Older Married Couples and Advance Directives

JAGS graphicJournal of the American Geriatrics Society Research Summary

Advance directives (ADs) are legal documents you can use to state in advance what medical treatments you do or do not wish to have under certain circumstances. You also can use an AD to name one or more people to act on your behalf if you are ever unable or uncomfortable making your own healthcare decisions.

Studies have shown that, at the end of life, people who have ADs receive less aggressive life-sustaining treatment and are less likely to be admitted to intensive care units, sometimes because those may not be options an older person wants to pursue. They are also more likely to die at home instead of in a hospital, and they receive hospice care earlier and for longer periods of time.

About 50 percent of people 65 and older in the United States have completed ADs. However, little is known about why some people have them while others do not. Most research treats the decision to complete an AD as an individual choice, but we know little about the roles that spouses and other family members may play in a person’s decision to engage in end-of-life planning.

A new study examined the effects spouses had on the decision of older adults to have ADs. The study was published in the Journal of the American Geriatrics Society. Continue reading

For Older Adults, Antibiotics May Not Be Appropriate Treatment for Some Urinary Tract Infections

JAGS graphicJournal of the American Geriatrics Society Research Summary

In a new research paper published in the Journal of the American Geriatrics Society, Thomas E. Finucane, MD, of the Johns Hopkins Geriatrics Center at Johns Hopkins in Baltimore, suggests that prescribing antibiotics for urinary tract infections (or “UTIs”) may often be avoided among older adults.

Here’s why:

  • “UTI” is a vague, overused diagnosis that may be applied to older adults who have no symptoms but may have bacteria in the urine and also may be experiencing confusion, falls, or other vague signs (including changes in the odor or color of urine). In most cases, antibiotics do not benefit these older people.
  • Researchers are coming to a new understanding about the kinds of bacteria, viruses, and other microorganisms that live in the human body naturally. We now know that everyone’s urine contains bacteria and viruses, for example. We also know that these microorganisms are usually helpful to overall well-being.
  • In some cases, antibiotic treatment can be harmful, especially for older adults.

Some groups of people do still benefit from antibiotic treatment of UTIs. These individual include:

  • People who are sick enough to require urgent antibiotic treatment regardless of findings in the urine.
  • People with invasive bacterial diseases, especially kidney infections.
  • Pregnant women and people about to have bladder or urinary tract surgery.

In his paper, Dr. Finucane says that microbiome studies—which examine the benefits and harms cause by the billions of organisms that naturally live in the human body—suggest that UTI treatment with antibiotics actually may be more harmful than we previously thought. If you think you have a UTI, or if you’re currently using an antibiotic to treat a UTI, it’s important to speak with a healthcare professional first before changing your care plan. Your doctor, nurse, or other provider can work with you to find a treatment plan that’s best for you.

This summary is from “Urinary Tract Infection: Requiem for a Heavyweight.” It appears online ahead of print in the March 2017 issue of the Journal of the American Geriatrics Society. The author is Thomas E. Finucane, MD, Co-director, Elder House Call Program, Johns Hopkins Bayview Medical Center and Professor of Medicine at Johns Hopkins Medicine.

Specific Long-Term Therapy May Not Prevent Fractures in Older Women

JAGS graphicJournal of the American Geriatrics Society Research Summary

Osteoporosis is a disease that causes thinning of the bones, loss of bone density, and increasingly fragile bones.  This puts people at higher risk for bone fractures. Risk for the disease increases as we age. In fact, 50% of women over the age of 50 will experience a bone facture due to osteoporosis.

By 2020, an estimated 61 million American adults will have low bone mineral density. A group of medications known as “bisphosphonates” are sometimes used to treat osteoporosis.  These medications increase bone mineral density, which strengthens bones and is thought to make them less likely to fracture. Studies have shown that the risk for bone fractures lessens when women with low bone mineral density take these medications for between 1 and 4 years. However, little is known about whether taking bisphosphonates for longer periods of time has the same effect.

Recently, a team of researchers examined whether older women taking bisphosphonates for 10-13 years had fewer bone fractures than older women with similar fracture risks who took these medicines only briefly. Their study was published in the Journal of the American Geriatrics Society. Continue reading

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

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 Two: Healing, Getting Stronger, Eating and Sleeping Better – Trial and Error and a Pinch of Patience

Because everyone’s recovery from surgery is different, your healthcare team can only give you basic information and guidance based on what they see and hear from other patients. Knowing what to expect in terms of wound healing, fatigue following surgery, physical activity, and eating and sleeping—all things which are essential to the healing process—is where trial and error and waiting may come into play.

Wound healing takes time. You can aid the health process by getting enough protein and calories, treating any anemia you might have, and keeping the wound and the surrounding area clean. These are all things that you can do with the help of a caregiver. Protein intake should ideally include 30 grams of protein with each meal for an average size adult male and less for a smaller female (30 grams includes a piece of meat, chicken, or fish the size of your fist, or several eggs). If you continue to feel unusually tired at home, tell your healthcare provider. They may do a blood test to check for anemia (an insufficient number of red blood cells, sometimes called “iron-poor blood”). If you have some anemia, your provider may have you take an iron supplement. Eating iron-rich foods is always a good idea when healing. Try dark leafy greens, dried fruit, beans, enriched breads and cereals, meat, eggs, and some fish. Keeping your wound clean with soap and water and showering as soon as you are able to will also help with healing. Then sit back and let the healing take place! Continue reading

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