A great read for SCs:
Handbook for Guardians of Adults by Brad Geller, Michigan State Long Term Care Ombudsman Program, 10th Edition, 2012
http://www.kalcounty.com/aaa/pdf_files/Guardian%27s%20Handbook%20-%202012%20word%20%283%29.pdf
Additional fact sheets on issues of LTC, rights and choices can be found at:
http://www.michigan.gov/osa/1,4635,7-234-43230_46224—,00.html
Hi All – An opportunity to think about the volunteer work done each day by your members and residents!
Office of Services to the Aging (OSA) and the Commission on Services to the Ag-ing are accepting nominations for this year’s “Senior Citizen of the Year.” Each year two older Michigan residents are selected to receive an award for their outstanding volunteerism—one for community leadership and one for service to others.
The award winners will be honored at a special ceremony during the 6th annual Older Michiganians Day on June 4 at the State Capitol in Lansing. Nominations are gladly accepted from businesses, community service and faith-based organi-zations, associations, fraternal organizations, and other public and private enti-ties who value older adults as a resource. Individuals age 60 or older are eligible for nominations for uncompensated work performed, especially over the past year.
Please complete the nomination form available online at www.michigan.gov/osa and return it to OSA no later than May 3!
Contact Shirley Bentsen by phone at 517-373-8765 or by email at the address listed above if you have any questions.
This week my supervisor (Alexa Lempert) and I were fortunate to be able to attend a seminar at the Institute of Gerontology as part of their Professional Development Series. Professor Voyko Kavcic, Ph. D., of the University of Primorska in Slovenia, presented initial findings of “A Bed Rest Study with 55-65 Year Olds”.
The application to the senior population suggests that long-term inactivity due to illness or lack of resources has detrimental consequences. This study has shown that that challenging cognitive activity during these times can have positive psychological effects as well as quicker rehabilitation and return to everyday activity and independence.
Horizontal bed rest studies were conducted over a two-week period to resemble the effects of long-term post-operative immobilization and sedentary lifestyles. This model could also be applied to physical inactivity and aging studies. The study had both pros and cons; researchers had 24/7 control of the external environment and control over food intake and physical activity. Negative aspects included prohibitive costs to the hospital conducting the study, paying of staff, the study was labor intensive, and IRB would likely not approve citing safety and coercion concerns.
Pre and post-test measurements of all participants included blood and urine tests, EEG, EKG, muscle diameter, gait, balance, cognition, and endothelial dilation. All study participants had to agree to rehabilitation and reconditioning immediately following the study.
Participants were divided into two separate groups. While in bed, Group 1 did 50 minutes of cognitive training at the 2nd and 13th days, using the Virtual Navigation Task program. This is a series of virtual mazes which requires adaptive thinking. Group 2 watched the Discovery Channel.
Initial findings suggest that Group 1, who had the cognitive training during the bed rest period, had improved post-test gait performance and peripheral blood circulation, compared to Group 2 who were only required to watch the Discovery Channel. The findings also suggest that cognitive training or cognitive activity has a preventative effect on the negative outcomes of prolonged immobilization and sedentary lifestyles.
On average, participants who had 2 weeks of total bed rest required 28 days of physical reconditioning, which leads one to assume that longer periods of inactivity will lead to even longer efforts toward rehabilitation
Good article from the New York Times relevant to last week’s professional development training on medication misuse. Also see Camille’s post for the listing of medications older adults should avoid.
Doctors in the United States routinely prescribe potentially harmful drugs to older patients, and the problem is particularly acute in the South, a new study shows.
The analysis found that more than one in five seniors on Medicare in the South were prescribed medications that health authorities have specifically advised doctors to avoid giving to older patients because of their severe side effects. Compared with people 65 and older living in New England, those living in the southern region from Texas to South Carolina were about 12 percent more likely to be prescribed a high-risk medication.
The researchers suspected that factors like education, socioeconomic status and access to quality medical care might be driving some of the regional differences. And to some extent, that appeared to be the case. As socioeconomic status grew lower, for example, the likelihood of being prescribed a high-risk drug increased. But even after accounting for these factors, the researchers found that the disparity persisted.
“We can’t specifically identify the reason the southern states have these rates that are so much higher,” said Dr. Amal Trivedi, an author of the study and an assistant professor of health services, policy and practice at Brown University’s Alpert Medical School. “But I think it’s important for physicians and patients to be aware of it.”
Dr. Trivedi and his colleagues published their findings in the latest issue of The Journal of General Internal Medicine. For the study, they referred to a list of 110 drugs to avoid in the elderly, compiled by the National Committee for Quality Assurance. Many of the drugs are widely used, often with few or moderate side effects in younger patients, but their risks are magnified in the elderly.
On the list are anti-anxiety medications like Valium. The drug, a benzodiazepine, can be harder for elderly patients to metabolize, resulting in the drug staying in their systems for longer periods of time. That can lead to prolonged sedation, and in turn potentially deadly falls and fractures. Because of their side effects and potential to cause addiction, benzodiazepines are not usually recommended for the elderly. But when used as a last resort, there are relatively safer, short-acting alternatives, said the lead author of the study, Danya Qato, a pharmacist and doctoral candidate in health services research at Brown.
Several muscle relaxants and diabetes medications can also remain in elderly patients’ systems for longer periods, causing a higher rate of complications.
“We started this study because we know that these medications are likely to have more harms than benefits in older patients,” Dr. Trivedi said. “We have tried to reduce the use of these medications, and it’s important to figure out exactly how common they are among the elderly and what types of factors contribute to their use.”
The researchers looked at data on more than six million older men and women from across the country who were enrolled in Medicare Advantage plans. Over all, they found that 1.3 million of those seniors, or roughly one in five, had been prescribed at least one high-risk medication in 2009 even though many of the drugs had safer substitutes. About 5 percent of the seniors in the study had been prescribed at least two medications from the list.
The city with the most alarming rate was Albany, Ga., where nearly 40 percent of seniors on Medicare had received a prescription for a high-risk drug. The city with the highest rate of seniors receiving at least two high-risk prescriptions was Alexandria, La.
The simultaneous use of multiple medications, a phenomenon known as polypharmacy, is a growing problem among seniors. According to other research, the average person over 65 takes at least four prescription drugs — a practice that can lead to dangerous and unexpected interactions. Adverse effects brought on by the combination of multiple drugs are thought to be responsible for nearly a third of all hospital admissions.
“Polypharmacy is a major public health problem,” Dr. Trivedi said. “Sometimes less is more, particularly for the elderly.”
Ms. Qato said it was unclear why doctors in the South were more prone to prescribing the blacklisted drugs to their older patients and it could be that patients were simply more likely to ask for them. Either way, she said, doctors and patients should be aware of them.
“These lists are readily available on the Internet,” she said. “The take-home message for patients is to take ownership of your medications and to regularly review them with your pharmacists or physicians.”
Source:
http://well.blogs.nytimes.com/2013/04/15/older-patients-too-often-prescribed-risky-drugs/?src=rechp
By Anahad O’Connor
Note: The following resource is HUGE (993 pages). However, there are good imbedded links for navigation.
Anyone in the field of aging knows it has its own unique language. Understanding all the shifting terms, however, can be a challenge. At 95, Walter Feldesman, a prominent New York attorney, has released the third edition of his Dictionary of Eldercare Terminology, and he’s making it available free exclusively through NCOA.
http://www.ncoa.org/assets/files/pdf/Eldercare-Dictionary_Feldesman.pdf?utm_source=NCOAWeek_130409&utm_medium=newsletter&utm_campaign=NCOAWeek
March Network Insider
Click here to download the March 2013 Network Insider from the Area Agency on
Aging 1-B. This issue includes info on:
Managing Fiscal Year 2013 & Preparing for Fiscal Years 2014-2016
Elder Abuse Media Campaign
Provider Spotlight: Living Indepedence for Everyone (LIFE)
DSP Vendor Updates: Reporting Missed Visits MDCH Requirement
The Choosing Wisely campaign, an initiative by the American Board of Internal Medicine Foundation in partnership with Consumer Reports, kicked off last spring. It is an attempt to alert both doctors and patients to problematic and commonly overused medical tests, procedures and treatments.
It took an elegantly simple approach: By working through professional organizations representing medical specialties, Choosing Wisely asked doctors to identify “Five Things Physicians and Patients Should Question.”
The idea was that doctors and their patients could agree on tests and treatments that are supported by evidence, that don’t duplicate what others do, that are “truly necessary” and “free from harm” — and avoid the rest.
Among the 18 new lists released last week are recommendations from geriatricians and palliative care specialists, which may be of particular interest to New Old Age readers. I’ve previously written about a number of these warnings, but it’s helpful to have them in single, strongly worded documents.
The winners — or perhaps, losers?
Both the American Geriatrics Society and the American Academy of Hospice and Palliative Medicine agreed on one major “don’t.” Topping both lists was an admonition against feeding tubes for people with advanced dementia.
“This is not news; the data’s been out for at least 15 years,” said Sei Lee, a geriatrician at the University of California, San Francisco, and a member of the working group that narrowed more than 100 recommendations down to five. Feeding tubes don’t prevent aspiration pneumonia or prolong dementia patients’ lives, the research shows, but they do exacerbate bedsores and cause such distress that people often try to pull them out and wind up in restraints. The doctors recommended hand-feeding dementia patients instead.
The geriatricians’ list goes on to warn against the routine prescribing of antipsychotic medications for dementia patients who become aggressive or disruptive. Though drugs like Haldol, Risperdal and Zyprexa remain widely used, “all of these have been shown to increase the risk of stroke and cardiovascular death,” Dr. Lee said. They should be last resorts, after behavioral interventions.
The other questionable tests and treatments:
No. 3: Prescribing medications to achieve “tight glycemic control” (defined as below 7.5 on the A1c test) in elderly diabetics, who need to control their blood sugar, but not as strictly as younger patients.
No. 4: Turning to sleeping pills as the first choice for older people who suffer from agitation, delirium or insomnia. Xanax, Ativan, Valium, Ambien, Lunesta — “they don’t magically disappear from your body when you wake up in the morning,” Dr. Lee said. They continue to slow reaction times, resulting in falls and auto accidents. Other sleep therapies are preferable.
No. 5: Prescribing antibiotics when tests indicate a urinary tract infection, but the patient has no discomfort or other symptoms. Many older people have bacteria in their bladders but don’t suffer ill effects; repeated use of antibiotics just causes drug resistance, leaving them vulnerable to more dangerous infections. “Treat the patient, not the lab test,” Dr. Lee said.
The palliative care doctors’ Five Things list cautions against delaying palliative care, which can relieve pain and control symptoms even as patients pursue treatments for their diseases.
It also urges discussion about deactivating implantable cardioverter-defibrillators, or ICDs, in patients with irreversible diseases. “Being shocked is like being kicked in the chest by a mule,” said Eric Widera, a palliative care specialist at the San Francisco V.A. Medical Center who served on the American Academy of Hospice and Palliative Medicine working group. “As someone gets close to the end of life, these ICDs can’t prolong life and they cause a lot of pain.”
Turning the devices off — an option many patients don’t realize they have — requires simple computer reprogramming or a magnet, not the surgery that installed them in the first place.
The palliative care doctors also pointed out that patients suffering pain as cancer spreads to their bones get as much relief, the evidence shows, from a single dose of radiation than from 10 daily doses that require travel to hospitals or treatment centers.
Finally, their list warned that topical gels widely used by hospice staffs to control nausea do not work because they aren’t absorbed through the skin. “We have lots of other ways to give anti-nausea drugs,” Dr. Widera said.
You can read all the Five Things lists (more are coming later this year), and the Consumer Reports publications that do a good job of translating them, on the Choosing Wisely Web site.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
Source: New York Times, 2/28/13, http://newoldage.blogs.nytimes.com/2013/02/28/for-the-elderly-lists-of-tests-to-avoid/
DAAA is hosting Aging Summits to shape its Vision for Strong Home and Community-Based Services for Seniors. See attached flyers for how you and your members/residents can get involved.
Presenters from The Senior Alliance (TSA) will be at Flat Rock Towers (FRT) on Monday, Jan. 7 to educate members on the PATH program. TSA is willing to bring the entire 6-week program to FRT if there is enough interest. Additionally, Rachel is visiting FRT that afternoon to answer member’s questions about the service coordination program.
See the attached flyer.
Evidence-based recommendations for improving face-to-face communication with older patients. The recommendations were contributed by experts in the fields of gerontology and communications. Each recommendation is accompanied by a brief explanation of the rationale, tips for implementing the recommendation in busy health care settings, and selected references for further reading. The objective is to encourage behaviors that consider the unique abilities and challenges of older adult patients and produce positive, effective interactions among everyone involved.
This publication is intended for physicians, nurses, pharmacists, biologists, psychologists, social workers, caregivers, economists, health policy experts?in fact, anyone who seeks to have the best possible interactions with older patients. We believe that this collection of recommendations will assist you in identifying and responding to opportunities to improve the health of older adults. This publication was developed by GSA and supported by McNeil Consumer Healthcare.
https://www.geron.org/Resources/Online%20Store/gsa-products/communicating-older-adults We have a hard copy of this report at Hannan House for anyone interested in reading it.
From:
Joan Ilardo, PhD Assistant Professor and Director of Research Training College of Human Medicine, Office of Research 965 Fee Rd., Room A209 East Fee Hall, East Lansing, MI 48824 office: 517 432 2208 fax: 517 432 8021 joan.ilardo@hc.msu.edu
Join the Michigan Society of Gerontology (MSG), the oldest gerontological society in the U.S. and the only statewide aging organization dedicated to bridging people in practice, policy and research. Join as a member or a sponsor -visit the MSG website at http://www.msginfo.org (click on membership information for more info)!
© 2012 The Luella Hannan Memorial Foundation. All Rights Reserved.
