Supporting who we are, what we need, and how we age as individuals — Ethnogeriatrics & Minority Health Month

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Sharon A. Brangman, MDVJ_Periyakoil
Professor of Medicine
Division Chief, Geriatrics
SUNY Upstate Medical University


VJ Periyakoil, MD

Director,
Stanford Successful Aging Program

Clinical Associate Professor
Stanford University School of Medicine

 

While each person is unique and wonderful, no two bodies are the same—and no two people will age in identical ways. That’s one of the joys, and also one of the challenges, in caring for older adults.

Geriatrics, the healthcare field specialized in caring for older people, has given us great knowledge about the health issues commonly seen in older adults and guides how to provide high-quality care to aging Americans. Even so, we also know that there will be twists, turns, and uncharted destinations along every person’s journey toward healthy aging. However, if older adults work in partnership with their healthcare team and family, life with quality is an attainable goal for all. In fact, that’s one of the critical life lessons we can take away from National Minority Health Month this April.

What is National Minority Month?
National Minority Health Month helps raise awareness for disparities in health and care among specific groups of people known as minorities. Minority groups like American Indians, Alaska Natives, Asian Americans, African Americans, Hispanics/Latinos, Native Hawaiians, and Pacific Islanders account for more than 35% of the U.S. population. Health and care aren’t completely different from one of these groups to the next, but minority health experiences do help highlight how certain conditions, concerns, and challenges may impact some of us differently than others. That’s an important distinction—so important, in fact, that an entire field of geriatrics known as “ethnogeriatrics” has developed around ways to provide culturally competent care to older adults from diverse ethnic and racial backgrounds.

Ethnogeriatrics is about finding important intersections between ethnicity, aging, and health to provide high-quality care. A perfect example of this type of work is a new tool that the American Geriatrics Society (AGS) developed with AARP to help a specific group of older adults who are Chinese Americans better understand and drive their own well-being.

“Chinese American Older Adults: A Guide to Managing Your Health”
This free resource highlights the most common health concerns in the Chinese American older adult community and ways that patients and caregivers can talk to healthcare providers about addressing them.

Health concerns like hepatitis B, certain types of cancer, depression, tuberculosis, cardiovascular disease, diabetes, and some genetic diseases are common among Chinese Americans. Many of these conditions require not only expert care but also sensitivity to cultural norms that can help or hinder care depending on how they are addressed. Continue reading

Making Healthcare Decisions for Me, Part 2

Nancy Lundebjerg casualNancy E. Lundebjerg, MPA
Chief Executive Officer
American Geriatrics Society
Health in Aging Foundation

In my last post, I shared some personal reflections on the importance of completing an advance directive—what the process has taught me about my needs, my wishes, and the type of voice and control I want to have should I ever need someone else to make healthcare decisions on my behalf.

That last point is quite important, and—in honor of today being National Healthcare Decisions Day—I thought I’d walk through some of the questions and considerations that helped drive my own search for a healthcare proxy. These are built on discussions I’ve had with this person—one who knows me well—about the questions, answers, and decisions that are important to me. While these points reflect my own thoughts and perspective, maybe you can use them as a guide for considering what’s important to you—and how you’d want those points acted upon should someone else need to make important health decisions on your behalf.

 Who You Are, Mr./Ms. Healthcare Proxy?

  • You are my advocate and you are most definitely the person who has final say in decisions if I’m unable to make them for myself. Collaborative decision-making in tandem with my doctor is OK—but you know what I would want better than most.
  • You will not let anyone rush you through a conversation—you’ll make sure all your questions are answered.
  • You’ll make sure I’m getting the best care possible—you’ll know who my doctors are and where they trained.
  • You are someone I trust to do whatever needs to be done—and that includes letting me go gently if that is the right decision. And by “right”, I mean your right—others can advise you, but the decision is yours to make based on what we’ve talked about and what you know about my wishes, needs, and expectations.

What You Know about Me

  • You know that quality of life is more important to me than length of life.
  • You know that I, personally, don’t have religious or moral beliefs that are relevant to decisions about life-sustaining treatments. You should make those decisions based solely on my medical condition and my long-term prognosis (the likely course of the disease or condition).
  • You know how I feel about artificial nutrition and hydration. I personally think it’s an OK short-term solution if you are “waiting and seeing” if I’ll recover, but please don’t pursue it for me if I’m in a persistent vegetative state or if scans show no activity in a substantial portion of my brain.
  • You know that I would ask for prognosis, weigh all the facts, make a decision, and then stick to that decision.
  • You know that I firmly believe that there are no wrong decisions.
  • You know that I am not afraid of living with disability nor am I afraid of dying.

What You Understand About My Long-Term Prognosis

  • Get the facts and the prognosis from the doctor(s) overseeing my care.
  • Ask about how I will physically function. Ask if I’ll have trouble with my mental capabilities. If I will, ask what that means in terms of my ability to function.
  • Weigh those answers within the context of what you know about me and make your decisions accordingly.
  • Finally, be sure to make time for yourself—being my (or anyone’s) proxy is not an easy task. I know, I’ve been there and done that. Most of all, know that I am going to be A-OK with whatever decisions you make. I trust you—and that’s what this relationship is all about.

 

Making Healthcare Decisions for Me, Part 1

Nancy E. Lundebjerg, MPA
Chief Executive Officer
American Geriatrics Society
Health in Aging Foundation

Have you ever imagined a time when you are unable to make decisions for yourself? Who knows how you would make decisions? What information would you want? What do you think about life-prolonging treatments? Who knows how you feel about dying? Who knows you?

Have you looked at that moment through the eyes of family who may have no—or every—legal authority to make decisions for you? Have you thought about the range of decisions that might need to be made for you—each decision likely leading to another decision and accompanied by concern that someone might not be doing what you would do if you were making this decision for yourself?

We don’t like thinking about those types of things—at least my family doesn’t, and I wouldn’t be surprised if yours didn’t as well. You might, like me, have an advance directive gathering dust in some corner of your home with another copy in the hands of your proxy and yet another copy stapled into a chart for a doctor you haven’t seen in more than fifteen years because you’ve moved on and so have they. You may have completed an advance directive as a part of writing your will, as someone recently told me they had, so you can mentally check it off your to-do list. Health Care Proxy/Advance Care Directive. Done.

But maybe we should start thinking about this as a conversation as one addressing how we would want to live rather than one focused on how we would want to die. I know how I want to die–without a long decline into disability and dementia. I also know that kind of death can be hard to come by. Simply put, in this day and age, we can live for much longer than we could before.

If you look at Advance Care Directive forms, you’ll see that most ask for some specificity. As an example, my home state of New York allows me to check off that I don’t want blood transfusions—just one of the 11 examples that the New York form provides. It’s enough to make my head spin.

To be honest, I am not sure I could outline every possible scenario in a way that would be a road map for my proxy. The thing I know from being a caregiver is that there will be a lot of decisions and a lot of nuances to those decisions. I know they will start small and build to a crescendo. And, at least for me, it’s been helpful to balance sharing my wishes with remaining flexible—not trying to control everything with a lot of instructions. That’s one of the most helpful parts of selecting a healthy proxy when completing an advance directive—you can identify a person you trust to do whatever is in your best interests.

It’s important to have an Advance Care Directive form completed and a decision-maker identified. No less important is empowering your decision-maker to act on your behalf. More on that in my next post.

 

How much sleep do older adults need?

setters

Belinda Setters, MD, MS, AGSF, FACP
Director, Mobile ACE & Transitional Care Programs
Associate Clinical Professor
Geriatric Medicine & Palliative Care
Robley Rex VA Medical Center

When most of us talk about sleep needs, we usually think about children. We know children need a certain amount of sleep to stay active and healthy and to grow into adulthood. Children have a bedtime and parents (and grandparents!) work hard to ensure they are in bed on time and get the sleep they need every night. But most of us don’t think about how much sleep we get or need as we grow older. And yet, sleep is just as critical to our health as we age.

As we age, our brains may tell us to go to sleep earlier. This is likely why so many folks fall asleep right after the evening news or dinner. Despite this, most older adults don’t always get a full 8 hours of sleep or awaken feeling refreshed. This may be because our brains don’t cycle through deep sleep as well or as much as they did when we were younger. Restless legs, arthritis, and breathing disorders can also keep us awake. And then there is the bladder. Older adults with prostate or bladder disorders often get up at night to use the bathroom. This disrupts sleep as well. Our bodies adapt as we age to adjust to these changes and as a result our sleep patterns adapt as well.

But do we really need 8 hours of sleep as we get older? Does napping make up for this lack of sleep at night? Is it possible to sleep too much?

The National Sleep Foundation says yes—to all of those questions. In an expert panel convened by the Foundation, sleep experts and other specialists reviewed extensive research on sleep needs by age groups, including older adults. Their February 2015 report reflects the most up-to-date recommendations on sleep needs. The panel found that while sleep patterns change with aging, adults 65-years-old and older still need between 7-8 hours of sleep nightly, and ideally over a continuous period of time.

The panel further determined that—while this range is ideal for older adults—some people may need slightly less or more sleep to meet their individual needs. Some people may have a sleep pattern that results in feeling fully refreshed with only 6 hours of sleep, for example.  Meanwhile other people may need an extra hour or so, for a total of 9 hours nightly. To account for these variations, the panel noted a range just outside the recommended hours most folks need. This can be seen in the diagram released with the report below. Continue reading

Slashing Budgets Could Cut More Than Just Costs

Ask any mayor, business person, or volunteer coordinator what they’d find most valuable to help their organization grow and their answers would probably focus on a single word: resources. The “three Ts”—time, talent, and treasure—go a long way toward allowing individuals, groups, and even whole communities to operate to their fullest potential. And they’re increasingly important in cases where “demand” must keep up with “supply.”

That’s certainly true for healthcare professionals who are working to keep innovation apace of growth for the older adult population in the U.S. By 2030, the number of people 65-years-old or older in America will exceed 70 million—double the number of older adults in 2000. These men and women will need specially trained professionals who understand how to address the complex healthcare needs of older adults.

Unfortunately, federal budget cuts have impacted not only the number of opportunities for current and future health professionals, but also the research needed to increase and improve our knowledge of aging.

Results of an American Geriatrics Society survey1 reveal how these budget cuts have created serious problems for geriatrics health professionals and the older adults they care for:

  • Job Loss. Nearly 60% of professionals who responded to the survey reported that, in the last five years, federal budget cuts or breaks in grant programs resulted in faculty or research staff lay-offs or the elimination of certain research programs. Specially trained researchers, statisticians, administrative staff, and research nurses were among those most affected. Sadly, these men and women are essential to pushing science and research forward.
  • Investigator Anxiety. The AGS survey indicated that 87% of respondents were also “very” or at least “moderately” worried that funding issues would prevent them from maintaining labs or research programs in the next 10 years. These concerns could discourage experienced and promising young researchers from pursuing careers in geriatrics.
  • Decreased Full-Time Positions. The vast majority of survey participants reported that the number of full-time positions they could offer for people committed to aging research decreased or stayed the same compared to 2008 levels. Little or no job growth can put important advancements at risk and result in fewer young scholars dedicating themselves to working with older adults.

Investments in Aging Research Yield Success
Despite these concerns, federally funded research continues to improve the health of older Americans by creating new models for healthcare, diagnostic methods, and treatment options. Respondents to the AGS survey cited many examples of advances arising from federally funded research, including: Continue reading