By PAULINE W. CHEN, M.D.
Published: January 21, 2010
The man was nearing 90, losing his sight and showing signs of early dementia. After examining his abdomen, I fumbled trying to help him get his shirt and pants back on. After an awkward few seconds, the patient’s middle-aged son sprang forward from his seat near the door and began working through the buttons, zipper and belt with a practiced deftness.
“Daddy,” he murmured softly as his fingers nimbly pushed each pearly button through its hole, “you can usually do this yourself, can’t you?” He continued cajoling his father, as he cinched the old man’s belt and patted the haphazard pleating that appeared around his waistline. “You can even feed yourself if I help get your food on the spoon, can’t you?”
My patient nodded absentmindedly, smiling at the fluorescent lights on the ceiling and tapping his fingers against his drooping mouth.
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
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1(800) 383-0520
I felt as if I had just witnessed a scene that played itself over and over again every morning.
Later outside the exam room, the son pulled me aside. I noticed the dark circles around his eyes. “You’re tired, aren’t you?” I asked him.
The man’s dark eyes began to fill with tears. I immediately, reflexively almost, started apologizing for not being able to do more for his father. But he stopped me.
“No, no,” he said, wiping the tears away with the back of his hand. “It’s not that. It’s not that at all.” He paused and looked toward his father, still lying on the table in the room and smiling at the lights. “It’s just that no doctor has ever asked me if I was tired.”
In truth, I probably would have never done so either except that a few years ago, I too had spent time caring for a frail loved one.
For all our assertions about the importance of caring in what we do, doctors as a profession have been slow to recognize family members and loved ones who care for patients at home. These “family caregivers” do work that is complex, physically challenging and critical to a patient’s overall well-being, like dressing wounds, dispensing medication, and feeding, bathing and dressing those who can no longer do so themselves.
Many of these caregiving tasks were once the purview of doctors and nurses, a central component of the “caring professions.” But over the past century, as these duties increasingly fell to individuals with little or no training, doctors and even some nurses began to confer less importance, and status, to the work of caregiving.
It comes as no surprise, then, that physicians now rarely, if ever, learn about what a family caregiver or health care aide must do unless they are faced with caring for their own loved ones. We doctors don’t know or aren’t always fully aware of what it takes to care for a patient after we leave the room.
In other words, for the 37 million people attending to the health care needs of a relative, partner, friend or neighbor, our best care goes only so far.
“If you look at the amount of time devoted to actual caregiving, the physician contributes a very modest amount,” said Dr. Arthur Kleinman, a professor of medical anthropology and psychiatry at Harvard Medical School and now a family caregiver himself.
“We’ve had outstanding diagnoses and very careful attention to defining the problem,” Dr. Kleinman said, referring to his own experience. “But once the problem is defined and the limited pharmacological interventions prescribed, there has been neither interest nor knowledge about the rest of the aftercare, even in the most simple parts like finding a home health aide or getting a needs assessment by a social worker.”
But our profession’s indifference may hopefully soon be a thing of the past.
This month, the American College of Physicians, the country’s leading professional organization of internal medicine physicians, issued its first position paper on working with caregivers. Endorsed by almost a dozen other professional medical organizations, the paper, published in The Journal of General Internal Medicine, highlights the challenges that can arise from the complex interaction among patient, doctor and caregiver and offers guidelines for providing the best care.
Using a framework of broad principles, like the need to respect and maintain a primary focus on the patient’s rights, dignity and values, the paper explores specific issues that are likely to arise in a given patient-doctor-caregiver relationship. How, for example, should physicians approach long-distance family caregivers? What should they consider when working with the caregiver of a terminal patient? How can they best support the caregiver who is convinced that he or she can never do “enough”?
“Normally everyone is always focused on the patient, patient autonomy and the patient’s wishes in terms of the ethical standpoint,” said Dr. Virginia L. Hood, chairwoman of the Ethics, Professionalism and Human Rights Committee of the American College of Physicians and one of the paper’s authors. “But family caregivers are an important part of the health care team, too. We need to value these caregivers better, think about their needs and consider how they are central to the patient’s care, not just someone who happens to be pushing the wheelchair.”
Of particular importance is understanding how the work of caregiving can also give rise to a new set of medical issues: those of the caregiver.
Caregiving duties place tremendous stresses on an individual, and not all of those stressors are simply physical and emotional. “Some of these 37-going-on-40 million family caregivers have had to give up their own jobs in order to care for the patients,” Dr. Hood said. “That means they aren’t going to be able to put aside money for their retirement. Who is going to take care of them and their medical problems in the future?”
Caring for more people can be difficult for physicians who are already stretched and not reimbursed for additional time spent with patients. “This tension regarding time and reimbursement has to be resolved,” Dr. Hood said. But, she added, “if the physician needs to spend more time with patients and their caregivers in order to make things better for the patients, then it has to be done; it’s all about the patient.”
And perhaps, it is also about how we define care, whether that care is provided by family members and loved ones, or by doctors and other clinicians.
“There is a moral task of caregiving, and that involves just being there, being with that person and being committed,” said Dr. Kleinman, of Harvard Medical School. “When there is nothing that can be done, we have to be able to say, ’Look, I’m with you in this experience. Right through to the end of it.’ ”
Join the discussion on the Well blog.
Wednesday, January 27, 2010
Friday, January 15, 2010
Psychology and Aging
People 65 years of age and older are the fastest growing segment of the U.S. population. An increasing number of older adults are immigrants or members of ethnic or racial minority groups. More than 5 million older adults were below the poverty level or classified as “near poor” in 2001.
Most older adults enjoy good mental health. However, it is anticipated that the number of older adults with mental and behavioral health prob- lems will almost quadruple, from 4 million in 1970 to 15 million in 2030. Mental health disorders, including anxiety and depression, adversely affect physical health and ability to function, especially in older adults. Some late-life problems that can result in depression and anxiety include coping with physical health problems, caring for a spouse with dementia or a physical disability, grieving the death of loved ones, and managing conflict with family members.
Psychology and Aging
Addressing Mental Health Needs of Older Adults...Continue to read http://www.apa.org/pi/aging/resources/guides/aging.pdf
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
I Care For You Home Care, L.L.C.
1(800) 383-0520
Most older adults enjoy good mental health. However, it is anticipated that the number of older adults with mental and behavioral health prob- lems will almost quadruple, from 4 million in 1970 to 15 million in 2030. Mental health disorders, including anxiety and depression, adversely affect physical health and ability to function, especially in older adults. Some late-life problems that can result in depression and anxiety include coping with physical health problems, caring for a spouse with dementia or a physical disability, grieving the death of loved ones, and managing conflict with family members.
Psychology and Aging
Addressing Mental Health Needs of Older Adults...Continue to read http://www.apa.org/pi/aging/resources/guides/aging.pdf
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
I Care For You Home Care, L.L.C.
1(800) 383-0520
Thursday, January 7, 2010
How to Train the Aging Brain
By BARBARA STRAUCH
Published: December 29, 2009
I LOVE reading history, and the shelves in my living room are lined with fat, fact-filled books. There’s “The Hemingses of Monticello,” about the family of Thomas Jefferson’s slave mistress; there’s “House of Cards,” about the fall of Bear Stearns; there’s “Titan,” about John D. Rockefeller Sr.
The problem is, as much as I’ve enjoyed these books, I don’t really remember reading any of them. Certainly I know the main points. But didn’t I, after underlining all those interesting parts, retain anything else? It’s maddening and, sorry to say, not all that unusual for a brain at middle age: I don’t just forget whole books, but movies I just saw, breakfasts I just ate, and the names, oh, the names are awful. Who are you?
Brains in middle age, which, with increased life spans, now stretches from the 40s to late 60s, also get more easily distracted. Start boiling water for pasta, go answer the doorbell and — whoosh — all thoughts of boiling water disappear. Indeed, aging brains, even in the middle years, fall into what’s called the default mode, during which the mind wanders off and begin daydreaming.
Given all this, the question arises, can an old brain learn, and then remember what it learns? Put another way, is this a brain that should be in school?
As it happens, yes. While it’s tempting to focus on the flaws in older brains, that inducement overlooks how capable they’ve become. Over the past several years, scientists have looked deeper into how brains age and confirmed that they continue to develop through and beyond middle age.
Many longheld views, including the one that 40 percent of brain cells are lost, have been overturned. What is stuffed into your head may not have vanished but has simply been squirreled away in the folds of your neurons.
One explanation for how this occurs comes from Deborah M. Burke, a professor of psychology at Pomona College in California. Dr. Burke has done research on “tots,” those tip-of-the-tongue times when you know something but can’t quite call it to mind. Dr. Burke’s research shows that such incidents increase in part because neural connections, which receive, process and transmit information, can weaken with disuse or age.
But she also finds that if you are primed with sounds that are close to those you’re trying to remember — say someone talks about cherry pits as you try to recall Brad Pitt’s name — suddenly the lost name will pop into mind. The similarity in sounds can jump-start a limp brain connection. (It also sometimes works to silently run through the alphabet until landing on the first letter of the wayward word.)
This association often happens automatically, and goes unnoticed. Not long ago I started reading “The Prize,” a history of the oil business. When I got to the part about Rockefeller’s early days as an oil refinery owner, I realized, hey, I already know this from having read “Titan.” The material was still in my head; it just needed a little prodding to emerge.
Recently, researchers have found even more positive news. The brain, as it traverses middle age, gets better at recognizing the central idea, the big picture. If kept in good shape, the brain can continue to build pathways that help its owner recognize patterns and, as a consequence, see significance and even solutions much faster than a young person can.
The trick is finding ways to keep brain connections in good condition and to grow more of them.
“The brain is plastic and continues to change, not in getting bigger but allowing for greater complexity and deeper understanding,” says Kathleen Taylor, a professor at St. Mary’s College of California, who has studied ways to teach adults effectively. “As adults we may not always learn quite as fast, but we are set up for this next developmental step.”
Educators say that, for adults, one way to nudge neurons in the right direction is to challenge the very assumptions they have worked so hard to accumulate while young. With a brain already full of well-connected pathways, adult learners should “jiggle their synapses a bit” by confronting thoughts that are contrary to their own, says Dr. Taylor, who is 66.
Teaching new facts should not be the focus of adult education, she says. Instead, continued brain development and a richer form of learning may require that you “bump up against people and ideas” that are different. In a history class, that might mean reading multiple viewpoints, and then prying open brain networks by reflecting on how what was learned has changed your view of the world.
“There’s a place for information,” Dr. Taylor says. “We need to know stuff. But we need to move beyond that and challenge our perception of the world. If you always hang around with those you agree with and read things that agree with what you already know, you’re not going to wrestle with your established brain connections.”
Such stretching is exactly what scientists say best keeps a brain in tune: get out of the comfort zone to push and nourish your brain. Do anything from learning a foreign language to taking a different route to work.
“As adults we have these well-trodden paths in our synapses,” Dr. Taylor says. “We have to crack the cognitive egg and scramble it up. And if you learn something this way, when you think of it again you’ll have an overlay of complexity you didn’t have before — and help your brain keep developing as well.”
Jack Mezirow, a professor emeritus at Columbia Teachers College, has proposed that adults learn best if presented with what he calls a “disorienting dilemma,” or something that “helps you critically reflect on the assumptions you’ve acquired.”
Dr. Mezirow developed this concept 30 years ago after he studied women who had gone back to school. The women took this bold step only after having many conversations that helped them “challenge their own ingrained perceptions of that time when women could not do what men could do.”
Such new discovery, Dr. Mezirow says, is the “essential thing in adult learning.”
“As adults we have all those brain pathways built up, and we need to look at our insights critically,” he says. “This is the best way for adults to learn. And if we do it, we can remain sharp.”
And so I wonder, was my cognitive egg scrambled by reading that book on Thomas Jefferson? Did I, by exploring the flaws in a man I admire, create a suitably disorienting dilemma? Have I, as a result, shaken up and fed a brain cell or two?
And perhaps it doesn’t matter that I can’t, at times, recall the given name of the slave with whom Jefferson had all those children. After all, I can Google a simple name.
Sally.
Barbara Strauch is The Times’s health editor; her book “The Secret Life of the Grown-Up Brain” will be published in April.
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
I Care For You Home Care, L.L.C.
1(800)383-0520
Published: December 29, 2009
I LOVE reading history, and the shelves in my living room are lined with fat, fact-filled books. There’s “The Hemingses of Monticello,” about the family of Thomas Jefferson’s slave mistress; there’s “House of Cards,” about the fall of Bear Stearns; there’s “Titan,” about John D. Rockefeller Sr.
The problem is, as much as I’ve enjoyed these books, I don’t really remember reading any of them. Certainly I know the main points. But didn’t I, after underlining all those interesting parts, retain anything else? It’s maddening and, sorry to say, not all that unusual for a brain at middle age: I don’t just forget whole books, but movies I just saw, breakfasts I just ate, and the names, oh, the names are awful. Who are you?
Brains in middle age, which, with increased life spans, now stretches from the 40s to late 60s, also get more easily distracted. Start boiling water for pasta, go answer the doorbell and — whoosh — all thoughts of boiling water disappear. Indeed, aging brains, even in the middle years, fall into what’s called the default mode, during which the mind wanders off and begin daydreaming.
Given all this, the question arises, can an old brain learn, and then remember what it learns? Put another way, is this a brain that should be in school?
As it happens, yes. While it’s tempting to focus on the flaws in older brains, that inducement overlooks how capable they’ve become. Over the past several years, scientists have looked deeper into how brains age and confirmed that they continue to develop through and beyond middle age.
Many longheld views, including the one that 40 percent of brain cells are lost, have been overturned. What is stuffed into your head may not have vanished but has simply been squirreled away in the folds of your neurons.
One explanation for how this occurs comes from Deborah M. Burke, a professor of psychology at Pomona College in California. Dr. Burke has done research on “tots,” those tip-of-the-tongue times when you know something but can’t quite call it to mind. Dr. Burke’s research shows that such incidents increase in part because neural connections, which receive, process and transmit information, can weaken with disuse or age.
But she also finds that if you are primed with sounds that are close to those you’re trying to remember — say someone talks about cherry pits as you try to recall Brad Pitt’s name — suddenly the lost name will pop into mind. The similarity in sounds can jump-start a limp brain connection. (It also sometimes works to silently run through the alphabet until landing on the first letter of the wayward word.)
This association often happens automatically, and goes unnoticed. Not long ago I started reading “The Prize,” a history of the oil business. When I got to the part about Rockefeller’s early days as an oil refinery owner, I realized, hey, I already know this from having read “Titan.” The material was still in my head; it just needed a little prodding to emerge.
Recently, researchers have found even more positive news. The brain, as it traverses middle age, gets better at recognizing the central idea, the big picture. If kept in good shape, the brain can continue to build pathways that help its owner recognize patterns and, as a consequence, see significance and even solutions much faster than a young person can.
The trick is finding ways to keep brain connections in good condition and to grow more of them.
“The brain is plastic and continues to change, not in getting bigger but allowing for greater complexity and deeper understanding,” says Kathleen Taylor, a professor at St. Mary’s College of California, who has studied ways to teach adults effectively. “As adults we may not always learn quite as fast, but we are set up for this next developmental step.”
Educators say that, for adults, one way to nudge neurons in the right direction is to challenge the very assumptions they have worked so hard to accumulate while young. With a brain already full of well-connected pathways, adult learners should “jiggle their synapses a bit” by confronting thoughts that are contrary to their own, says Dr. Taylor, who is 66.
Teaching new facts should not be the focus of adult education, she says. Instead, continued brain development and a richer form of learning may require that you “bump up against people and ideas” that are different. In a history class, that might mean reading multiple viewpoints, and then prying open brain networks by reflecting on how what was learned has changed your view of the world.
“There’s a place for information,” Dr. Taylor says. “We need to know stuff. But we need to move beyond that and challenge our perception of the world. If you always hang around with those you agree with and read things that agree with what you already know, you’re not going to wrestle with your established brain connections.”
Such stretching is exactly what scientists say best keeps a brain in tune: get out of the comfort zone to push and nourish your brain. Do anything from learning a foreign language to taking a different route to work.
“As adults we have these well-trodden paths in our synapses,” Dr. Taylor says. “We have to crack the cognitive egg and scramble it up. And if you learn something this way, when you think of it again you’ll have an overlay of complexity you didn’t have before — and help your brain keep developing as well.”
Jack Mezirow, a professor emeritus at Columbia Teachers College, has proposed that adults learn best if presented with what he calls a “disorienting dilemma,” or something that “helps you critically reflect on the assumptions you’ve acquired.”
Dr. Mezirow developed this concept 30 years ago after he studied women who had gone back to school. The women took this bold step only after having many conversations that helped them “challenge their own ingrained perceptions of that time when women could not do what men could do.”
Such new discovery, Dr. Mezirow says, is the “essential thing in adult learning.”
“As adults we have all those brain pathways built up, and we need to look at our insights critically,” he says. “This is the best way for adults to learn. And if we do it, we can remain sharp.”
And so I wonder, was my cognitive egg scrambled by reading that book on Thomas Jefferson? Did I, by exploring the flaws in a man I admire, create a suitably disorienting dilemma? Have I, as a result, shaken up and fed a brain cell or two?
And perhaps it doesn’t matter that I can’t, at times, recall the given name of the slave with whom Jefferson had all those children. After all, I can Google a simple name.
Sally.
Barbara Strauch is The Times’s health editor; her book “The Secret Life of the Grown-Up Brain” will be published in April.
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
I Care For You Home Care, L.L.C.
1(800)383-0520
Saturday, January 2, 2010
Older workers get help in a tough job market
Baylie Evans
Dec. 27, 2009 (McClatchy-Tribune Regional News delivered by Newstex) -- CHEYENNE -- Searching for a job is hard for anyone, particularly in an economy like this one. But for senior workers, it can be even harder.
Many are entering the workforce for the first time because they find a need for additional income. Others are re-entering after retirement.
One of the biggest obstacles that older workers face when entering the workforce is a lack of computer knowledge, said Amy Reyes, the employment and training coordinator for the local Experience Works program.
Experience Works is a national, non-profit organization aimed at helping workers aged 55 and older find, keep and train for work.
The local Experience Works program recently received additional federal grant money from the American Recovery and Reinvestment Act to help teach computer skills to older workers.
"You can't even apply anywhere nowadays without having some knowledge of computers," she said.
So Experience Works helps train workers in computer skills while giving them work to do and a salary. And they have room for more in the program.
Nationwide, unemployment numbers for people 55 and older have gone up 54 percent since November of 2008, according to a news release from the national Experience Works program.
And nationally, "the number of older workers who are seeking assistance from Experience Works has increased an average of 33 percent over last year," said Cheryl Kulm, Wyoming state director for Experience Works in the release.
The local office is seeing increased traffic as well. That office used to get about one or two phone calls a day from people interested in the program, Reyes said. Now, it's up to four or five calls a day.
And even the demographics are changing locally. Where the office used to serve mostly people older than 60, now most are 55-58.
Despite their possible lack of training, older workers are a valuable and overlooked group of workers, Reyes said
For Mary Abraham, the program helped her get back on her feet after her husband passed away last May. She lost all of his income when he died and had to return to work.
She had been retired for more than two years when she decided to go back to work. And she had held just one job for many years before that.
She hadn't interviewed for a job in about 15 years, she said, and things had changed.
"They just kind of looked at my gray hair and said 'We don't want you,'" she said.
The problem wasn't that she had never worked before or didn't have office experience.
"It never dawned on me that I wouldn't get a job," she said.
She has been in the Experience Works program for about five months now. And after a year, the expectation is that she will have reliable, fulltime employment.
For questions about the program or to get involved, call the local office at 634-7417.
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
I Care For You Home Care, L.L.C.
1(800) 383-0520
Dec. 27, 2009 (McClatchy-Tribune Regional News delivered by Newstex) -- CHEYENNE -- Searching for a job is hard for anyone, particularly in an economy like this one. But for senior workers, it can be even harder.
Many are entering the workforce for the first time because they find a need for additional income. Others are re-entering after retirement.
One of the biggest obstacles that older workers face when entering the workforce is a lack of computer knowledge, said Amy Reyes, the employment and training coordinator for the local Experience Works program.
Experience Works is a national, non-profit organization aimed at helping workers aged 55 and older find, keep and train for work.
The local Experience Works program recently received additional federal grant money from the American Recovery and Reinvestment Act to help teach computer skills to older workers.
"You can't even apply anywhere nowadays without having some knowledge of computers," she said.
So Experience Works helps train workers in computer skills while giving them work to do and a salary. And they have room for more in the program.
Nationwide, unemployment numbers for people 55 and older have gone up 54 percent since November of 2008, according to a news release from the national Experience Works program.
And nationally, "the number of older workers who are seeking assistance from Experience Works has increased an average of 33 percent over last year," said Cheryl Kulm, Wyoming state director for Experience Works in the release.
The local office is seeing increased traffic as well. That office used to get about one or two phone calls a day from people interested in the program, Reyes said. Now, it's up to four or five calls a day.
And even the demographics are changing locally. Where the office used to serve mostly people older than 60, now most are 55-58.
Despite their possible lack of training, older workers are a valuable and overlooked group of workers, Reyes said
For Mary Abraham, the program helped her get back on her feet after her husband passed away last May. She lost all of his income when he died and had to return to work.
She had been retired for more than two years when she decided to go back to work. And she had held just one job for many years before that.
She hadn't interviewed for a job in about 15 years, she said, and things had changed.
"They just kind of looked at my gray hair and said 'We don't want you,'" she said.
The problem wasn't that she had never worked before or didn't have office experience.
"It never dawned on me that I wouldn't get a job," she said.
She has been in the Experience Works program for about five months now. And after a year, the expectation is that she will have reliable, fulltime employment.
For questions about the program or to get involved, call the local office at 634-7417.
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
I Care For You Home Care, L.L.C.
1(800) 383-0520
Friday, December 25, 2009
Keeping an eye on the elderly
Thursday, December 24, 2009 3:04 AM
MAIN STORY
* Best holiday gift: Check up on your elderly parents
Children can observe their elderly parents during the holidays for signs of dementia and other health issues that need to be addressed. Here are a few places to start:
• The kitchen. Is there enough food? Is it fresh? Is food that needs refrigeration in the refrigerator?
• The home. Is it at least fairly clean? Brightly lighted? Are blinds pulled all day?
• The mail. Are bills getting paid? Is mail being opened?
• Friends and neighbors. Do they have concerns about your parents?
• Health. Are there marked changes in mobility, speech, weight, memory?
• Driving. Can they drive safely?
• Conversations. Do they engage with others? Can they hear what others say?
• Clothing. Is it clean? Do they get dressed every day? Are they bathing regularly?
Sources: Golden Guidance, Barbara McVicker
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
I Care For You Home Care, L.L.C.
1(800) 383-0520
MAIN STORY
* Best holiday gift: Check up on your elderly parents
Children can observe their elderly parents during the holidays for signs of dementia and other health issues that need to be addressed. Here are a few places to start:
• The kitchen. Is there enough food? Is it fresh? Is food that needs refrigeration in the refrigerator?
• The home. Is it at least fairly clean? Brightly lighted? Are blinds pulled all day?
• The mail. Are bills getting paid? Is mail being opened?
• Friends and neighbors. Do they have concerns about your parents?
• Health. Are there marked changes in mobility, speech, weight, memory?
• Driving. Can they drive safely?
• Conversations. Do they engage with others? Can they hear what others say?
• Clothing. Is it clean? Do they get dressed every day? Are they bathing regularly?
Sources: Golden Guidance, Barbara McVicker
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
I Care For You Home Care, L.L.C.
1(800) 383-0520
Tuesday, December 15, 2009
Studies Shows Elderly Blacks Are More Likely To Skip Their Medication Than Whites And Maybe At Risk For Other Medication-Related Problems
Older adults experience a number of medication-related problems, including under treatment, suboptimal drugs, suboptimal dosing, and non-adherence, which can have negative effects on their quality of life. Now new research1, from the UNC Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill shows that blacks have more medication-related problems than whites, and non-adherence to medical regimens is a particular issue for this group. Dr. Mary Roth and colleagues' study of the racial disparities in the quality of medication use appears this week in the Journal of General Internal Medicine², published by Springer.
Older adults are likely to have a number of co-existing chronic diseases, visit more than one doctor, and use multiple drugs, which puts them at greater risk of developing medication-related problems. As a consequence, their health status and quality of life can be compromised. For the first time, Dr. Roth and her team's paper looks at the overall quality of medication use in individuals rather than focusing on certain medication-related problems or diseases. Their work also assesses the effect of race on the overall quality of medication use, another new dimension.
A total of 200 (100 white and 100 black) adults 60 years of age and older were recruited through the Department of Aging and two senior housing complexes in North Carolina. They were interviewed three times in their own homes, once at the start of the study, after six months and a year. Roth and colleagues measured quality of medication use in two ways: a clinical pharmacist's judgment and using Assessing Care of Vulnerable Elders quality indicators. This paper presents findings from the pharmacist assessment of quality only.
The researchers found that, on the whole, whites used more medications than blacks, had a greater number of chronic medical conditions and used more physicians. Nearly a third of blacks (28 percent) could not purchase their medication due to cost compared with only 12 percent of whites. Whites (58 percent) were more likely to have adequate health literacy skills than blacks (29 percent).
Each participant had at least one medication-related problem. The most common problems for both whites and blacks were under treatment (83 percent vs. 87 percent), suboptimal drug use (59 percent vs. 66 percent), suboptimal dosing (48 percent vs. 56 percent) and non-adherence (42 percent vs. 68 percent). The difference between whites and blacks was particularly noteworthy for non-adherence to medications, with smaller differences noted for inadequate medication monitoring. Interestingly, although blacks were prescribed fewer medications than whites, they had significantly more problems than whites. The authors note that this study supports previous findings that elderly blacks have higher rates of nonadherence to medications than whites, but beyond this, suggests that medication-related problems, in general, are prevalent and persist in both races.
The authors conclude: "Strategies to better measure the quality of medication use in older adults are needed, and efforts to improve the quality of medication use in older adults must account for potential differences in both the number and types of problems affecting whites and blacks."
Funding was provided by the National Institutes of Health, National Institute on Aging (Principal Investigator (MTR): Research and Career Development Award). The study was also supported by an American College of Clinical Pharmacy (ACCP) Frontiers Fund Research and Career Development Award.
References
1. Roth MT et al (2009). Racial disparities in the quality of medication use in older adults: baseline findings from a longitudinal study. Journal of General Internal Medicine. DOI 10.1007/s11606-009-1180-9
2. The Journal of General Internal Medicine is the official journal of the Society of General Internal Medicine.
Source: Ami Finkelthal
New York University
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Older adults are likely to have a number of co-existing chronic diseases, visit more than one doctor, and use multiple drugs, which puts them at greater risk of developing medication-related problems. As a consequence, their health status and quality of life can be compromised. For the first time, Dr. Roth and her team's paper looks at the overall quality of medication use in individuals rather than focusing on certain medication-related problems or diseases. Their work also assesses the effect of race on the overall quality of medication use, another new dimension.
A total of 200 (100 white and 100 black) adults 60 years of age and older were recruited through the Department of Aging and two senior housing complexes in North Carolina. They were interviewed three times in their own homes, once at the start of the study, after six months and a year. Roth and colleagues measured quality of medication use in two ways: a clinical pharmacist's judgment and using Assessing Care of Vulnerable Elders quality indicators. This paper presents findings from the pharmacist assessment of quality only.
The researchers found that, on the whole, whites used more medications than blacks, had a greater number of chronic medical conditions and used more physicians. Nearly a third of blacks (28 percent) could not purchase their medication due to cost compared with only 12 percent of whites. Whites (58 percent) were more likely to have adequate health literacy skills than blacks (29 percent).
Each participant had at least one medication-related problem. The most common problems for both whites and blacks were under treatment (83 percent vs. 87 percent), suboptimal drug use (59 percent vs. 66 percent), suboptimal dosing (48 percent vs. 56 percent) and non-adherence (42 percent vs. 68 percent). The difference between whites and blacks was particularly noteworthy for non-adherence to medications, with smaller differences noted for inadequate medication monitoring. Interestingly, although blacks were prescribed fewer medications than whites, they had significantly more problems than whites. The authors note that this study supports previous findings that elderly blacks have higher rates of nonadherence to medications than whites, but beyond this, suggests that medication-related problems, in general, are prevalent and persist in both races.
The authors conclude: "Strategies to better measure the quality of medication use in older adults are needed, and efforts to improve the quality of medication use in older adults must account for potential differences in both the number and types of problems affecting whites and blacks."
Funding was provided by the National Institutes of Health, National Institute on Aging (Principal Investigator (MTR): Research and Career Development Award). The study was also supported by an American College of Clinical Pharmacy (ACCP) Frontiers Fund Research and Career Development Award.
References
1. Roth MT et al (2009). Racial disparities in the quality of medication use in older adults: baseline findings from a longitudinal study. Journal of General Internal Medicine. DOI 10.1007/s11606-009-1180-9
2. The Journal of General Internal Medicine is the official journal of the Society of General Internal Medicine.
Source: Ami Finkelthal
New York University
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Monday, December 7, 2009
Seniors May Need Help Overcoming Holiday Blues
HealthDay
Sat Nov 28, 11:47 pm ET
SATURDAY, Nov. 28 (HealthDay News) -- For many seniors, the holiday season can trigger melancholy as they think about lost loved ones, struggle with health issues or worry about money problems, according to the American Geriatrics Society.
To help overcome the seasonal blues, the AGS Foundation for Health in Aging offers the following advice:
* Get out and socialize or invite family and friends over. Those who find it hard to get around should ask relatives and others for help traveling to parties and events.
* Volunteering can help improve mood. Contact the United Way or call local schools or religious organizations to ask about opportunities nearby.
* Don't drink too much alcohol because it can actually lower your spirits.
* Accept the fact that many people feel blue during the holidays and there is nothing wrong with not being "merry."
* Talking to someone about your feelings may help you understand the reasons why you feel sad.
* Watch for warning signs of depression. While holiday blues are temporary and mild, depression is more serious. Signs of depression include: persistent sadness; lack of interest; frequent crying; changes in appetite, weight or sleep; constant feelings of fatigue, restlessness, worthlessness, or guilt; suicidal thoughts.
* If you're depressed, contact your health-care provider. Depression is treatable.
The AGS Foundation for Health in Aging also offers tips for people with older loved ones who experience sadness during the holidays:
* Invite them out and to gatherings. Remember to take into account their needs, such as transportation or special diets.
* Lend a hand by offering to help with shopping and preparations for get-togethers in their homes.
* Encourage them to talk about their feelings. Acknowledge their sadness, including a sense of loss if family or friends have died or moved away.
* Suggest your loved one talk with a health-care provider. Many older people don't realize when they're depressed. Let your loved one know depression is a medical illness and there's no shame in having it.
More information
Mental Health America has more about holiday depression and stress.
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
I Care For You Home Care, L.L.C.
1(800) 383-0520
Sat Nov 28, 11:47 pm ET
SATURDAY, Nov. 28 (HealthDay News) -- For many seniors, the holiday season can trigger melancholy as they think about lost loved ones, struggle with health issues or worry about money problems, according to the American Geriatrics Society.
To help overcome the seasonal blues, the AGS Foundation for Health in Aging offers the following advice:
* Get out and socialize or invite family and friends over. Those who find it hard to get around should ask relatives and others for help traveling to parties and events.
* Volunteering can help improve mood. Contact the United Way or call local schools or religious organizations to ask about opportunities nearby.
* Don't drink too much alcohol because it can actually lower your spirits.
* Accept the fact that many people feel blue during the holidays and there is nothing wrong with not being "merry."
* Talking to someone about your feelings may help you understand the reasons why you feel sad.
* Watch for warning signs of depression. While holiday blues are temporary and mild, depression is more serious. Signs of depression include: persistent sadness; lack of interest; frequent crying; changes in appetite, weight or sleep; constant feelings of fatigue, restlessness, worthlessness, or guilt; suicidal thoughts.
* If you're depressed, contact your health-care provider. Depression is treatable.
The AGS Foundation for Health in Aging also offers tips for people with older loved ones who experience sadness during the holidays:
* Invite them out and to gatherings. Remember to take into account their needs, such as transportation or special diets.
* Lend a hand by offering to help with shopping and preparations for get-togethers in their homes.
* Encourage them to talk about their feelings. Acknowledge their sadness, including a sense of loss if family or friends have died or moved away.
* Suggest your loved one talk with a health-care provider. Many older people don't realize when they're depressed. Let your loved one know depression is a medical illness and there's no shame in having it.
More information
Mental Health America has more about holiday depression and stress.
Verlia Caldwell, Pres.
Visit us at http://www.icareforyouhomecare.com if you need home care in Charlotte, N.C..
I Care For You Home Care, L.L.C.
1(800) 383-0520
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