The Conversation Project

It’s not easy to contemplate the end of your life and consider what kind of care you do, and don’t, want when that time comes. And it’s equally difficult to talk with a loved one about the kind of end-of-care care he or she would prefer. My guess is that discussions like these are particularly difficult for us in the US, where we tend to shy away from discussions about death in general. “We Americans don’t like limits, we don’t like boundaries, (and) death is the ultimate boundary,” the journalist Bill Moyers recently pointed out. “So why talk about something we don’t want to happen?”

The answer to that question is this: As uncomfortable as discussions about what we and our loved ones want at the end of life may be, these are among the most important conversations we will ever have. Deciding in advance what care we do and don’t want, while we are able to weigh the benefits and drawbacks of our options and share and discuss our choices with those we love and our healthcare providers, can make the difference between a good death and one that is less so.

Encouraging these essential conversations—with both your loved ones and your healthcare providers—is the focus of The Conversation Project, an important new initiative of the Institute for Healthcare Improvement. I hope you’ll visit the initiative’s website, and encourage others to do the same.

The Conversation Project was the inspiration of Pulitzer Prize winning journalist Ellen Goodman, who conceived of it after her mother’s death. “My mother and I talked about everything,” she  explained in a recent interview. “But when she was no longer able to make her own decisions, I realized we hadn’t talked about her wishes for the end of life. I understood only after her death how much easier it would have been if I had heard her voice in my ear as these decisions had to be made.”

Among other things, The Conversation Project website includes an extremely thoughtful and thought provoking feature, “Your Conversation Starter Kit.” It begins with some truly attention-getting statistics about what people tell pollsters they want at the end of life and, in contrast, what many of us actually get. It also includes thought-provoking questions that can help you clarify what you want, what roles you’d like your loved ones to play at the end of your life, and what your healthcare providers need to know. It also helps you figure out with whom, when, and where you want to have The Conversation, and tips for introducing the subject in a non-threatening way. Just as important, the site urges readers to take time to make these decisions, formulating them over the course of many, not one, conversation. I encourage you take a look at the starter kit and let it help you find where you want to go.

Managing Multiple Health Problems

More than half of all older Americans have “multimorbidity,” a medical term that means having multiple chronic health problems like heart disease, arthritis, and diabetes. It can be challenging for healthcare professionals, older adults and their friends and family to manage multiple health problems.  There are many more factors to think about.  For example, treating one health problem may make another health problem worse.  And having multiple health problems often requires taking more than one medication, which can result in unwanted drug interactions and side effects.

To help healthcare providers and patients better manage multiple health problems, the American Geriatrics Society (AGS) recently asked leading experts in the field to develop “guiding principles” for the care of older adults with multiple medical conditions.

The principles don’t specify what kind of care clinicians should provide a given patient. Instead, they outline steps to care that is tailored to each patient’s unique needs. You can read more about these principles and living with multiple health problems here.

Here is a very short summary of ways patients and their caregivers can work with healthcare providers to enhance care when dealing with multiple health problems:

Get informed - Learn as much as you can about your healthcare problems and treatment options. Ask your healthcare providers for information and advice, and get family and friends to help you with research.

Make sure your healthcare professionals understand what’s most important to you - For many older adults, for example, remaining as independent as possible is a top priority. Find out how different treatment options will affect your priorities.

Ask bout “trade-offs” – Ask your healthcare provider how the benefits of different care options compare with their risks.

Call if there are problems – Because there isn’t a lot of research examining how older adults with multimorbidity respond to different treatments, clinicians may not be able to predict exactly how a treatment will affect you. So let your healthcare provider know if you’re having unwanted side effects or aren’t getting the desired results from a certain treatment.

Ask for something simpler if you need to – The more complicated treatments are, the more likely patients are to stop following them. Ask for a simpler treatment plan if necessary.

Make sure your care plan does three things - Your healthcare providers should:

  • Make sure that treatments that are most important to you get the highest priority.
  • Maximize the benefits of your treatment.
  • Minimize risks by, for example, using non-drug medications when possible to lower risks of drug-drug side effects.

 

 

Getting Your Flu Shot

With autumn just around the corner, now’s the ideal time to get your flu shot.  Influenza season can start as early as October, and it takes your body about two weeks to respond to the vaccine by creating the flu-fighting antibodies you need to fight off the virus. That’s why healthcare professionals recommend getting the shot as soon as it becomes available in your community— usually early September. I’m planning to get my shot when I see my healthcare provider this month.

If you’re 65 or older, it’s particularly important to get vaccinated. Older adults run an increased risk of potentially serious complications of the flu, such as pneumonia. Some people, however, should talk with their healthcare provider before getting a flu shot, especially if you’ve experienced any of the following:

  • severe allergic reaction to chicken eggs
  • have had a serious reaction to the flu shot in the past
  • have been diagnosed with Guillain-Barre Syndrome

And if you have a fever, hold off until it’s gone before getting your shot .

Though some vaccines protect you for years, the flu shot is only effective for one year.  Why? The flu virus is constantly changing, so the vaccine that worked against last year’s virus won’t take care of this year’s. Don’t skip a year!

Good news: Medicare covers annual flu shots, and there’s no copay. You can get the flu vaccine from your healthcare professional, or at senior centers, urgent care clinics, and health departments.   Many retail pharmacies also offer the flu shot for a small fee.  As of late August, the vaccine was available in many communities throughout the U.S. To find where you can get a shot near you, visit the frequently updated Flu Vaccine Locator on the Center for Disease Control and Prevention’s website.

And for more information about the flu and other essential immunizations for older people, take a look at these tipsheets: “Flu Prevention and Treatment Tips” and “Essential Vaccination Information for Older Adults.”

Staying Safe in the Heat

When the weather starts warming up—as it is in much of the United States right now—the body uses a variety of clever strategies to cool down. Sweat glands work overtime, sending more sweat to the surface of the skin where it evaporates and cools the body. Muscles relax so more heat-carrying blood flows to the skin where that heat can escape into the air. Even tiny body hairs get involved. They flatten themselves so surrounding air can more easily circulate over the skin and allow more heat to escape.

However, as we get older, age-related changes in our bodies lessen our ability to use these important cooling strategies. And this increases our risks of dangerous heat-related health problems such as heat stroke—a potentially life-threatening increase in the body’s internal temperature. Age-related changes also makes it harder for the body to tell when it’s getting dangerously dehydrated—or “dried out”—and needs water right away. In addition to age, medical conditions such as heart disease and diabetes can boost older people’s risks of heat-related medical problems. Some medications can also affect how you feel in the heat.  Heat-related medical problems can be very serious. An estimated 200 older Americans die of heat-related health complications each year.

And that simply shouldn’t happen. With some simple precautions, older adults can avoid heat- related dangers. There are several tips from the experts in this new, easy-to-understand “tip sheet” for staying safe when it’s just too darn hot.  You can find the new tip sheet, Hot Weather Safety Tips for Older Adultshere.

Older adults and their caregivers need to be especially careful when the temperature reaches 90°F and keep an eye out for signs of heat-related problems.  The Health in Aging team hope you’ll share these tips with older friends and neighbors as well, and that this important information will make the livin’ easier, even as the mercury rises this summer.

How do you plan to stay cool this summer?

Never Too Old to Play

Recently, I came across some fascinating research by Stuart Brown, MD, a psychiatrist who founded the National Institute on Play and is widely known as “the father of play research.” Studies that he and other researchers have conducted show that play – defined as any activity that’s “fun, purposeless, and all-consuming” – isn’t just kid stuff. Rather, play is essential to wellbeing throughout life.

I’ll certainly vouch for that. Over the years, I’ve learned that, once I start feeling overwhelmed by all the “to do” items on my lists, it’s time to take a break and do something that doesn’t serve any purpose other than engaging and making me feel happy. Things like golf, going to orchid shows, getting together with “gal pals,” discovering new neighborhoods, competing with my husband on the Wii, and lately, scoring on “Angry Birds.”  In short, I play!

This year, the U.S. Administration on Aging (AoA) — which has designated May “Older Americans’ Month” – has come up with a particularly fun theme for the month: “Never Too Old to Play.” To celebrate, we at the Foundation for Health in Aging hope you’ll join us in celebrating this important month – by playing.  With this in mind, we’d like to share some of our favorite ways to play, as well as some of the terrific suggestions for play that the AoA recommends.

These suggestions for play are appropriate for families with older members; residents of long-term care facilities and those who care for them; and you and your neighbors, of all ages:

  • Organize an intergenerational family Wii bowling tournament.
  • Play Charades, chess, Scrabble, Uno, Pictionary or other favorite board games.
  • Invite your neighbors to a kite-flying contest or croquet tournament at a nearby park.
  • Help organize or contribute to a block party complete with games of chance.
  • Paint a community mural (with permission from your local representatives, of course).
  • Plant something – whether in a pot on your windowsill or in a large community plot – gardening connects us with living, growing things and is fun and therapeutic.
  • Make music – sing in the shower, play an instrument alone or in a group, or just clap your hands to a song on the radio.
  • Take a walk and smile and say hello to passersby – it’s contagious and can generate some playful conversations.

Ready?

Set?

Play!