Taking the Keys Away: A Geriatrician’s Perspective

okhraviHamid R. Okhravi, MD
Associate Professor of Medicine/Geriatrics
Director, Driving Evaluation Clinic
Director, Memory Consultation Clinic
Glennan Center for Geriatrics and Gerontology
Eastern Virginia Medical School

As geriatricians, we often need to have difficult conversations with our patients, their families, and/or their caregivers. One of the most difficult of these is when we have to tell a patient that he or she is no longer capable of driving safely.

Not so long ago, I had this discussion with a patient of mine, Mr. M, a 79-year old with mild dementia. His daughter brought him to our Memory Clinic when she became worried about his driving skills.

According to Mr. M, he’s a good driver. But his daughter told me that Mr. M had caused two minor accidents within the last year. She also said that he occasionally got lost when driving outside his familiar routes.

I gave him tests to gauge his ability to think and make decisions, and he did poorly on all three of them.

When I discussed his test results with Mr. M and his daughter, I explained that his impaired performance didn’t necessarily prove that he’s an unsafe driver. However, his scores did show that his driving skills needed further evaluation. I suggested that medical disorders, such as cognitive impairment, could worsen his skills and increase the risk of driving errors that can lead to vehicle crashes.

Naturally, Mr. M was unhappy to hear what I had to say. He told me that he’s always been a safe driver, and he refused to stop driving. He told me that not being able to drive would change his life for the worse, and that it would be terrible not to be able to shop for groceries or attend the two weekly social activities he enjoys with his friends.

Despite his concerns, with his daughter’s encouragement, he agreed to have his driving evaluated. Continue reading

Recovering after Surgery: Perspectives from a Patient and Healthcare Professional (Part One)

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Professor
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

Introduction

This is the latest in a series of blog posts by Barbara Resnick, PhD, CRNP, written from her perspective as both a healthcare professional and as a patient during the course of intensive treatment for esophageal cancer. This two-part article was written about two months following her surgery. Part One discusses the importance of preparing for going home throughout the course of a hospital stay following surgery. Part Two addresses managing ongoing recovery at home. These blog posts will be helpful to older adults undergoing surgery and their families, as well as to hospital administrators and healthcare providers.

Part One: Preparing for Life at Home throughout Your Hospital Stay
My recent experience in the hospital following surgery for esophageal cancer has made me aware that healthcare professionals (of which I am one) have much they can learn to support their patients’ day-to-day recovery following surgery, as well as to help them prepare for going home. This learning can be enhanced by acknowledging that patients know a lot about their own bodies and preferences, and by valuing the knowledge and experience patients and caregivers gain each day in the hospital. Therefore, you and your caregivers can be a valuable source of information to your healthcare team.
Although people’s responses to surgery are individualized, there are some basic approaches that can be applied to most types of surgeries and hospital stays. My experience was rather intensive, as the original surgery was an esophagectomy. This is a procedure where the esophagus (the tube that moves food from your throat to your stomach) is removed and then rebuilt from part of your stomach or large intestine. I had several complications and had to have a second surgery, all of which resulted in almost five weeks in the hospital!

My experience taught me the importance of thinking ahead and preparing for life at home while I was still in the hospital. Patients and families need to take an active part in this process, because the hospital care team is understandably often more focused on their patients’ immediate medical problems and needs. Patients and families need to ask and remind the healthcare team to teach them things that they’ll have to do when they go home, such as how to care for surgical incisions, what to do with a wound drain, or how to use a feeding tube. Patients and families need to practice these things while in the hospital, under the guidance of their care team. The healthcare team should also explain each medication when it is first given, including the name, what it’s for, how to take it, and what possible side effects to watch out for.

Also, practicing basic daily activities while you are still in the hospital is key to your recovery and in helping you know what you can do safely once you home. These activities include things such as bathing, dressing, eating, grooming, and walking, I was fortunate to have a family caregiver with me throughout my hospital stay. I made sure that I bathed and dressed daily with someone standing by me to help as needed. I walked through the hallways at least a few times a day because my family member could help carry tubes and push the IV pole. If you don’t have someone with you in the hospital, it’s important to ask the nursing staff to help with you these activities. On the actual day of my discharge, I insisted that the nurse teach me and my family how to set up the tube feedings I needed when I first went home and to practice with us.

Continue reading

The Financial Costs of Family Caregiving: A Stark Reality

200-lynn-friss-feinberg-aarp.imgcache.rev1320086023339-1Lynn Friss Feinberg, MSW
Senior Strategic Policy Advisor
AARP Public Policy Institute

(This post was originally published on the AARP blog and is re-posted with permission.)

Families and close friends are the most important source of support to older people and adults with a chronic, disabling, or serious health condition. They already take personal responsibility for providing increasingly complex care to the tune of $470 billion (as of 2013). That figure, representing family caregivers’ unpaid contribution in dollars, roughly equals the combined sales of the four largest U.S. tech companies (Apple, IBM, Hewlett Packard and Microsoft, $469 billion) in 2013.

The out-of-pocket hit

Caregiving families feel great uncertainty and high anxiety about how they will continue to pay for long-term services and supports (LTSS) for a relative or close friend with increasing self-care needs. And for good reason. Family caregivers not only provide help with daily activities and carry out complex medical and nursing tasks, they also spend a considerable amount of money out of pocket for caregiving.

Out-of-pocket spending for caregiving generally refers to the purchase of goods and services on behalf of the person the family caregiver is helping. This can include housing, medical and medication premiums, copays, meals, transportation, mobility and other assistive devices, supportive services (such as adult day services and paid home care), and other goods and services.

A recent AARP research study finds that more than 3 in 4 family caregivers (78 percent) report incurring out-of-pocket costs as a result of caregiving. In 2016, family caregivers of adults on average spent nearly $7,000 on out-of-pocket costs related to caregiving, amounting to 20 percent of their total income. Among racial or ethnic groups, out-of-pocket spending for caregiving was highest among Hispanic/Latino family caregivers. They spent an average of $9,022, representing 44 percent of their total income in 2016.

Caregiving, therefore, can have a major impact on one’s current and future financial situation. A consensus report from the National Academies of Sciences, Engineering, and Medicine concludes that family caregiving for older adults poses substantial financial risks for some family caregivers. Especially vulnerable to financial harm are families caring for older relatives with significant physical impairments or dementia, low-income family caregivers, and those who live with or live far away from their older relative who needs care. Continue reading

Aging Well Through Arts

image001 (3)For too long, old age has been associated with negative images, words, and ideas. This special report from NextAvenue—public media’s first and only outlet dedicated to older adults—examines the vitality, excitement, and joy that comes to those who connect aging and art. Learn more here.

This post and the original special report first appeared on NextAvenue.org.

 

On Becoming an Older Driver

altshul headshotSara Altshul
AGS Staff Writer

I didn’t run right out and get my driver’s license on my 16th birthday, like so many of my high school pals did. In my rural hometown, a car was more necessity than luxury. Town was three miles away, school even further.

But my overprotective mom was reluctant to let me learn how to drive on her new manual-shift Saab. Instead, she chauffeured me wherever I wanted to go, and if I wanted to get somewhere when she wasn’t around, I walked or got a ride.

I finally got my license at 18, a few months before landing the coolest summer job of all time – as a Good Humor truck driver. Soon, I bought myself a $500 Simca, a tiny four-door French beauty whose battery was tied on with a shoelace. I had it for years before it literally fell apart.

Since then, I’ve driven hundreds of thousands of miles. Two cars I owned during my 40’s topped out at nearly 200,000 miles each. For the three years I lived there, I even zipped through the Italian countryside, up hills and through narrow, cobblestoned streets, in my second-hand, four-on-the-floor Mitsubishi. Coming to a stop on Tuscan hills in first gear took plenty of practice. Just ask my husband.

Thankfully, I’ve never had a crash and despite a speeding ticket or two over the years, my driving record is pristine.

I’m 66 now. My faculties are sharp and intact. But when I’m driving, I recognize that I have to be more conscious, more focused, and more alert than my younger self ever was. I exert a deliberate effort when I’m behind the wheel: I don’t pass as frequently, I don’t go as fast, and I don’t take chances like I may have done in the past. I am acutely aware of keeping myself, and my passengers, safe on the road. Continue reading