Good Medical Care for the Elderly and How to Get It

Talking about End-of-Life Care

Thanks to my friend, Wendy Harpham, author of Happiness in a Storm and Only 10 Seconds to Care, for bringing to my attention a new guide for patients and their loved ones helpful to families and patients who are coping with final illness. Written by Paula Span, author of When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions, “Advanced Cancer Care Planning: What Patients and Families Need to Know About Their Choices When Facing Serious Illness” may be downloaded free of charge from the American Society of Clinical Oncology’s website.

I read the guide and believe it may be useful in any kind of situation—not just when a final illness is cancer. Using language that if both compassionate and direct, the booklet is easy to read. It explains, for example, that the word “advanced” is synonymous with 'end-stage' or 'terminal,' and that this doesn’t mean that an advanced illness is untreatable or that death is imminent. It also explains that choices for care relieving pain and discomfort remain when cancer is progressing even though a patient is receiving the best available anti-cancer therapies.

Internet resources for seniors & others seeking affordable medical insurance

Reported in a newsletter by MoveOn.org, here is some valuable information about Internet resources to assist seniors (and others) trying to assess and access affordable health care.

• Yesterday, www.HealthCare.gov, a new online portal where anyone can go to find insurance options in their state, went live. It's a very handy resource for information that used to be difficult to find. It's available to help millions who need insurance find it, and as a resource for those who want to shop around for new options or find out their new benefits under the new law.

What it means to be a health care proxy

I just watched Keith Olbermann's Special Comment -- MSNBC -- February 24, 2010. Olbermann spoke  movingly about what it means to be a patient advocate for a loved one and about the importance of end-of-life planning, both for the patient and for the loved one(s) who may be chosen to make health care decisions when a patient is no longer able to do so. Olbermann also spoke passionately how important it is for our Congress to make health care accessible to all Americans.

I have to say that, having acted as a health care proxy for my parents at the end of their lives, I wept throughout Olbermann's extremely moving plea.

The "Don't kill Granny" list

Rosanne M. Leipzig is a physician and professor at Mount Sinai School of Medicine. She wrote in the New York Times today about how lacking in skill and training most doctors are in the practice of geriatrics. This is particularly troubling to her because geriatrics is not a required course in medical schools around the country. If you’re a caregiver or if you are one of those who is “of a certain age” to need competent curative and/or preventative care from a doctor, you’ll want to read what Dr. Leipzig has to say. In a nutshell . . .

“I was part of a group of doctors and medical educators who recently published in the journal Academic Medicine a set of minimum abilities that every medical student should demonstrate before graduating and caring for elderly patients. Nicknamed the “don’t kill Granny” list, it includes being able to prescribe medicines, assess patients’ ability to care for themselves, recognize atypical presentations of common diseases, prevent falls, recognize the hazards of hospitalization and decide on treatments based on elderly patients’ prognosis and their personal preferences.

“The 2008 Institute of Medicine report “Retooling for an Aging America” resolved that all licensed health care professionals should be required to demonstrate such competence in the care of older adults. But this resolution lacks teeth. Medical resident training programs that receive Medicare money should be required to demonstrate that their trainees are competent in geriatric care. Medicare should finance medical training in nursing homes. And state licensing and medical specialty boards should require demonstration of geriatric competence for licensing and certification.

“Basic geriatric knowledge is preventive medicine. Nurses, social workers, pharmacists and other health care professionals should have it, too, in order to improve care for older people. But until doctors get this basic training, we can’t even begin to give 80-year-olds the care they need.”

Dr. Leipzig’s entire op-ed piece can be read here.

For more information see Elsevier Health's publication: "Human Anatomy Books" 

The importance of eliminating risks for falling

Falls can be deadly. About 10,000 elderly persons die every year in the U.S. as a result of injuries suffered in falls. Over one-third of these deaths occur among persons older than 85 years. The vast majority of these deaths are related to hip fractures; patients with hip fractures are 15 to 20 times more likely to die than those who have not had a fracture. Even when falls do not cause death, they can cause significant disability in the elderly, such as minor soft tissue injuries, hip fractures, other types of fractures, and serious soft tissue injuries. Injuries from falls may mean that your loved one won't be able to grow old in his or her own home.

Is online medical record storage safe?

As I have earlier written on Aging in Place, companies like Microsoft and Google are getting into the medical record storage business.  Last week, however, the New England Journal of Medicine raised important questions about whether medical privacy rules should be extended to these private firms. Steve Lohr wrote in the New York Times that the authors of The New England Journal article say there are still more questions than answers about the new “personalized health information economy.'’

Avoiding an inappropriate psychiatric hospitalization

Recently, a caregiver complained that a hospital would not allow her to elect a transfer to a psychiatric unit for her parent suffering from dementia. The hospital’s position was that the health care power of attorney did not allow the patient advocate to make a psychiatric admission. They said that only the patient could make that choice. The patient was described as being “delusional.” What seemed probable was that this patient was delirious, not psychotic. If that were the case, then a psychiatric admission would potentially be very harmful to the patient.

Avoiding an inappropriate psychiatric hospitalization for an elderly person can be life-saving for that patient.

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.

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.

Speak up and prevent health care errors

Caring at Home has published a valuable article about how seniors can help prevent serious medical errors by paying attention and speaking up when they have questions about their care or the medications prescribed for them.

You can read and reprint this article here.

"To Prevent Health Care Errors, Patients are Urged to SPEAK UP"