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.

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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

Older Adults Are Being Overlooked When it Comes to Mental Heath Care

dr-sewellDaniel D. Sewell, MD
Director, Senior Behavioral Health, UC San Diego Medical Center
President, American Association for Geriatric Psychiatry

(This blog post originally appeared on CareForYourMind.org, a resource created by the Depression and Bipolar Support Alliance (DBSA) and Families for Depression Awareness (FFDA) to help society engage in critical discussions and decisions about mental health.)

For most individuals in the U.S., accessing mental health care is a struggle, but older adults may have it worst of all. Due to stigma, misinformation, and false beliefs about aging, they frequently go without adequate care for depression and other psychiatric illnesses and psychological problems. Too often, doctors offer prescription drugs as a cure-all solution, and fail to address the overall mental health and well-being of the older patient.

The truth is, addressing mental health issues in older populations requires paying more attention, not less. In aging adults, depressive symptoms can point to a physical illness, while physical pain or other physical complaints can often be a sign of mental health issues.

The good news is, when accurately diagnosed, mental health issues are just as treatable in older populations as in younger, but it takes commitment and understanding. In order to help aging Americans get healthier and happier, the system needs to properly address the physical and mental needs of these patients.

What gets in the way of patient-centered care?
Research shows that older adults are often less comfortable seeking care from a mental health professional than their younger counterparts. Due to historical shame and ignorance surrounding mental illnesses and psychological problems, stigma tends to be more powerful among those who came of age before the 1960s.

Depression is also experienced, witnessed, and treated differently in older adults. In this population, depression symptoms can present as physical complaints, irritability, and/or cognitive impairment rather than overt signs of sadness such as crying. Alternatively, psychiatric symptoms can often point to a physical ailment that’s been overlooked. Depression can also be an early sign of dementia.

Additionally, medical illnesses are too often misdiagnosed or wrongfully labeled as purely psychiatric illnesses. To test this theory, we did a six-month chart review in our geriatric psychiatric inpatient unit and discovered that 34% of patients referred to our unit had a previously unrecognized or documented but inadequately treated medical illness—and that illness was likely the source of the psychiatric symptoms. Based on that data, one out of three older patients may actually need medical care versus behavioral health care.

Insurance issues
Insurance companies also get in the way of good care. To cite one shocking example, a nurse employed by a continuing care community in my area was checking in on a patient. When she arrived, she saw the resident on the balcony, with one leg over the railing, clearly about to jump. Luckily, the nurse was able to pull the patient back. I was immediately contacted. When I tried to get pre-authorization for inpatient care from the patient’s insurance company, they told me she didn’t meet the criteria for care because she hadn’t actually jumped. Continue reading

A Flu Shot is The Best Shot at Prevention for People 65 and Older

cdc-dj-vaccination-clinic_title-2Daniel B. Jernigan, MD, MPH
Director of the Influenza Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention

For millions of people, the flu can mean a fever, cough, sore throat, body aches, and fatigue for a week or more. But did you know that if you are 65 years or older, you are at increased risk of serious flu-related complications, like pneumonia?

“People’s immune systems can become weaker with age, which places older adults at high risk of serious flu-related complications,” says Dr. Lisa Grohskopf, a medical officer with CDC’s Influenza Division.

While flu seasons vary in severity, people 65 years and older bear a comparatively greater burden of serious flu-related illness compared to other age groups during most flu seasons. Data from recent seasons shows that between about 70 to 90 percent of seasonal flu-related deaths in the United States have occurred among people 65 years and older. For hospitalizations, this number is between about 50 and 70 percent.

This is why flu vaccination is especially important for people 65 years and older. While flu vaccine can vary in how well it works, there are a lot of scientific data showing that flu vaccination prevents illness and hospitalizations, even among people 65 and older for whom the vaccine may not work as well. A new CDC study published this summer in the journal Clinical Infectious Diseases (CID) found that flu vaccination reduced the risk of flu-related hospitalization among people 65 to 74 years by 61%. Vaccinated people 75 and older were similarly protected (57%).

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Polypharmacy and Deprescribing

WebDoes the number of medications you’re taking sometimes seem too high? Maybe it’s time for you and your healthcare provider to give your medication list a check-up by taking a closer look at the prescription and over-the-counter (OTC) treatments you take.

As you grow older, you’re more likely to develop health conditions that require taking multiple medications—some of which you may take for a long time. Many older people also take OTC medications, vitamins, or supplements as part of their routine care. As a result, older adults have a higher risk of overmedication, also known as “polypharmacy”—the medical term for taking four or more medications at the same time. Polypharmacy can increase your chances of unwanted reactions (also called “adverse drug reactions”) due to medications taken on their own or together.

To address this increasingly common problem, healthcare providers are focusing on how to reduce the number of medicines older adults are using through a practice called “deprescribing.” Dr. Michael Steinman, a member of the American Geriatrics Society (AGS) and a geriatrician at the University of California, San Francisco, recently appeared on WPUR—Boston’s NPR News Station—to discuss deprescribing with Dr. Barb Farrell, a pharmacist from Bruyère Geriatric Day Hospital in Ottawa, and Laura Landro, assistant managing editor at the Wall Street Journal. Hear what they had to say.

Want access to more tips and tools to help you manage multiple chronic conditions or multiple medications? We’ve got you covered.