The intersection of elderly parents and multiple medications continues to be a conundrum for many adult children. It certainly is for my family! Two recent Washington Post articles about medication issues may be useful for the children or aging adults to read and then share with one another.
In Older Patients Sometimes Need to Get Off of Their Meds, but It Can Be a Struggle, physician Ravi Parikh writes about evaluating medications with the aim of de-prescribing some of the medicines that people take. He describes the struggles that can arise when patients hesitate to go off medications that they have been taking for years, because their sense is that their medications are working. People are reluctant to associate physical problems with medications that they already take, so when new symptoms arise, many people seek a prescription for that problem and are less inclined to examine whether or not the new problem might be caused by medications they already take.
The moment a person needs health information, the inclination is to Google it, even though there are much better places to visit — places that offer high-quality and reliable health information. A Google search does not guarantee good quality information — especially when it comes to health information, and due to sponsored advertisements and what I call pseudo health websites, a search may actually send a searcher in a wrong direction. Moreover, these days television ads, infomercials, and online ads seek to grab and hold people’s attention, and it’s difficult to figure out what’s a good source and what’s bad.
The good health information issue becomes even more critical for aging parents and elders, who often have many health concerns. Each day pharmaceutical advertisements and self-improvement ads bombard older adults with sales info disguised as health support. When they do Google searches, they encounter carefully groomed advertisements that may swoop in and look trustworthy. It can be difficult for a person of any age to tell what information is really useful and what information is just trying to get attention … and money.
When we are sick, how much health care is good health care? These days when we call an ambulance, the medics rush in with all sorts of equipment and medications — called advanced life support, which replaces the basic life support that many of us learned in CPR classes.
Doing More for Patients Often Does No Good, a January 12, 2015 article appearing in the New York Times, makes the point that more advanced therapies and medical care do not guarantee higher quality or better outcomes. Written by Aaron E. Carroll, M.D., the piece shares a study in the journal JAMA Internal Medicine that compared the outcomes for patients who had received life support — basic or advanced — before being admitted to the hospital. He also writes about other studies that appear to show how the most advanced emergency care does not necessarily mean longer survival.
Dr. Carroll, a professor of pediatrics at Indiana University Medical School, further reinforces this “more may be less” point of view by describing studies that show how women with breast cancer receive complex and also more expensive breast surgical cancer treatments that are no more effective than outcomes with a more standard breast conservation therapy.
This article requires readers to process fairly complex explanations about medical care, and it may be necessary to read some paragraphs more than once. Yet, it’s worth taking the time to understand that doing more medical care in many cases will not give us extra quality or a better outcome.
Just when you think that you have settled the most significant adult child-aging parent issues — when you and your parents have spoken about medical care support, finances, and the range of their end-of-life wishes — along comes another concern to worry about, and it’s one that may be completely out of our control.
We now need to be concerned about the possibility of a parent entering a hospital and assigned to observation status for several days. Observation means that, rather than being officially admitted as a patient, the person is there to be watched, sort of like an out-patient, but not really an out-patient. The problem is, it’s difficult to discover what status a hospital assigns a patient — the two look almost alike with nurses, doctors, hospital rooms, blood pressure checks, etc. Admission and observation do not look that different to the patient and family, and apparently many hospitals are not especially forthcoming with the information.
Why is patient status significant? It’s simple, really. If your parent needs to enter a skilled nursing facility or nursing home after three days of observation status, Medicare will not pay and the family will be required to pay all of the bills, including the hospital costs. For Medicare to pay the bills, a family member must be admitted as a patient for at least three days and not assigned observation status.
Over the past year newspapers and medical or health journals have carried stories about elders and observation, and I share them here so that you can learn as much as you can.
I’ve just returned to the hospital for another surgery on my right eye. My retina condition has a name — proliferative vitreoretinopathy (PVR) — which basically means that, so far, my retina keeps detaching. When I last reported on my detached retina issues, I explained how oil was placed into my eye to hold the retina in place.
Click to read about epiretinal membranes @ the Mayo Clinic.
The oil went in four months ago, and since that surgery I’ve been reporting to my retina specialist on a regular basis, and he has been monitoring my condition. He is watching the development of epiretinal membranes (read about them at the Mayo Clinic site — 4th paragraph down), studying them through the oil at each visit. These membranes needed to be removed, because extra tissue puts pressure on my retina.
So today my surgeon performed a vitrectomy, going in through the oil and removing the scar tissue but leaving the oil in place. The plan is to watch the retina for another two or three months, let it continue to heal, and then remove the oil and see how my retina fares (yes, I’m crossing my fingers and toes, just in case it helps). Continue reading →
Our family’s dog is ready for the Red Sox celebration parade.
Ever so often a blogger, in this case me, discovers a piece of news that’s old, but so interesting and relevant. When Best Friends Can Visit, appearing in the New York Times New Old Age blog, is just such an article.
This report, written by Judith Graham, describes how some hospitals and medical centers have decided to allow pets — as opposed to trained therapy dogs — to visit sick patients. One of these programs, at the University of Maryland Medical Center, has been in place since 2008. The report is filled with patient and family testimonials, explaining the positive differences that visiting pets can make.