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Geriatrician Looks at Sensitive Issue of Senior Gun Ownership

In the United States the debate around gun ownership often focuses on teenagers; however, research shows that elderly Americans are the most likely to own a gun and that presents both medical and legal problems for physicians and carers.

Writing in an issue of the Journal of the American Geriatrics Society, Dr. Ellen Pinholt explored these issues and proposed a series of “red flag” questions which caregivers must ask.

While there is no upper age limit on owning a firearm, Americans aged over 65 have the highest prevalence of dementia, depression and suicide. Federal law prohibits mentally incompetent persons from possessing a gun; however, this only applies to a formal finding by a court and not necessarily to a physician’s diagnosis of dementia.

Using a series of case studies to explore the medical and legal dimensions of the issue, Dr. Pinholt suggested “5 Ls,” questions about gun ownership which should be asked as routinely as questions about driving.

  1. If there is a gun present, is it LOCKED?
  2. Is it LOADED?
  3. Are LITTLE children present?
  4. Does the gun owner feel LOW?
  5. Is the gun owner LEARNED about how to safely use the gun?

Source: Wiley Online Library News Release; Journal of the American Geriatrics Society, 4 June 2014

Learn More

The U.S. Department of Veterans Affairs offers a free online brochure, “Firearms and Dementia.”

Social Network Games Create Intergenerational Ties

If you have a Facebook account, you are probably well aware of FarmVille, Candy Crush Saga, Diamond Dash, Bejeweled Blitz and a host of other social network games (SNGs). Most of us think of these games as a pleasant diversion at best, and, at worst, a waste of time. But did you know that today, these games help create connections among family members who are separated by distance—and sometimes, by years?

According to a recent study from Montreal’s Concordia University, published in the journal Information, Communication and Society, more families are playing these games together, and it is a fun and meaningful way to interact—similar to the old board games many of us enjoy, but available to family members who aren’t able to sit across the table from each other.

Senior author Mia Consalvo says, “Maintaining those connections is especially important as families find themselves dispersed across countries and continents. SNGs give families a convenient and cheap way to transcend geographical boundaries.”

Consalvo and her team from Concordia’s Game Studies and Design department interviewed social network gamers about the ways they connected with family through gaming. The researchers reported, “These online games offer families a common topic of conversation and enhance the quality of time spent together, despite the fact that most SNGs don’t necessarily involve any direct communication.”

SNGs might also, in a sense, enlarge our family circle, as we connect with family members we’ve lost touch with—or have never even met. Chatty Facebook posts get us acquainted with distant cousins, and gaming with them helps cement the sense of family circle.

And the best news for seniors: the Concordia team calls social gaming “transgenerational.” Says Consalvo’s colleague Kelly Boudreau, “It’s not just siblings in their early 20s using SNGs to connect. Grandfathers are playing online games with granddaughters, mothers with sons. These multigenerational interactions prove social networks are tools that break down both communication and age barriers.”

Source: IlluminAge AgeWise reporting on study from Concordia University, Montreal, Quebec, Canada [optional link: http://www.concordia.ca/news/media-relations/news-releases/cunews/main/releases/2014/11/18/facebook-games.html]

The 100+ Population is Expected to Soar

Will you live to be 100 years old? A study from Kings College London predicts a steady increase in the number of us who will achieve that advanced age. In 2011, there were approximately 300,000 centenarians worldwide. The Kings College researcher project that there will be three million people 100 or older by the year 2050—and by the end of this century, there could be 17 million!

Where will these oldest seniors spend their final years, and what services will they need? Dr. Catherine Evans, Clinical Lecturer in Palliative Care at the Cicely Saunders Institute, King’s College London said: “Centenarians have outlived death from chronic illness, but they are a group living with increasing frailty and vulnerability to pneumonia and other poor health outcomes. We need to plan for health care services that meet the ‘hidden needs’ of this group, who may decline rapidly if they succumb to an infection or pneumonia. We need to boost high quality care home capacity and responsive primary and community health services to enable people to remain in a comfortable, familiar environment in their last months of life.”

The researchers call for appropriate care at the end of life for these frail elders, to reduce hospital admissions and to support quality of life.

Source: AgeWise reporting on study from Kings College London; you can read more about the study here: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001653

Senior Living Communities Urged to Protect Residents from Financial Exploitation

Older adults are at high risk of financial abuse and scams. According to the Consumer Financial Protection Bureau (CFPB), a government agency that helps consumers take more control over their economic lives, older Americans lose close to $3 billion to financial exploitation each year! The CFPB even calls this threat “the crime of the 21st century.”

Con artists have a wide variety of schemes that take advantage of seniors, and when an older adult has been victimized, the crooks often target the same person again. The perpetrator might even be a family member or other trusted person who is handling or has access to the senior’s money. Seniors who are living with cognitive impairment are at particular risk; even mild cognitive impairment makes it more likely that a person will be victimized.

The CFPB’s Office for Older Americans reports that about half of nursing facility residents and 40 percent of assisted living residents are living with memory loss. According to CFPB Director Richard Cordray, “Financial exploitation and scams can put seniors in danger of losing their housing and nursing care by robbing them of the money to pay for that assistance.” Recognizing the role nursing homes and assisted living facilities can play in protecting vulnerable residents, the CFPB recently released a guide to help staff recognize and report financial mistreatment. The guide, “Protecting Residents from Financial Exploitation” [link to: http://files.consumerfinance.gov/f/201406_cfpb_guide_protecting-residents-from-financial-exploitation.pdf ] , is for managers and staff who are in a key position to protect the people in their care from theft and fraud.

The guide suggests that senior living organizations follow three R’s:

Recognizing: Facilities are advised to train staff to be aware of red flags, such as unpaid facility bills, disappearance of possessions, frequent checks made out to “cash,” a resident who is distraught after a family member or friend visits, or seeing a previously uninvolved person claiming authority to manage a resident’s finances without proper documentation. Other warning signs include a mailbox full of sweepstakes offers and scams involving free lunches and charity appeals.

Recording: Facility managers should urge staff to talk about concerns and report suspicions. Direct care staff, housekeeping and maintenance staff may be the “front line” in this effort, as they are often most familiar with individual residents and might be present during interactions with visitors. Keep records of these observations; this can assist law enforcement and other first responders.

Reporting: There are specific federal requirements for nursing homes to report financial crimes, including exploitation or theft, directly to law enforcement. Facility administrators should be aware of their state’s reporting requirements.

Visit the Consumer Financial Protection Bureau website (www.consumerfinance.gov) to download the guidebook [optional link to: http://files.consumerfinance.gov/f/201406_cfpb_guide_protecting-residents-from-financial-exploitation.pdf ] and to find more resources promoting financial protection for older people. [optional link: http://www.consumerfinance.gov/older-americans]

Source: AgeWise reporting on Consumer Financial Protection Bureau materials.

How Do Seniors Choose Among Their Medicare Plan Options?

Seniors appreciate having a wide range of Medicare private plan choices available to them but often feel unqualified to choose among them, a new Kaiser Family Foundation report concludes. Based on discussions with seniors in four cities around the country, the report captures seniors’ experiences and frustrations in making decisions about their Medicare plans.

Seniors cite many factors as influencing their initial choice of a Part D or Medicare Advantage plan, including premiums, benefits, out-of-pocket costs, brand recognition (i.e., AARP) and adequate coverage for their health care needs, including coverage for their specific medications and, for Medicare Advantage plans, access to desired physicians and hospitals.

However, many seniors say the initial process of comparing and choosing plans was not easy due to the large volume of information they receive and their inability to compare plan features to determine which option is best for them. Few used the government’s online comparison tool, and those that did cite several shortcomings. Many relied on advice from sources they trust, including insurance agents, plan representatives, friends, family members, medical professionals and pharmacists.

After they enroll in a plan, many seniors are reluctant to revisit their initial decision and switch plans, even when premiums go up, because of frustration and confusion during their initial selection process and because of fears about disrupting their care or increasing out-of-pocket costs. They lack confidence in their ability to choose a plan that would be appreciatively better for them.

“How are Seniors Choosing and Changing Health Insurance Plans?” was based on focus-group discussions with seniors in Baltimore, Md.; Seattle, Wash.; Memphis, Tenn.; and Tampa, Fla.; and is authored by researchers at the Kaiser Family Foundation and PerryUndem Research and Communication.

The report’s findings were discussed as part of a policy briefing in Washington, D.C.. Watch a video of the archived webcast of the briefing here. [add link to: http://kff.org/medicare/event/may-13-briefing-how-well-are-seniors-making-choices-among-medicares-private-plans-and-does-it-matter]. Click here to read the full report [link to: http://kff.org/medicare/report/how-are-seniors-choosing-and-changing-health-insurance-plans].

Source: The Henry J. Kaiser Family Foundation. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.

 

Helping Someone Move to a Long-Term Care Facility

Moving to a long term care facility is often difficult for an older adult. But there are many things family members and friends can do to reduce the physical and emotional stresses involved. They can help plan the move, participate on the day of the move, and provide love and support after the move.

Moving to a nursing home is an important long term care option for many older or disabled adults. Sometimes, a person moves to a nursing facility because the care they need just isn’t available or practical at home. Or, they may have special rehabilitative care needs after leaving the hospital, but before they return home.

Whatever the circumstances, there are a few simple steps you and other family members and friends can take to help the person you care for make a smooth, hassle-free transition to new surroundings.

Before the Move

Moving to a long-term care facility usually means making do with less space than the person is used to. Long-term care residents have the right to keep and use items of personal property, to the extent space permits. But space is almost always in short supply. So choices may have to be made about what to take along…and what to leave behind. Friends and family can help by:

  • Learning from the facility exactly what space limitations apply
  • Helping prepare for the move, including arranging for storage or other disposition of items left behind
  • Discussing the facility’s policies for safeguarding resident property; for example, you may be advised to mark all clothing and personal belongings with the person’s name, and to make (or helping the resident or facility make) a list of the resident’s things
  • Anticipating and responding to special concerns, such as care for a pet.

On the Day of the Move

Moving to a new home is always stressful. You can help minimize feelings of disorientation and dislocation by:

  • Helping your loved one unpack…and making sure that pictures, personal mementos and other similar items are placed where they will create a feeling of home
  • Sharing a meal at the new facility
  • Getting to know staff members  and learning about all the various programs, services, and activities the facility has to offer
  • Spending some quiet time after everything is unpacked to make sure your family member or friend is as comfortable, relaxed, and reassured as possible.

After the Move    

When people move to a care facility, they often fear that the move will come between them and people and activities they love. They may worry about being alone and out of touch. It may take some time and effort to get over these concerns, to be reassured by the support of loved ones, to make new friends, and to settle into new and interesting patterns of living. You can help by:

  • Staying in touch right from the beginning…communicating frequently and positively
  • Working closely with your loved one and staff to make sure any difficulties are ironed out
  • Establishing regular visiting times so your loved one can plan ahead for them
  • Making a few surprise visits as well
  • Visiting individually or as a family group for special occasions, such as birthdays and anniversaries
  • Attending care conferences and family support groups
  • Working with your loved one and staff to make the new living situation a happy, successful one.

15 Great Ways to Help Your Loved One Feel Connected

  1. Send flowers or balloons on a special day.
  2. Write frequent cards, notes or e-mail.
  3. Give a prepaid, senior-friendly cell phone or calling card.
  4. Set up Skype chats with your loved one
  5. Visit as often as you can.
  6. Send pictures or videos of family events, grandchildren, or friends.
  7. Bring a card or small gift when you visit.
  8. Get to know the resident’s new friends and care providers, and greet them during your visits.
  9. Check to see what types of food items would be appropriate as a gift, and include them occasionally when you visit.
  10. Remember to acknowledge and thank members of staff whenever appropriate.
  11. Offer to take along other long-time friends, so they can visit also.
  12. Go for a stroll outside if weather permits.
  13. Take the resident on a day trip, or come along on a resident outing.
  14. Inform friends, family and your loved one’s faith community of their new contact information.
  15. Become a volunteer in your loved one’s new home.

Source: AgeWise

Not All Senior Financial Advisors Are Created Equal

Our nation’s growing senior population means that an increasing number of older adults will need help managing their household wealth, retirement accounts and other assets. In response, more financial advisors are claiming to be experts on the financial needs of older adults. But according to a report from the Consumer Financial Protection Bureau (CFPB), the confusion arising from the many types of financial advisors who put the term “senior” in their title puts older consumers at risk of fraud. The report found that many such advisors lack expertise in senior financial issues, and some may in reality be little more than high-pressure salesmen.

The report, “Senior Designations for Financial Advisors: Reducing Consumer Confusion and Risks,”  http://files.consumerfinance.gov/f/201304_CFPB_OlderAmericans_Report.pdf  revealed that:

  1. The variety of titles and acronyms of senior designations confuse seniors.
  2. There is a wide variation in the training and qualification process and regulation associated with different titles.
  3. There is a need for a single authority to ensure that those using the “senior” designation do not mislead or harm consumers, selling them inappropriate investment and financial products or otherwise defrauding them.

According to CFPB director Richard Cordray, the report “underscores the need for consistent high-level standards of training and conduct for those advisors who want to acquire a bona fide senior designation.”

What can seniors and families do now to protect elder assets? Visit the CFPB’s Financial Protection for Older Americans web page (www.consumerfinance.gov/older-americans) to learn more about selecting a financial advisor [optional link to: http://files.consumerfinance.gov/f/201311_cfpb_flyer_senior-financial-advisors.pdf ] and to find information on other senior financial issues.

Copyright © AgeWise, reporting on information from the Consumer Financial Protection Bureau, 2014

Are Emergency Rooms Senior-Friendly?

A report from the American College of Emergency Physicians calls for increased training in geriatrics for emergency room personnel, as well as ER features that support the needs of older patients. Researchers examined data from around the world and found that many senior patients experienced functional and cognitive problems after a trip to the hospital after a fall or other health event.

Said study author Dr. Leonard Gray of the University of Queensland in Brisbane, Australia, “These patients have complex profiles before they come to the ER, and even more complicated needs once they get there. Dependence on others and geriatric illnesses, such as cognitive impairment and mobility problems, affect the majority of older emergency patients across a wide range of nations with different health systems and cultural contexts. They require specialized care to avoid missed diagnoses, pressure ulcers and a range of other potential problems associated with this particular population.”

With the growing senior population, more hospitals in the U.S. have established specialized ER facilities for older adults. Said Dr. Gray, “Frailty, confusion and dependence on others make these our most fragile emergency patients. Specialized training in geriatric care and even specialized layout and procedures can help us provide the best assessment and care.”

The study appeared in the Annals of Emergency Medicine.

Source: AgeWise reporting on study from the American College of Emergency Physicians (www.acep.org)

Health Law Requires Medicare to Cover Dementia Evaluation

Health Law Requires Medicare to Cover Dementia Evaluation

Provided by Kaiser Health News (www.kaiserhealthnews.com)

For the millions of seniors who worry that losing their keys may mean they’re losing their minds, the health law now requires Medicare to cover a screening for cognitive impairment during an annual wellness visit.
But in a recent review of the scientific research, an influential group said there wasn’t enough evidence to recommend dementia screening for asymptomatic people over age 65.

What’s a worried senior to think?

Dementia screening tests are typically short questionnaires that assess such things as memory, attention and language and/or visuospatial skills. One of the most common, the mini-mental state examination, consists of 30 questions (such as “What month is this?” and “What country are we in?”) and may be completed in about 10 minutes.

In its review, the U.S. Preventive Services Task Force, an independent panel of medical experts, evaluated the evidence of the benefits, harms and clinical utility of various screening instruments for cognitive impairment. It concluded that the evidence for routine population-based screening was insufficient. While declining to  recommend the practice for everyone older than 65, the reviewers noted that some screening tools can be useful in identifying dementia.

“Clinicians need to use their judgment,” says Albert Siu, professor and chair of geriatrics and palliative care at Mount Sinai School of Medicine in New York, who was co-vice chair of the task force on dementia screening. “The evidence isn’t clear that there is a net benefit to screening for individuals that are asymptomatic.”
The risk of dementia increases with age: its prevalence is 5 percent in people aged 71 to 79, rising to 37 percent of those older than 90. Mild cognitive impairment has many definitions, but the term generally refers to people whose impairment isn’t severe enough to hamper their ability to manage their daily lives. By some estimates up to 42 percent of people older than 65 have it. Mild cognitive impairment is a warning sign, but it may not progress to Alzheimer’s disease, says Dean Hartley, director of science initiatives at the Alzheimer’s Association.

Alzheimer’s is the most common form of dementia, accounting for up to 80 percent of cases. Other types include vascular dementia, many cases of Parkinson’s disease and Huntington’s disease.

Someone without symptoms who does poorly on a screening test may have other medical conditions, such as depression or sleep apnea, that can cause memory or other problems, says Hartley. That’s why it’s important that people take the tests in a medical setting with a trained professional who can evaluate them and take a good medical history from patients and their family members, he says.

One-time screenings at shopping malls or health fairs should be avoided, experts agree. Taking a quick test without any accompanying medical evaluation may raise more questions than it answers.

But seniors may want to consider having an evaluation for cognitive impairment as part of their annual wellness visit with their health provider. It is covered with no out-of-pocket charge.

The Alzheimer’s Association recommends that seniors undergo cognitive impairment screening and evaluation to establish a baseline for comparison, and then have regular follow-up assessments in subsequent years.

There is no cure for Alzheimer’s disease. Some drugs, such as Aricept, may improve memory or other symptoms temporarily, but no medical treatment halts or reverses the disease.

That is a key argument against large-scale routine screening of people older than 65, says Ariel Green, a geriatrician at Johns Hopkins Bayview Medical Center. “We don’t have studies that show that such a screening program improves the care of people with dementia,” she says.

Still, if an individual has concerns about dementia because of a family history of Alzheimer’s or memory lapses, for example, a medical professional should evaluate the person and a screening test may be appropriate.

And although research hasn’t yet shown that large-scale screening is effective at improving dementia care overall, screening may help individuals and their families identify a cognitive impairment or dementia early on. The drugs that are available are most effective in the early stages of the disease. In addition, Green says, “it’s helpful for people to hear a diagnosis of dementia, if it’s an accurate diagnosis, because it can help people anticipate their future needs and plan for that.”

Source: Kaiser Health News (www.kaiserhealthnews.org), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. This article was produced by Kaiser Health News with support from The SCAN Foundation (www.thescanfoundation.org).

 

June is Scleroderma Awareness Month

Questions and answers from the National Institute of Arthritis and Musculoskeletal Diseases:

Q: What is Scleroderma?

A: Scleroderma is a group of diseases that affect connective tissue in the body. This tissue supports your skin and internal organs. Scleroderma involves tissue that become hard or thick. It can also cause swelling or pain in the muscles and joints. Some types of scleroderma lead to hard, tight skin. Other types affect blood vessels and major organs (such as the heart, lungs, and kidneys).

Q: What causes scleroderma?

A: The cause is unknown. You can’t catch it from other people. Doctors don’t think it is passed through genes.

Q: What are the types of scleroderma?

A: Scleroderma’s main types are localized and systemic. Localized means the disease only affects certain parts of the body, often skin tissues, and does not harm major organs. The systemic type affects the skin, tissues under it, blood vessels, and major organs.

Q: Who gets scleroderma?

A: Scleroderma is more common in women than men. Anyone can get it, even children. Most types show up before age 40.

Q: How is scleroderma diagnosed?

A: Doctors diagnose the disease using the patient’s medical history, a physical exam, lab tests and a skin biopsy. Scleroderma may be hard to diagnose, as other diseases have similar symptoms.

Q: How does scleroderma affect the lives of patients?

A: People with scleroderma may worry about the way their skin looks. They may have problems dressing, bathing or handling basic daily tasks. The disease may also affect a person’s relationships and self-esteem.

Q: How is scleroderma treated?

A: A rheumatologist (a doctor who treats arthritis and other diseases that cause swelling in the joints) may lead the healthcare team and refer the patient to health experts who treat problems with skin, kidneys, heart, digestion, lungs, teeth, movement and speech.

Q: Can scleroderma be cured?

A: At present, there is no cure for scleroderma.

Q: How is scleroderma treated?

A: It’s important for patients to follow the doctor’s recommendations about lifestyle, medication and treatment. Symptoms and damage can be reduced. Patients may receive treatment for:

Raynaud’s phenomenon. This condition affects the fingers, feet and hands, making them change color when the person is cold or anxious. Treatment may include medication and exercises.

Stiff, painful joints. Hard skin around the joints can cause discomfort and loss of motion. Treatment includes exercises, medication and learning to do things in a way that puts less stress on the joint.

Skin problems. With scleroderma, collagen builds up in the skin and can make skin stiff and dry. Treatment consists of creams and lotion, using sunscreen, following the healthcare provider’s advice about protecting skin, and regular exercise. Skin changes can also change how the skin looks, affecting a patient’s self-image. Laser treatment and plastic surgery may fix some skin damage and approve the appearance.

Dry mouth and dental problems. Tight skin on the face makes it difficult to care for the teeth, leading to decay and loss. The dentist can suggest ways to protect and clean the teeth.

Gastrointestinal problems. Problems include heartburn, trouble swallowing, diarrhea, constipation and gas. Patients should follow the doctor’s instructions about nutrition and ways to eat that may lessen the problem.

Lung damage. When the lungs are affected, patients may have loss of some lung function, high blood pressure, fatigue, shortness of breath and other breathing problems. Follow the healthcare provider’s advice and get regular flu and pneumonia shots.
Heart problems. Problems include scarring and weakness, swelling of the heart, and abnormal heartbeat. These problems can all be treated.

Kidney problems. Scleroderma can cause very high blood pressure and kidney failure in some people. It’s important that patients check their blood pressure often and notify the doctor right away if it is above normal.

Source:  The National Institute of Arthritis and Musculoskeletal Diseases (www.niams.nih.gov). Visit their website for more information about scleroderma and other diseases of the joints and skin.

Learn More

The Scleroderma Foundation (http://scfo.convio.net), sponsors of Scleroderma Awareness Month, offers information, resources and support for people who are living with this devastating disease.

The information in this article is not intended to replace the advice of your healthcare provider. Talk to your doctor with questions about your condition.