TUESDAY, Oct. 7 (HealthDay News) -- End-of-life discussions between a doctor and a terminally ill patient do not result in more distress for patients. In fact, they result in less aggressive medical interventions and enhanced quality of life in a patient's final days, a major new study found.

"For the past two decades, the debate has been around when, whether and how to have end-of-life conversations, but it wasn't clear if it was worth it," said study lead author Dr. Alexi A. Wright, a hematology-oncology fellow and research scholar at the Center for Psycho-Oncology and Palliative Care Research, both at Dana-Farber Cancer Institute in Boston. "This study is the first to look at outcomes and quality of life."

"A lot of doctors are afraid they will rob patients of hope if they have these conversations," Wright added. "But there's the possibility that the patient may be robbed of the opportunity to make informed decisions and live the life they want."

Experts had been concerned that such conversations might increase a patient's despondency and anxiety. This left doctors and other health-care providers relying heavily on avoidance tactics.

For the new study, the researchers interviewed 332 pairs of dying patients -- all of whom had advanced cancer -- and their informal caregivers. The median time from enrolment in the study to death was 4.4 months. The caregivers' psychological state and quality of life was assessed about 6.5 months after the patient's death.

At the start of the study, 37 percent of the patients said they'd had end-of-life discussions with their doctor. Contrary to expectations, these talks did not increase the rates of depression or worry.

And those patients who did have such talks with their physician had lower rates of ventilation (1.6 percent versus 11 percent); resuscitation (0.8 percent versus 6.7 percent) and admission to the intensive care unit (4.1 percent versus 12.4 percent). These patients also enrolled in a hospice earlier; longer hospice stays were associated with better quality of life, while aggressive medical care had the opposite effect, the study found.

Meanwhile, caregivers were significantly less likely to experience major depressive disorders if the loved one did not die in an intensive care unit.

One previous study, published last year in the New England Journal of Medicine, had found that when doctors spend 10 minutes more than usual listening to the families of people dying in the intensive care unit and provide them with a brochure on bereavement, those family members are far less likely to suffer from stress, anxiety or depression after the death of their loved one.

"This really highlights the importance of patients having end-of-life discussions with a health-care professional," said Dr. Robert McCann, professor of medicine at the University of Rochester School of Medicine and Dentistry and chief of medicine at Highland Hospital in Rochester, N.Y. "Just by having discussions -- we don't know anything about the quality of the discussion or what was said -- led patients to better choices, things that would make a bigger difference in quality of life."

For the physician, Wright said: "It's important to have a healthy dose of empathy and frank truth, ask the patient if they have thought about what this really means. Mental and physical health often deteriorate rapidly at the end, and this can leave health-care providers and loved ones wondering what the patient would have wanted."

More information

The National Hospice and Palliative Care Organization   has more on end-of-life care.

FRIDAY, Oct. 3 (HealthDay News) -- Cataracts used to be terrible to treat.

Removing them meant stitches in your eye and days spent recuperating. And artificial replacement lenses only came in one power, which meant eyeglasses for most recipients.

But those days are over.

Cataract surgery has been honed to the point where it's now done on an outpatient basis, and people are back seeing in no time at all with vision often much improved over what they had -- even before their lenses clouded up.

"We don't usually have to put a single stitch in the eye," said Dr. Jim Salz, a clinical professor of ophthalmology at the University of Southern California and a spokesman for the American Academy of Ophthalmology. "We make an incision that seals itself. Recovery is much quicker and much more painless."

And many patients aren't only back seeing, they're seeing better than ever, thanks to advances in artificial lenses that more closely mirror normal vision.

"Cataracts are the most common operation performed anywhere in the body in the United States," said Dr. David F. Chang, clinical professor of ophthalmology at the University of California, San Francisco, and chairman of the American Academy of Ophthalmology's Cataract Preferred Practice Pattern Committee. "We're now approaching three million cataract surgeries performed annually, and there have been many improvements in the techniques."

A cataract is a clouding of the eye's lens. Most cataracts are related to growing older, and by age 80, more than half of all Americans either have a cataract or have had cataract surgery, according to the U.S. National Eye Institute.

Some cataracts occur when the proteins that make up much of an eye's lens begin to clump together and start to cloud a small area of the lens. Over time, the cataract can grow larger and cloud more of the lens, affecting vision.

Other cataracts involve the normally clear lens slowly changing to a yellowish or brownish color, which adds a brownish tint to vision.

Researchers don't know exactly why a lens changes with age. One possibility is damage caused by unstable molecules known as free radicals. Smoking and exposure to ultraviolet light are two sources of free radicals. It also could just be general wear and tear on the lens over the years that causes changes in protein fibers, according to eye experts at the Mayo Clinic.

Most cataract surgeries are performed using a procedure known as phacoemulsification. A tiny incision, usually smaller than 3 millimeters, is made on the side of the cornea -- the clear, dome-shaped surface that covers the front of the eye -- and a tiny probe is inserted into the eye. The device emits ultrasound waves that break up the cataract.

"We break the cataract up into small pieces that are sucked out through this tube with very little discomfort to the patient," Salz said. "The surgery can be over anywhere from 10 minutes to 30 minutes. They have very little discomfort, and then they go home. Patients used to be hospitalized for three or four days, with stitches in their eye."

But the truly revolutionary innovation comes into play once the cataract has been removed. Recent breakthroughs have given patients a number of options for replacement lenses that can make their eyesight as good as new.

"In the past, we would take the cataract out, put an implant in, and the patient would have better vision than they'd ever had in their life," Salz said. "But they would still need glasses to read."

That changed about four years ago, when companies began producing artificial lenses that could mimic the eye's ability to see both near and far.

"The multifocal lens is a lens with a special optical design that provides some focus at distance and some focus up close, and therefore reduces the necessity to wear glasses as much," said Chang, who's also chairman of the American Society of Cataract & Refractive Surgery's Cataract Clinical Committee.

"The lens is creating two focal points at any given time," Chang added. "It's like we're here talking, and there's music playing in the background. At any point, you could tune me out and listen to the music, or you could pay so much attention to what I'm saying that you're not aware of the music at all."

Another type of lens is designed to move and flex in response to the eye muscles that control focus. "Unfortunately, it doesn't allow them to focus from the farthest pint to the nearest point, like a young person's lens," Chang said. "But compared to the conventional lens implants, it again provides more range of focus, allowing the patient to wear glasses less."

There remains one significant barrier to access to these new technologies -- cost.

Medicare will cover cataract surgery with standard replacement lenses, but the newer and more revolutionary lens designs are considered luxury items, Salz said. Patients may have to pay $800 to $900 for the additional cost of the lens implant, and another $700 to $1,500 extra to the surgeon, he said.

More information

To learn more about cataracts, visit the American Academy of Ophthalmology  .

THURSDAY, Sept. 25 (HealthDay News) -- Voice and swallowing problems aren't a normal part of aging, but many seniors with these conditions don't receive treatment, even though they may suffer serious quality-of-life issues such as anxiety, depression and social withdrawal, say Duke University Medical Center researchers.

They surveyed 248 octogenarians and found that almost 20 percent had dysphonia (hoarseness, weakness or loss of voice), and 14 percent had dysphagia (difficulty swallowing). The Duke team also found that 77.6 percent of those with dysphonia and 79.4 percent of those with dysphagia had not sought treatment, even though 55.9 percent of them expressed interest in getting help.

Half of those surveyed weren't aware there are treatments for dysphonia and dysphagia.

The findings were presented at the annual meeting of the American Academy of Otolaryngology--Head and Neck Surgery, in Chicago.

"Voice and swallowing issues are serious concerns, and people who want medical care are not getting it," study author and otolaryngologist Dr. Seth Cohen said in a Duke news release.

"Is it because they have so many medical problems, and these issues are getting pushed aside or overlooked? We don't know. What we do know is these medical concerns have a huge impact on quality of life, and more people should be aware of treatments available and be able to obtain them," Cohen said.

Previous research has suggested that almost 25 percent of seniors believe voice and swallowing problems are a normal part of aging. This belief is even more common among seniors with voice and swallowing problems. This attitude may lead some elderly people to simply accept these conditions and not seek treatment, said the Duke researchers.

"Our results highlight the need for better education of the general public and primary-care providers," Cohen said. "Whether this effort leads to increased awareness and/or better outcomes for these patients is the basis of further study. But, for now, we know these problems have a significant negative impact on quality of life, and obtaining appropriate treatment can make a big difference."

More information

The American Academy of Otolaryngology--Head and Neck Surgery has more about voice and aging  .