Keeping Elders Out of Hospitals as Much as Possible

H 4 hospAnyone who has spent time with an elder parent in the hospital knows just how easy it is for one problem to be solved only to have the person discharged with different problems. This is not necessarily the fault of the medical caregivers or the hospital itself — it’s a result of a system that puts older people into beds and keeps them there. Add in bed alarms, the inability to move much, and that hospitals isolate elder patients from their routines and support communities, and you have a recipe for unsuccessful care, a result of age associated hospital complications.

So I recommend reading The Hospital is No Place for the Elderly, a November 20, 2013 article that appeared in the The Atlantic. This piece aptly illustrates the conundrum of frail elderly patients with chronic health issues admitted to hospitals where medical care focuses primarily on fixing acute health problems. The difficulty is that most of frail elders’ medical issues cannot be fixed — but the quality of their lives can improve. Author Jonathan Rauch also describes several programs in the United States — teams of physicians, nurses, and other health professionals — that collaborate to keep patients as healthy as possible and out of the hospital. The teams even save money.             Continue reading

More on Financial Scams Aimed at the Elderly

Read the FBI senior fraud prevention suggestions.

Check out Protecting Elderly from Scams, a July 4, 2012 article in the San Francisco Chronicle.

Staying alert for the many troubling phone calls and other communications that elders receive is challenging. Just the other day we received yet another frustrating phone call from credit card services.

My past blog post feature links to many fraud prevention sites.

Read — Making the Best of What Could be the Worst – Atlantic Article

Image from Dr. Bycok's website.

Read the March 7, 2012 Atlantic article, Making the Best of What is Often the Very Worst Time of Our Lives.

Whether we are helping to support aging parents right now or thinking about the years when we become elderly adults, we all know the situation. Our health care system and long-term care options are not prepared for the generational tsunami that is aging at this moment in time, and no workable solutions are in site to manage the big picture.

The Atlantic magazine piece is an excerpt from a book, The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life , by Ira Byock, the director or palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

Quotes from the Article

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Different Falls – Different Interventions

If you have aging parents who falls — and recently one of my parents took a spill — read the article about senior falling in the September 2010 Journal of the American Geriatrics Society. Mobilize Boston, the organization that conducted the research stated on its website that, “The purpose of the study is to collect information that will help us learn how older adults can maintain their health and independence longer.” The article abstract is free, but the article itself requires payment (or you can visit the library at your local hospital).

Identifying the differences between senior falls that occurred inside and those that occurred outside, the Mobilize Boston Study followed a cohort of 765 randomly selected men and women, most over 70 years old. Researchers collected data through questionnaires and medical examinations. During a median follow-up period of 21.7 months, 1,122 total falls occurred, consisting of 598 indoors and 524 outdoors. All study participants were Boston, Massachusetts residents, and they reported falls as they occurred.

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Another Article on the Geriatrician Shortage

Learn more about geriatrics at the American Geriatrics Society.

Read the Associated Press article in the Seattle Post Intelligencer, about the the shortage of geriatricians. In Boomers’ Aging Casts Light on Geriatrics Shortage, reporter Matt Sedensky describes the increasing shortage of  geriatricians –physicians who are trained to treat aging seniors. For those of us who are moving toward retirement, this is a serious problem.

Given my dad’s summer hospitalizations due to medication interaction, I find this the most thought-provoking sentence in the report:

Though not every senior needs a geriatrician, their training often makes them the best equipped to respond when an older patient has multiple medical problems. Geriatricians have expertise in areas that general internists don’t, including the changes in cognitive ability, mood, gait, balance and continence, as well as the effects of drugs on older individuals.

How Does One Decide to Stop Getting Medical Tests?

I am astonished at the number of diagnostic tests prescribed for older seniors. When my husband’s mother was 90, she had a gynecological exam — we suggested it and the doctor carried it out — and though I knew the doctor was gentle, Mother cried out because of the discomfort. Afterward we wondered why we put her through this exam and what we might have done if the test had identified the problem. We worried that we might have caused more health problems, especially the urinary tract infections were an ongoing problem, given Mother’s frail health. Ditto a year earlier when she prepped for a colonoscopy.

Every time my parents go to for a diagnostic test, I worry about what germs and complications they might bring home.

I don’t know the answer to this question, but several recent articles have reminded me how many of these diagnostic tests are performed and re-performed on elderly patients, despite that in the last years of life greater risks arise from the tests than from many of the health conditions.

The following three articles explore these issues.

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