…….Here are DeSilva’s five tips on how to tell if a senior relative needs immediate medical attention:
The person is unkempt with poor personal hygiene.
The home is very messy, dirty and has a foul odor.
Minimal movement by the person appears to be painful.
Mentally, the person is agitated or confused.
The person has not seen a physician in several months and is visibly unwell.
“Try to contact the primary-care physician first and alert them to the situation,” DeSilva said. But if holiday schedules or lack of information prevent that, bring them to the closest Emergency Department.
In the Emergency Department, you can expect the following:….
(Garrison, NY) In a feature article in The New Republic,(subscription only, check your local public library for availability) Daniel Callahan and Sherwin Nuland propose a radical reinvention of the American medical system requiring new ways of thinking about living, aging, and dying. They argue that a sustainable—and more humane— medical system in the U.S. will have to reprioritize to emphasize public health and prevention for the young, and care not cure for the elderly.
An interesting twist on their argument, which would aim to bring everyone’s life expectancy up to an average age of 80 years but give highest priority for medical treatment to those under 80, is that Callahan and Nuland are themselves 80 years old. Daniel Callahan, Ph.D., is cofounder and president emeritus of The Hastings Center and author most recently of Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Sherwin Nuland, M.D., is a retired Clinical Professor of Surgery at the Yale School of Medicine and author of How We Die and the Art of Aging. He is also a Hastings Center Fellow and Board member.
“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare,” said Callahan and Nuland. “That warfare, however, has come to look like the trench warfare of World War I: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer, heart disease, stroke, and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public must adapt it to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”
The article notes that the Affordable Care Act might ease the financial burden of this system, but not eliminate it. It reports, for example, that the cost of Alzheimer’s disease is projected to rise from $91 billion in 2005 to $189 billion in 2015, and to $1 trillion in 2025 – twice the cost of Medicare expenditures for all diseases now.
“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person,” the authors write. “An old age marked by disability, economic insecurity, and social isolation are also great evils.” They endorse a culture of care, not cure, for the elderly, with a stronger Social Security program and a Medicare program weighted toward primary care that supports preventative measures and independent living.
Callahan and Nuland point the way to a more sustainable path that reprioritizes the entire system. Among their recommendations:
- improve medicine at the level of public health and primary care, while reducing its use for expensive high-tech end-of-life care;
- shift resources for the elderly to greater economic and social security and away from more medical care;
- subsidize the education of physicians, particularly those who go into primary care, and decrease medical subspecialization;
- train physicians better to tell the truth to patients about the way excessively aggressive medicine can increase the likelihood of a poor death;
- shift the emphasis in chronic disease to care rather than cure;
- conduct a top-down, bottom-up, long-range study of the entire American system of health care, including the training of physicians, with a view toward reconstituting it along systematic lines that take science, humanistic concerns, economics, and social issues into account.
- Andrew Reinbach: Health Care Could Kill Us: We Don’t Have to Let It (huffingtonpost.com)
- New at Reason: Ronald Bailey on Health Care Reform (reason.com)
Study shows small day-to-day changes can result in measurable improvements in quality of life
Small, healthy lifestyle changes and involvement in meaningful activities—going beyond just diet and exercise—are critical to healthy aging, according to a new USC study.
Guided by lifestyle advisors, seniors participating in the study made small, sustainable changes in their routines (such as visiting a museum with a friend once a week) that led to measurable gains in quality of life, including lower rates of depression and better reported satisfaction with life.
The study validates the current trend in public health strategies to focus on preventing illness and disability, as opposed to treating issues once they have already begun to negatively impact health, according to lead investigator Florence Clark.
“What is critical is that, as we age, we continue to be engaged in life through a sustainable mix of productive, social, physical and spiritual activities. This goal of prevention and wellness is really a key to health care reform, and results in cost savings to society,” said Clark, professor and associate dean of the Division of Occupational Science and Occupational Therapy at the Herman Ostrow School of Dentistry of USC, and president of the American Occupational Therapy Association.
“The emphasis now is prevention,” she said. “There are non-pharmacologic interventions that work.”
The network of public services that supports California’s low-income, disabled elderly is fragile, affecting the ability of these vulnerable residents to live independent lives in their own homes, according to a new study from the UCLA Center for Health Policy Research.
This policy note reports the first findings from a yearlong effort to follow the lives and challenges encountered by several dozen representative older Californians in Los Angeles, San Diego, San Francisco and Santa Clara who are enrolled in Medicare and Medi-Cal and who receive in-home and community care.
The documentary project comes as California lawmakers consider additional cuts to a network of services that help seniors remain “safely in their homes” — the stated goal of these public programs and the way in which an overwhelming number of Americans say they want to age.
The policy note, “Holding On: Older Californians with Disabilities Rely on Public Services to Remain Independent,” shows seniors struggling to live functional lives in the face of already reduced caregiving hours. For example:
Caring for the caregivers
Sara cares for her disabled son and husband, whose heart disease, diabetes, incontinence and limited mobility require 24-hour care. There’s help from In-Home Supportive Services (IHSS) and other family members, but Sara is the primary caregiver. Now, her back is acting up. She’s been delaying seeing a doctor to take care of her own needs — who will care for her family if she’s hospitalized?
Paralyzed by polio, Mary breathes with the help of a ventilator and gets around in a wheelchair. She needs help to dress, bathe, use the toilet and eat. She’s created an elaborate system to meet her needs, using maximum IHSS hours of support and offering room and board to another caregiver in return for care. Mary’s happy with her life and rates her health as “excellent,” but she knows that even a small change in the delicate balance of her care system will send her to a nursing home.
Incapacitated by stroke and diabetes and confined to a wheelchair, Jack spent time in a nursing home a couple of years ago, and he’s not in a hurry to go back. In the nursing home, he felt unsafe and more isolated than he does in his own house with support from IHSS. Jack’s a realist. He knows a nursing home may be in his future again, but he wants to choose when and where he’ll go.
According to the researchers, all participants in the study are aware that the networks of care they’ve cobbled together could easily unravel, and most say they’d rather “make do” by eating less often, letting their homes become less safe or allowing their medical conditions to worsen than give up their independence and go to a nursing home — the likely scenario if they lose the in-home services they now rely upon.
“These seniors are using every sort of innovation and self-deprivation to make do,” said Steven P. Wallace, the study’s senior author and associate director of the UCLA Center for Health Policy Research. “They have nowhere to turn if their fragile care systems are further undermined.
“Policymakers need to see the faces of these vulnerable Californians as they crunch the numbers in budget discussions,” Wallace added. “Further cuts are an assault on their independence. Slashing in-home and community care will also increase total health care costs as these seniors increasingly use emergency room care, are hospitalized or enter institutions — under conditions that could have been prevented.”
Budget cuts looming
California, which is home to the largest number of older adults in the country, has several programs funded by federal, state and local dollars to assist low-income adults with disabilities. Proponents of these programs say that while such care isn’t perfect, it is far less expensive and more humane than the alternative — placing seniors in publicly financed nursing homes.
Yet, IHSS program-hours were trimmed by 3.6 percent in January 2011, and they face further across-the-board cuts of 8.4 percent, plus additional targeted reductions in the governor’s proposed budget. Adult day health care centers are slated for elimination, and supplemental security income cash benefits are to be reduced for single low-income aged and disabled individuals.
All the older adults in the study receive IHSS support, ranging from 20 hours of in-home help each month to the maximum of 283 hours per month. Most need help with household tasks, such as cleaning and cooking, and personal tasks like getting dressed or taking medications. Many require help getting in and out of bed, bathing and using the toilet. Some who might benefit from adult day health care or other supportive programs are unable to participate because of limited mobility or lack of transportation.
“California’s current system to support old and young adults with disabilities at home operates in silos and is not person-centered,” said Bruce Chernof, M.D., president and CEO of the SCAN Foundation, which is funding the study. “The Brown administration has an important opportunity to design a more stable, integrated, efficient and person-centered system that can meet the needs of these vulnerable residents throughout the state.”
- Home Care Services (MedlinePlus.gov) has links in areas as related issues (as nursing home alternatives), financial issues,organizations, and law/policy)
- US Administration on Aging has links to local programs, a benefits check up, related information, and more.
- National Association of Area of Area Agencies on Aging includes information on policy/advocacy, programs and resources/publications. It also includes links to local resources.
Today’s older Americans enjoy longer lives and better health than did previous generations. These and other trends are reported in Older Americans 2010: Key Indicators of Well-Being, a unique, comprehensive look at aging in the United States from the Federal Interagency Forum on Aging-Related Statistics.It is divided into five subject areas: population, economics, health status, health risks and behaviors, and health care. A link to a powerpoint slide of charts may be found here.
Emotional intelligence peaks as we enter our 60s, research suggests
Older people may have a harder time keeping a lid on their feeings, but they’re better at seeing the positive side of a stressful situation
Older people have a hard time keeping a lid on their feelings, especially when viewing heartbreaking or disgusting scenes in movies and reality shows, psychologists have found. But they’re better than their younger counterparts at seeing the positive side of a stressful situation and empathizing with the less fortunate, according to research from the University of California, Berkeley.
A team of researchers led by UC Berkeley psychologist Robert Levenson is tracking how our emotional strategies and responses change as we age. Their findings – published over the past year in peer-review journals – support the theory that emotional intelligence and cognitive skills can actually sharpen as we enter our 60s, giving older people an advantage in the workplace and in personal relationships.
“Increasingly, it appears that the meaning of late life centers on social relationships and caring for and being cared for by others,” Levenson said. “Evolution seems to have tuned our nervous systems in ways that are optimal for these kinds of interpersonal and compassionate activities as we age.”
In the first study, researchers looked at how 144 healthy adults in their 20s, 40s and 60s reacted to neutral, sad and disgusting film clips. In particular, they examined how participants used techniques known as “detached appraisal,” “positive reappraisal” and “behavior suppression.” Heading up that study was Michelle Shiota, now an assistant professor of psychology at Arizona State University. The findings were published in the journal, Psychology and Aging.