How Older Patients Can Dodge Pitfalls Entrenched In The Health Care System

By Judith Graham
This article originally appeared on Kaiser Health News
It can be found here: https://khn.org/news/how-older-patients-can-dodge-pitfalls-entrenched-in-health-care-system/

Doctor talking to elderly couple in doctors surgery

(Sally Elford/Ikon Images via Getty Images)

Being old and sick in America frequently means a doctor won’t ask you about troublesome concerns you deal with day to day — difficulty walking, dizziness, a leaky bladder, sleep disturbances memory lapses, and more.

It means that if you’re hospitalized, you have a good chance of being treated by a physician you’ve never met and undergoing questionable tests and treatments that might end up compromising your health.

It means that if you subsequently seek rehabilitation at a skilled nursing facility, you’ll encounter another medical team that doesn’t know you or understand your at-home circumstances. Typically, a doctor won’t see you very often. In her new book, “Old & Sick in America: The Journey Through the Health Care System,” Dr. Muriel Gillick, a professor of population medicine at Harvard Medical School and director of the Program in Aging at Harvard Pilgrim Health Care Institute, delves deeply into these concerns and why they’re widespread.

Her answer: a complex set of forces is responsible.  Some examples:

  • Medical training doesn’t make geriatric expertise a priority.
  • Care at bottom-line-oriented hospitals is driven by the availability of sophisticated technology.
  • Drug companies and medical device manufacturers want to see their products adopted widely and offer incentives to ensure this happens.
  • Medicare, the government’s influential health program for seniors, pays more for procedures than for the intensive counseling that older adults and caregivers need.

In an interview, Gillick offered thoughts about how older adults and their caregivers can navigate this treacherous terrain. Her remarks have been edited for clarity and length:

Q: What perils do older adults encounter as they travel through the health care system?

The journey usually begins in the doctor’s office, so let’s start there. In general, physicians tend to focus on different organ systems. The heart. The lungs. The kidneys. They don’t focus so much on conditions that cross various organ systems, so-called geriatric syndromes. Things like falling, becoming confused or dealing with incontinence.

Q: What can people do about that?

Older people are often unwilling to bring these issues to the attention of their doctors. But if a family member is accompanying the patient, they should speak up.

In some practices, a nurse practitioner may be more attuned to these issues than the physician. So, it’s a good idea to learn who in the medical office you go to is good at what.

Another approach is to request a geriatric assessment or consultation that will bring these issues to the forefront.

Q: How do geriatric assessments work?

A geriatric assessment does two major things. It looks at the whole person. And it focuses on that person’s functioning — on what they can do. Can they dress themselves, walk, get to the bathroom? Can they cook meals? Take a bus downtown? Balance their checkbook?

An outpatient geriatric assessment is typically 1½ to two hours and conducted by an interdisciplinary team. A social worker or a mental health professional will ask about the person’s family situation. Are they living alone? Do they have support? A nurse practitioner will look at physical function. And a physician will go over medical concerns and examine the cognitive performance of the individual. Then, the team pulls all these pieces together to look at what’s going on with that person.

When someone starts being frail — having consistent difficulty doing things — an assessment of this kind is often a good idea.

Q: The next step you talk about in your book is the hospital.

One of the big perils in the hospital is technology, which is also its great virtue.  Technology can improve quality of life and be life-extending. But, sometimes, it creates endless complications.

An example are imaging tests such as CT scans. Physicians hardly think of this as an invasive test. But often one has to administer a dye to see what’s going on.  That dye can cause kidney failure in someone with impaired kidney function — something that’s common in older adults.

Sometimes there’s no real need for scans. An example would be an older person who becomes acutely confused in the hospital, which happens a lot. The appropriate response is to look at what’s causing the confusion and take away the offending agent. Often, that’s a medication that was started in the hospital. Or, it’s an infection. But the routine knee-jerk reaction is to do a CT scan to rule out the possibility of a stroke or bleeding in the brain.

For the most part, doctors want to do whatever it takes to diagnose a problem.  For younger patients, this may make sense. But for frail older patients with multiple medical conditions, a cascade of complications can result.

Q: What do you advise older patients and their families do?

When a test is proposed, ask the doctor “how important is it to pursue this diagnosis” and “how will the results change what you do?”

It’s also reasonable to say something along the lines of “every time I’ve had a test, it seems like I get into some kind of trouble. So, I really want to know, with this test or this treatment, what kind of trouble could I get into?”

Q: In your book, you talk about how a doctor-patient relationship can be sidelined when someone goes to the hospital. Instead, hospitalists provide care. How should people respond?

It’s really important to give that doctor a sense of the patient and who they are.  Say, your 88-year-old mother is in the hospital, and she’s become profoundly confused. The doctor doesn’t know what she was like a week or a month ago. He may assume she has dementia unless he hears otherwise. He won’t understand it might be delirium.

You or a caregiver want to come across as someone who can make it easier for the doctor to do his or her job — versus someone who’s a nuisance. You want to build trust, not annoyance.

Q: What about skilled nursing facilities?

These are settings that people go to after the hospital, to get rehabilitation.  Typically, the contact with doctors is minimal after an initial evaluation, though there’s a spectrum as to how much medical care there is.

A subset of older adults go to rehab just to get physical therapy after they’ve had a joint replacement or a hip fracture. They are really pretty stable, medically. If they get good physical therapy and nursing care, it’s probably OK that the doctor isn’t around much.

But there are also older patients who come to skilled nursing facilities, or SNFs, after having had one complication after another in the hospital. These patients can be very fragile, with many medical problems. They’re at risk of getting some new problem in the SNF — perhaps an infection — or an exacerbation of one of the problems they already have that hasn’t resolved.

Q: What do you recommend?

When you arrive at an SNF, it’s a new cast of characters. A physician whom you’ll see fleetingly. Nurses. Physical therapists. Aides. If you’re a caregiver, make sure you have face-to-face time with these staffers.

SNFs are required within the first week or so to have a care planning meeting with the team. They’re supposed to invite patients and their representatives to the meeting. This is a good place to say something along the lines of “My mother has been through a lot, and now that we’ve met you and seen what you can do, we’d like you to do your best to treat her here and not send her back to the hospital.”

You have to have trust to make that happen. The family has to trust the medical team. And the team has to trust that the family isn’t going to get upset and sue them. A meeting of this kind has the potential to allow everyone to figure out what’s important and what the plan will be going forward.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN’s coverage related to aging and improving care of older adults is supported in part by The John A. Hartford Foundation.

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6 Surprising Signs Of Dementia

MARKHAM HEID

This article originally appeared on prevention.com

Lovely grandmother

Not feeling like your usual, upbeat self? Your cloudy mood may be a sign a bigger storm is brewing. Depression appears to be one of the earliest symptoms of dementia—a symptom that settles in well ahead of any memory problems, shows a new Neurology study.

The study team asked about 2,400 healthy adults (all over age 50) to answer questions about their mental and physical health. After 7 years, the researchers followed up to find out how many people had developed signs of dementia.

The people who’d started showing signs of dementia during those 7 years were twice as likely to have reported feeling depressed at the start of the study. It’s possible the underlying causes of depression may be wrapped up with the underlying causes of dementia and Alzheimer’s, the study authors say—though they’re quick to point out that hasn’t yet been proved. In fact, many of the non-dementia sufferers—nearly 15%—also showed signs of depression at the start of the experiment. So while feeling down in the dumps is worth keeping an eye on if you’re concerned about dementia (and your overall quality of life), it’s far from a sure sign the disease will settle in.

Here are five more surprising early signs of dementia—be sure to tell your doctor if any of these sound familiar.

Your taste buds change.
Big shifts in the kinds of foods you crave—especially a newfound preference for sweets—is another early warning sign, finds a Japanese study. The researchers say disease-related changes to the parts of your brain that control your taste buds and appetite may explain their findings. Some of the dementia sufferers in their study were even known to eat expired or rotten food.

You’ve started claiming “five-finger discounts.”
New criminal behaviors—stealing, trespassing, driving violations—may be an early sign of dementia, especially a front-brain variation of the disease called frontotemporal dementia (FTD). Research published in JAMA Neurologyfound breaking bad was the first sign of dementia in 14% of those suffering from FTD. The disease attacks the part of your brain that helps you recognize and respect social rules and conventions, which may explain the criminal behaviors, the authors say.

Sarcasm is lost on you.
Can’t tell when someone’s pulling your leg? An inability to detect lies, sarcasm, and other forms of “insincere speech” is another early symptom, suggests research from the University of California, San Francisco. The study authors say the disease messes with parts of your brain that spot and interpret “higher-order” verbal information.

You’re slowing down—physically.
A decrease in walking speed can precede any cognitive symptoms of Alzheimer’s. New research suggests beta-amyloid buildup in the brain may be to blame. Those pieces of protein form the hallmark plaques thought to spur Alzheimer’s-related damage in the brain. In the latest study, published in Neurology, researchers tested the walking speed and scanned the brains of 128 people with an average age of 76 and found a link between beta-amyloid buildup and a slower gait. In fact, they estimate that beta-amyloid accounts for as much as 9% of the difference in people’s walking speed.

You’ve become a pack rat.
Hoarding and other compulsive, “ritualistic” behaviors have been linked to dementia, shows research from the University of California, Los Angeles. For example, buying a newspaper every day and saving it but never reading it is one example of the sort of new, compulsive behavior that may signal the onset of dementia.

 

 

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Retirement Roommates: Were ‘The Golden Girls’ Right?

older women roommates

Learning boundaries — and understanding what a roommate is and isn’t — is important

By Lori Martinek

(This essay was originally published in SixtyandMe.)

Many of us share common fears as we enter retirement. We fear financial challenges, failing health and feelings of disconnectedness as we grow older. The good news is that there is one strategy which can help us effectively face all three — living with roommates.

Shared housing is an age-old concept that is becoming the latest housing trend. More than a third of boomers are single and most of those flying solo are female. Living alone is expensive and simply beyond the reach of many single retirees.

Living alone can also prove to be isolating and lonely. Neighbors don’t necessarily become support systems. Housemates often do. We all have fond memories of watching Blanche, Dorothy, Rose and Sophia bond (for better or worse) on The Golden Girls TV series in the late 1980s.

Embracing the idea of retirement with roommates opens the door to affordable shared housing options. You’ve done it before (which is why you may be cringing as you think about being in a roommate situation again). Likely, you gained something from that experience. Retiring with roommates makes sense on many levels.

The Benefits of Living with Roommates in Retirement

First and foremost, it is cheaper to live with other people. You share housing costs, utilities and often food. If you own a large home, you can offset the cost of maintaining it by taking on roommates. You get to age in place and your roommates gain a more affordable way to live.

There’s something to be said for having friendly faces around instead of empty rooms.

There will be other people to share chores and responsibilities and to provide a helping hand when needed.

It is more likely that someone will be around to help if you take a fall, to notice if you don’t come home or to call 911 when necessary. This can provide real peace of mind.

There is a sense of security that comes with having roommates — and not just when you hear a noise in the middle of the night. You gain companionship and people to potentially share holidays and special occasions with. Your circle will grow, as you meet the friends and family that roommates bring to the equation. Only you can decide if that is desirable or not.

A sense of community is good for your mind, body and spirit. We need people around us to offer advice or support, provide social interaction, get us out of the house and push us to try new things. Living with other people is one way to create such a valuable support circle.

The Challenges of Living with Others

There are, of course, challenges to living with other people. Collaboration and cooperation are key to a successful house sharing arrangement. People who live together need to maintain healthy boundaries and respect privacy.

Roommates are not surrogate spouses or friends. They are not caregivers, chauffeurs or home health providers. They are your partners in a living arrangement. Perspective is key.

An ability to respect other opinions, religions, world views and lifestyles is essential. Most of us have lived with a roommate at some point in our lives (at camp, college or in the military) and we know how challenging it can be. We’ve also learned from those experiences, and potentially have more to offer (and gain) in a shared housing arrangement as adults.

Making Shared Housing Work

A written (and signed) rental agreement is essential to outline house rules, shared responsibilities for rent, related bills and household chores and to help maintain harmony between housemates. Private and shared spaces in the home should be clearly outlined. Policies regarding visitors, overnight guests and quiet time are important.

Potential roommates should provide references and undergo a background check at minimum, and be introduced to their potential housemates if possible. People who interact well with each other in a social setting are more likely to get along as house partners.

As with many things in life, it’s the ingredients which lead to a successful outcome. The ideal roommates should share some similarities and interests, but also bring unique strengths to the table. Maintaining a home requires many different talents, including cooking, gardening, handyman skills, painting, pet sitting, bookkeeping or working with contractors.

Being able to make a unique contribution to the household will help each housemate feel needed and appreciated, and learning from each other can be a great bonding experience.

 

Traxx Mobility Systems Titan 500 is a freestanding overhead patient lift for home care.  It allows a single caregiver to safely transfer a patient without injury.  Visit our website, find us on Facebook and watch our YouTube channel.