Category Archives: Caregiving – General

This article by Kaiser Health News (KHN) stresses that the time after hospital discharge is a dangerous period. “Bad coordination often plagues patients’ transition to the care of home health agencies, as well as to nursing homes and other professionals charged with helping them recuperate, studies show.” The example given in this article, published in the Washington Post, is of a woman who died as a result of medication mistakes made by a pharmacy technician and two RNs at a home health agency.

The article mentions a few other danger-points worth repeating:

• “At hospitals, federal data show that fewer than half of patients say they’re confident that they understand the instructions of how to care for themselves after discharge.”
• “In nursing homes, case management frequently comes up short. A 2013 government report found more than a third of facilities did not properly assess patients’ needs, devise a plan for their care and then follow through on that.”
• “And at home health agencies, where failures to create and execute a care plan are the most common issues government inspectors identify, followed by deficient medication review, according to KHN’s analysis.”

See: www.washingtonpost.com/news/to-your-health/wp/2016/04/29/from-hospital-to-home-a-dangerous-transition-for-many-patients/

Robin

This is one of the best recent articles I’ve read on polypharmacy–taking five or more medications a day.

The New York Times – Health
THE NEW OLD AGE
The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills
by Paula Span
April 22, 2016
www.nytimes.com/2016/04/26/health/the-dangers-of-polypharmacy-the-ever-mounting-pile-of-pills.html

Here are some key points made in the article, published in today’s New York Times:

• While drug interactions can occur in any age group, over 15% of older adults are at risk for a major drug interaction.
• Older people are more vulnerable. “Most have multiple chronic diseases, so they take more drugs, putting them at higher risk for threatening interactions. The consequences can also be more threatening. ‘They’re more prone to fall, because they don’t have the same reserves of balance and strength’ as the young or middle-aged, [Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco] said. ‘And if they do fall because they’re dizzy, they’re more likely to get hurt.'”
• “Some common combinations that cropped up in the study and could spell trouble: aspirin and the anti-clotting drug clopidogrel (Plavix)…; aspirin and naproxen (Aleve); …the cholesterol drug simvastatin (Zocor) and the blood pressure medication amlodipine (Norvasc).”
• “[Patients] and families can ask their physicians for brown bag reviews, including every supplement, and discuss whether to continue or change their regimens. Pharmacists, often underused as information sources, can help coordinate medications, and some patients qualify for medication reviews through Medicare.”
• We don’t consider when medications should be stopped.

Some of you may want to check out the NYT website and investigate some of the links within the article.

Robin

Nice article about caregiving in the sandwich generation.  See:  https://www.washingtonpost.com/lifestyle/how-to-cope-with-caring-for-baby-boomer-parents-while-raising-small-children/2016/02/16/5912f07a-ca9a-11e5-a7b2-5a2f824b02c9_story.html

Here are two excerpts:

* The term “sandwich generation” was coined in the 1980s to describe people who are squeezed between taking care of their children and their parents. Now, as members of the baby boom generation are entering their 70s, that sandwich is poised to become a footlong.

* “Caregivers are notorious for not doing self-care. They feel guilty for not being there,” said Anjana Chacko, a social worker who runs a pre-hospice program… “Having breaks and getting out and doing something fun for themselves is not frivolous. It’s self-care. It’s vital.”  Chacko said one client of hers was recently stressed out from the intensity of caring for a loved one.  “She says to me, ‘I do get a break — I go to the dry cleaner and the grocery.’ . . . I said, ‘Okay, we need to have a talk about what we consider a break.’ ”

Robin

This is a good article about the promise many families are asked to make: “Promise you’ll never put me in a nursing home.”    See http://washingtonpost.com/local/social-issues/promise-youll-never-put-me-in-a-nursing-home/2016/02/08/1ce8737c-cb62-11e5-a7b2-5a2f824b02c9_story.html

Here are some excerpts:

* To Bill Thomas, a geriatrician who is working to change American attitudes about old age, the promise is a red herring. “It’s actually the only thing we know how to do because we don’t have the actual language to say what we’re really asking: ‘Promise me you’ll protect my dignity, promise you’ll protect my privacy, promise to make sure I don’t live in pain.’

* Caregiving can take a severe financial toll, and studies have shown higher rates of depression, physical illnesses and mortality among family caregivers. And yet the impulse to keep a loved one at home is powerful.

* “It’s always best to not make promises you can’t keep or qualify,” [Gary Small, director of the Division of Geriatric Psychology at UCLA’s School of Medicine] said. “You could say, ‘Look, mom, I know you want to stay in your home, and we’re going to do whatever we can to keep you there, but . . . there could be things that you don’t anticipate.'”

* Talking it through early while everyone is still healthy can help. So can doctors or support groups, which can affirm when a move to a facility would be in everyone’s best interest.

* “The only thing he asked me to promise him was to not put him in a facility and walk away from him, and I have not done that,” she said.

Robin