Archive for January 2012
Medication Misuse
I attended an inservice at Home Instead Senior Care in Phoenix on medication misuse presented by staff from the Area Agency on Aging. They have received a grant to provide community outreach and education about this public health issue. We learned that 50% of elders misuse medications and ER visits are up because of related falls or accidental poisonings. These statistics resonated for me as I thought of one of our clients in particular. There are many reasons for medication misuse – some intentional, some not – and I realized that she had fallen victim to several factors that have led to numerous falls and a recent ER visit.
First of all, she lives alone. She also takes many medications given by different doctors who don’t communicate with each other. She doesn’t completely understand what each medication is for or whether there are drug interactions she should be aware of. In addition, she doesn’t always have the money to pay for her medications, so she sometimes skips doses. This leads to inconsistency in drug effectiveness.
What she does right, though, is to keep a list of current medications handy, she doesn’t mix alcohol with her medications and she never shares medications with anyone else. But there’s more she can do, and more that I, as her elder care coordinator, can do to help enhance her safety and avoid more trips to the ER.
Some solutions offered in the inservice include: (1) Know your medications – what condition are they treating, what are the potential side effects and possible drug interactions. (2) Take all medications only as prescribed. (3) For my client who keeps an accurate listing of all current medications – make sure that all treating physicians have that list, so they can be on the lookout for drug interactions. (4) Ask health care professionals if there are programs to help pay for medications if you don’t have health insurance. For additional information, contact www.aaaphx.org.
Preventative Care….for your loved ones
Yesterday, I attended the funeral of one of my weight-lifting friends, who had suddenly died of heart failure while sitting at the breakfast table. This gentleman, only a year older than I, was a PhD Physical Therapist, and the go-to person on our team for any strains or injuries we thought we had incurred during a training session. He was also a loving husband and father who cared for his wife and their children during both of his wife’s bouts with cancer.
But like the cobbler’s children who have no shoes, my friend never bothered to get checked out himself – in fact, it had been more than six years since he visited the doctor. My friend had put on some weight over the years, and he enjoyed an occasional cocktail – did he stay away from the doctor because he didn’t want to be scolded for these lifestyle choices? Was he afraid to get a definitive answer about something he suspected? Or, as a partner in a busy practice with multiple family obligations, was it just something that continually moved to the bottom of a long to-do list? Unfortunately, we will never know.
What we do know is that the choice to stay away from the doctor not only affected my friend, but also his family, his business partners, his patients and all of us who care about him.
As part of the Affordable Care Act, both Medicare and private health insurers are required to provide many preventative services, including an annual physical and screening mammograms and colonoscopies, at no cost to the patient. The purpose of this law is to give you the opportunity to learn whether you have a potentially dangerous health condition when it can still be effectively treated. It can also prevent a much deeper pain for those who can’t imagine going forward without you.
Understanding Advance Directives
As readers of this blog know, I strongly encourage my clients, groups that I have the opportunity to speak with, and my friends and family to prepare advance directives so that they can make their own decisions about what medical care they do, or do not, want to if they are unable to communicate that decision.
I recently received this article by Dr. Nathan Laufner, President of the Maricopa County Medical Association. Dr. Laufner cautions that Living Wills and Do Not Resuscitate (“DNR”) Orders are frequently misunderstood, both by the individual and the medical personnel who need to rely on it. For example, the individual may have one thing in mind when he says that he does not want treatment if he has a terminal illness, but his doctor may interpret that differently. (See Dr. Laufner’s article at http://www.mcmsonline.com/president/nathan-laufer-md/do-not-resuscitate-orders-lets-prolong-life-not-prolong-death.)
Living Wills and DNR Forms do raise complex and often confusing issues. As Dr. Laufner points out, the hospital personnel who give these forms to patients as they are being admitted may not be equipped to answer the patient’s questions, not to mention the impact of all of the emotions that person may be feeling at that time. This is why I recommend that these forms be completed in advance of any particular illness or hospitalization, when a person has time to think about what they want and confer, sometimes more than once, with family members and loved ones.
Dr. Laufner also says that, when patients hand doctors Advance Directives that they have completed previously, they often don’t understand what they mean. While “self-service” forms, available from many private organizations or state attorneys general, are certainly better than nothing, Dr. Laufner’s observation highlights the importance of working with an elder law or estate planning attorney when preparing these forms. The attorney will take the time required to explain the meaning of the various options, and is the advocate for the individual, not his family or his health care providers, who, while well-meaning, may have different perspectives and interests.
Taking Care of those who Care for our Parents
