It’s Not Normal: Falls

Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio 

It is the middle of winter here in Cleveland and we have experienced an unusual amount of snow, sleet and ice. In fact, if you live anywhere with winter, I’ll bet this weather has been challenging. One problem that we see more of in the winter is falls. I ask all of my patients if they have experienced a fall.  Can you  guess the most common answer I get? It isn’t “no”— it’s “not yet.”  Isn’t that interesting? That answer means that they expect to fall sometime. In other words, they think it’s normal. But we are here to find out otherwise!

Falls are certainly common. Most people can tell you about friends or family members who have fallen and suffered a serious injury from a fall, such as a broken hip. Most people also tell me that falling is one of the things they fear the most. The good news is that while falls are common, they are not inevitable. There are well defined risk factors that make it more likely for someone to fall.   And there are also recommendations on how to prevent falls. These recommendations will require you and your healthcare professional to work closely together.

Continue reading

Caregiving for an Older Adult: Stressing and a Blessing

Clare WohlgemuthClare M. Wohlgemuth, RN, GCNS-BC
Nursing Director, Geriatric Services
Boston Medical Center
Boston, Massachusetts

 If you are helping a family member or friend over age 50 with things such as dressing, bathing, housework, or taking medicine on a regular basis, then you are a caregiver. You are not alone—there are close to 50 million Americans involved in caregiving. Caregivers spend an average of 20 hours each week caring for one (or more) older adults. About one in four of caregivers have been giving care for more than five years. About three in four caregivers work a paying job and spend up to $5000 out of pocket each year to help with caregiving costs.

Caregiving has been a part of community life for a long time. These days, the amount and types of help provided by family caregivers has increased a great deal. This has also raised the costs of caregiving—both economic and psychological. Now, loved ones often come home from the hospital earlier and with more complicated conditions. This means that caregivers often take on many roles in addition to providing companionship and emotional support. Caregivers may give medications, find and coordinate services, and perform basic nursing. They also communicate with healthcare providers, coordinate care during transitions from hospital to home, and advocate for their loved ones during visits with healthcare providers and hospital stays.

Caregivers are at higher risk for symptoms of anxiety and depression because of the burden of these many roles. Their physical health may also suffer. It is normal for caregivers to feel alone and overwhelmed. Caregivers may also feel unable to communicate well with the person receiving care and/or other family members. They also report needing information on how to keep their loved ones safe at home and to find activities to do with them. And caregivers also need resources to help them manage their own stress and make time for themselves.

In our recent study of geriatrics health providers who are also caregivers, we found all of these challenges. Even those most prepared to handle all the different caregiving tasks found it very difficult. If you are a caregiver AND a healthcare professional, you may face additional burdens—and will also benefit from support. [You can click here to read the full study.]

What You Can Do
In order to cope with the demands of caregiving, all caregivers need to get help. It is good to ask questions, and to ask for help! If you are not happy with the answers you are getting, it’s important to keep asking. Also keep looking for the information and support that you need, perhaps from other resources. There are many places you can look to for help: hospitals, your community, and online resources.

Continue reading

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

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.

Continue reading

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.