National Family Caregiver Month

When you hear the words “family caregiver” what image comes to mind? Odds are, you envision a woman. We tend to assume that family caregivers are wives, daughters, sisters, nieces, and granddaughters. But here’s a surprise: According to a recent Pew Research Center report, 45 percent of relatives caring for older adults in the U.S. are men.
What accounts for the growing percentage of men caring for older family members? According to a recent Wall Street Journal article, decades-long declines in family size, and increasingly far-flung families, are likely contributors. If your aging mom needs help, and you’re the only nearby, you step up to bat. Period.

So this month—National Family Caregiver Month—and beyond, we at the American Geriatrics Society Foundation for Health in Aging (HIA) hope you’ll show your support for the women and men you know who are caring for their aging relatives. While growing numbers of husbands, sons, brothers, nephews, and grandsons are now playing this role, they may be less likely than women to reach out for help with caregiving when they need it, according to a recent Wall Street Journal article. This means we need to do more to reach out to them.

Organizations and services for family caregivers are already doing this. The Journal story, for example, spotlights a Colorado home care service that created a virtual community just for men—www.malecaregivercommunity.com—thinking it would be more appealing to male caregivers . It has been. “Since it started in June, more than 84 discussions have developed,” the paper reports.

In addition to support, family caregivers also need top-notch information. And that’s where Healthinaging.org comes in. Among other things, it offers comprehensive information about caring for even the most medically complex older adults—those with multiple, chronic health problems. Just as important, it offers information about caring for yourself if you’re a caregiver. We hope you’ll mention the site to the family caregivers you know— men and women alike.

Improving Quality of Life for Seniors Living with Multiple Chronic Conditions

Healthinaging.org is pleased to feature this guest blog from Anand K. Parekh, MD, MPH, HHS Deputy Assistant Secretary for Health (Science and Medicine).

 

 

Did you know that 75 million Americans, including three of four persons over 65, have multiple chronic conditions? This means the typical senior may not only have diabetes, he or she may also have arthritis, high blood pressure and perhaps even asthma.

That’s a lot to manage.

And people with multiple chronic conditions are at higher risk for hospitalizations, hospital readmissions, and adverse drug events.

The U.S. Department of Health & Human Services (HHS) has put together a plan to help in managing multiple health problems. The plan has four goals: to foster health care and public health system changes, to maximize the use of self-care management, to provide tools and information to health workers, and to facilitate research to fill knowledge gaps.

At HHS, we’ve supported significant research on health outcomes among individuals with multiple chronic conditions and have created a nationwide research network. We’ve worked with partners such as the National Quality Forum to create tools that will facilitate the development of quality measures for this population. These measures help patients and families determine whether their healthcare providers and facilities are using well-tested approaches to caring for people with multiple conditions. And finally, we’re working with the research and regulatory community to ensure that individuals with multiple chronic conditions are included in research studies.

In addition, the Affordable Care Act provides new and innovative ways to tackle this public health challenge. Millions of Americans with multiple chronic conditions are now eligible for preventive care, such as flu shots, blood pressure and cholesterol tests, mammograms, and colonoscopies – free of charge. Many are also participating in new care coordination models, such as “medical homes” and “accountable care organizations,” which promote the use of electronic health records and other mechanisms for managing patient care, so that those with multiple doctors can be confident that all their doctors have the information they need.

So, if you have multiple chronic conditions, here are four tips that may be helpful:

  1. Identify a medical quarterback. It’s critical to have a provider, usually a primary care physician, who is responsible for managing all your conditions and medications.
  2. Make healthy choices. It’s estimated that 80% of heart disease and stroke, 80% of type 2 diabetes, and 40% of cancers could be eliminated if Americans would do three things: stop smoking, eat a healthy diet, and get regular exercise.
  3. Take advantage of community resources. There are many local resources that can support opportunities for health promotion and disease prevention. Find a trusted organization, such as a local YMCA or Area Agency on Aging, to see if they have programs that may be able to help you.
  4. Monitor your medications. People with multiple chronic conditions usually take multiple medications. Develop a reminder system to make sure that you’re taking your medications at the right time.

By taking these four steps, people with multiple chronic conditions can optimize their health status and quality of life.

The American Geriatrics Society’s guiding principles on managing the care of older adults with multiple health problems builds on our work at HHS. We are pleased to share and promote our common goal of optimizing the health and quality of life for older adults with multiple chronic conditions.

Tell us about your experiences caring for friends and family or patients with multiple health problems, or how you’ve managed your own complex health issues.

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.

 

 

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?