How likely is an assisted living resident to have a drinking problem?
The short answer is: nobody really knows. But a study by a University of Pittsburgh team, recently published in Research on Aging, provides some useful clues. More than 800 aides working in assisted living facilities in Pennsylvania were asked in a questionnaire about behaviors they had observed, or had evidence of, in the elderly people they cared for. Their responses suggested that:
-Nearly 70 percent of assisted living residents drank alcohol.
-More than a third drank daily.
-Twelve percent had abused alcohol (defined as drinking enough to cause “physical or psychosocial harm”) in the past three months.
-Almost 20 percent had experienced an apparent influence on their health from alcohol use in the past three months.
You might ask why the researchers relied on reports from nursing aides, who provide the bulk of hands-on care in assisted living, instead of asking residents themselves. One reason, admitted Nicholas Castle, a leading health policy researcher at the University of Pittsburgh, is that the team didn’t have the money to train and pay interviewers for an extensive multistate investigation that would provide a deeper understanding of this largely overlooked issue. That’s one limitation of this approach.
But as many readers pointed out the last time we talked about drinking and aging, denial is not just a river. “People tend to underestimate their consumption,” Dr. Castle said. He was not sure that residents would provide more accurate information than nursing aides, who are deeply involved with residents. “They tend to know what’s going on,” he said.
Alcohol misuse or abuse does not appear to increase with age, but it may have more serious consequences for people in their 80s, as the great majority of assisted living residents are. Their tolerance for alcohol changes; the amount they have drunk daily for years can become more intoxicating, more apt to cause falls, depression, high blood pressure and other accidents and illnesses.
In assisted living, too, most people take multiple medications and also show at least some cognitive decline. “With their changing metabolism and the possible interactions with prescription drugs, they may not need to drink a lot to have problems with alcohol,” Dr. Castle said.
Full Article
Wednesday, February 8, 2012
Friday, February 3, 2012
'The Talk' is never easy - Autoweek
The discussion with my father was, to be frank, painful. No, not that discussion--the birds-and-the-bees talk was a cakewalk compared with the one in which I asked him to stop driving. I had been thinking that we needed to talk for a while. He was in his late 80s, and his eyesight and hearing were declining, not to mention his reflexes. I had ridden with him in his pickup on a short drive from his house to the hardware store, and it had me terrified. It was as if he was on autopilot, not really noticing the world around him.
I worried for his safety and the safety of others. He lived in a rural area, and his ability to drive represented freedom and independence. After my mom died, he was eating most of his meals out of the house and that represented the bulk of his social activity, and he needed to be able to drive. Public transportation is nonexistent where he lived, and after a lengthy discussion, we came up with a compromise we could both live with: He wouldn't drive out of town, and he would not drive at night. When he wanted to visit our house, about 40 miles away, we would go and get him.
My dad was a member of what has become known as the Greatest Generation. He fought in Europe in World War II and was a self-made man. He was a strong man in every sense of the word. His son telling him that he shouldn't drive anymore was not something he thought he'd ever hear. It's not something I thought I'd ever have to say to him, either.
I tried using logic on him, repeating the words back to him--parents love that stuff--that he told me when I first got my driver's license. I remember him telling me that driving a car is one of the most serious things I'll ever do, just before handing over the keys to the olive-green 1968 Pontiac Catalina that had been the family car. He told me that when I was behind the wheel, I was responsible not only for my actions, but that I had to look out for the other guy.
Full Article
I worried for his safety and the safety of others. He lived in a rural area, and his ability to drive represented freedom and independence. After my mom died, he was eating most of his meals out of the house and that represented the bulk of his social activity, and he needed to be able to drive. Public transportation is nonexistent where he lived, and after a lengthy discussion, we came up with a compromise we could both live with: He wouldn't drive out of town, and he would not drive at night. When he wanted to visit our house, about 40 miles away, we would go and get him.
My dad was a member of what has become known as the Greatest Generation. He fought in Europe in World War II and was a self-made man. He was a strong man in every sense of the word. His son telling him that he shouldn't drive anymore was not something he thought he'd ever hear. It's not something I thought I'd ever have to say to him, either.
I tried using logic on him, repeating the words back to him--parents love that stuff--that he told me when I first got my driver's license. I remember him telling me that driving a car is one of the most serious things I'll ever do, just before handing over the keys to the olive-green 1968 Pontiac Catalina that had been the family car. He told me that when I was behind the wheel, I was responsible not only for my actions, but that I had to look out for the other guy.
Full Article
Thursday, February 2, 2012
Sleep Apnea Linked to Silent Strokes, Small Lesions in Brain - Science Daily
People with severe sleep apnea may have an increased risk of silent strokes and small lesions in the brain, according to a small study presented at the American Stroke Association's International Stroke Conference 2012.
"We found a surprisingly high frequency of sleep apnea in patients with stroke that underlines its clinical relevance as a stroke risk factor," said Jessica Kepplinger, M.D., the study's lead researcher and stroke fellow in the Dresden University Stroke Center's Department of Neurology at the University of Technology in Dresden, Germany.
"Sleep apnea is widely unrecognized and still neglected. Patients who had severe sleep apnea were more likely to have silent strokes and the severity of sleep apnea increased the risk of being disabled at hospital discharge."
The researchers found:
-Ninety-one percent (51 of 56) of the patients who had a stroke had sleep apnea and were more likely to have silent strokes and white matter lesions that increased risk of disability at hospital discharge.
-Having more than five sleep apnea episodes per night was associated with silent strokes.
-More than one-third of patients with white matter lesions had severe sleep apnea and more than 50 percent of silent stroke patients had sleep apnea.
-Even though men were more likely to have silent infarcts, correlations between sleep apnea and silent infarcts remained the same after adjustment for such gender differences.
Full Article
"We found a surprisingly high frequency of sleep apnea in patients with stroke that underlines its clinical relevance as a stroke risk factor," said Jessica Kepplinger, M.D., the study's lead researcher and stroke fellow in the Dresden University Stroke Center's Department of Neurology at the University of Technology in Dresden, Germany.
"Sleep apnea is widely unrecognized and still neglected. Patients who had severe sleep apnea were more likely to have silent strokes and the severity of sleep apnea increased the risk of being disabled at hospital discharge."
The researchers found:
-Ninety-one percent (51 of 56) of the patients who had a stroke had sleep apnea and were more likely to have silent strokes and white matter lesions that increased risk of disability at hospital discharge.
-Having more than five sleep apnea episodes per night was associated with silent strokes.
-More than one-third of patients with white matter lesions had severe sleep apnea and more than 50 percent of silent stroke patients had sleep apnea.
-Even though men were more likely to have silent infarcts, correlations between sleep apnea and silent infarcts remained the same after adjustment for such gender differences.
Full Article
Wednesday, February 1, 2012
Bargaining for a Child’s Love - The New York Times
ECONOMIC malaise and political sloganeering have contributed to the increasingly loud conversation about the coming crisis of old-age care: the depletion of the Social Security trust fund, the ever rising cost of Medicare, the end of defined-benefit pensions, the stagnation of 401(k)’s. News accounts suggest that overstretched and insufficient public services are driving adult children “back” toward caring for dependent parents.
Such accounts often draw on a deeply sentimental view of the past. Once upon a time, the story line goes, family members cared for one another naturally within households, in an organic and unplanned process. But this portrait is too rosy. If we confront what old-age support once looked like — what actually happened when care was almost fully privatized, when the old depended on their families, without the bureaucratic structures and the (under)paid caregivers we take for granted — a different picture emerges.
For the past decade I have been researching cases of family conflict over old-age care in the decades before Social Security. I have found extraordinary testimony about the intimate management of family care: how the old negotiated with the young for what they called retirement, and the exertions of caregiving at a time when support by relatives was the only sustenance available for the old.
In that world, older people could not rely on habit or culture or nature if they wanted their children to support them when they became frail. In an America strongly identified with economic and physical mobility, parents had to offer inducements. Usually, the bait they used was the promise of an inheritance: stay and take care of me and your mother, and someday you will get the house and the farm or the store or the bank account.
But of course what was at stake was never just an economic bargain between rational actors. Older people negotiated with the young to receive love, to be cared for with affection, not just self-interest.
The bargains that were negotiated were often unstable and easily undone. Life expectancies were considerably lower than they are now, but even so, old age could easily stretch for decades. Of course, disease, injury, disability, dementia, insanity, incontinence — not to mention sudden death — were commonplace, too. Wills would be left unwritten, deeds unconveyed, promises unfulfilled, because of the onset of dementia or the meddling of siblings. Or property was conveyed too early, and then the older person would be at the mercy of a child who no longer “cared” — or who could not deal with the work of care.
Full Article
Such accounts often draw on a deeply sentimental view of the past. Once upon a time, the story line goes, family members cared for one another naturally within households, in an organic and unplanned process. But this portrait is too rosy. If we confront what old-age support once looked like — what actually happened when care was almost fully privatized, when the old depended on their families, without the bureaucratic structures and the (under)paid caregivers we take for granted — a different picture emerges.
For the past decade I have been researching cases of family conflict over old-age care in the decades before Social Security. I have found extraordinary testimony about the intimate management of family care: how the old negotiated with the young for what they called retirement, and the exertions of caregiving at a time when support by relatives was the only sustenance available for the old.
In that world, older people could not rely on habit or culture or nature if they wanted their children to support them when they became frail. In an America strongly identified with economic and physical mobility, parents had to offer inducements. Usually, the bait they used was the promise of an inheritance: stay and take care of me and your mother, and someday you will get the house and the farm or the store or the bank account.
But of course what was at stake was never just an economic bargain between rational actors. Older people negotiated with the young to receive love, to be cared for with affection, not just self-interest.
The bargains that were negotiated were often unstable and easily undone. Life expectancies were considerably lower than they are now, but even so, old age could easily stretch for decades. Of course, disease, injury, disability, dementia, insanity, incontinence — not to mention sudden death — were commonplace, too. Wills would be left unwritten, deeds unconveyed, promises unfulfilled, because of the onset of dementia or the meddling of siblings. Or property was conveyed too early, and then the older person would be at the mercy of a child who no longer “cared” — or who could not deal with the work of care.
Full Article
Tuesday, January 31, 2012
The Caregivers’ Bookshelf: An Alzheimer’s Classic - The New York Times
More than 30 years ago, when the psychiatrist Dr. Peter Rabins and the psychologist Nancy Mace began working with dementia patients and their families at Johns Hopkins Hospital, they had to write and mimeograph (younger readers: look it up) small pamphlets to explain to them what was going on and what was to come.
It’s hard to remember how different things were. If you had stopped 20 people at random on the streets of Baltimore in 1981, I asked Dr. Rabins recently, how many would have known what Alzheimer’s disease was?
“If you asked 20 random doctors and nurses at Johns Hopkins, I don’t think any would have known,” he said.
In 1981, nothing had been published for a general readership. The Alzheimer’s Association was a little over a year old. Scientists had determined that dementia was a disease, not part of normal aging, and that it was caused by changes in the brain, not hardened arteries. “But that information was just barely starting to trickle out,” Dr. Rabins said.
As people from other cities started asking the Hopkins staff to mail copies of their pamphlets, Dr. Rabins and Ms. Mace decided they needed a publisher. They approached 10, five of whom said there was no market for such a book and five of whom never responded. The Johns Hopkins University Press finally agreed to take on the project.
“There was an interesting concatenation: family groups forming, six or seven research centers across the country making diagnoses, baby boomers starting to write about this mysterious condition affecting their parents, and that’s when the book came out,” he said. “It met a need.”
Full Article
It’s hard to remember how different things were. If you had stopped 20 people at random on the streets of Baltimore in 1981, I asked Dr. Rabins recently, how many would have known what Alzheimer’s disease was?
“If you asked 20 random doctors and nurses at Johns Hopkins, I don’t think any would have known,” he said.
In 1981, nothing had been published for a general readership. The Alzheimer’s Association was a little over a year old. Scientists had determined that dementia was a disease, not part of normal aging, and that it was caused by changes in the brain, not hardened arteries. “But that information was just barely starting to trickle out,” Dr. Rabins said.
As people from other cities started asking the Hopkins staff to mail copies of their pamphlets, Dr. Rabins and Ms. Mace decided they needed a publisher. They approached 10, five of whom said there was no market for such a book and five of whom never responded. The Johns Hopkins University Press finally agreed to take on the project.
“There was an interesting concatenation: family groups forming, six or seven research centers across the country making diagnoses, baby boomers starting to write about this mysterious condition affecting their parents, and that’s when the book came out,” he said. “It met a need.”
Full Article
Thursday, January 19, 2012
Many Seniors Leave Hospital Without Their Regular Meds - Quality Health
While hospitals can be lifesavers, especially for the elderly, an alarming number of older patients fail to continue taking their regular medications after they return home—particularly if they spent time in intensive care. Why? Mainly because they neglect to renew their prescriptions.
Researchers at Toronto's St. Michael's Hospital examined data on almost 400,000 people living in Ontario between 1997 and 2009. They were all over the age of 66 and were regularly taking one of five medications commonly used to treat chronic conditions-statins for lowering cholesterol, anti-clotting drugs, thyroid replacement hormones, respiratory inhalers, and drugs that suppress gastric acid. During that time, slightly fewer than half of the study participants were hospitalized for unspecified conditions, and less than 10 percent of those were admitted to the ICU. What the researchers found is that admittance to a hospital resulted in patients being less likely to renew a long-term prescription. Almost one-fifth of patients did not renew their medications after discharge. Being admitted to the ICU carried an even higher risk-almost one-quarter of ICU patients failed to renew medications after discharge.
Why do so many seniors neglect their medications once discharged from the hospital, particularly if they were in the ICU? The study's lead researcher, Dr. Chaim Bell, said in a statement that the reason may be that ICUs are focused on treating acute illnesses, not chronic conditions. It's not uncommon for a long-term medication to be temporarily discontinued as the critical-care staff deals with a more pressing problem. Regular prescriptions "may later be forgotten or overlooked upon discharge," Bell said. He also noted that ICU patients are typically sent to a regular hospital bed once the emergency is over, and this handoff presents another opportunity for miscommunication and error.
The problem with seniors forgetting to take long-term medications is that the diseases for which the medications are intended are still present and causing damage. Patients who suspend their prescriptions are at increased risk of being readmitted to the hospital. That's why it's a good idea for senior citizens to keep a record of all prescriptions in one handy place. If one medication is temporarily suspended, the patient can review the list with his or her doctor upon discharge and make sure there are fresh prescriptions for everything needed.
Full Article
Researchers at Toronto's St. Michael's Hospital examined data on almost 400,000 people living in Ontario between 1997 and 2009. They were all over the age of 66 and were regularly taking one of five medications commonly used to treat chronic conditions-statins for lowering cholesterol, anti-clotting drugs, thyroid replacement hormones, respiratory inhalers, and drugs that suppress gastric acid. During that time, slightly fewer than half of the study participants were hospitalized for unspecified conditions, and less than 10 percent of those were admitted to the ICU. What the researchers found is that admittance to a hospital resulted in patients being less likely to renew a long-term prescription. Almost one-fifth of patients did not renew their medications after discharge. Being admitted to the ICU carried an even higher risk-almost one-quarter of ICU patients failed to renew medications after discharge.
Why do so many seniors neglect their medications once discharged from the hospital, particularly if they were in the ICU? The study's lead researcher, Dr. Chaim Bell, said in a statement that the reason may be that ICUs are focused on treating acute illnesses, not chronic conditions. It's not uncommon for a long-term medication to be temporarily discontinued as the critical-care staff deals with a more pressing problem. Regular prescriptions "may later be forgotten or overlooked upon discharge," Bell said. He also noted that ICU patients are typically sent to a regular hospital bed once the emergency is over, and this handoff presents another opportunity for miscommunication and error.
The problem with seniors forgetting to take long-term medications is that the diseases for which the medications are intended are still present and causing damage. Patients who suspend their prescriptions are at increased risk of being readmitted to the hospital. That's why it's a good idea for senior citizens to keep a record of all prescriptions in one handy place. If one medication is temporarily suspended, the patient can review the list with his or her doctor upon discharge and make sure there are fresh prescriptions for everything needed.
Full Article
Tuesday, January 17, 2012
"Right-sizing" nursing homes - The Connecticut Mirror
State officials are developing a plan to dramatically reshape the state's long-term care system, just as demand for it is expected to skyrocket.
The effort -- referred to as "right-sizing" the system -- is aimed at allowing more seniors and people with disabilities to live in community settings rather than institutions.
If it goes as officials hope, nearly one in four nursing home beds in the state won't be needed within the next two decades -- at least according to projections being used by state officials. They're planning to award millions of dollars in federal grant money to nursing homes looking to diversify their business models.
Those leading the effort say it's about creating choice, removing the barriers that make it harder to get Medicaid-funded long-term care at home than in an institution.
"We're designing a system that will someday support us," Dawn Lambert told a roomful of people helping to design the effort, including state agency officials, home health care and nursing home industry leaders, long-term care recipients and advocates for seniors, people with disabilities and mental illnesses.
Lambert is project director for Money Follows the Person, a federal-state initiative to help people in institutions move into home- or community-based settings and rebalance the long-term care system.
Doing so requires transforming not just the care system, but the infrastructure of a state sorely lacking affordable, accessible housing and transportation options. There will be a need for community supports to help people avoid being isolated at home, and a major increase in home care workers, who are already in short supply.
The shift will also require a more subtle change in the way care is thought of, those behind the effort say, from a sometimes-paternalistic model that treats people as patients in the care of an institution to one that emphasizes independence, choice and the right to take risks, including getting less care than professionals might advise. While many nursing home residents are seniors, the changes will also affect people with disabilities and mental illnesses, some of whom live in nursing homes.
Many longtime advocates for rebalancing the system say they're cautiously optimistic, saying previous resistance seems to have subsided, and policy changes are starting to reflect a move toward expanding home- and community-based care. Gov. Dannel P. Malloy's administration has already announced plans to expand Money Follows the Person, and Malloy issued a controversial executive order establishing a path for home care workers in state-funded programs to gain collective bargaining rights, citing the expected increase in demand for personal care attendants.
"I don't think we have any choice," AARP Connecticut State Director Brenda Kelley said. "The services that we currently have are not what people want. They're not what people need, and we can't afford it."
The nursing home industry is participating in the planning process, and leaders have acknowledged that a shift toward more home care is inevitable. The industry understands that an overreliance on institutional care, mixed with the looming demographic trends, will lead the state to a long-term care system that's unaffordable, said Matthew V. Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes.
Full Article
The effort -- referred to as "right-sizing" the system -- is aimed at allowing more seniors and people with disabilities to live in community settings rather than institutions.
If it goes as officials hope, nearly one in four nursing home beds in the state won't be needed within the next two decades -- at least according to projections being used by state officials. They're planning to award millions of dollars in federal grant money to nursing homes looking to diversify their business models.
Those leading the effort say it's about creating choice, removing the barriers that make it harder to get Medicaid-funded long-term care at home than in an institution.
"We're designing a system that will someday support us," Dawn Lambert told a roomful of people helping to design the effort, including state agency officials, home health care and nursing home industry leaders, long-term care recipients and advocates for seniors, people with disabilities and mental illnesses.
Lambert is project director for Money Follows the Person, a federal-state initiative to help people in institutions move into home- or community-based settings and rebalance the long-term care system.
Doing so requires transforming not just the care system, but the infrastructure of a state sorely lacking affordable, accessible housing and transportation options. There will be a need for community supports to help people avoid being isolated at home, and a major increase in home care workers, who are already in short supply.
The shift will also require a more subtle change in the way care is thought of, those behind the effort say, from a sometimes-paternalistic model that treats people as patients in the care of an institution to one that emphasizes independence, choice and the right to take risks, including getting less care than professionals might advise. While many nursing home residents are seniors, the changes will also affect people with disabilities and mental illnesses, some of whom live in nursing homes.
Many longtime advocates for rebalancing the system say they're cautiously optimistic, saying previous resistance seems to have subsided, and policy changes are starting to reflect a move toward expanding home- and community-based care. Gov. Dannel P. Malloy's administration has already announced plans to expand Money Follows the Person, and Malloy issued a controversial executive order establishing a path for home care workers in state-funded programs to gain collective bargaining rights, citing the expected increase in demand for personal care attendants.
"I don't think we have any choice," AARP Connecticut State Director Brenda Kelley said. "The services that we currently have are not what people want. They're not what people need, and we can't afford it."
The nursing home industry is participating in the planning process, and leaders have acknowledged that a shift toward more home care is inevitable. The industry understands that an overreliance on institutional care, mixed with the looming demographic trends, will lead the state to a long-term care system that's unaffordable, said Matthew V. Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes.
Full Article
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