Does More Care Do More Good?

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.

Effectiveness – A Frustrating Concept in Medical Care

Over the past several years we’ve heard a lot about the effectiveness of medical treatments. It’s frustrating to put together the puzzle parts on this issue, but especially so when a family member is ill with a serious disease. Sometimes going forward with a treatment feels better than seeming to do nothing. When aging issues are added to the thinking mix, decisions become even more complex.

Check out this Scientific American article.

In her New York Times Well blog column, When Less Treatment is More, Pauline W. Chen, M.D., points out that it’s often necessary for a physician to figure out when less treatment is better than more. Although quite a bit of research provides evidence and identifies treatments that are less effective, patients continue to receive those medical treatments, sometimes at great risk, because they or their doctors believe those are better care.

A medical treatment or surgery is considered effective if the desired outcome is achieved.

Dr. Chen describes research at Yale University School of Medicine that investigated whether radiation treatments after surgery were effective for women over age 70 with less invasive breast cancers and whether the patients lived longer. After examining the records of 13,000 women, the researchers found that the addition of radiation therapy to their treatments made little difference in their survival rate. Continue reading

Aging Seniors: What a Difference a Word Makes #2

Words matter, especially words that describe people who are aging. In every day conversation, disrespectful phrases such as “old people” or “old folks,” are commonly used. My parents and many of their friends detest these comments.

This week I listened to a podcast of a panel discussion, produced by a well-known media outlet, and buried in the interesting content were comments such as “too old” and “not all there.” So many of these words emphasize the gap between older and younger people. The problem is ageism, plain and simple.

Virginia Mennonite Retirement Community Supportive Language Card, Side 1

Growing old is a normal part of life, and while it can be hard work, most people manage it quite well with intellects intact.

Yet keeping a sense of self, not to mention pride, is a daily challenge so rigorous that perhaps it should even be added to the activities of daily living (ADL’s). Older seniors navigate a minefield of unintentional (my dad calls them tacky) comments and references designed to trivialize. The International Longevity Center, founded by the late Dr.Robert N. Butler (NY times Obituary), posts this short article, Old Age has Value in Today’s Youth-Oriented Society by Ithaca College Gerontology Professor John A. KroutDr Krout also heads the Ithaca College Gerontology Institute.

Some communities are trying to address the problem. Continue reading

The Good Caregiver: Rules of the Road for Adult Children

Rules of the Road for Caregiving

I have just read The Good Caregiver cover-to-cover. The recently published book, by Robert L. Kane, M.D., is an all-in-one user’s guide with thorough, indexed, and therefore easy-to-find information about every aspect of elderly parent caregiving. Though he is a world-renowned specialist on aging and long-term care (Read Dr. Kane’s faculty bio), and he produces lots of research papers, Dr. Kane’s writing style is low-key and easy to read. Listen to his talk about aging and his book on a recording made for the Public Health Moment series, a program produced by the University of Minnesota School of Public Health.

My husband and I have twice assisted with caregiving. The first time, for his father, we managed our mini-part from a long distance; the second, for his mother, also began as a long distance affair but moved close to our home for the last several years. Despite great challenges the two of us, both only children, mastered much of the minutia and took care of ourselves. Still we yearned for a user’s manual.

The Good Caregiver is that manual, the one we all need. Read some of the reviews. Continue reading

Aging Parents, Adult Children: Back Aches!

Most of us have experienced back aches of some type, and a fair number of our senior parents have back pain even more often than we do. For me, the only solution is to wait out a back ache and keep moving, even if it doesn’t feel so good to move (and it doesn’t). Most of us hurt, obsess, and use pillows — I do especially when I play the piano — wondering all the time why modern medicine cannot provide minimal medical care (a visit to a doc, a prescription, a quick co-pay, voila no pain) to solve the problem. Then one day the pain starts going away, at least a bit, though sometimes it doesn’t for a long time. While back pain can be, well — a pain — I do not want to even think about surgery.

Note:  If I exercise  and stretch regularly (4-5 times a week) my back pain is minimal. If I don’t exercise for a while, say for a week, the back pain returns at some point, and for the exercise and stretching to start working again takes some time. Check out this MedlinePlus tutorial about preventing back pain. When I am working hard to keep back aches at bay — which I should be all of the time — I use these exercises from the Mayo Clinic website in addition to walking and exercising on an elliptical trainer.

Continue reading

Nuts and Bolts of Green House Planning: Part III

“Whatever form they take, there should always be as little distinction as possible between a Green House and the other housing nearby.”
What Are Old People For? How Elders Will Save the World by William H. Thomas, M.D. (page 233)

The Green House vision projected by Dr. Thomas has become a small, growing movement with combined knowledge that benefits aspiring Green House builders like Virginia Mennonite Retirement Community. NCB Capital Impact, a company that supports these building initiatives, is the repository of this increasing knowledge, organizing the information and experiences so newer Green House projects, like that at VMRC, benefit from lessons already learned.

I have visited the site and the trees are already there.

While VMRC has decided to build 10 Green Houses — the number it will take to replace Oak Lea — the community expects to build three houses in phase one. Money needs to be raised, stakeholder education has to continue, and a resident committee of people currently living in other VMRC neighborhoods is organizing to ensure the success of the project. Building these houses requires long-term “buy-in” from many people.

The first part of the project will cost $4.5 million. VMRC retained NCB Capital Impact to help with a feasibility study and pre-development planning and continues to work with the company today. Fundraising is ongoing, now in a silent phase, and if the recession has  hampered things a bit, activity is proceeding enthusiastically, nonetheless.

The plan is to build VMRC Green Houses  in a tree-filled area near other VMRC residences, a high school, residential housing, and the Eastern Mennonite University. Continue reading