Health In Aging Blog


“The Four M’s” of Caring for an Older Adult with Dementia

Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio

Your older relative has just been diagnosed with dementia. Your head is spinning with questions, concerns, fears, and yes, disbelief.  Still, you want to know all you can. If you are going to be a caregiver, you want to be a good one. So, where to start?

Start with the things that, if not managed well, have the greatest chance of getting your relative into trouble! Start with “The Four M’s.”

 

Meals
From planning to shopping to preparing, meal preparation is a very complicated task—for someone with a memory problem. You may notice that the older person is losing weight, that they eat little at home but eat well when they go out to eat, or that there is spoiled food in the refrigerator.

Try: Have simple foods – especially your relative’s favorite ones – around the house, such as sandwiches, soup, and cereal. Bring in ready meals that just need to be microwaved. Consider arranging for home delivered meals. Try to make meal time a social time when possible. Ask friends, church and family members to stop in and stay during meals.

Medicine
Medication management can also be overwhelming and older adults are often taking 10 or more medications, including over-the-counter ones.

Try: Discuss simplifying the regimen with the primary healthcare provider. Are all medications still necessary, and how many can be given just daily? Set up the medicine in a “days of the week” pill box and monitor if they are being taken. Call daily to remind. Consider hiring help for in-person reminders. Take over the refill tasks. Continue reading

Medication Adherence: A Tough Pill to Swallow

KIM MOON - KimPick1 - webresKimberly Moon, PharmD
Clinical Pharmacist

Blue Cross Blue Shield of Michigan David2


David Dadiomov
Doctor of Pharmacy Candidate
University of Michigan
College of Pharmacy

 

The number of Americans with chronic medical conditions is increasing, which means that chronic medication use is playing a larger role in their lives. The World Health Organization estimates that 157 million Americans will require medications for at least one chronic disease, such as high blood pressure, high cholesterol, or diabetes. Luckily, treatments exist for these diseases that prolong life and improve quality of life as well. Medications can help improve medical conditions when they are taken as prescribed.

Taking medications improperly not only affects people who take these medications, but is also costly for our entire health care system. Medication non-adherence leads to 1/3rd of all medication-related hospitalizations and about $300 billion in avoidable costs. It is clear that medication non-adherence is a huge problem; several common concerns may be responsible for this issue.

“I’m worried about cost”
Cost is an important factor for those that take medications. When people first get placed on medications it is a relatively unexpected cost that they must now budget for. Luckily, many oral medications for management of blood pressure, cholesterol or diabetes are available as affordable generic medications. These medications are on the most affordable level of co-payment on most health plans, but even those without insurance may still benefit from pricing at various pharmacies that offer these medications at a low cost. For those who are prescribed expensive medications, most drug manufacturers have patient assistance programs to help with medication costs for those who qualify. Also, taking a long-term perspective is important. The daily cost of most medications is certainly less than the cost of a hospitalization due to a heart attack, stroke, or dialysis due to kidney damage.

“I’m concerned about the side effects”
No drug is without side effects. Luckily, for most people, side effects are minimal and medications are generally well tolerated. Sometimes certain side effects may prevent people from taking their medications as prescribed. Often a pharmacist’s recommendation on medication use or management of side effects can help alleviate concerns. For instance, certain medications should be taken with food, or at a certain time of day. Other medications may have side effects for the first few weeks, but then go away. It is important to ask questions when being prescribed a new medication and calling the pharmacist with questions about the medication or how to take it. Keeping a clear line of communication is important to medication adherence.

“I take too many pills”
Taking several medications is often discouraging for people, and may make it hard to remember to take them at the correct times. A pill box for each day of the week can help manage medications and at the very least, help see how many doses were missed during the week. Many medications are available in a once-daily formulation or even in a combination with another routine medication to reduce the total number of pills taken per day. Again it is important to talk with your prescribing healthcare provider and pharmacist.

“I don’t feel I need my medications”
People with conditions such as high cholesterol don’t have symptoms, so they could feel medications for this condition are not needed. It is important to remember that medications that lower cholesterol are important in reducing the 10-year-risk of developing a heart attack or stroke. People may not “feel” the medicine working, but research studies show taking medications as prescribed can help reduce risk of heart attack or stroke. Remember: Having high blood pressure or diabetes may not always make you feel like there is anything wrong with you, but these diseases can damage your kidneys and lead to kidney disease that may require dialysis.

Questions to ask the pharmacist:

  • How am I supposed to take this medication?
  • What is this medication used for?
  • How does this medication work?
  • What can I expect with this medication?
  • How will I know this medication is working?

 

Integrating Community Programs in Healthcare: A Personal Experience of Health Professionals Sharing a Lot More than Lunch!

Michael Malone, MD
Professor of Medicine and Section Head of Geriatrics
University of Wisconsin School of Medicine and Public Health
Medical Director

Aurora Senior Services and Aurora at Home

Two years ago, members of Milwaukee’s Aurora Health Care geriatrics program where I work began doing something different for lunch. The geriatrics fellows (who are learning to be experts at caring for older persons with multiple chronic illnesses) started to share meals once a week with the nurses, social workers, and teaching doctors who also work with the patients we serve. The fellows and faculty enjoyed helping each other overcome struggles in providing “best care” for vulnerable older individuals. Over shared meals, physicians started reaching out to social workers and others at the table to get input, feedback, and recommendations. This was particularly helpful, as many of the challenges our doctors have encountered centered on the social aspects of a patient’s needs and where and how to find appropriate support.

Creating a Network to Achieve “Best Care”
Gradually, we started to use these lunches to discuss cases more formally. We would discuss patient needs in five specific areas: 1) medical needs, 2) medications, 3) social needs , 4) psychological needs, and 5) how patients understood and perceived their own illnesses. The in-person discussions have given our physicians, nurses, and social workers a chance to develop working relationships with one another. We’ve all developed a better understanding of programs provided by the ADRC, and our patients are better served as we work together.

Importance of the Older Americans Act
As I reflect on how our clinic serves older individuals in Wisconsin, I’m struck by the importance of integrating community programs into health care. The Older Americans Act (OAA), for example, provides for caregiver support, health promotion, meals, and transportation for vulnerable elders. Our sharing and learning together during lunch has resulted in a better understanding of the whole person (physical, mental, social needs), and how that person supports and is supported by a community shaped in one way or another by initiatives like the OAA. Reauthorizing the OAA represents an important opportunity to help modernize and improve the aging services network to meet the needs of our nation’s older adults.

Among other objectives, the bill aims to address

  • Elder abuse;
  • The importance of evidence-based care;
  • The effective coordination of services at the federal, state, and local levels; and
  • Several other challenges confronting older Americans and their health providers.

These are topics I hope to discuss at lunch with colleagues for many years to come not only because they are important but also because they can be addressed—effectively, reliably, and equitably—through sustained support of the OAA. I’d encourage you to do some digging of your own regarding legislation that supports older Americans—you might be surprised at just how expansive public support for healthy aging has become, but also how vital it will be to ensure this support not only remains constant but also shifts to reflect new realities as more and more of us turn 65.

The Older Americans Act Reauthorization Act of 2015 was approved by the U.S. Senate last week and has now been sent to the House of Representatives for a final vote.  You can help support swift passage of this important legislation by writing to your Representative to encourage her to stand behind the important services that the OAA provides.  Visit the Health in Aging Advocacy Center for more details.

About the Author
Dr. Malone is the Chair of the AGS Public Policy Committee.

Finally summer! Time to get some sunshine!

Syed picQuratulain Syed, MD
Assistant Professor of Medicine,
Division of General Medicine and Geriatrics,
Emory University School of Medicine

Now that the long, harsh winter is over and the Sun has finally decided to shine on people living beyond Florida, it’s time to take advantage of the warm weather while it lasts. So ladies and gentlemen, let’s head out to lose the pounds you put on eating your favorite pies the last holiday season.

Outdoor activities have many health benefits, including helping your body make vitamin D, losing unwanted pounds, helping lower your blood pressure, and keeping your heart healthy. While outside, it’s important to take some precautions to avoid getting sick from excessive heat exposure. Here are some tips to help you enjoy the sun:

  • Walk in the early morning (before 10am) or late evening hours (2-3 hours prior to sunset) to avoid excessive heat exposure.
  • Keep a bottle of water with you and sip from it while you are out to avoid getting dehydrated.
  • Wear light colored, loose fitting, and lightweight clothing (such as cotton).
  • Get your hats out and wear them. You get to show them off and avoid the direct heat of the sun.
  • To prevent sunburns and skin cancer, buy sunblock lotion or spray from your local pharmacy and apply it liberally on all exposed parts of your body.
  • Choose pavement or a shaded trail in a park to walk on. Make sure to select a trail which is clean and even, to avoid stumbling on slippery stones and rocks. If you have been under trees and walked through grass, check for ticks on your skin and in skinfolds. Ticks prefer to be in hot moist areas. Also check your scalp after you get home. Have a healthcare provider remove the tick if you find one attached to your skin.
  • Try going to an indoor shopping mall to walk. However, if you love to shop, you might want to leave your credit card at home!
  • Be mindful of your surroundings and be sure to walk in well-lit, clean, and safe walking spaces. Let someone know where you are going and when you expect to return. Take your cell phone with you!
  • Water exercises are a great way to stay in shape for everyone, including people with joint aches and arthritis who can’t walk or run long distances. If there is a swimming pool available at the community center near you, ask about their water exercise schedule. If there are no water exercise classes, put your swimsuit on and walk from one shallow end to the other.
  • Pack some light snacks as low-salt crackers, vegetables (e.g., carrots, cucumbers etc.), and peanut butter to enjoy while you sit on a bench to rest during and after a long walk.
  • Make sure to wear comfortable walking shoes with good support and cushioning. No high heels!
  • If you have one, remember to bring your cane or walker with you. You might need it if you get exhausted from the exercise.
  • Keep your medicine list and emergency contact information in your wallet or handbag at all times.
  • If you experience a severe headache, nausea, spinning of your head, too much sweating, or your heart racing very fast, it may be signs of a condition called heat exhaustion. If this happens, do not wait. Alert your companion or asking people passing by to help you to a shaded place and call for help.

Enjoy the summer and stay safe!

About the Author
Dr. Syed is a member of the American Geriatrics Society’s Public Education Committee.

A Good Day at the White House—#AGSProud

Attachment-1

Heading into the East Room of the White House.

The White House Conference on Aging (WHCOA) was this week. It’s a once-in-a-decade gathering of people who are passionate about older Americans. The next time this conference occurs, I’ll be 66 and my siblings will be in their 60s with one turning the corner to 70. With a little luck and some healthy choices, we’ll be active and engaged with our communities well into our golden years.

One thing that is clear from the 2015 conference is that, as a country, we still have a lot of hard work to do if our communities are going to be ready for me and my siblings. That said, I was proud to represent geriatrics health professionals at the WHCOA and it gave me hope that the type of future we envision for older adults could be a reality (especially on the cusp of some momentous news today from the U.S. Senate—you’ll just have to keep reading to find out more!).

WHCOAPresObama

President Obama giving his remarks.

First, the things that made me proud…

Falls Prevention Takes Center Stage at the Centers for Disease Control & Prevention: In 2001, the American Geriatrics Society (together with the British Geriatrics Society and the American Academy of Orthopedic Surgeons) released our first Guideline for the Prevention of Falls in Older Persons, with an updated guideline issued in 2010. This was seminal work, and not just for the AGS. In fact, our most recent guideline informed the U.S. Centers for Disease Control and Prevention (CDC) work on creating the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative that was announced at the WHCOA. STEADI provides educational tools to healthcare professionals that can help them identify individuals at risk for falls, understand how to modify certain risks that they are likely to find, and learn how to implement effective options for preventing falls altogether. The CDC has been working with Epic Systems Corporation (an electronic health record technology provider) and EPIC will be rolling out a clinical support tool for falls assessment. This resource will make it easier for ALL healthcare providers to screen for falls, intervene to reduce risk, and provide follow-up care. AGS members are leading the STRIDE study that is testing a multifactorial fall injury prevention strategy that is being co-funded by the Patient-Centered Outcomes Institute (PCORI) and the National Institute on Aging (NIA). I’m proud of AGS and our members—we built the foundation for STEADI and, looking towards the WHCOA in 2025, I expect that we will have progressed even further in our understanding of how to prevent older adult falls.

Medicare & Geriatrics Health Professions Funding: President Obama had some good news for geriatrics health professionals, as well—noting that we are working to implement Medicare payment models that support the quality rather than the quantity of care. AGS has been at the forefront of efforts that will benefit beneficiaries by ensuring that clinicians are supported to provide care coordination, care transitions, and advance care planning. We continue to advocate for payment models that support geriatrics health professionals in doing what they love to do: maximize the function and quality of life of the older adults they serve. Look for more news from us on the recently released 2016 proposed physician fee schedule rule in the coming weeks.

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