Health In Aging Blog


Alzheimer’s & Brain Awareness Month

Brangman,Sharon27resized

Sharon A. Brangman, MD
Professor of Medicine
Division Chief, Geriatrics
Director, Central New York Alzheimer’s Disease Assistance Center

SUNY Upstate Medical University

Summer is definitely in full swing: the temperatures are rising, the days are getting longer, and the world is looking a bit more…purple. That may sound strange, but it’s part of a new initiative championed by the Alzheimer’s Association to commemorate the first Alzheimer’s and Brain Awareness Month this June.

In the spirit of Alzheimer’s and Brain Awareness Month, it’s important to understand what Alzheimer’s disease really is (and what it isn’t) and what you can do if you’re concerned about the condition, already living with it, or supporting someone who has been diagnosed.

Dementia and Alzheimer’s: What’s the Difference?
Alzheimer’s disease and dementia are often lumped together, but they aren’t the same thing. Dementia is the umbrella term that covers a wide range of symptoms related to loss of memory and thinking skills severe enough to affect a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of all dementia cases. Vascular dementia, which can follow a stroke, is the second most common type. Additionally, many other, often-reversible conditions like thyroid problems or vitamin deficiencies can cause dementia-like symptoms.

Despite what many people think, dementia isn’t a normal part of aging. Many people have memory loss issues—but that doesn’t mean they have dementia or Alzheimer’s. Those two conditions mean something very different, which is why it’s so important to get a check-up from a healthcare professional if you’re concerned about your cognitive abilities and the potential for developing Alzheimer’s disease. Continue reading

Multiple Chronic Conditions and You

Nancy Lundebjerg casual

I have multiple chronic conditions (MCCs). There—I’ve said it: in my mid-50s, I already have MCCs. Fortunately, nothing is life-threatening, but I do need to keep track of my arthritic toe, my eyesight, and a bit of acid reflux. My friends and I also talk about our weak bladders—likely the precursor to being incontinent later in life, but for now we are managing with the philosophy (in my case, after speaking with my gynecologist): “If there’s a bathroom, we should use it because we never know when we’ll spot another one!”

You’re probably wondering why I’m sharing all of this on the Health in Aging blog. After all, at my age I don’t yet qualify as an older adult. But thinking about all of your conditions any time you get a new diagnosis, try a new vitamin, or are prescribed a new medicine is important at any age. It’s particularly important as you get older, and the American Geriatrics Society (AGS) and the Health in Aging Foundation have tools you can use to create care plans with your providers that take into account all of your conditions and your preferences.

So just what is a chronic condition? Simply put, it’s a physical or mental condition that lasts a year or more and requires ongoing medical attention and/or limits what you can do on a daily basis. At one point, my arthritic left toe was limiting how far I could walk, which, for a New Yorker, had a big impact on my quality of life. Even now, post-surgery, the toe requires an orthotic and monitoring by my doctor. Cute little shoes are basically not an option!

MCC Tools for You
According to Medicare data, more than two-thirds of beneficiaries have 3 or more chronic conditions. If you—or someone you care for—has MCCs, the AGS Health in Aging Foundation has tools that can guide you as you work with clinicians to plan a course of care that takes into account your goals and also helps to prevent having a bad outcome. I always start with our A-Z chapters, as these provide a general overview of a topic and serve as a road map to AGS Health in Aging Foundation resources and those from other organizations. Our chapter on Managing Multiple Health Problems is based on a piece that we created to assist health professionals who are caring for older adults. You can also find other tools, including advice from Drs. Cythia Boyd and Matt McNabney.

Tools for Your Clinicians
The tools and resources that we provide on HealthinAging.org are drawn from the health professional resources of the AGS. In 2012, AGS developed “Guiding Principles for the Care of Older Adults with Multimorbidity: A Stepwise Approach for Clinicians,” which provides a stepwise approach (or one based on a series of stages or steps) for any clinician who is caring for someone with MCCs. One of our primary goals in creating this document was to help clinicians who do not have training in geriatrics and who are treating patients for one or more of their chronic conditions. This is why, with funding from the Agency for Healthcare Research and Quality (AHRQ), we created and released our MCC Geriatrics Evaluation and Management Strategies (GEMS) app this past May and are currently disseminating it to our specialty physician partners. The MCC GEMS app provides a short overview of the guiding principles for busy clinicians as well as some suggested tools that can be helpful to them in managing their older patients.

I know I need to take an active role in managing my own healthcare. That’s why I look for information from trustworthy sources whenever I have a decision to make. Having worked with leaders in the field of geriatrics and gerontology on creating HealthinAging.org, I also know that the information we provide is based on the best evidence available and that it can help you (or someone you love) make healthcare decisions that are consistent with your goals and preferences.

About the Author
Nancy Lundebjerg is the Chief Executive Officer of the American Geriatrics Society and the AGS Health in Aging Foundation.

Why the Older Americans Act is Important

The Older Americans Act and Me

After they both retired, my parents volunteered with Meals on Wheels, which delivers food to home-bound elders. Programs like Meals on Wheels have been supported through legislation like the Older Americans Act (OAA), a historic bill that was passed in 1965 to help all of us remain independent in our homes and communities as we age, but which has been overdue for reauthorization (the process by which Congress makes changes to laws over time) since 2011.

Independence is something my friends and I think about a lot now that we are in our 50s and 60s, with many of us caring for our own parents, too. We talk about how we can remain independent in our homes for as long as possible—and legislation like the OAA plays an important role in those thought processes.

As CEO of the American Geriatrics Society, I know that two important pillars to remaining independent in our homes as we age are (1) ensuring we have a workforce that is competent to care for us wherever we may reside; and (2) supporting access to home and community-based services. Many of the programs I will likely need when I am older are funded by the OAA. Recently, key legislation has been introduced by U.S. Senators Lamar Alexander (R-TN), Patty Murray (D-WA), Richard Burr (R-NC), and Bernie Sanders (I-VT) to reauthorize the OAA. In so doing, this effort will strengthen support that will address elder abuse, evidence-based disease prevention and health promotion initiatives, effective coordination of services at the federal, state, and local levels, and several other challenges confronting older Americans and their health providers.

What the OAA Supports
In this post, I want to highlight three types of services supported by the OAA that have more than likely impacted you or someone you know: nutritional services, supportive services, and programs to assist family caregivers.

These are services that currently support elders remaining in their communities. They are programs that I—like many of us—will need when I’m older.

  • The nutritional services supported by the OAA—like the Meals on Wheels programs—ensure the health and well-being of older adults by enhancing access to nutritious food at home and in the community. More than 90 percent of older adults receiving home-delivered meals from programs like Meals on Wheels say this support has helped them to remain in their own homes. In fact, Citymeals-on-Wheels, which operates in my native New York, provides 2 million meals to 18,000 older New Yorkers each year. In addition to nutritionally balanced senior meals, staff from Citymeals and volunteers also deliver vital human companionship—an important added benefit for older men and women who get to enjoy regular visits from people they know and can trust.
  • The supportive services authorized by the OAA provide flexible funding to state and local agencies to offer senior transportation programs, information and referral services, case management services, adult day care, chore services, in-home services for frail older adults, and much more. In 2009, for example, this type of support under the OAA helped communities across the country offer nearly 8 million hours of adult day care, some 28 million rides to healthcare professionals’ offices, and upwards of 29 million hours of personal care and homemaker services for older adults in need. It’s especially encouraging to see so many older adults who live alone accessing transportation services: as many of these men and women report, without this important benefit, they might otherwise be homebound.
  • The OAA-funded National Family Caregiver Support Program (NFCSP) helps older adults age in place by promoting family caregiving and reducing reliance on institutionalization. Specifically, the NFCSP provides grants to states and territories, based on their population aged 70 and older, to fund a range of supports that assist family and informal caregivers who help older adults live at home for as long as safely possible. More than 75% of caregivers participating in programs supported by this provision of the OAA say these services have enabled them to provide care longer than would have been possible otherwise, and an astounding 89% of caregivers reported that program services helped them to be better caregivers.

These are but a few of the vital safety net programs supported by the OAA. They’re programs that matter because I’m a caregiver, but also because I know we can all benefit from their sustained support as we grow older. Reauthorizing the OAA is essential to that future reality, and I know that it will take all of us to make that possible moving forward.

So—what can you do?
Well, visiting our Health in Aging Advocacy Center is a great first step. It has lots of easy-to-use resources that can help you get in touch with your Senators and House Representative to make sure that your voice is heard as we look toward a future with an even stronger OAA—one that we helped shape here and now!

 

National Nurses Week 2015: Celebrating Profiles of Geriatrics in Nursing—Terry Fulmer

TF-cropped-photo-by-andy-camp-webTerry Fulmer, PhD, RN, FAAN, AGSF
President, The John A. Hartford Foundation
University Distinguished Professor and Dean
Bouve College of Health Sciences, Northeastern University

The field of geriatrics relies on so many different healthcare professionals to provide expert, high-quality, patient-centered care for older adults. In honor of National Nurses Week 2015 (May 6-12), we’re celebrating the commitment of nurses committed to elder care by helping them share their stories in their own words. Here’s what Terry Fulmer—the new president of The John A. Hartford Foundation and a professor of Public Policy and Urban Affairs at Northeastern University—had to say about her career as a gerontological nurse practitioner.

It was her first experience as a nurse that convinced Terry Fulmer the best part of nursing was caring for older patients. Fresh from Skidmore College, where she earned her BS in Clinical Nursing in 1975, Dr. Fulmer had just started working as a staff nurse at Boston’s Beth Israel Hospital, one of Harvard’s teaching hospitals.

“I discovered in the midst of this remarkable teaching hospital that I had this incredible autonomy and authority when working with the older patients,” says Dr. Fulmer, whose mother was a nurse and who decided (at age five) that no other profession could possibly be more exciting or satisfying. “Older adults often need help with activities of daily living, and when they’re very ill, they often need help with geriatric syndromes such as incontinence, confusion, and falls, and that’s all in the domain of nursing care,” she continues. “A physician might diagnose those problems but it’s the nursing practice that creates a care plan to address them. With older patients, the most important component of care, by far, is nursing care. It’s very motivating.”

After recognizing that geriatric nursing was for her, Dr. Fulmer’s first step was to go back to school. While working at Beth Israel, she earned her Master’s degree at Boston College and started her doctorate. Before she’d even finished her PhD she was offered and accepted a position as assistant professor of nursing at the college, where she both taught and began doing research into the detection and prevention of elder abuse and neglect. Dr. Fulmer, who was soon promoted to associate professor, also headed the Beth Israel Hospital Elder Abuse Committee.

Elder abuse remains a focus of Dr. Fulmer’s research and is among several areas in which her work has had considerable impact. In addition to publishing scores of papers, sitting on key panels, and training healthcare professionals to detect abuse and neglect, Dr. Fulmer also played a key role in the development of the Elder Assessment Instrument, a screening checklist now used nationwide.

“I’ve had families call and say that because of our work in this area, they recognized elder abuse in their families,” says Dr. Fulmer. “I’ve also had nurses tell me they’ve been able to help patients because of our work. And I’ve heard from promising young scientists in nursing, medicine and other disciplines that they’ve been impressed by the work and want to carry it on. That’s even better.”

Along with clinical care and research, teaching and training have always been Dr. Fulmer’s passions. “Working with students, every day there’s an ‘Aha!’ moment when they know they’re improving the quality of life for their patients,” Dr. Fulmer says. “You might show a student nurse how to provide excellent mouth care for an older adult who, as a result, is able to eat more nutritiously. It’s amazing. All of a sudden there’s this profound moment when you help them understand how pivotal their work is.”

“You know, I have the same passion today that I had when I started,” adds Dr. Fulmer.” I can’t imagine anything I’d rather do than care for older patients and teach others to do the same.”

National Nurses Week 2015: Celebrating Profiles of Geriatrics in Nursing—Phyllis J. Atkinson

Phyllis_Atkinson

Phyllis J. Atkinson, RN, MS, GNP-BC, WCC
Gerontological Nurse Practitioner

The field of geriatrics relies on so many different healthcare professionals to provide expert, high-quality, patient-centered care for older adults. In honor of National Nurses Week 2015 (May 6-12), we’re celebrating the commitment of nurses committed to elder care by helping them share their stories in their own words. Here’s what Phyllis J. Atkinson had to say about her career as a gerontological nurse practitioner.

Phyllis Atkinson remembers, vividly, the day she started rethinking her career in nursing. A critical care nurse, Atkinson was working at a small hospital in Ohio at the time. One morning, an elderly man was admitted to the Intensive Care Unit. He was very frail and gravely ill.

Though it was clear that the man didn’t want invasive procedures or treatments—he resisted with the last of his strength—the ICU team followed protocol and proceeded to restrain and treat him.

“We did all these invasive things to this gentleman, who eventually died,” Atkinson recalls. “I witnessed how he died: It was a death with literally no dignity. And I realized there was something we didn’t understand, something that we could be doing differently to provide him and others like him with more dignity at the end of their lives. I also realized that I wanted to know how older people differ from younger people, and that I wanted to be an advocate for them.”

That realization ultimately led Atkinson to become a geriatric nurse practitioner, a GNP.

Growing up in northwestern Ohio, Atkinson planned on a career in medicine right from the start. She was the kind of kid who asked for chemistry sets for Christmas and caught and dissected frogs to teach herself anatomy. After finishing high school, she completed a three-year nursing diploma program at Toledo Hospital School of Nursing. To become a GNP, she then had to earn her Bachelor’s in Nursing, and then her Master’s. She did both at Ohio State University . Meanwhile, she continued working in hospital ICUs while she and her husband raised their son and daughter. In 1993, she was one of the first to graduate from Ohio State’s newly established GNP program.

Drawn to critical care because of the highly demanding nature of the work, Atkinson found geriatrics even more demanding—and satisfying.

“Geriatrics is more challenging than critical care for a number of reasons,” says Atkinson, 48, who now manages a team of 10 nurse practitioners caring for older adults in nursing homes in the Cincinnati area. She’s is a part-time adjunct professor at Northern Kentucky University, where she teaches geriatrics to nursing students. Among other things, older adults often have multiple, chronic health problems, which makes their care more complex, she says. In addition, geriatrics emphasizes the importance of collaborating closely with the patient—to ensure that his or her treatment isn’t only effective, but that it’s also what he or she wants.

Despite the coming Age Boom, interest in GNP programs lags in part because many universities discourage NPs from specializing, lest this limit their marketability, Atkinson says. Students’ misconceptions about geriatrics also play a role, she adds. “They think it’s not going to be challenging, so I tell them that I know from experience that this is even more challenging than critical care,” she adds.

Looking back at her career in geriatric nursing, Atkinson says she has no regrets about switching from critical care. She offers an anecdote to illustrate why. The anecdote is also about an older adult at the end of life, but it differs dramatically from her experience with the elderly man whose death marked a turning point in her career.

“We had this one patient who was in end-stage dementia,” says Atkinson. “She had severe complications from diabetes and one of her physicians recommended bilateral amputations of her extremities. But her family decided they didn’t want to hospitalize or amputate, but to focus on palliative comfort care instead. So we worked with them to reassure them that they knew what was best for her. We had multiple meetings; we called them almost daily until she died. I can’t tell you how rewarding it was to support them in making decisions that focused on the quality of this woman’s life at the end of her life.”