy lifestyles," he pointed out.

Prof. Jankowski acknowledged that cardiologists have a rich spectrum of options for monitoring heart rate, not only through advanced, specialized, devices, but also the kind that not only people with a diagnosed problem, but many people who consider themselves healthy, use on a daily basis. - The use of monitoring by wearing a wristband or watch can help prevent stroke, provided that if the device shows an arrhythmia, there is a reaction, such as reporting the problem to a family doctor, who should enjoy great authority, the expert said. In fact, however, the condition for success, he explained, is the time and attentiveness with which patients should be treated at the level of the primary care team, because it is not just the doctor, but the entire team of medical professionals who should take care of the patient. Meanwhile, such teams are still in the realm of plans or projects, because dietitians, for example, are still "not seen" by the system.

In turn, Dr. Michal Sutkowski, president-elect of the College of Family Physicians, drew attention to the difficult realities and limitations in the work of primary care clinics, estimating that one of the main reasons for the problems is the inability of politicians to take up the challenge of changing the system holistically. - You can't reform an elephant with one ear or a piece of the trunk," he said jokingly, though by no means in a joking mood. He pointed out that there are examples in Europe of countries that have taken the task of changing the system seriously and carried out reforms, prepared by experts across political divides, implementing them consistently over many years. In Poland, Dr. Sutkowski said, "the worst part of the system is the politicians." And since it is on their decisions that the functioning of the system depends, to a huge extent - we have what we have. An example? Coordinated care. - It's a good direction and we definitely want to move in that direction, we want to develop coordinated care, but at the same time we see that there are ways to improve it, relatively easily and at little cost," he said, pointing to the area of cooperation between PCPs and AOS specialists but also representatives of other medical professions as examples. As he reminded, although these issues have been the subject of debate for years, for years we have also had a law on primary health care, which defines the tasks of the primary care physician team and also determines that issues of health education, prevention and diagnosis should be the domain of the primary care. What is missing, however, is implementation. - Why can't I, as a family doctor, order an echo heart test if I don't provide coordinated care? - he asked. In his opinion, Poland should carefully analyze how countries such as the Netherlands, Sweden, Denmark and the Czech Republic have changed their systems, strengthening the foundations.

- The paths of seniors and nurses in the system intersect very often," said Kamilla Gólcz, secretary of the Supreme Council of Nurses and Midwives, while drawing attention to the systemic problem of underestimating the competence of nurses. - We are desirable professionals in the world, she reminded, meanwhile in Poland there is no green light for nurses to work independently to a significantly greater extent. The solution is to be advanced practice nursing, which, she stressed, will provide substantial support primarily to the primary care physician in caring for senior patients receiving long-term care also at home. - Patients who are covered by nursing care are less likely to go both to primary care physicians and AOS specialists and to hospitals, she reminded. The reason is obvious - better control over how medical recommendations are followed and possible quick correction of irregularities. - However, let's remember that the nursing profession is in permanent crisis, we have a massive shortage of staff. Of the 370,000 nurses appearing in the registers, about 240,000 are working in the system," she said.

There is no doubt, however, that neither PCPs nor nurses are closest to the patient, but - pharmacists working in pharmacies. Dr. Nikolai Konstanty, vice president of the Supreme Pharmaceutical Council, spoke about how this translates into pharmacists' knowledge of patients' habits. - We see seniors at drug disposal points not only discussing medications. You exchange them! - he said, addressing the seniors' representatives sitting in the hall. Therefore, in his opinion, everything must be done to make the pharmacy - following the example of the United Kingdom - a meeting place between the patient and the medical professional, whose knowledge and competence go far beyond dispensing and selling medicines. - The use of other medical professions (other, by default, than doctors and nurses - ed.) is key to the success of systemic change, he argued, citing data that up to 60 percent of patients do not follow their doctor's recommendations for taking medications: either they do not buy them, or when filling prescriptions they do not take the drugs, or on their own they modify doses or do not take the drugs regularly. Patients are repeatedly discontinuing treatments when their test results improve. - How many times have I heard the question, "should we poison ourselves for the rest of our lives?" - admitted the expert, stressing that pharmacists are prepared to join on a larger scale, for example, in the implementation of preventive programs, not only in the area of vaccinations but also, for example, cardiovascular diseases.