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.

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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.

 

National Family Caregiver Month

When you hear the words “family caregiver” what image comes to mind? Odds are, you envision a woman. We tend to assume that family caregivers are wives, daughters, sisters, nieces, and granddaughters. But here’s a surprise: According to a recent Pew Research Center report, 45 percent of relatives caring for older adults in the U.S. are men.
What accounts for the growing percentage of men caring for older family members? According to a recent Wall Street Journal article, decades-long declines in family size, and increasingly far-flung families, are likely contributors. If your aging mom needs help, and you’re the only nearby, you step up to bat. Period.

So this month—National Family Caregiver Month—and beyond, we at the American Geriatrics Society Foundation for Health in Aging (HIA) hope you’ll show your support for the women and men you know who are caring for their aging relatives. While growing numbers of husbands, sons, brothers, nephews, and grandsons are now playing this role, they may be less likely than women to reach out for help with caregiving when they need it, according to a recent Wall Street Journal article. This means we need to do more to reach out to them.

Organizations and services for family caregivers are already doing this. The Journal story, for example, spotlights a Colorado home care service that created a virtual community just for men—www.malecaregivercommunity.com—thinking it would be more appealing to male caregivers . It has been. “Since it started in June, more than 84 discussions have developed,” the paper reports.

In addition to support, family caregivers also need top-notch information. And that’s where Healthinaging.org comes in. Among other things, it offers comprehensive information about caring for even the most medically complex older adults—those with multiple, chronic health problems. Just as important, it offers information about caring for yourself if you’re a caregiver. We hope you’ll mention the site to the family caregivers you know— men and women alike.

Managing Multiple Health Problems

More than half of all older Americans have “multimorbidity,” a medical term that means having multiple chronic health problems like heart disease, arthritis, and diabetes. It can be challenging for healthcare professionals, older adults and their friends and family to manage multiple health problems.  There are many more factors to think about.  For example, treating one health problem may make another health problem worse.  And having multiple health problems often requires taking more than one medication, which can result in unwanted drug interactions and side effects.

To help healthcare providers and patients better manage multiple health problems, the American Geriatrics Society (AGS) recently asked leading experts in the field to develop “guiding principles” for the care of older adults with multiple medical conditions.

The principles don’t specify what kind of care clinicians should provide a given patient. Instead, they outline steps to care that is tailored to each patient’s unique needs. You can read more about these principles and living with multiple health problems here.

Here is a very short summary of ways patients and their caregivers can work with healthcare providers to enhance care when dealing with multiple health problems:

Get informed - Learn as much as you can about your healthcare problems and treatment options. Ask your healthcare providers for information and advice, and get family and friends to help you with research.

Make sure your healthcare professionals understand what’s most important to you - For many older adults, for example, remaining as independent as possible is a top priority. Find out how different treatment options will affect your priorities.

Ask bout “trade-offs” – Ask your healthcare provider how the benefits of different care options compare with their risks.

Call if there are problems – Because there isn’t a lot of research examining how older adults with multimorbidity respond to different treatments, clinicians may not be able to predict exactly how a treatment will affect you. So let your healthcare provider know if you’re having unwanted side effects or aren’t getting the desired results from a certain treatment.

Ask for something simpler if you need to – The more complicated treatments are, the more likely patients are to stop following them. Ask for a simpler treatment plan if necessary.

Make sure your care plan does three things - Your healthcare providers should:

  • Make sure that treatments that are most important to you get the highest priority.
  • Maximize the benefits of your treatment.
  • Minimize risks by, for example, using non-drug medications when possible to lower risks of drug-drug side effects.