Monday, December 16, 2013

Good News: Strokes Fatalities on the Decline


The December 2013 edition of the American Heart Association journal Stroke released a statement saying that stroke deaths in the United States have declined dramatically in recent decades due to improved treatment and prevention. 
"The decline in stroke deaths is one of the greatest public health achievements of the 20th and 21st centuries," said Daniel T. Lackland, Dr. P.H., chair of the statement writing committee and professor of epidemiology at the Medical University of South Carolina, in Charleston, S.C. "The decline is real, not a statistical fluke or the result of more people dying of lung disease, the third leading cause of death."
Public health efforts including lowering blood pressure and hypertension control that started in the 1970s have contributed greatly to the change, Lackland said. It's estimated that there has been a 30% reduction, dropping stroke from the third leading cause of death, to now the fourth. 
In addition, smoking cessation programs, diabetes education and management, cholesterol control, now has better and faster treatments than ever before. All of which play a pivotal role in preventing strokes. Notwithstanding, improvement in acute stroke care and treatment is also associated with lower death rates.
"We can't attribute these positive changes to any one or two specific actions or factors as many different prevention and treatment strategies had a positive impact," Lackland said. "Policymakers now have evidence that the money spent on stroke research and programs aimed at stroke prevention and treatment have been spent wisely and lives have been saved. For the public, the effort you put into lowering your blood pressure, stopping smoking, controlling your cholesterol and diabetes, exercising and eating less salt has paid off with a lower risk of stroke."
Stroke deaths dropped in men and women of all racial/ethnic groups and ages, he said.

Know the Signs- Remember FAST
FaceAsk the person to smile. Does the side of  their face droop? 
Arms- Ask the person to raise both arms. Does one arm droop downward? 
Speech- Ask the person to repeat a simple phrase. Is their speech slurred or strange?
Time- If you observe any of these signs, call 9-1-1. Time is brain! 

Other symptoms include sudden numbness or weakness (especially on one side of the body), confusion, trouble speaking or understanding, trouble seeing in one or both eyes, trouble walking, dizziness, or severe headache. It is important to keep you loved one safe during this time but sitting them or laying them down. Do not give them food, liquid, or medications at this time. Simply call 9-1-1. 
If the symptoms subside after several minutes, this is still reason to call the doctor as it may be a "mini-stroke" or Transient Ischemic Attack (TIA). 

You never know when you may save the life of your loved one. 


REFERENCES: 
Stroke. 2013: published online before print December 5, 2013, 10.1161/01.str.0000437068.30550.cf.
University of Alabama at Birmingham, news release, Nov. 21, 2013

Friday, December 13, 2013

Put Preventative Care on the Calendar

Those famous birthday landmarks: 30, 40, 50, 60, 70, 80... 

Some see them as milestones, others see them as wrinkles, however your doctor sees them completely different. With age, comes the increased risk of certain types of health conditions. In fact there are screenings, tests, and vaccinations that are highly encouraged based solely on age. But who can keep track of them!?


Let me introduce you to the Aging for Healthcare Research and Quality Electronic Preventative Services Selector (AHRQ ePSS). Based on five questions (including your age), this program will give you a printable list of health promotion and prevention recommendations unique to you. 

 Consider that in 2012, a scant 3 percent of current health care spending in the United States is now focused on prevention and public health, while a whopping 75 percent of health care costs are related to preventable conditions. The United States can — and must — do better, especially considering that its per capita health care spending is twice the average of other industrialized nations even as it still ranks a dismal 24th out of 30 for life expectancy.
Obamacare will radically change this, offering free (yes, free) preventative care. 
Today people are living longer but are also spending more time living with chronic ailments. Over the course of the 20th century, global life expectancy soared by 30 years, 25 of which stemmed from public health advances such as improved sanitation, environmental advances, vaccine campaigns, and tobacco control. 
So at your next milestone, put preventative care on your calendar. You and your loved ones can be the start of a new statistics of people who choose to max out their preventative care and take care of things early. It's never too late to start. 


Thursday, December 12, 2013

Caregiver Travel Guide



Traveling with a loved one who have a chronic health condition or memory impairment may be more difficult, however there are certainly steps that can be taken that make the trip well worth it. Melissa Kahn, founder of Kahn Healthcare Consulting LLC and author of The Personal Healthcare Passport says, "Just because someone is living with a chronic condition, it shouldn't prevent them from traveling to visit loved ones, going to new destinations, and having new experiences." Here are some tips to help you along:  

1. Plan Ahead
     Start off at your health care provider. Once you get the ok, have them give you written prescriptions just in case the bottles you take with you are lost. While at your healthcare providers, ask for the name of a doctor or a hospital in the area that you're traveling, in case you need to see someone. If you're going to a location that is in a different time zone, find out if medication dosing times need to be changed. From there, something like shipping supplies or suit cases to your destination may be a good way of minimizing the amount of baggage you carry while traveling. Call the travel company ahead and find out what supplies you can and cannot take onboard. For example, oxygen tanks cannot be taking on board planes. Another good thing is to ask for travel assistance between flights or ask for permission to board early. As for your carry on, always carry medications with you along with a medication list, and bring a pack of goodies, puzzles, a photo album, Ipod with books on tape or movies, etc. Especially for those with memory impairment, things that are familiar such as a specific board game or movie will help ease their anxiety during travel.  They key being, plan ahead to minimize stress. 

2. Have Realistic Expectation
     Be mindful of nonverbal cues of your loved one while traveling. So much stimulus can be exhausting, not to mention the fact that they now have a new routine. Go less by the clock, and more by what they are experiencing in terms of when to eat, rest, etc.

3. Anticipate Needs
    With certain medical conditions comes the need to adapt, particularly to changing environments. For example, someone with heart disease may benefit from wearing support hose for long plane flight to prevent swelling in their legs. Other things to consider might be an extra pair of undergarments and disposable wipes, ear plugs, eye mask, special utensils, and so forth. Likewise, consider travel insurance or find out if your medical insurance covers you and/or your loved at your travel destination (particularly if you're traveling to another country). 

4. Be Flexible
    It's no secret that the travel industry has seen a lot of changes over the past decade. With that in mind, try to find airlines, cruises and hotels that are age friendly. Keep in mind that you might not be able to do some things due to these regulations, however a travel company that is used to catering to health needs, may be more accommodating. Ultimately, expect the unexpected.  


This Monday, December 16th, join me along with other healthcare professionals and caregivers for a Tweetchat to discuss travel woes, the do's and don'ts of flying with elderly loved ones, how to find an age friendly travel company, and hear lots of great tips to help you enjoy your travel this holiday season. The Tweetchat starts at 4pmPT/7pmET at #Nurseup.  

Monday, December 9, 2013

Savvy Baby Boomers Push the Envelope

Savvy boomers are pushing the envelop for senior living. More and more, 50-somethings are relying on the Internet for initial research on senior living and other health care products and services. 
According to Andy Cohen, the co-founder and CEO of Caring.com - more than 50% of the senior living industry's referrals are coming from the web.In the 2012  study by the Pew Internet and American Life Project, titled Baby Boomers and Digital Technology, close to 77% of the boomers, ages 47 to 65 are Internet users. According to the same study, 91% of that age group use the Internet for Search Engine activities and 81% use the Internet to Research products and services.
Social networks are also acquiring more senior users with each passing year. The Pew study demonstrates that internet users aged 74+ have experienced the fastest growth in use of social networking sites, which has quadrupled since 2008. Since social media users are significantly more likely to check their email frequently, the rise in social networking among senior citizens signals a further increase in frequent email use.
By 2015, eMarketer forecasts there will be over 26 million senior internet users in the U.S. By 2030, when tech-savvy baby boomers will mature into this demographic, the US Census Bureau predicts nearly one in five Americans will be seniors — a citizen demographic that cannot be ignored.
So what does this mean for longer term care and retirement homes? Like restaurants, senior living facilities will need to keep close tabs on their online reviews, rankings, and "google-ability". 
1) Review are crucial. About 87% of U.S. consumers trust local businesses after reading positive online reviews.
2) Dozens of senior care facility directories are popping up all over the internet. If you're not on the list, you will most likely go unnoticed. 
3) According to HubSpot (2012), 75% of users never scroll past the first page of search results. Talk about pressure.
Meanwhile, games like bridge, shuffle, and dominos will be hitting the shelf, while e-readers, I-pads, and outlets will become a hot commodities. 

Where do you see the future of long term care and senior living communities? Will admission decrease or increase over the next 15-20 years? 

Sunday, December 8, 2013

Are You A "Healthy Ager"?


A new study finds that exercise among older adults helps ward off depression, dementia and other health problems, such as heart disease, cancer and diabetes.
The researchers found that exercise increased the odds of healthy aging as much as sevenfold. Even better news, it's never too late to start: Even adults who begin exercising later in life could increase their odds of healthy aging threefold.
The report was published online Nov. 25, 2013 in the British Journal of Sports Medicine.
"In a growing elderly population, it is important to encourage healthy aging. Physical activity is effective in maintaining health in old age," said lead researcher Mark Hamer, from the department of epidemiology and public health at University College London, in England. "Encouraging physical activity in older adults is of benefit, and small changes are also linked to healthier aging." 
Samantha Heller, a senior clinical nutritionist and exercise physiologist at NYU Langone Medical Center in New York City, said it's no secret that physical activity and exercise are good for us. "What this study emphasizes is that the 'I'm too old' excuse doesn't fly, because it is never too late to get your fanny off the couch and out the door for some exercise," she said.
The benefits of exercise include improved bone, muscle, cardiovascular and organ health. Even better circulation and brain benefits like an increase in communication between neurons. In fact Heller confirmed that exercise may slow the brain tissue loss associated with aging and mental decline.
"The question we face now is, How do we motivate and support people of all ages to get moving and keep moving? There is an undeniable resistance among non-exercisers to the notion of motion," Heller said. "On an individual level, we can gently insist that family and friends join us in regular walks, a dance or yoga class, a game of tag, or an exercise DVD."
Partnering with someone is a real motivator or even investing money so the money isn't "lost" if the membership or equipment goes untouched. 
For the study, Hamer and his colleagues collected data on nearly 3,500 people with an average age of 64 who participated in the English Longitudinal Study of Aging. The researchers kept track of their exercise, along with serious health problems, such as heart disease, stroke, diabetes, emphysema and Alzheimer's disease. They also monitored the participants' mental health and physical strength. 
Over eight years, almost one in 10 participants became active and 70 percent remained active. The others stayed inactive or became inactive.
By the end of the study, almost 40% of the participants developed a chronic medical condition, almost 20% were depressed and one-third had a disability.
1 in 5, however, was considered by the researchers to be a "healthy ager," an obvious association being between healthy aging and exercise. 
The researchers found that people who partook in moderate or vigorous physical activity at least once a week were 3-4 times more likely to be healthy agers, compared with those who remained inactive. People who were active at the start of the study were 7 times more likely to be healthy agers than people who were inactive and remained so. 

The CDC recommends 2 hours and 30 minutes of moderately intense exercise a week, or 1 hour and 15 minutes of vigorously intense exercise, along with two or more days of muscle strength training. If you're not already, this may be a great New Years Resolution (*hint* hint*).    

Reference:
Hamer, M., Lavoie, K., Bacon, S. (2013). Taking up physical activity in later life and healthy ageing: The English longitudinal study of ageing. Br J Sports Med doi:10.1136/bjsports-2013-092993

Friday, December 6, 2013

Strategies To Help Increase Your Participation With Your Healthcare Provider

Many patients are nervous about asking questions of their doctors, afraid of being labeled as ‘difficult’ or taking up too much of their provider’s time. Patients resist speaking up, according to a new Health Affairs study.
I [Martine Ehrenclou] interviewed several health psychologists for my new book, The Take-Charge Patient: How You Can Get the Best Medical Care to find out why patients tend to be submissive and timid with their doctors. Several explained that patients tend to relate to their doctors as they do to authority figures in their lives, which directly relates to the power imbalance. Others mentioned that patient’s health worries influence their confidence when interacting with providers. Increasing confidence as a patient will help you interact more effectively and maximize your engagement in your health care.
Consider your own vulnerability when you don’t feel well and you see your doctor for a medical visit, especially if the doctor is rushed and moves quickly to assess your symptoms and arrive at a diagnosis. You are dependent on your doctor’s expertise and good will, his or her ability to diagnose you correctly and provide a treatment plan that works for you.
Following are a number of strategies that will help reduce your anxiety and increase your participation in care.
  1. Find a doctor who welcomes your participation. Look for a physician who accepts and welcomes your questions. Good communication is essential for a successful relationship with your doctor. Good doctors are good communicators and listeners. If you feel that your doctor does not value your contribution and isn’t really listening to you, walk away.
  2. Prepare ahead of time before your medical appointment. List your top three medical concerns and create a list of questions for your doctor. If you are prepared for your office visit, you’ll feel less anxious and more able to ask questions. Also create a list of your current medications and their dosages, over-the-counter medications, herbs and supplements, and allergies to medications. Bring it with you to every doctor/medical office visit. In addition, create a brief health summary about how you have been feeling and list any changes in your health, changes in medications, other physicians you’ve seen and for which medical reasons.
  3. Create a simple health history of major medical events over your lifetime such as births, surgeries, procedures, major tests and current medical diagnoses. This allows a new doctor to see a snapshot of what you’ve been through. By creating this, it also increases your familiarity with what you’ve experienced, which in turn increases your confidence.
  4. Create a symptom diary. For a week or two before you see your doctor, take note of any symptoms you want addressed by your physician such as when they started, what makes them worse or better and the time of day they occur. This will help facilitate an accurate diagnosis and you’ll present as a patient invested in your health who values the time spent with the medical provider. This also familiarizes you with your symptoms over a period of time and increases your confidence so you can discuss them with your doctor.
  5. Obtain copies of your medical records from your doctor(s) over the last five years. This includes copies of pertinent test results and reports, MRIs, CT scans etc. Place them in a health file. This allows you control over your own medical records and gives you the freedom to bring copies of pertinent test results or reports to a medical provider, instead of relying on a doctor’s office or imaging center to do this for you. The latter may not happen in a timely manner or at all.
  6. Do a little research. If a medical professional has given you a diagnosis and/or treatment plan, do some research from credible resources such as academic, government or professional medical society/academy websites. These end in .gov, .edu, and .org. Doing research on your own gets you more informed so you can evaluate what is best for you. It empowers and prepares you to ask questions of your doctor.
  7. This is your time with the doctor. Remember, this is your office visit and you are paying for it. Many patients are fearful of using up too much of the doctor’s time and resist asking important questions. This backfires for the patient and the doctor.

Most importantly, be assertive!

By: Martine Ehrenclou, M.A., is an award-winning author, patient advocate and speaker. Her newest health book, The Take-Charge Patient: How You Can Get The Best Medical Carewinner of sixteen book awards, empowers readers to become proactive and effective participants in their own health care.  You can find out more about her and her book by visiting www.thetakechargepatient.com

Wednesday, December 4, 2013

Fall Prevention Made Simple

If you have fallen lately, you are not alone. 

There are more than 11 million people over the age of 65 fall every year who fall -- that's 1 of every 3. With videos like "Scarlet Took a Tumble" going viral on youtube, a fall might not seem like anything too serious. However, countless times as a nurse I see broken bones, internal bleeding and death, due to a fall. 



There are a handful of things that can be done to prevent a fall. 

First step: Walk

The first step to fall prevention is to perform an assessment by walking the living space to see if you can fluidly go from room to room and from furniture to furniture. Do you have to navigate between furniture or avoid bulky shelves? Are there unmarked steps that have no side-rail? Is the lighting dim or the switch hard to find? All of the above are hazards. You may know that they are there, but when the going gets...well, going, these things can easily be missed. 


Step two: Plan

Brainstorm what can be done to reduce these hazards. Often, the simplest answer is the best answer. Instead of considering how to sell the bulky furniture, simply think how it came be arranged to where the legs are not within a high traffic walking area. Instead of throwing out flowerpots, simply put them on tables or shelves. A solid plan of action will make for easier implementation.


Step three: Do

 Time to put your plans to action. Remove rugs, add a rubber mat to the bathtub, install ramps or handlebars and railings, and arrange furniture. 


Step Four: Evaluate 

Make sure the changes fit the lifestyle and reducing the risk of falls. Do another walk through and assess your changes. Ask someone else for a second opinion. This process of evaluating is continuous, as needs change and new norms are established. 



This plan of action for fall prevention can be applied to any location: home, hotel, hospital room, assisted living community, etc. Take advantage of these basic tips and prevent falls today. 


This post is in honor of my Aunt Sunny who passed away Sunday, December 2nd, 2013 after a fall. Her sunny spirit lives on in my family's memories. 

Join me Monday, December 9th, on Twitter to chat more about how to fall-proof the living space of your loved one. The TweetChat starts at 4pmPT/7pmET at #Nurseup. See you there! 


Below are a list of changes from HipProtector.com: 

Bathroom

  • Grab bars to get into and out of the tub
  • Use a bath chair or stool in the shower
  • Don't use throw rugs or wax on the bathroom floor
  • Use a raised toilet seat with arm rails
  • Buy soap on a rope, or put a bar of soap in a nylon stocking with one end tied to a towel bar

    Bedroom

  • Never get up in the dark - make sure the room is well lit
  • Keep light switch close to bed 
  • Avoid slippery socks or slippers
  • Consider using a Bed Transfer Handle or Bed Security Rail
  • Hide all loose extension cords
  • Use carpets and rugs with skid-proof backing or tacked to the floor

    Kitchen

  • Use a long-handled sponge/mop to wipe up spills
  • Keep your floors smooth but not slippery
  • Store your often-used supplies in easy-to-reach cabinets
  • Avoid hard-to-reach wall phones; consider a cordless phone that can be carried from room to room, or a counter model

    Around the House

  • To be safer, consider using a Medical Alarm / PERS System
  • Stairwells should be well lit; consider nightlights for hallways and bathrooms
  • Wear low-heeled, comfortable shoes with nonskid soles;
  • Don't walk around in socks, slippers, or stockings on bare floors
  • Keep rooms and hallways free of clutter
  • Make sure carpets, including those on stairs, have skidproof backing or are tacked to the floor
  •   

    Monday, December 2, 2013

    Elder abuse: Know the signs

    Does something not seem right? 


    Who is in your elderly loved ones’ lives, besides you? Never underestimate those people’s influence, whether they are family members, outside caregivers you have  engaged, or just  someone whom your elder has befriended. Unfortunately, their influence can be negative, and even devastating, as there are many who will take advantage of an elder’s trust to steal money and other assets. If there is cognitive impairment, the exploitation becomes easier. As a loving and caring family member, you are the first line of defense against exploitation, and it is a duty that cannot be delegated or outsourced!

    Although you might not be able to be with your elders as much as you would like, you can help protect them by watching for signs such as these, and responding quickly:

    Isolation is the exploiter’s sharpest tool. When you call, does the caregiver answer, and tell you the elder is sleeping, or for some other reason can’t come to the phone? Does the caregiver find ways to make sure you aren’t able to speak with your elder one-on-one; for example, managing to be present every time you visit, and perhaps answering questions you have asked your loved one directly? The caregiver might be suggesting to your elder that you are no longer attentive because you don’t call. And being present during visits can be the caregiver’s way of inhibiting a conversation that otherwise might reveal undue influence. Look at the relationship…if the caregiver is between you and your loved one in any way, something isn’t right.

    Don’t let it happen. All phones make outbound calls, and long distance is cheap. If your elder can’t come to the phone when you call, leave a message to call you. If it doesn’t happen, follow up. And when you visit, take your elder to lunch or dinner, without the caregiver. The elder probably will appreciate the opportunity to get out. (And good caregivers will appreciate the break!)

    In the case of hired  caregivers, execute a written agreement that the caregiver will not accept gifts of any kind, including bequests in a will. This might mean modifying the standard agreement. It also is advisable to hire the caregiver through an agency that is bonded (providing you a way to recover in case of theft), has professional liability insurance, and conducts thorough background checks on its applicants. (But a clean background report doesn’t necessarily mean the caregiver would not take advantage of an opportunity.)

    Talk to the caregiver about his or her own family, and interests, and encourage conversation about your elder’s well-being. Listen for inconsistencies and evasion. If you ever get to a point where you are uncomfortable with the caregiver for any reason, terminate the relationship. You don’t need to explain or apologize. Protecting your elder outweighs all other considerations.


    Is money disappearing? Warning signs include checks written to people you don’t know, gifts to the caregiver, an unusual number of cash withdrawals, use of an ATM when the person has not used one in the past, lack of amenities the elder could afford, inappropriate or questionable investments or financial instruments, and hesitancy to answer questions about financial transactions. If a caregiver is dependent on the elder for support (sometimes the case with a family caregiver), the risk of exploitation often increases.

    Don’t let it happen. If you have durable power of attorney, you can receive duplicate copies of your elder’s bank statements and bills, or view them online. Having power of attorney also might make your elder more willing to answer questions about financial transactions that don’t seem right to you. If you live close to your elder, consider having his/her mail go to a post office box, and pick up the mail yourself. Otherwise, an exploiter might intercept the mail…including bank statements. Sometimes exploiters have changed the address for bank and credit card statements, so the exploiter receives the statements and the elder and his/her family never see overdrafts, unauthorized credit card expenditures, etc.

    Estate planning, with the help of an attorney specializing in elder law, includes strategies to make sure the elder’s assets will be disposed of according to the elder’s wishes, as expressed to the family in official documents. For example, creating a trust can shield assets from the effects of a changed will. Occasionally, tell your elder, “Let’s review your estate documents, and see if we need to change anything. By the way, have you changed anything?” That’s also a good time to remind elders they never should give personal information to someone who contacts them to try to sell goods or services, or who says he or she is a representative of a government agency (government agencies do not call to obtain or “verify” information.)

    Is your elder’s personality or appearance deteriorating? If an elder is exploited by a caregiver, another family member or a new acquaintance, you might be able to detect changes in the elder’s personality… nervousness, suspicion, withdrawal from normal activities, hesitancy to speak or make eye contact, for example. He or she also might exhibit poor hygiene or evidence of malnutrition. There might be unexplained bruises or other injuries, if he or she is being abused physically. The home might be dirty and unkempt. These are all signs that abuse might be occurring.

    Put a stop to it. Talk to your elder. Express your concern, in a gentle way, using specific examples of what you have noticed. Remind him or her of your love and support, and ask questions. Don’t be discouraged if your elder doesn’t respond right away. It might take time to undo the damage. Also, don’t depend on the elder’s doctor or other professional to discover evidence of exploitation. Unfortunately, a ‘don’t ask, don’t tell’ mentality exists among many professionals. Unless someone expresses a concern, your loved one’s doctor, banker, financial advisor, attorney who does not specialize in elder law, or other professional is not likely to identify and report abuse. The situation is getting better, with the creation of Financial Abuse Specialist Teams (FAST) in many locations around the country (professionals being trained to spot signs of financial exploitation) but we have a long way to go with that effort.


    When you suspect abuse has occurred, do not hesitate to confront the suspected abuser. If abuse is not occurring, the caregiver or acquaintance you suspect will be able to explain the situations that concern you, satisfactorily. Remember that you have your local social services department, Adult Protective Services, and law enforcement agencies available to help. You do not have to have an ironclad case before you go to them. Just tell them what you know, and have observed. They are trained to investigate on behalf of you and your elderly loved one. 

    A few resources:

    Adult Protective Services -- www.apsnetwork.org
    National Center on Elder Abuse -- www.ncea.aoa.gov
    Long-term Care Ombudsman (nursing home abuse) www.ltcombudsman.org
    Eldercare Locator – 800.677.1116
    Clearinghouse on Abuse and Neglect of the Elderly – www.cane.udel.edu
    Center For Excellence on Elder Abuse and Neglect, University of California at Irvine School of Medicine – www.centeronelderabuse.org
    Ageless Alliance – www.agelessalliance.org



    By: William R. Henry, Jr.,  coauthor, with elder law attorney A. Frank Johns, Jr., of The Crown of Life Society, the first novel devoted to elder exploitation and family caregiving. More information about the book and its authors, and resources to prevent elder exploitation and to support caregivers, are at www.crownoflifesociety.com.