You’re Never Too Old: Elderly Couple Plays Impromptu Duet at Mayo Clinic

Categories: Active Senior Living

You’re never too old to have a little fun and enjoy life.  This is a YouTube video we want to share with our readers for some inspiration! An elderly couple, married for 62 years, walked into the Mayo Clinic and played an impromptu duet for patients and visitors.

New Online Service Offers Diagnosis and Prescriptions via Internet: Help or Harm for Seniors?

Categories: Caring For Elderly, Medical

The Star Tribune recently ran an article titled “Online medicine in a hurry,” which detailed MinuteClinic’s new feature for patient prescriptions called “Zipnosis.”  This time-saving option is actually an online pharmacy that can release prescriptions for various illnesses and symptoms, simply by charging the patient $25 and having that person fill out a survey. As for the office visit? Nonexistent. A doctor or nurse reviews the received information and releases the prescription via internet. This process happens without ever having to see or talk to a clinician in person, or even on the phone.

In terms of convenience, this service has great potential for the right patient.  But this convenience might produce be a different outcome for seniors.  Many elderly patients are currently receiving wrong medications and misdiagnosis even while the patients are sitting in front of the clinician.

Medical needs can be the most stressful part of caregiving for the elderly, and these needs can be most confusing not only for the caregiver but for the patients as well. While symptoms can vary from person to person for each diagnosis, many seniors are not as technologically savvy as the average internet user.  A service that seems to be as easy as going online to get medications might actually be more difficult for an older individual and leave more room for error. Yes, caregivers may be able to assist seniors in need, but there is no clinical discussion about the possible side effects of mixing multiple types of medications. What if the effects are worse than the current symptoms?  Visiting a doctor as an elderly person or caregiver is often a fact-finding endeavor. The ensuing conversation defines the diagnosis through direct questions, observations and communication.

What do you think about this new service – is it just what we have been missing, or is it a too-good-to-be-true feature that may cause more potential problems for misdiagnoses especially for the elderly?

Hospital Delirium: Real Danger from Hallucinations – Part II

Categories: Aging Advocacy, Caring For Elderly, Hospitalization

Hospitals and families alike are becoming more aware of the dangers of hospital delirium and are taking steps to reduce triggers.

Situations like being without eyeglasses, being in a dark room and being unaware of the day and time can trigger delirium. Hospital rooms should have clocks, calendars and adequate light, and nurses and doctors should make sure that patients have their glasses, hearing aids and dentures.

Family members can bring objects to help a patient stay oriented. Things like photos, a favorite blanket, or a familiar possession can be comforting.

Family members can also help by remaining calm and reassuring. Remind the patient where he or she is and why. Families should limit the length of visits and number of visitors to prevent patients from feeling overwhelmed, but they should also try to make sure the patient is rarely alone.

If the patient experiences an acute episode of delirium, relatives should try to arrange shifts so someone can be present around the clock. For more help and to ask questions, contact a qualified geriatric care manager before hospitalization to assist during the transitions.

Here are six questions to ask the hospital to help protect your elderly patients – thanks to the NY Times:

1. Do the nurses and doctors routinely screen for delirium or identify high-risk patients?

Older and younger patients who develop severe infections or heart, liver or kidney problems are at higher risk for delirium. But about 75 percent of delirium cases are missed when the hospital or its intensive care unit is not actively screening for it. While delirium can cause patients to become aggressive, disruptive or incoherent, it can also manifest itself in much less obvious ways, making a patient seem withdrawn or disconnected. Even with regular screening, family members are often the first to notice subtle changes. If you detect new signs that could indicate delirium — like  confusion, memory problems or personality changes — it is important to discuss these with the nurses or physicians as soon as you can.

2. How does the hospital deal with agitation or delirium in patients if it develops?

The longer the duration of the delirium, the greater the chances of poor consequences for the patient, so it should be addressed quickly. Experts say hospitals can treat delirium by helping patients sleep, making sure patients are hydrated, allowing family members to stay at patients’ bedsides to help them become reoriented, and getting patients up and walking when it is safe to do so. Family members should also inquire about hospital policies involving restraints for confused patients. Removing restraints is often recommended because they can cause patients to feel paranoid or trapped. Some hospitals use anti-psychotic medications like haloperidol, but some experts caution that these should be used in moderation and are not yet proven to work.

3. What does the hospital do to keep patients from becoming disoriented?

Situations like being without one’s eyeglasses, being in a darkened room and being unaware of the day and time can trigger delirium. Hospital rooms should have clocks, calendars and adequate light, and nurses and doctors should ensure that patients have their glasses, hearing aids and dentures. Family members should make sure the hospital staff knows if the patient needs these items. The family can also bring a few familiar objects from home to help a patient stay oriented. Things like family photos, a favorite blanket for the bed, a beloved book or relaxation tapes can be comforting for all patients. Family members can also help by speaking in a calm, reassuring tone of voice and reminding the patient where he or she is and why.  Massage can be soothing for some patients, and if it is all right with the medical staff, family members can walk with the patient in the hallways. Families should limit the length of visits and number of visitors to prevent patients from feeling overwhelmed, but they should also try to make sure the patient is rarely alone. If the patient experiences an acute episode of delirium, relatives should try to arrange shifts so someone can be present around the clock.

4. What policies are in place to make sure patients get adequate sleep?

Family members should find out if patients are able to sleep through the night or if they will be awakened for medical tests. Find out how the hospital controls noise and whether it offers any nondrug measures like back rubs or warm tea to promote sleep.

5. If my family member needs a urinary catheter or other bedside interventions, how does the hospital decide when to remove them?

A common procedure like a catheter insertion can spur anxiety in frail, vulnerable patients. Experts say it’s important to remove catheters, intravenous lines and other equipment whenever possible because they can make patients feel trapped, leading to delirium.

6. Will the physicians and pharmacy staff review my family member’s medications to identify medications that increase delirium risk?

Bring to the hospital a complete list of all medications and dose instructions, as well as over-the-counter medicines. It may help to bring the medication bottles as well. Prepare a “medical information sheet” listing all allergies, names and phone numbers of physicians, the name of the patient’s usual pharmacy and all known medical conditions. Also, be sure all pertinent medical records have been forwarded to the doctors who will be caring for the patient.

Hospital Delirium: Real Danger from Hallucinations – Part I

Categories: Aging Advocacy, Caring For Elderly, Hospitalization

Hospitalized older people often experience bizarre and disturbing hallucinations. Doctors are recognizing so-called “hospital delirium” and are developing ways to prevent or treat it.

Hospital delirium affects about one-third of patients over 70. The American Geriatrics Society finds that a greater percentage of intensive-care or post-surgical patients experience the episodes.

While the cause of delirium is unclear, there are many triggers: medications, infections, surgery, and pneumonia. Other triggers involve disruptive hospital procedures, such as sleep interrupted for tests, feelings of isolation, and changing rooms. Procedures like catheter insertions can create fear in frail, vulnerable patients.

Episodes of hospital delirium can mean setbacks for patients. It can extend hospitalizations, delay scheduled procedures, and require more time and attention from staff members. After an incident, patients are more likely to be placed in nursing homes or rehabilitation centers. Research from the Indiana University Center for Aging Research finds that elderly patients experiencing delirium were hospitalized six days longer, and placed in nursing homes 75 percent of the time, five times as often as those without delirium.

Furthermore, an episode of hospital delirium can have deadly consequences. Nearly ten per cent of elderly patients experiencing delirium died within a month. Experts say delirium can contribute to death by weakening patients or leading to complications like pneumonia or blood clots.

Watch on Thursday for Part II of the Real Danger from Hallucinations of Hospitalized Elderly!

Excuse me, Doctor, but I’m over here!

Categories: Aging Advocacy, Caring For Elderly, Hospitalization

Recently I accompanied an elder client to a doctor’s appointment.  Estelle was a new patient so we had no idea what to expect from this visit other than the doctor was a specialist in pain management, and Estelle had plenty of chronic pain.  What occurred is nothing like Estelle had ever experienced before; yet as a geriatric care manager for the past 8 years, what happened during the appointment is becoming too common and very unsettling.

Estelle’s daughter filled out form after form after form with Estelle’s medical history, current medications, and why she was seeing the doctor.  Yet when we walked into the examination room, the doctor was sitting behind a desk staring at a computer screen and a young woman was sitting behind him peering over his shoulder.  He apologized saying he was learning a new computer system and training a new office person at the same time as he was seeing Estelle.

For the next hour the physician, his eyes glued to the computer monitor, proceeded to ask a litany of questions barely waiting for an answer from Estelle or her daughter before he asked another.  Many of the questions were the same questions Estelle’s daughter had just answered on the myriad of forms.  Where does it hurt?  How long has it been hurting?  Did you do something to injure this area? On and on while seldom giving Estelle the common courtesy of eye contact or time to answer.  After an hour the doctor wrote Estelle a prescription for oxycodone, and asked Estelle’s daughter to make another appointment in a week; he would do an exam then.

This is just one example of a numerous doctors’ appointments where the physician failed to use common courtesies and effective communication skills.  In 1971 a study conducted by Albert Mehrabian concluded that 93% of communication is non-verbal:  55% of communication is body language, 38% is tone of voice and only 7% of what is being communicated is done so through words.  What did the doctor’s non-verbals say to Estelle?

My interpretation was:

• this computer is more important than you
• you are merely an interruption in my day
• you do not deserve my attention
• I don’t really care if I can help you or not

My role in a doctor’s appointment is to serve as an advocate for the elder patient.  Most often what I do is guide the physician toward effectively communicating with their patient.  I ask the physician to speak directly to the patient (not me); to slow down and give the elder person time to process an answer; to be patient; to use common courtesy; to give the respect that our elders have earned.

My recommendations for the doctor and others who see themselves in this scenario:

• make eye contact unless you know that it is a cultural negative to do so
• make small gestures such as touching the patient’s arm
• lean forward telling the patient you are listening
• nod in understanding
• wait for the patient to answer a question before you ask another

For the sake of quality care, I ask you to think about your communication style especially with your elder patients.  If you are a care partner for an elderly person, resolve to become an advocate for better communication between the physician and their elder patients.  Everyone benefits!

Review of Alzheimer’s Studies Finds No ‘Silver Bullet’.

Categories: Active Senior Living, Alzheimer's, Caring For Elderly, Dementia

You slavishly complete the daily newspaper crossword puzzle, eat enough olive oil to single-handedly solve Greece’s economic trade imbalance and take your brisk morning stroll like clockwork. You may do these things for their own pleasure and satisfaction, but also because you hope they may keep you mentally sharp and promote active senior living.

Busy mind, Mediterranean diet, active lifestyle. Each of these strategies have been linked to lowering the risk of Alzheimer’s Disease in preliminary studies.

But a new, comprehensive review of a 165 studies failed to confirm that any of these strategies will provide a guaranteed protective effect against the cognitive disease.

A group put together by the National Institutes of Health looked at 165 studies to tease out whether lifestyle, diet, medical factors or medications, socioeconomic status, behavioral factors, environmental factors and genetics might help prevent Alzheimer’s and other forms of dementia.

The report is published in the June 15 issue of the Annals of Internal Medicine.

Although biological, behavioral, social and environmental factors may contribute to the delay or prevention of cognitive decline, the study couldn’t draw firm conclusions about an association between modifiable risk factors and dementia.

The study found that while lifestyle factors, including consuming omega-3 fatty acids, being physically fit and participating in leisure activities, are associated with a lower risk of cognitive decline, the current evidence is “too weak to justify strongly recommending them to patients.”

The panel also found that there is “insufficient evidence to support the use of pharmaceutical agents or dietary supplements to prevent cognitive decline or Alzheimer’s disease,” the panel wrote.

However, smokers and people with diabetes do have an increased risk for cognitive decline, the panel found.

Insight into the Aging GLBT Community.

Categories: Caring For Elderly, GLBT

The U.S. Census Bureau and the Urban Institute found that at least two million Gay, Lesbian, Bisexual and Transgendered Americans are approaching or have reached retirement age!

GLBT Baby Boomers will process and perceive retirement differently than the general population. Most will delay retirement. Largely single and living alone, they will rely more on close friends than family for support as they age.

This according to a survey for MetLife, conducted by the American Society on Aging in connection with the GLBT Aging Issues Network.

The MetLife study polled 1,200 GLBT individuals and 1,200 people from the general population. It shows both differences and similarities between the two groups with regard to attitudes, demographics and aging.

Members of the GLBT group are more likely to say they will be at least 70 before they can retire, 48% compared with 40% in the general population. Economics is cited as the number one reason for the delayed retirement. Only a quarter or fewer in the GLBT group say they have saved what they need to live in retirement.

A higher percentage of GLBT Boomers have completed living wills, health care proxies, rights of visitation and partnership agreements, in comparison to the general population.

The study found that 77 per cent of the general population are in a relationship, compared to 61 per cent in the GLBT sample. However, nearly two-thirds of GLBT Boomers say they have a “chosen family,” a group of people they consider family, even though they are not legally or biologically related.

Stroke Risk Heightened for Stressed Out Caregiving Spouses.

Categories: Caring For Elderly, Resources

Providing care for an ailing spouse can cause its own ailments, according to a new study.

Caregivers who regard their duties as highly stressful may be at increased risk for stroke. Published in the journal Stroke, the study examined 767 people who were responsible for providing in-home care for a sick husband or wife.

The caregivers who said tending to their spouse caused “a lot of strain” were 23% more likely to have a stroke compared with their caregiving counterparts who said they felt no strain regarding their responsibilities.

The study found that the stroke risk was most pronounced among men.
“Highly stressful caregiving can include many difficult and uncontrollable stressors such as witnessing the suffering of a loved one, managing stressful behavior problems, financial strain, social isolation, and providing physically and psychologically demanding personal care tasks,” write the researchers, led by William E. Haley, PhD of the University of South Florida in Tampa.

Dr. Haley said that providing counseling to the caregiver can help them manage their own stress. Some caregivers also benefit from getting more day to day help and from going to support groups. He also said caregivers should seek programs or help from a geriatric care manager that will teach them ways to feel better prepared in taking care of their spouse.

Previous studies have shown that caregiver stress can increase the risk of depression.

Losing Keys has Health Implications for Seniors

Categories: Caring For Elderly, Elderly Drivers

It can be one of the most difficult power struggles families face.

When is someone too old to drive? State laws determining fitness to drive vary widely across the United States, from mandatory road tests to more frequent vision checks to in-person license renewals. Rules on whether a doctor must report to authorities that a patient is an unsafe driver vary as well.

The American Medical Association and the National Highway Transportation Safety Administration provide a physician guide for assessing and counseling older drivers. It includes monitoring changes in hearing, flexibility, reaction time and mental function.

While physical or mental decline in an elderly driver may make them unsafe behind the wheel and a genuine threat to public safety, research suggests that continuing to drive is a powerful factor in keeping seniors independent and healthy.

A study published in The Journals of Gerontology found that seniors who stopped driving were four to six times more likely to die within the next three years than seniors who continued to drive.

According to the National Institute on Aging, some 600,000 people 70 and older stop driving each year. And AARP surveys show that a third of older non-drivers complain of feeling isolated from other people, compared to 19 percent of older people who continue to drive.

“Traditionally, family members are concerned about how to get older drivers to stop driving, “ said Jerri Edwards at the University of South Florida. “We now see there are also bad consequences from driving cessation.”

Edwards, an associate professor of aging studies at USF, found that when seniors stop driving, their death rates increase, regardless of their health. She said that she is one of the many geriatric researchers who are exploring new methods that can help extend seniors’ ability to function. She said that cognitive training programs reduce driving cessation risk of those trained by 40 percent, allowing them to keep driving safely, longer.