Good Medical Care for the Elderly and How to Get It

Reducing incidence of bedsores using teamwork

Bedsores can be a serious complication of aging. The clinical name is pressure ulcers. These ulcers occur when skin breaks down because blood circulation is cut off by sustained pressure. Bedsores can be so difficult to heal that prevention is the recommended approach. A recent study shows that a teamwork approach can reduce the incidence of bedsores by 69%.

Patients who are confined to beds and wheelchairs in hospitals and nursing homes are most at risk for bedsores. Other complications, such as dehydration and poor nutrition, can put the elderly at greater risk to develop bedsores. Incontinence also can lead to bedsores.

Heparin warnings

The New York Times reports today that Baxter Healthcare, the manufacturer of about half of the heparin used in the U.S., has stopped making it after hundreds of patients reported severe allergic reactions to the drug. Heparin is a blood thinner widely used in surgery and dialysis. Reportedly, at least four people have died. It's important to note that the complications reported were related to large dosages being injected in patients. Most of the cases were reported in late December or January. 40 percent of the cases were reportedly serious.

Federal regulators say that a shutdown in manufacturing will surely result in shortages of the drug.
Alternative drugs do exist. However, doctors were warned today of serious consequences if heparin becomes truly scarce.

You may read the New York Times article, Problems in Drug Lead to Halt by Factory here.

The checklist | A simple way to reduce medical error

In the December 10, 2008 issue of the New Yorker, author Atul Gawande writes: “If something so simple [as a checklist] can transform intensive care, what else can it do?”

Gawande gives some amazing examples of extraordinary ICU care evolving through the use of checklists. ICU care is complicated. A time and motion study of ICU care in Israel was cited. The study showed that the average ICU patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs. Any kind of mistake, in the procedure or in the sequence of actions, could result in fatal error.

Rizzo & Associates new blog

A Traverse City elder law practice, Rizzo & Associates, has just begun a new blog -- Michigan Elder Law Updates. I've already emailed friends in Kentucky a link to the article about changes in Michigan's property tax. As summer residents and property owners in my neighborhood, they will be very interested in this update.

You'll find Michigan Elder Law Updates here: http://michiganelderlaw.blogspot.com/

Aging in Place | A change in the tax law may help

On January 30, 2008 the Wall Street journal reported an important change to the tax code. A cherished tax break is the exclusion of as much as $500,000 of gain from gross income when, as a one-time event, a couple sells their principal residence as long as they file their tax returns jointly. (The exclusion is $250,00 for a single person). Yes, there are some conditions. You aren’t entitled to the exclusion unless you owned the home -- and lived in it as your primary residence -- for at least two of the five years prior to the sale.

Healthy Survivorship | Wendy Harpham coined the phrase!

Usually I write about issues important to the elderly. Today, I want to introduce you to Wendy S. Harpham, M.D. I am proud to call Wendy my friend, and I am grateful for her mentoring. Without Wendy’s thoughtful suggestions and encouraging words, Taking Charge: Good Medical Care for the Elderly and How to Get It would not exist. Wendy read the manuscript twice. She helped me “find my voice” as an advocate and she encouraged me every step of the way.

Wendy is an amazing woman. She was a young internist with a thriving private practice when she was diagnosed in 1990 with non-Hodgkin's lymphoma. Her children were 1, 3, and 5. While going through chemotherapy, she was amazed by and grateful for all she was learning about life on the other side of the stethoscope. From her useful perspective as physician-patient, she wrote a manuscript to guide patients through diagnosis, evaluation and treatment. WW Norton, a major publisher, offered Wendy a contract two days after she sent them the manuscript. Now in its third edition, it is entitled, Diagnosis Cancer: Your Guide Through the First Few Months of Healthy Survivorship.