by Emily Carton
It is not uncommon for families to be separated by great distances. But what happens when one or both parents reach a stage in their lives where they appear to be frail and vulnerable? What can you do to keep from living with an enormous amount of guilt and worry or feeling that to help means sacrificing your own life?
This article will offer a few suggestions as starting points for gaining control of the situation.
Begin by having a thorough assessment of your parent's situation. You need to make sure that what you hear long distance from your parent and about your parent matches the reality of the situation. Everyone has different perceptions about how one should live and when one's safety is at risk. A dirty or cluttered house may not mean a parent can no longer live by himself, only that he needs help in caring for his home. It may mean he is willing to live with lower standards in order to remain at home. If you are uncertain about the situation and potential risks, consider an assessment by an outside professional who can offer a more objective evaluation.
A careful evaluation means taking a close look at the physical, emotional, and social well being of the older person to determine what her needs are. For example: Is your parent able to prepare her own meals? Does she still have friends and a social life? Are her medical needs being met? Is she managing her own medication. How safe is her living situation? Is she still able to manage finances? What is her state of health? What long term plans need to be made?
Once you understand the issues, a care plan can be put in place. Are there people or agencies available to him that can provide him with home delivered meals? Are there senior centers where he can go? Does he have an informal network of people, who can look in on him or telephone him? Does he have funds to pay for services he might need? Is there a friend or a professional who could be an emergency contact? Is relocating to a different environment the best option for him?
Clearly, there may be a great deal of emotional turmoil, guilt, and concern in regards to an aging parent. It is important to remember that if your parent is still able to articulate what she wants, and a physician determines she still has the capacity to make her own decisions, then it is her decision as to where and how she lives. Just as a parent needs to let go of adult children to live their own lives, a child needs to give his parent space as well. Unless your parent wishes to move or receive more assistance, she has every right to refuse, even if family and friends think she is making a mistake. All you can do is insure that she is making an informed decision and share your concern with her.
If you feel that your parent is not capable of making an informed decision, then contact his physician for an assessment of his cognitive abilities. This poses different questions about safety and the ability to care for oneself. Yet, even in cases of dementia, there still might be resources available to help keep your parent at home. To do this, engage a geriatric social worker to assist you in making up a care plan and obtaining the necessary resources. If this is not possible due to a parent's extreme incapacity or limited resources, a social worker can also help you to either relocate him to a safer environment or assist in relocation to a facility closer to you.
Without fully assessing your parent's situation no one can offer specific options. Find a professional who can fully evaluate the situation and provide a series of options for your parent. Prior to your next visit to your parent, you may wish to locate a physician if your parent does not already have an ongoing relationship with one. You can also contact a social service agency or a private care manager to meet with you and your parent. If there are legal matters you may need an attorney. By trying to locate services prior to your next visit, you will save yourself days of searching and waiting for appointments.
There are no simple answers or solutions. Each person's situation is different. Each child has a different relationship with her parent, and this may also determine the level of your involvement. You need to think about your parent's needs and your own needs as well. You cannot force services upon a parent who is capable of making decisions and willing to live with some level of risk in order to remain at home. However, if your parent is no longer capable, then you need to act. Even if you notice only a small decline, it is not too early to know what resources are available and who might be able to help. You don't need to do it all yourself. Elicit the help of family members and friends, and, if appropriate, find a professional who knows the resources and can help you through the maze of decision making. You do not have to face this alone.
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, March 11, 2010
Tuesday, March 2, 2010
Elderly patients who survive ICU stay have high rate of death in following years
March 2, 2010
An analysis of Medicare data indicates that elderly patients who are hospitalized in an intensive care unit (ICU) and survive to be discharged from the hospital have a high rate of death in the following three years, and that, in particular, patients who receive mechanical ventilation have a substantially increased rate of death compared with both hospital and general population controls in the first several months after hospital discharge, according to a study in the March 3 issue of JAMA.
Although there has been a decrease over time in the risk of in-hospital death for patients who receive intensive care in the United States, little is known about subsequent outcomes for those discharged alive. "Patients older than 65 years now make up more than half of all ICU admissions," the authors write. "Information is needed to understand the patterns of mortality, morbidity, and health care resource use in the months and years that follow critical illness to allow for better targeting of follow-up care."
Hannah Wunsch, M.D., M.Sc., of Columbia University Medical Center and NewYork-Presbyterian Hospital/Columbia, New York, and colleagues examined the 3-year outcomes and health care resource use of ICU survivors, and identified subgroups of patients and periods in which patients are at highest risk of death, using a 5 percent sample of Medicare beneficiaries older than 65 years. A random half of all patients were selected who received intensive care and survived to hospital discharge in 2003 with 3-year follow-up through 2006. From the other half of the sample, 2 matched control groups were generated: hospitalized patients who survived to discharge (hospital controls) and the general population (general controls), individually matched on age, sex, race, and whether they had surgery (for hospital controls).
In the data analyzed for the study, 35,308 ICU patients survived to hospital discharge. The ICU survivors had a higher 3-year mortality (39.5 percent) than hospital controls (34.5 percent) and general controls (14.9 percent). The ICU survivors who did not receive mechanical ventilation had minimal increased risk compared with hospital controls (3-year mortality, 38.3 percent vs. 34.6 percent).
"However, mortality for those who received mechanical ventilation was substantially higher than for the corresponding hospital controls (3-year mortality: 57.6 percent vs. 32.8 percent, respectively). This difference was primarily due to mortality during the first 2 quarters following hospital discharge (6-month mortality: 30.1 percent for ICU survivors vs. 9.6 percent for hospital controls)," the authors write.
Discharge to a skilled care facility for ICU survivors (33.0 percent) and hospital controls (26.4 percent) also was associated with high 6-month mortality (24.1 percent for ICU survivors and hospital controls discharged to a skilled care facility vs. 7.5 percent for ICU survivors and hospital controls discharged home).
"The magnitude of the postdischarge use of skilled care facilities for both ICU survivors and hospital controls and the high long-term mortality for all of these patients call into question whether discharge to skilled care facilities is merely a marker for higher severity of illness with appropriate delivery of care. These patients could have been discharged prematurely from acute care hospitals, and needed a higher level of care than they received. It also is possible that these patients could have had better outcomes if discharged home, but were not able to be sent there due to lack of sufficient support from family or friends to act as caregivers. These findings highlight the need for a much more detailed understanding of the long-term care needs of these patients," the authors conclude.
More information: JAMA. 2010;303[9]:849-856.
Provided by JAMA and Archives Journals (news : web)
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
An analysis of Medicare data indicates that elderly patients who are hospitalized in an intensive care unit (ICU) and survive to be discharged from the hospital have a high rate of death in the following three years, and that, in particular, patients who receive mechanical ventilation have a substantially increased rate of death compared with both hospital and general population controls in the first several months after hospital discharge, according to a study in the March 3 issue of JAMA.
Although there has been a decrease over time in the risk of in-hospital death for patients who receive intensive care in the United States, little is known about subsequent outcomes for those discharged alive. "Patients older than 65 years now make up more than half of all ICU admissions," the authors write. "Information is needed to understand the patterns of mortality, morbidity, and health care resource use in the months and years that follow critical illness to allow for better targeting of follow-up care."
Hannah Wunsch, M.D., M.Sc., of Columbia University Medical Center and NewYork-Presbyterian Hospital/Columbia, New York, and colleagues examined the 3-year outcomes and health care resource use of ICU survivors, and identified subgroups of patients and periods in which patients are at highest risk of death, using a 5 percent sample of Medicare beneficiaries older than 65 years. A random half of all patients were selected who received intensive care and survived to hospital discharge in 2003 with 3-year follow-up through 2006. From the other half of the sample, 2 matched control groups were generated: hospitalized patients who survived to discharge (hospital controls) and the general population (general controls), individually matched on age, sex, race, and whether they had surgery (for hospital controls).
In the data analyzed for the study, 35,308 ICU patients survived to hospital discharge. The ICU survivors had a higher 3-year mortality (39.5 percent) than hospital controls (34.5 percent) and general controls (14.9 percent). The ICU survivors who did not receive mechanical ventilation had minimal increased risk compared with hospital controls (3-year mortality, 38.3 percent vs. 34.6 percent).
"However, mortality for those who received mechanical ventilation was substantially higher than for the corresponding hospital controls (3-year mortality: 57.6 percent vs. 32.8 percent, respectively). This difference was primarily due to mortality during the first 2 quarters following hospital discharge (6-month mortality: 30.1 percent for ICU survivors vs. 9.6 percent for hospital controls)," the authors write.
Discharge to a skilled care facility for ICU survivors (33.0 percent) and hospital controls (26.4 percent) also was associated with high 6-month mortality (24.1 percent for ICU survivors and hospital controls discharged to a skilled care facility vs. 7.5 percent for ICU survivors and hospital controls discharged home).
"The magnitude of the postdischarge use of skilled care facilities for both ICU survivors and hospital controls and the high long-term mortality for all of these patients call into question whether discharge to skilled care facilities is merely a marker for higher severity of illness with appropriate delivery of care. These patients could have been discharged prematurely from acute care hospitals, and needed a higher level of care than they received. It also is possible that these patients could have had better outcomes if discharged home, but were not able to be sent there due to lack of sufficient support from family or friends to act as caregivers. These findings highlight the need for a much more detailed understanding of the long-term care needs of these patients," the authors conclude.
More information: JAMA. 2010;303[9]:849-856.
Provided by JAMA and Archives Journals (news : web)
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
Wednesday, February 24, 2010
Vision problems linked to higher dementia risk
By Amy Norton
NEW YORK (Reuters Health) - Elderly adults with poor vision, particularly untreated vision problems, may have a higher risk of developing dementia than those with better vision, a new study suggests.
Researchers found that among 625 older Americans with initially normal cognition, those who said they had poor vision even with corrective lenses were more likely to develop dementia over the next 8.5 years.
During the study period, 168 participants developed Alzheimer's disease or other forms of dementia. Of those men and women, less than 10 percent had rated their vision as "excellent" at the start of the study. That compared with almost 31 percent of participants who maintained normal brain function over the study period.
On the other hand, about one-quarter of the study participants who went on to develop dementia had rated their vision as "fair" or "poor" at the outset, versus 11 percent of those whose memory and thinking remained intact.
When the researchers looked at the effects of treatment, they found that the highest odds of dementia were among people with poor vision left untreated. The risk was lower when they received some form of eye care.
The findings, published in the American Journal of Epidemiology, do not prove that vision problems contribute to dementia -- or that eye care can help slow cognitive decline.
But they do suggest that could be the case, according to lead researcher Dr. Mary A.M. Rogers, a research assistant professor of internal medicine at the University of Michigan in Ann Arbor.
It has long been known that there is an association between dementia and vision disorders, Rogers noted in an interview with Reuters Health. But in practice those problems are often detected and treated after a dementia diagnosis.
The current findings, Rogers said, show that vision problems may precede a dementia diagnosis by years.
It's not clear why eye disorders and poor vision would contribute to dementia. One possibility, Rogers explained, is the fact that limited vision could keep older adults from being active -- whether it's getting out and walking, reading, doing crosswords or socializing. All of those things, she noted, have been linked to a decreased risk of dementia in older adults.
The findings are based on 625 older U.S. adults who were part of a larger health study begun in 1992.
Overall, Rogers' team found, study participants who reported "very good" or "excellent" vision were 63 percent less likely to develop dementia over the next 8.5 years than those with poor vision.
The researchers then looked at the combined effects of vision problems with or without treatment on the risk of Alzheimer's disease specifically. Compared with people who had good vision and at least one visit to an ophthalmologist during the study period, those with poor vision and no visits were more than nine times as likely to be diagnosed with Alzheimer's.
By comparison, among study participants who had poor vision and at least one ophthalmologist visit, the risk of Alzheimer's was not significantly increased.
Similarly, men and women with poor vision who had received no eye procedures, such as cataract removal, had a five-fold increase in the risk of Alzheimer's. That risk was elevated by 2.5 times among people with poor vision who had received such procedures.
According to Rogers, the findings imply that older adults with vision problems should seek treatment -- if for no other reason than to improve their sight.
"If you have poor vision, don't sit on it. Go and see your doctor," she said. It's best, Rogers added, to see an ophthalmologist, a medical doctor who can diagnose the range of problems common in elderly adults, such as cataract, glaucoma, macular degeneration and diabetes-related retinopathy.
More studies are needed to replicate the current findings and determine whether vision problems are an actual risk factor for dementia, according to Rogers. With the number of people with Alzheimer's disease increasing, she said, it is becoming even more important to "take a look at the things we can do to either delay or prevent dementia."
SOURCE: American Journal of Epidemiology, online February 11, 2010.
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
NEW YORK (Reuters Health) - Elderly adults with poor vision, particularly untreated vision problems, may have a higher risk of developing dementia than those with better vision, a new study suggests.
Researchers found that among 625 older Americans with initially normal cognition, those who said they had poor vision even with corrective lenses were more likely to develop dementia over the next 8.5 years.
During the study period, 168 participants developed Alzheimer's disease or other forms of dementia. Of those men and women, less than 10 percent had rated their vision as "excellent" at the start of the study. That compared with almost 31 percent of participants who maintained normal brain function over the study period.
On the other hand, about one-quarter of the study participants who went on to develop dementia had rated their vision as "fair" or "poor" at the outset, versus 11 percent of those whose memory and thinking remained intact.
When the researchers looked at the effects of treatment, they found that the highest odds of dementia were among people with poor vision left untreated. The risk was lower when they received some form of eye care.
The findings, published in the American Journal of Epidemiology, do not prove that vision problems contribute to dementia -- or that eye care can help slow cognitive decline.
But they do suggest that could be the case, according to lead researcher Dr. Mary A.M. Rogers, a research assistant professor of internal medicine at the University of Michigan in Ann Arbor.
It has long been known that there is an association between dementia and vision disorders, Rogers noted in an interview with Reuters Health. But in practice those problems are often detected and treated after a dementia diagnosis.
The current findings, Rogers said, show that vision problems may precede a dementia diagnosis by years.
It's not clear why eye disorders and poor vision would contribute to dementia. One possibility, Rogers explained, is the fact that limited vision could keep older adults from being active -- whether it's getting out and walking, reading, doing crosswords or socializing. All of those things, she noted, have been linked to a decreased risk of dementia in older adults.
The findings are based on 625 older U.S. adults who were part of a larger health study begun in 1992.
Overall, Rogers' team found, study participants who reported "very good" or "excellent" vision were 63 percent less likely to develop dementia over the next 8.5 years than those with poor vision.
The researchers then looked at the combined effects of vision problems with or without treatment on the risk of Alzheimer's disease specifically. Compared with people who had good vision and at least one visit to an ophthalmologist during the study period, those with poor vision and no visits were more than nine times as likely to be diagnosed with Alzheimer's.
By comparison, among study participants who had poor vision and at least one ophthalmologist visit, the risk of Alzheimer's was not significantly increased.
Similarly, men and women with poor vision who had received no eye procedures, such as cataract removal, had a five-fold increase in the risk of Alzheimer's. That risk was elevated by 2.5 times among people with poor vision who had received such procedures.
According to Rogers, the findings imply that older adults with vision problems should seek treatment -- if for no other reason than to improve their sight.
"If you have poor vision, don't sit on it. Go and see your doctor," she said. It's best, Rogers added, to see an ophthalmologist, a medical doctor who can diagnose the range of problems common in elderly adults, such as cataract, glaucoma, macular degeneration and diabetes-related retinopathy.
More studies are needed to replicate the current findings and determine whether vision problems are an actual risk factor for dementia, according to Rogers. With the number of people with Alzheimer's disease increasing, she said, it is becoming even more important to "take a look at the things we can do to either delay or prevent dementia."
SOURCE: American Journal of Epidemiology, online February 11, 2010.
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, February 9, 2010
Love Is (Not) All You Need
by Mary A. Fischer, March & April 2010
To provide for loved ones who need long-term care, too many older Americans are resorting to extreme measures. It doesn't have to be this way
In 2004 Roberta H. and her husband, Alex, both 64, were living a contented life in a small town in western Massachusetts. Married for 39 years, with two grown sons, they had saved for years and were looking forward to traveling in a year or two, once they retired from their respective jobs—Alex was a college English professor, and Roberta was director of communications for a consortium of local colleges.
Then disaster struck. Alex was diagnosed with early-stage dementia and took early retirement from his job. Determined to care for her husband at home, Roberta paid a variety of people—at a cost of about $1,000 a month—to take him for walks, drive him to the YMCA, and prepare his lunch. She filled in the gaps by telephoning him several times a day.
As his dementia worsened, though, Alex needed full-time care, so Roberta found an adult-daycare center that could take care of him while she worked. For 18 months Roberta dropped off Alex in the mornings and picked him up after work, a routine that worked well until he had a medical emergency—painful urine retention—that landed him in the hospital. Medicare paid for Alex's stay, but after three days the hospital released him, even though he could barely walk. "It was such a stressful time," says Roberta, "and I had no time to figure out where Alex should go to get the therapy he needed."
"I felt terribly guilty about getting a divorce, but I felt I had no choice."
A flurry of phone calls later, she found a skilled nursing home that didn't have a waiting list, but there was a catch: Medicare would cover a total of only 100 days of skilled care and rehab. After the coverage ended, Roberta began drawing on the couple's savings, paying the nursing home $7,500 a month, plus miscellaneous expenses. Eight months and $75,000 later, the stock market crashed and cut the value of the couple's savings in half.
Membership – Join, renew, or learn about exclusive AARP member benefits.
"I was so scared," Roberta recalls. "Not only was my husband disappearing, but our savings were, too. All I could think was, if something happened to me, there'd be nothing left and I'd be out on the street." At the urging of a financial counselor, she made an appointment with a respected elder-law attorney in the area. When he laid out her options, only one—divorce—allowed her to get care for her husband and hang on to their remaining savings. By divorcing Alex, the love of her life, he would become indigent, thus becoming eligible for Medicaid.
"I felt terribly depressed and guilty," says Roberta, "but I felt I had no choice." She received the final divorce papers on August 15, 2008, the day before the couple's 44th wedding anniversary.
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
To provide for loved ones who need long-term care, too many older Americans are resorting to extreme measures. It doesn't have to be this way
In 2004 Roberta H. and her husband, Alex, both 64, were living a contented life in a small town in western Massachusetts. Married for 39 years, with two grown sons, they had saved for years and were looking forward to traveling in a year or two, once they retired from their respective jobs—Alex was a college English professor, and Roberta was director of communications for a consortium of local colleges.
Then disaster struck. Alex was diagnosed with early-stage dementia and took early retirement from his job. Determined to care for her husband at home, Roberta paid a variety of people—at a cost of about $1,000 a month—to take him for walks, drive him to the YMCA, and prepare his lunch. She filled in the gaps by telephoning him several times a day.
As his dementia worsened, though, Alex needed full-time care, so Roberta found an adult-daycare center that could take care of him while she worked. For 18 months Roberta dropped off Alex in the mornings and picked him up after work, a routine that worked well until he had a medical emergency—painful urine retention—that landed him in the hospital. Medicare paid for Alex's stay, but after three days the hospital released him, even though he could barely walk. "It was such a stressful time," says Roberta, "and I had no time to figure out where Alex should go to get the therapy he needed."
"I felt terribly guilty about getting a divorce, but I felt I had no choice."
A flurry of phone calls later, she found a skilled nursing home that didn't have a waiting list, but there was a catch: Medicare would cover a total of only 100 days of skilled care and rehab. After the coverage ended, Roberta began drawing on the couple's savings, paying the nursing home $7,500 a month, plus miscellaneous expenses. Eight months and $75,000 later, the stock market crashed and cut the value of the couple's savings in half.
Membership – Join, renew, or learn about exclusive AARP member benefits.
"I was so scared," Roberta recalls. "Not only was my husband disappearing, but our savings were, too. All I could think was, if something happened to me, there'd be nothing left and I'd be out on the street." At the urging of a financial counselor, she made an appointment with a respected elder-law attorney in the area. When he laid out her options, only one—divorce—allowed her to get care for her husband and hang on to their remaining savings. By divorcing Alex, the love of her life, he would become indigent, thus becoming eligible for Medicaid.
"I felt terribly depressed and guilty," says Roberta, "but I felt I had no choice." She received the final divorce papers on August 15, 2008, the day before the couple's 44th wedding anniversary.
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
Wednesday, January 27, 2010
Offering Care for the Caregiver
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..
I Care For You Home Care, L.L.C.
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.
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..
I Care For You Home Care, L.L.C.
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.
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
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