It’s Not Normal: Falls

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

It is the middle of winter here in Cleveland and we have experienced an unusual amount of snow, sleet and ice. In fact, if you live anywhere with winter, I’ll bet this weather has been challenging. One problem that we see more of in the winter is falls. I ask all of my patients if they have experienced a fall.  Can you  guess the most common answer I get? It isn’t “no”— it’s “not yet.”  Isn’t that interesting? That answer means that they expect to fall sometime. In other words, they think it’s normal. But we are here to find out otherwise!

Falls are certainly common. Most people can tell you about friends or family members who have fallen and suffered a serious injury from a fall, such as a broken hip. Most people also tell me that falling is one of the things they fear the most. The good news is that while falls are common, they are not inevitable. There are well defined risk factors that make it more likely for someone to fall.   And there are also recommendations on how to prevent falls. These recommendations will require you and your healthcare professional to work closely together.

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Caregiving for an Older Adult: Stressing and a Blessing

Clare WohlgemuthClare M. Wohlgemuth, RN, GCNS-BC
Nursing Director, Geriatric Services
Boston Medical Center
Boston, Massachusetts

 If you are helping a family member or friend over age 50 with things such as dressing, bathing, housework, or taking medicine on a regular basis, then you are a caregiver. You are not alone—there are close to 50 million Americans involved in caregiving. Caregivers spend an average of 20 hours each week caring for one (or more) older adults. About one in four of caregivers have been giving care for more than five years. About three in four caregivers work a paying job and spend up to $5000 out of pocket each year to help with caregiving costs.

Caregiving has been a part of community life for a long time. These days, the amount and types of help provided by family caregivers has increased a great deal. This has also raised the costs of caregiving—both economic and psychological. Now, loved ones often come home from the hospital earlier and with more complicated conditions. This means that caregivers often take on many roles in addition to providing companionship and emotional support. Caregivers may give medications, find and coordinate services, and perform basic nursing. They also communicate with healthcare providers, coordinate care during transitions from hospital to home, and advocate for their loved ones during visits with healthcare providers and hospital stays.

Caregivers are at higher risk for symptoms of anxiety and depression because of the burden of these many roles. Their physical health may also suffer. It is normal for caregivers to feel alone and overwhelmed. Caregivers may also feel unable to communicate well with the person receiving care and/or other family members. They also report needing information on how to keep their loved ones safe at home and to find activities to do with them. And caregivers also need resources to help them manage their own stress and make time for themselves.

In our recent study of geriatrics health providers who are also caregivers, we found all of these challenges. Even those most prepared to handle all the different caregiving tasks found it very difficult. If you are a caregiver AND a healthcare professional, you may face additional burdens—and will also benefit from support. [You can click here to read the full study.]

What You Can Do
In order to cope with the demands of caregiving, all caregivers need to get help. It is good to ask questions, and to ask for help! If you are not happy with the answers you are getting, it’s important to keep asking. Also keep looking for the information and support that you need, perhaps from other resources. There are many places you can look to for help: hospitals, your community, and online resources.

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Improving the Care of Older Adults with Diabetes

Are you an older adult with diabetes, or a caregiver to an older person who has this disease? The odds are good that you are. Today, more than one in every four Americans aged 65 and older has diabetes.  And this is cause for concern. Diabetes can cause serious complications—including high blood pressure, depression, nerve pain, and difficulty thinking and remembering. But there’s some good news: Researchers and healthcare providers are learning more about how to help older adults with diabetes stay as healthy as possible.

This month the American Geriatrics Society (AGS) published a new guideline (The American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 Update), to help healthcare professionals  improve care for older people with diabetes. And based on the guideline, the Healthinaging.org has created two easy-to-read  tip-sheets.

One of the tip-sheets offers up-to-date, expert advice about living with diabetes in later life. The other summarizes the latest recommendations for  managing the complications of diabetes. [Click on the underlined words to see the tip sheets.]

We hope you will find this  information helpful, and encourage you to  talk to your healthcare provider about how you can put it to use. Please help us spread the word and share this news with other older people who have diabetes.

 

Transferring Older Adults from Hospitals to Nursing Homes

Ken Covinsky, MD, a geriatrician at the University of San Francisco (UCSF), recently published a blog on GeriPal  addressing an issue that affects many older adults—problems with transfers from the hospital to the nursing home.  Dr. Covinsky worked with Healthinaging.org to include some specific recommendations for caregivers, who can play an active role in helping to ensure safer transfers between sites of care for their older family members and friends.

Recent Study Shows Poor Communication Between Hospitals and Nursing Homes
Huge numbers of older people are transferred from hospitals to nursing homes.  Often, an older hospitalized patient needs skilled nursing care before they are ready to return home.  In other cases, a nursing home resident who needed hospitalization is returning to the nursing home.  Older patients and their families certainly hope that great communication between the hospital and nursing home will ensure a seamless transition in care.

But a recent study in the Journal of the American Geriatrics Society (click here for a copy of the article) suggests that the quality of communication between the hospital and the nursing home can be very problematic.  The study was led by researchers from the University of Wisconsin, including nurse researcher, Dr. Barbara King, and geriatrician, Dr. Amy Kind.

The authors conducted interviews and focus groups with 27 front-line nurses in skilled nursing facilities.  These nurses noted that very difficult transitions from the hospital to nursing home were common.  Sadly, when asked to give the details of a good transition, none of the nurses were able to think of an example.

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