Friday, May 18, 2012
   
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Mind and Body

What is a Geriatrician?

By Pamela D Wilson, The Care Navigator, CSA, MS, BS/BA, CG

couple_counselingBy Pamela D Wilson, The Care Navigator, CSA, MS, BS/BA, CG

A geriatrician is a doctor for older adults, like a pediatrician is a doctor for children. People see geriatricians for two main reasons, the first is that they do not want to "get old", and the second is because they "got old". Geriatricians are physicians that specialize in the aging process. They complete training in internal or family medicine and then specialize in geriatrics for one to three years.

They are more likely to listen and to treat complaints that non-geriatricians might disregard as just old age. They are also more up to date on the most recent preventative therapies. They may be able to recommend strategies to delay memory problems or screen for bone density and make suggestions to treat osteoporosis before a fall or other injuries occur.

Read more: What is a Geriatrician?

 

Staying Healthy by Avoiding the Doctor - The Art of Living to 100

older_woman_hat_flowersBy Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA, CG

Lately I've been on a quest to find out how individuals living well into their nineties and hundreds have achieved this great feat.  Most of you know I do a weekly radio program called The Caring Generation.  In August I interviewed a woman, Garnet, who began hiking the Grand Canyon at 65 and made more than twenty trips. She's 103.  There's a woman living in an independent living community in Denver who is 104 and still going.  Another woman I just met told me that if one goes to the doctor enough "they'll eventually find something."  If traditional medicine isn't going to extend our lives, what will?

Read more: Staying Healthy by Avoiding the Doctor - The Art of Living to 100

   

Do Medical Quality Measures Result in Greater Harm than Good?

By Pamela D Wilson, The Care Navigator, CSA, MS, BS/BA, CG

washing_handsBy Pamela D Wilson, The Care Navigator, CSA, MS, BS/BA, CG

There is discussion in health care circles about "quality metrics" for example standards that must be met by physicians in order to ensure certain levels of patient care and in return that ensure certain levels of physician reimbursement. Many states also have pay for performance programs.

Hand washing is a simple example. Imagine that the likelihood of infection being passed hand to hand or hand to mouth decreases with the activity of hand washing. Washing your hands is a very simple act that can help you avoid catching a cold. According to the Centers for Disease Control, hand washing is the single most important means of preventing the spread of infection. Thus it would be logical to believe that by implementing a standardized protocol for hand washing (quality metric) in hospitals, medical offices etc. that the risk of passing on infection is likely to decrease.

Read more: Do Medical Quality Measures Result in Greater Harm than Good?

 

Diabetic Care for Older Adults

taking_pulseBy Pamela D Wilson, The Care Navigator, CSA, MS, BS/BA, CG

The Center for Disease Control issued a background sheet on diabetes. As with many chronic diseases, proper diabetes care in older adults is even more important. In a perfect situation, an older adult with diabetes will have a care team of individuals that includes a physician, dietitian, pharmacist and possibly a home care provider to assist with meals, personal care and exercise.
Physical activity is just one important component of healthy aging, especially for persons with diabetes. At a general physical exam upon request, your physician may prescribe a physical therapist visit to assess current fitness levels. The physical therapist will then make recommendations for aerobic activity and strength training exercises. As with everything, the prescribed exercises are only effective if they are done on a regular basis.
Equally important for persons with diabetes is a balanced diet. Again working with your physician, a referral may be obtained to a dietitian who can make recommendations about label reading, the glycemic index of foods, recipe modifications and ongoing diet recommendations. A dietitian can also discuss consumption of carbohydrates, sugar, frequent snacks and a plan for weight loss if recommended.
Personal care relative to bathing and frequent foot checks is also important. Many older adults lose flexibility and do not have the ability to reach their toes to trim nails, wash properly or perform skin checks. Personal care also includes medication reminding for those who may forget to take medications.
Relative to foot care, diabetes may cause loss of feeling in the nerves of the foot, often called peripheral neuropathy. Persons with diabetes are also more prone to infections and slower healing in areas with poor circulation, like the feet. Foot ulcers are also very common. Proper care, including daily washing and skin checks are very important. Regularly scheduled visits to a podiatrist are also important to ensure nails and feet receive proper care.
Exercise, diet and personal care are important to maintain health at any age. However, as we age, these three areas are the most difficult to maintain. Because many older adults live alone, these daily activities become less important and more difficult to do because of physical or mental difficulties. Only 22% of the U.S. population exercises on regular basis; this number declines as we age. Fast food and boxed meals have become the norm. Why should this be any different as we age? And, due to physical declines from lack of mobility and exercise, personal care becomes difficult because of safety issues and fear of falling.
The good news is that help exists. Older adults wishing to maintain exercise, diet and personal care can decide to take advantage of home care to provide these support services. The result for many can be improvement in physical function, diet and personal care.

The Center for Disease Control issued a background sheet on diabetes. As with many chronic diseases, proper diabetes care in older adults is even more important. In a perfect situation, an older adult with diabetes will have a care team of individuals that includes a physician, dietitian, pharmacist and possibly a home care provider to assist with meals, personal care and exercise.

Physical activity is just one important component of healthy aging, especially for persons with diabetes. At a general physical exam upon request, your physician may prescribe a physical therapist visit to assess current fitness levels. The physical therapist will then make recommendations for aerobic activity and strength training exercises. As with everything, the prescribed exercises are only effective if they are done on a regular basis.

 

Read more: Diabetic Care for Older Adults

   

Between the Ages of 51-61? Expect At Least One Major Lifestyle Change

old_woman_with_rosesBy Pamela D Wilson, The Care Navigator, CSA, MS, BS/BA, CG

According to a study by the Center for Retirement Research at Boston College (1), nearly seventy five percent of individuals between the ages of 51-61 will experience a negative event that will affect their long term financial security and lifestyle. These shocks include job layoffs, widowhood, divorce, diagnosis of new health problems, or having to help frail parents or in-laws; 28% of these adults already have their own health issues.
Adding to the complexity of helping frail parents or in-laws, a recent study by the Alzheimer's Association (2) indicates that ten million caregivers provide care to a person age 60 or older with Alzheimer's disease. Many of these individuals are generally unprepared for what may be a very long journey of providing care to a loved one that is physically and emotionally exhausting not to mention financially draining.
The study cites that total per-person payments from all sources for health and long-term care were three times higher for Medicare beneficiaries aged 65 and older with Alzheimer's and other dementias than for other Medicare beneficiaries in the same age group ($33,007 compared with $10,603 per person). (3)
These issues not only have a profound effect on our daily lives but on society in general because they exert cost pressures on health care, government benefits, employment, social security, long term care and many related areas. With available statistics like this, why are individuals so shocked when an event occurs that tosses their lives into uncertainty? The reality is that many of us go through life day to day just making due, unable to plan for our future. Even when young, we dispute the wisdom and advice of our parents; especially the importance of education.
The CRR study shows that lifestyle shocks are especially common among those with limited education. Fifty two percent of individuals age 51-61 without high school diplomas developed new medical conditions over this ten year period compared to 43% of high school graduates and 33% of college graduates. These medical conditions include severe disabilities and conditions that result in work limitations resulting in ability to earn income and save for retirement.
The results of this study relate to the financial impact of a variety of issues some within our control like divorce and health problems (assuming we take proper care of ourselves) and others not in our control like job layoffs, widowhood, or having to help frail parents or in-laws. However the foundation for many of these issues and how we learn and work through them began with the relationships with our parents and begin with the relationships we now as parents cultivate with our children. This includes the way that we respond to authority, our ability to get along with others, the way we react to a variety of situations, establishing morals and taking responsibility and initiative for our own lives.
It's no secret that many of us learned from our parents> Our lives model their lives unless somewhere along the way an intervention occurs that causes us to change course for the better or worse. If we expect the shocks of life to improve for current and future generations we must take individual responsibility for our own families and continue to educate ourselves on a wide variety of subjects. In addition, we must advocate and support larger issues through the system of government.
The current administration has goals for improving not only health care but education and unless we participate in shaping these goals the outcomes may not be what we expect. There are two websites where you can learn more about contacting your senators and representatives. Visit www.senate.gov and www.house.gov to learn more about issues currently under review. Take steps now for a better tomorrow.
References:
(1) Copyright 2005, Richard W. Johnson, Gordon B.T. Mermin, and Cori E. Uccello. When the Nest Egg Cracks: Financial Consequences of Health Problems, Marital Status Changes and Job Layoffs at Older Ages. Center for Retirement Research at Boston College www.bc.edu/crr
(1) Alzheimer's Association 2009 Alzheimer's Disease Facts and Figures, to be published in Alzheimer's & Dementia, Volume 5, Issue 3.
(2) Bynum, J. Characteristics, Costs, and Health Service Use for Medicare Beneficiaries with a Dementia Diagnosis: Report 1: Medicare Current Beneficiary Survey (Lebanon, N.H.: Dartmouth Institute for Health Policy and Clinical Care, Center for Health Policy Research, January 2009).

According to a study by the Center for Retirement Research at Boston College (1), nearly seventy five percent of individuals between the ages of 51-61 will experience a negative event that will affect their long term financial security and lifestyle. These shocks include job layoffs, widowhood, divorce, diagnosis of new health problems, or having to help frail parents or in-laws; 28% of these adults already have their own health issues.

Adding to the complexity of helping frail parents or in-laws, a recent study by the Alzheimer's Association (2) indicates that ten million caregivers provide care to a person age 60 or older with Alzheimer's disease. Many of these individuals are generally unprepared for what may be a very long journey of providing care to a loved one that is physically and emotionally exhausting not to mention financially draining.

Read more: Between the Ages of 51-61? Expect At Least One Major Lifestyle Change

 

Dress Up Your Yard With Trees

wheelbarrel_with_flowersBy Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA, CG

One acre of forest absorbs six tons of carbon dioxide and puts out four tons of oxygen. This is enough to meet the annual needs of 18 people."—U.S. Department of Agriculture "The net cooling effect of a young, healthy tree is equivalent to ten room-size air conditioners operating 20 hours a day."—U.S. Department of Agriculture "Trees properly placed around buildings can reduce air conditioning needs by 30 percent and can save 20 - 50 percent in energy used for heating."—USDA Forest Service

Read more: Dress Up Your Yard With Trees

   

Prevention

It has been said that the United States is not a prevention society. We push our bodies until something breaks and then expect a pill or surgery to cure everything. After age 30, our bodies begin to weaken at the rate of 1% per year. This means that by age 60, unless we take steps to prevent the decline, our bodies will be 30% weaker. Prevention can take the form of health prevention or it can be seen as other actions taken to remain healthy and independent. Exercise is a significant action that can be taken to prevent physical decline.
For many of us, not only older adults, taking steps toward preventing the decline of our bodies or accepting preventative isn't easy. Exercise and eating well takes time, attention and work. Most of us "don't need any help" because we're stubborn, set in our ways or just do not want to consider that something else may be better. Think about family, friends or neighbors you know who may not be in the best of health. They may live alone, eat canned soup and frozen dinners, have little social contact and rarely leave their homes - they are just getting by, yet they "don't need any help". Who wants to admit that someone has a better idea or better way of doing things that we?
How much fuller could the life of this family member, friend or neighbor be with just a little in home help - nutritious meals, companionship, assistance around the house, running errands, doing a hobby or social activity or just knowing someone will be by to check on them? It doesn't take much to improve or make life a little more interesting, but it does take an open attitude and a willingness to try.
Many times it's not in home help that is needed - it's an individual or advocate who can manage organizational details: balancing a checkbook, paying bills, arranging car maintenance, setting doctor appointments, reordering medications, completing income tax returns, making sure insurance is up to date and so on. These tasks requiring what is called executive function, often fall by the wayside and have the potential to cause significant problems. I worked with individuals very adept at bouncing checks, forgetting to pay property taxes, having income tax penalties and lapsing on health insurance payments who have no idea this is even occurring because they have significant short term memory loss.
Whether you are at the beginning stages of considering help, I encourage you to do so in order to prevent significant issues. Having an advocate and personal manager is a good idea especially when these tasks have never been your strength, have been handled by a spouse no longer with us or when you are experiencing memory issues.
Copyright © 2009 Pamela D. Wilson All rights reserved. This publication may not be reproduced by any mechanical, photographic or electronic process, transmitted or otherwise copied for public or private use without prior written permission from the author. Website: www.thecarenavigator.com

women_tai_chi

By Pamela D Wilson, The Care Navigator, CSA, MS, BS/BA, CG

It has been said that the United States is not a prevention society. We push our bodies until something breaks and then expect a pill or surgery to cure everything. After age 30, our bodies begin to weaken at the rate of 1% per year. This means that by age 60, unless we take steps to prevent the decline, our bodies will be 30% weaker. Prevention can take the form of health prevention or it can be seen as other actions taken to remain healthy and independent. Exercise is a significant action that can be taken to prevent physical decline.

Read more: Prevention

 

Medications and the Mature Adult

medications-for-mature-adultsBy Pamela D. Wilson, CSA, MS, BS/BA, CG, The Care Navigator

Many adults I work with often complain about the quantity of medications their physicians prescribe. Admittedly, many take five to ten different medications on any given day. Many previously healthy persons often say that they do not want to take pills or become "pill poppers". This becomes an issue especially when the medications prescribed are important to maintaining physical and mental health. The question we forget to ask is how did we get in this situation in the first place? It could be heredity but more likely it's because we were lax in taking care of our physical or mental health in the first place. No one wants to admit we chose to NOT exercise, to NOT eat healthy, to NOT manage our weight, thus we find ourselves in a situation we don't like.

Read more: Medications and the Mature Adult

   

Access to Investigational Drugs – A Privilege or a Right?

By Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA

stethoscope_250x166How many times have we heard the statement "no risk, no gain"? For thousands of individuals with life threatening diseases this statement has become a daily motto. These individuals, the "lab rats" of today, help promote advanced drug technologies. But at what cost and what benefit?

At present there are thousands of ongoing clinical trials in the United States. One only needs to visit www.clinicaltrials.gov to learn more about national trials or www.clinicaltrialssearch.org/colorado_clinical_trials.html to find out about local Colorado trials.

 

Read more: Access to Investigational Drugs – A Privilege or a Right?

 

Are You a Difficult Patient? Take This to Your Doctor and Make Up

Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA, CG

male doctor at desk_167x250Ever imagine what your doctor would say to you if he/she could? I think you should find a new doctor. I feel dread each time I see you on my appointment list. You might be surprised to learn that "doctors consider 15 to 25% of their patient encounters difficult. Those with relatively high numbers of problematic patients were more likely to report that they had provided suboptimal care or they expected to make future errors in their practice." (1)

The medical profession never predicted the need for greater communication and social skills to treat patients. After all, doctors practice medicine, not consult the etiquette recommendations of Miss Manners. Watch Dr. House on television, everyone hates him, he has no social skills but seems to pull out all the stops just at the last moment to save the patient when all else fails. What would you rather have -- a nice doctor with good social skills or a qualified, skilled doctor who is less likeable? Patients want a combination of the two. We all want to feel like our doctor takes an interest in us even though we may only see them once or twice a year.

 

Read more: Are You a Difficult Patient? Take This to Your Doctor and Make Up

   

Grieving the Loss of Physical Abilities

By Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA, CG

man outside walker_166x250It often takes a critical event in our lives to bring feelings of grief. This event might be the death of a family member, the slow progression of a disease or the sudden shock of a health emergency like a fall resulting in broken bones, a stroke or a heart attack. Regardless of the situation there are options to support recovery.

Many older adults surviving a health emergency experience diminished physical capacity. A person recovering from a stroke may no longer be able to dress or bathe alone. They may experience confusion or memory loss. Their previous sharp wit may be notably slower. A person recovering from a broken hip may have great difficulty walking and may now have a significant fear of falling so they limit their activity.

 

Read more: Grieving the Loss of Physical Abilities

 

Investigating Holistic Health

Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA

coneflowers_250x179Several months ago I met a married couple aged 97 and 95 and was amazed that they were still living at home and were fairly active. Most clients I meet who are this advanced in age have multiple chronic diseases and great difficulty with daily activities. This was not the case with Jim and Barbara. I met with them because they were beginning to wonder IF they should move from their home into a retirement community.

I was immensely curious how they managed to live to such advanced ages and after assessing the situation and responding to their questions, I could not leave their home without asking their secret. Jim told me that throughout his life he had an interest in holistic health. He survived cancer and several other serious illnesses. Barbara had a similar experience. They both believed that investing money in natural health was the secret to their good health and longevity. Barbara admitted that she just stopped hiking because she lost a long time friend who was her main hiking partner but she is now walking three miles a day.

Read more: Investigating Holistic Health

   

Nostalgia - The Natural Anti-Depressant

Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA, CG

generational family_250x167Dorothy in the Wizard of Oz clicking her red ruby slippers repeating, "There's no place like home" so she could be transported back to that little farm house in Kansas.  What is it about remembering past times that gives us warm, happy feelings?  How many of you experience nostalgic memories on a regular basis?  The music - feeling of a place -- memories of good friends?  What makes these memories better than the memory of the root canal you had last week?

Nostalgia is beneficial for several reasons.  It makes our day, especially if we're having a bad day more bearable.  It also supports feelings of belonging and social connection, ridding ourselves of feelings of loneliness and depression.  Research done years ago saw the concept of nostalgia as negative because researchers believed nostalgic people to live in the past.  No more!  Today research shows that nostalgia is beneficial.  It helps people maintain a sense of identity, to look back at our values and priorities to do a check on where we are today.  Nostalgia provides a sense of stability in our ever changing worlds.

 

Read more: Nostalgia - The Natural Anti-Depressant

 

Preventing Falls

By Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA, CG

very sad_250x167Falls become a more common occurrence as we age. Studies indicate that falls in the elderly often serious consequences – limited physical activity, premature nursing home placement and premature death. With proper action and attention the likelihood of falls can be reduced or prevented.

A fall may be an early indicator of an undiagnosed health problem. If a relatively healthy elderly person begins to lose balance or fall, a medical appointment should be made immediately. A new health diagnosis, or progression of a previously diagnosed disease like Parkinson's or dementia, may be the cause of the imbalance or falls. Poor vision, depth perception, vertigo or a combination of drugs may also contribute to balance problems. Even something as simple as a urinary tract infection may result in poor balance and a subsequent fall.

 

Read more: Preventing Falls

   

Ten Tips to Make Your Next Medical Appointment a Success

By Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA, CG

couple counseling_237x167Ever feel rushed or unimportant when you visit your physician or health care provider? Studies suggest that individuals receive fifteen to twenty minutes on average with their doctors mainly due to insurance regulations. Below are ten tips to make your next medical appointment a success.

  1. Create a medication list to take with you to all medical appointments. This should include medications you have taken in the past, why you are no longer taking them, current medications and any supplements or over the counter medications you are taking. You would be surprised to learn that many medications interact with supplements or over the counter medications. It's important that your doctor know all medications and supplements you take.

    Read more: Ten Tips to Make Your Next Medical Appointment a Success

 

Cardiac Rehab is Underutilized

By Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA, CG

heart healthy_206x167Heart disease tops the list of chronic diseases as we age. It is one of the most under diagnosed diseases in women, more women dying from heart disease than breast cancer. By age forty, one in two individuals have high blood pressure which is among the other risks heart disease that include high cholesterol, diabetes, obesity and a sedentary lifestyle. Chronic disease affects nearly every individual over age 65 and results in significant costs to the healthcare system.

In looking at successful outcomes, why, after major heart surgery do we failure to recommend or acknowledge that individuals would benefit from disease management programs and cardiac rehab? Individuals having a hip replacement or experiencing a stroke know that they need rehabilitation and it is almost always recommended. But rehab is rarely discussed with heart patients. Recommendations typically come from physicians and are influenced by physical therapists, nurses, Case Managers and others. This is one area where those with influence can and should do a better job of making recommendations but often don't.

Read more: Cardiac Rehab is Underutilized

   

Don’t Neglect Your Feet – They’re The Only Pair You Have!

By Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA, CG

women tai chi_250x166Your feet are two of your most important body parts; they carry you wherever you want to go, yet many of us give them the least attention, especially when we become older. Only when they hurt or prevent us from walking easily do we give them proper attention. As we age our flexibility lessens and it's more physically difficult to bend and reach our feet. Our toenails become thicker and more difficult to trim – so we let them go. We walk barefoot, wear shoes that do not fit properly and bathe less. We grow calluses on our feet because of improperly fitting shoes.

Read more: Don’t Neglect Your Feet – They’re The Only Pair You Have!

 

Monitoring Your Health: 4 Good Measures

By Pamela D. Wilson, The Care Navigator, CSA, MS, BS/BA, CG

scale measuring tape_250x166How many times have you gone for your annual medical appointment and the doctor discussed your "measures"? How many times did you remember the numbers but not remember what they mean? I'm referring to the measures of blood pressure and cholesterol. These combined are a fairly good predictor of heart health. According to the Centers for Disease Control, heart disease is the leading cause of death in the U.S. representing 29% of the population and is the leading cause of disability.

Blood pressure consists of two readings the top number and the bottom number. The top number is called systolic pressure, defined as the pressure of blood in the arteries as the heart contracts to pump blood. The bottom number is called diastolic pressure, defined as the pressure of blood in the arteries that occurs when your heart is at rest between heartbeats.

Read more: Monitoring Your Health: 4 Good Measures

   

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