It’s Not Normal: Persistent Pain

Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio 

There are many issues facing older adults that are common, but should not be considered inevitable. This blog will launch a series for 2014, all bundled under the general heading of “It’s Not Normal”.  Over the next year, I intend to cover a variety of topics that include dementia, incontinence, falls and depression. If you have suggestions for this series, please leave a comment.

The kick-off for this series is pain. While pain is common as we age, it should never be considered “normal”.  Pain should always be discussed with your healthcare provider, so that he or she can help determine the cause (or causes).  Your healthcare provider can then help you figure out an approach to remove or reduce both the pain and the affect it has on your life.

Acute pain is pain that has happened recently and usually has a known cause. An example of this is a sprained ankle. A few weeks of ice, rest and over the counter pain medications (such as acetaminophen) is usually all that is required for relief to occur.

Chronic or persistent pain, however, is more of a problem. You may have had this pain for some time and the direct cause may not be known.  There are different kinds of chronic pain. These include:

  • pain from nerves, such as diabetic neuropathy or pain from a stroke
  • joint or bone pain such as arthritis or gout
  • some kinds of internal pain, such as abdominal pain from Irritable Bowel Syndrome

Improving the Care of Older Adults with Diabetes

Are you an older adult with diabetes, or a caregiver to an older person who has this disease? The odds are good that you are. Today, more than one in every four Americans aged 65 and older has diabetes.  And this is cause for concern. Diabetes can cause serious complications—including high blood pressure, depression, nerve pain, and difficulty thinking and remembering. But there’s some good news: Researchers and healthcare providers are learning more about how to help older adults with diabetes stay as healthy as possible.

This month the American Geriatrics Society (AGS) published a new guideline (The American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 Update), to help healthcare professionals  improve care for older people with diabetes. And based on the guideline, the Healthinaging.org has created two easy-to-read  tip-sheets.

One of the tip-sheets offers up-to-date, expert advice about living with diabetes in later life. The other summarizes the latest recommendations for  managing the complications of diabetes. [Click on the underlined words to see the tip sheets.]

We hope you will find this  information helpful, and encourage you to  talk to your healthcare provider about how you can put it to use. Please help us spread the word and share this news with other older people who have diabetes.

 

Transferring Older Adults from Hospitals to Nursing Homes

Ken Covinsky, MD, a geriatrician at the University of San Francisco (UCSF), recently published a blog on GeriPal  addressing an issue that affects many older adults—problems with transfers from the hospital to the nursing home.  Dr. Covinsky worked with Healthinaging.org to include some specific recommendations for caregivers, who can play an active role in helping to ensure safer transfers between sites of care for their older family members and friends.

Recent Study Shows Poor Communication Between Hospitals and Nursing Homes
Huge numbers of older people are transferred from hospitals to nursing homes.  Often, an older hospitalized patient needs skilled nursing care before they are ready to return home.  In other cases, a nursing home resident who needed hospitalization is returning to the nursing home.  Older patients and their families certainly hope that great communication between the hospital and nursing home will ensure a seamless transition in care.

But a recent study in the Journal of the American Geriatrics Society (click here for a copy of the article) suggests that the quality of communication between the hospital and the nursing home can be very problematic.  The study was led by researchers from the University of Wisconsin, including nurse researcher, Dr. Barbara King, and geriatrician, Dr. Amy Kind.

The authors conducted interviews and focus groups with 27 front-line nurses in skilled nursing facilities.  These nurses noted that very difficult transitions from the hospital to nursing home were common.  Sadly, when asked to give the details of a good transition, none of the nurses were able to think of an example.

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Using Feeding Tubes in Patients With Dementia

Ramona Rhodes, MD

Dr. Ramona Rhodes

Healthinaging.org is pleased to feature a guest blog by Dr. Ramona Rhodes.

Ramona Rhodes, MD, MPH, MSCS, AGSF
Assistant Professor of Internal Medicine
Geriatrics and Palliative Care Sections
University of Texas Southwestern Medical Center

 

My Cousin Opal was my paternal grandmother’s cousin.  They were close in age, grew up together, and were best friends.  Cousin Opal was college educated—a great accomplishment for an African American woman born in the South in the early 1920s.  She was a school teacher, community leader, social butterfly, and true fashionista.

I met Cousin Opal when I was in high school.  Cousin Opal was widowed and did not have children.  She had relocated from the Northeast to our small town, and was living with my grandmother at the time.  Cousin Opal began to exhibit problems with her memory, and though the word “Alzheimer’s” was whispered, my grandmother would never discuss it.

Over time, Cousin Opal became increasingly more forgetful, and she would only say a few words.  Food became harder to swallow, so my grandmother would blend things up into a puree to make it easier.  Eventually Cousin Opal stopped talking, stopped walking, and could not get out of bed.  And then, of course, Cousin Opal stopped eating.  My grandmother then made the decision to place a feeding tube.

Dementia is a neurodegenerative disorder (disorder that affects the brain) that results in memory loss and decline in function.  As dementias like Alzheimer’s disease progress to the advanced stage, patients become weaker and more dependent.  They lose their ability to talk, move around, and have a hard time with chewing and swallowing.  As a result, caregivers of dementia patients are often faced with the decision to place, or not place, a feeding tube for nutritional support.

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