Health issues
Health Benefits for Elder Caregivers
Having someone who “needs” you gives you reason to get up in the morning. The psychological rewards of feeling purposeful and needed can’t be overstated. That being said, providing care to an elderly relative 24/7 can be a stressful and exhausting experience, one that could cause illness and a shortened lifespan for some. I have often counseled caregivers to take care of themselves too, or they may not be around to take care of their loved one.
Although caregiving can take a toll on someone’s health and wellbeing, there apparently are some significant physical benefits as well. A new study described in “Caregiving’s Hidden Benefits” by Paula Span (www.newoldage.blogs.nytimes.com) showed that a group of caregivers, who were followed over eight years, had lower mortality rates, maintained stronger physical ability and did significantly better on memory tests than non-caregivers. Caregiving is physical, and exercise improves physical health and cognition.
This is good news! However, regardless of the benefits, caregivers should continue to be encouraged to practice good self-care. This includes periodic respite, where care is relinquished to someone else for periods of time, and regular checkups with their primary physicians.
Does Money Sometimes Motivate Medical Decisions?
A recent study in the highly respected New England Journal of Medicine (http://www.nejm.org) reports that a significnt number of patients with Alzheimer’s disease or other terminal conditions are moved from their care facilities to the hospital for tests or treatment that do not make medical sense. It appears that some percentage of these moves are motivated by the fact that Medicare will pay a premium to the nursing home when it takes the patient back after a period of hospitalization.
In addition to enduring the trauma of the move, these patients are more likely to have a feeding tube inserted or to develop a pressure wound (bedsore) than those patients who remain in their care facility. And many of the conditions for which these individuals are moved could be treated just as well in the nursing home.
Many of us who are involved in caring for the elderly, either in our families or through our professions, react by thinking “they needed a study to tell us that?” Unfortunately, for all the focus in The Patient Protection and Affordable care Act on reducing hospital readmissions, there is minimal attention to preventing unnecessary first admissions.
As with most medical decisions at the end of life, the best prevention is to have your medical directives in place, and to make sure the agent in your health care power of attorney understands that you do not wish to endure unnecessary hospitalizations at the end of your life. The ability to honor our loved one’s wishes can be the best gift we can give them at this sacred time of life.
Delirium vs Dementia
When I was ten years old, my 40-year-old mother suffered a massive stroke. She lived to age 76, but not without significant challenges. My once soft-spoken, easy-going mother would suddenly become belligerent and combative with my father. After we had been through this several times, we came to understand that it was the hallmark of a urinary tract infection (UTI) and knew we had to get her to the doctor for diagnosis and treatment. Unfortunately, many people dealing with this issue think it is the hallmark of early dementia in elders, or progression of dementia in someone diagnosed with mild cognitive impairment. In fact, it is delirium, not dementia.
Delirium, also known as acute confusion, is a sudden change in mental functioning and behavior. It can present as agitation, disorientation and sometimes even hallucinations. There can be many causes for these changes. Before deciding that someone is experiencing signs and symptoms of dementia, seek medical advice to rule out a treatable physical condition. A course of antibiotics brought the mother we all knew back to us.
Seniors choose their living companions and their hospital visitors
Two posts in today’s weekly bulletin for members of the National Academy of Elder Law Attorneys highlight the ways in which our institutions need to continue to evolve to keep pace with changes in our society. (www.naela.org)
According to figures from the most recent U.S. Census, the number of couples over 65 who are living together has tripled over the past decade. This may be partly due to financial reasons, as both parties want to keep the maximum amount of Social Security income that they can, and may want to avoid co-mingling their funds. But it also reflects changes in attitude, as the number of people who believe that living together outside of marriage is sinful is steadily declining. As more and more baby boomers – many of whom lived together before their marriages – reach this age, these numbers are likely to continue to grow.
The second post talks about increased enforcement of government guidelines to protect hospital patients’ rights to choose their own visitors. Without these regulations, adult children could exclude their parent’s live-in companion, or other relatives could exclude a same-sex partner. However, according to the standards that all hospitals must follow in order to be eligible for Medicare and Medicaid reimbursement, hospitals much explain to their patients that they have the right to choose who may visit them, whether it is a family member, a domestic partner of either gender, or any other visitor, and they can also withdraw their permission for visitation at any time. Earlier this week, The Centers for Medicare and Medicaid sent a letter to the state agencies that audit compliance with their rules highlighting these new procedures. More information on the CMS guidance.
Alzheimer’s at Age 59?
We’ve always thought of Alzheimer’s as a disease of the elderly. But we’re now learning that’s not always the case.
Bravo for the courage of women’s college basketball coach, Pat Summit, to confront her diagnosis of early-onset Alzheimer’s Disease head on and in the public eye. She has a difficult journey ahead, but by bringing her diagnosis out into the open she, as well as we, benefit. She and her family can benefit from all there is to offer in terms of education, research, treatment and support. Her openness allows for early and effective life care planning going forward. We benefit from a new awareness that can hopefully bring about more research, treatments and support for families coping with the disease (www.alz.org).
For more information please contact Marsha Goodman
Hospice in the Nursing Home
Many nursing homes or skilled nursing facilities (SNFs) do a wonderful job of providing appropriate care to people with dementia who cannot be cared for at home. But not all have the specific skills in symptom management, sensory stimulation and family support so crucial to a person with end-stage dementia. Therefore, it was not surprising to read about an analysis of hundreds of family surveys in the Journal of American Geriatrics Society, showing that “Hospice services substantially improved the provision of care and support for nursing home patients dying of dementia and their families.” For example, according to Dr. Joan Teno, a Brown University gerontologist and the lead author of the study, one in five family members of patients not in hospice reported an unmet need for shortness of breath while only 6.1 percent for people in hospice did. Everyone benefits, including the SNF staff, by the additional resources of hospice: expertise in pain and symptom management, volunteers, spiritual and emotional support.
This research comes as Medicare funding for hospice has been swept up in the debate over the federal deficit. Hopefully the positive results of this study will increase awareness of dementia as a terminal illness and highlight the appropriateness of hospice in caring for people with end-stage dementia and their families in the SNF setting.
Medicare and Hospice
As a proponent of hospice philosophy and care — comfort and dignity at end of life — it was concerning to read the article, “Hospice and Its Costs,” http:/newoldage.blogs.nytimes.com/2011/06/27. According to the article, hospice costs have risen dramatically over the last 10 years. In these tough economic times, and with Medicare in the spotlight, it would be easy to see the benefit eventually being scaled back. This could hurt the people who really need it. It’s one program that Medicare has done well and can have a tremendous impact on the physical and emotional well being of the terminally ill and their families. For one thing, hospice brings medical care providers to the patient where they can be tended to in their own environment and in the comfort of their own home. Perhaps there has been abuse of the Medicare benefit by some organizations. Perhaps patients are at times accepted into hospice too early with diagnoses such as dementia where it’s difficult to determine when they might die. The new requirement of “face-to-face” visits by physicians or nurse practitioners before a patient can be recertified to remain on hospice may be one way to identify those who should be discharged from the program and thereby bring Medicare costs down. But for those who truly have a limited life expectancy, hospice is an invaluable and needed service, especially for our elderly population and their families.
Collaborative Efforts to Address Alzheimer’s Disease
This was the title of the opening session at the Annual Public Conference of the Arizona Alzheimer’s Consortium (AAC) held in Peoria last Friday, June 3. It reflects the bringing together of medical, research, political, elder law and social resources to address the public health issue of Alzheimer’s and related dementias. It was my first exposure to the Consortium and I was impressed with the caliber of presenters and their dedication not only to the treatment of this disease, but the support and recognition of caregivers. The AAC (www.azalz.org) is the nation’s leading model of statewide collaboration in Alzheimer’s disease research. Alzheimer’s disease is more prevalent than ever before simply because we are living longer. So we all have a stake in research to discover new treatments, making sure that treatments are available to those who can benefit from them, and helping people with the disease maintain dignity and helping caregivers cope day to day.
