For Seniors, Is This (Hospital) Trip Necessary?

Hospital care is expensive. Yet according to a recent report from the Medicare Payment Advisory Commission (MedPAC), 60 percent of all Medicare emergency room visits and 25 percent of hospital admissions are “potentially preventable.” And this is not just a matter of money. Hospitals, it turns out, are not always the best care setting for seniors. Researchers are looking at ways to keep older adults out of the hospital. This includes:

• Encouraging patients to be treated by their primary physician rather than at the emergency room
• Better preventive care and management of diabetes, heart failure and other common health problems
• Helping seniors manage their medications
• Identifying and treating depression, which increases emergency room use
• Improved healthcare education and information for consumers.

Avoiding the Hospital Revolving Door

Re-hospitalization is also an expensive and dangerous problem. According to the National Association of Area Agencies on Aging (n4a), nearly 20 percent of Medicare patients discharged from the hospital are readmitted within 30 days, costing over $26 billion every year. Why are seniors readmitted at such a high rate? Sometimes they have nowhere else to go—they can’t get an appointment with their primary care physician or don’t understand their care instructions. Studies show that in other cases, patients are released too soon: almost half of all surgical complications happen after discharge. And often, the reason for readmission is unrelated to the condition for which the patient was hospitalized. (See “Is Post-Hospital Syndrome Real?” below for more about this.)

For hospitals, there is a new emphasis on preventing unneeded readmissions. Medicare penalties are one reason for the concern: beginning in October, Medicare began reducing payments to certain hospitals which have high rates of preventable readmission.

Of course, not all readmissions can be prevented. But healthcare agencies are taking steps to help seniors, professionals and consumers address the problem. The Agency for Healthcare Research and Quality (AHRQ) calls for improvements in care transitions between the hospital and care facility or home:

• Education for patients about their diagnosis and treatment while they are in the hospital and upon discharge
• Making appointments for needed follow-up care
• Improved instructions on how to take medications
• Following up with patients within a few days of discharge

Improved communication is also important. Said Dr. Elizabeth Rasch of the National Institutes of Health, “When a person has an emergency department visit, their primary care providers often don’t know or don’t get the results of that visit, and vice versa. The emergency department often doesn’t know about the complex medical history people bring with them. That’s where things tend to break down.”

The AHRQ also recognizes that patients may be unable to remember discharge instructions. Family caregivers play a valuable role. Hospital discharge planners, geriatric care managers or other professionals may also be of help at this time.

Is “Post-Hospital Syndrome” Real?

Care received in a hospital saves the lives of millions of seniors each year, and helps many enjoy a higher level of independence and quality of life. Yet studies over the past few years have confirmed that a hospital stay can have a negative impact on seniors. In a January 2013 study appearing in the New England Journal of Medicine, Yale University’s Dr. Harlan Krumholz showed that many hospital readmissions are for a medical condition that is different from the initial cause of hospitalization—”post-hospital syndrome,” a 30-day period where patients are at risk.

A stay in the hospital can leave seniors vulnerable to medication problems, urinary tract and other infections, sleeplessness, bedsores, and even falls, which can lead to a more serious problem than that for which the senior was admitted. Of special concern is hospitalization delirium—a sudden state of confusion that sometimes occurs after surgery or a serious illness. This temporary event is sometimes mistaken for dementia—and delirium has been found to raise the risk of or hasten the course of cognitive decline in some patients.

Hospitals are making changes to support better outcome for elders. Some have opened geriatric emergency departments to meet the special needs of frail older patients, with such features as specially trained personnel, a quieter setting and thicker mattresses for comfort and bedsore prevention. Experts are calling for more geriatric training in medical and nursing schools, as well as policies that make geriatrics a more attractive specialty for med students.

Consumer Resources

Download the Agency for Healthcare Research and Quality booklet: “Taking Care of Myself: a Guide for When I Leave the Hospital.”

The Joint Commission healthcare accreditation organization offers the “Speak Up” series of patient education brochures and videos.

The Eldercare Locator offers the online booklet “Hospital to Home: Plan for a Smooth Transition.” 

Read more about the post-hospitalization syndrome study in the New England Journal of Medicine.

Copyright © AgeWise, 2013

During the exhibition at the Heritage at Lowman, Lutheran Homes demonstrated numerous technology applications and other programs utilized across its statewide care continuum — five continuing care retirement communities, Lutheran Hospice and BeWell Home Services. An advocate for new and innovative programming, Dr. Thomas Brown, Jr. D.Ph., President and CEO of Lutheran Homes of South Carolina, explains that with the onset of the expanding numbers of aging adults, that it is essential for aging service providers to think creatively about new, and efficient alternatives to enhance care and service delivery. Lutheran Homes showcased technology for applications such as resident and patient care documentation, health record keeping, patient monitoring, personal emergency response systems, medication management, staff education, and other IT applications used in their care of older adults.

In response to Lutheran Homes’ selection as one of the eight study tour site visits, Dr. Brown noted, “We are proud to represent aging services in South Carolina and the US for this important international exchange. We welcome this opportunity to participate in dialogue with our Australian care colleagues as we explore new and emerging technology trends in the care of older adults.”

About Studying & Advancing Global Eldercare – SAGE:
From an embryonic idea over seven years ago, SAGE’s vision is to host a quality program of study tours throughout the world, investigating new and emerging trends in the care of the elderly. The SAGE initiative is sponsored and supported by Aged & Community Services, Australia, (ASCA); Leading Age Services Australia, the International Association of Homes and Services for the Aged (IAHSA), ThomsonAdsett, a design concept company and LeadingAge Center for Aging Services Technologies (CAST) and LeadingAge South Carolina (LASC).

About LeadingAge Center for Aging Services Technologies:
LeadingAge is an association of 6,000 not-for-profit organizations dedicated to advance policies, promote practices, and conduct research that supports, enables, and empowers people to live fully as they age. The LeadingAge Center for Aging Services Technologies (CAST) leads the charge to expedite the development, evaluation, and adoption of emerging technologies that can improve the aging experience. CAST is an international coalition of more than 400 technology companies, aging services organizations, research universities, and government representatives.

Researchers at the Ohio State University Wexner Medical Center have a study underway to determine whether deep brain stimulation (DBS) can improve thinking and function in people with Alzheimer’s. Deep brain stimulation is similar to a cardiac pacemaker device, but is placed in the brain rather than in the heart. “Basically the pacemakers send tiny signals into the brain that regulate the abnormal activity of the brain and normalize it more,” says neurosurgeon Dr. Ali Rezai, who is director of the OSU neuroscience program. At present, DBS is in use to successfully treat 100,000 patients who are living with Parkinson’s disease and other movement disorders.

Dr. Rezai and colleague Dr. Douglas Scharre will be placing the devices in the brains of ten research subjects in an ongoing FDA-approved study. Says Dr. Rezai “Right now, from what we’re seeing in our first patient, I think the results are encouraging, but this is research. We need to do more research and understand what’s going on.” He says, “If the early findings that we’re seeing continue to be robust and progressive, then I think that will be very promising and encouraging for us.”

The study, which will enroll people with mild or early-stage Alzheimer’s disease, will help determine if DBS has the potential to improve cognitive, behavioral and functional deficits. It will conclude in 2015. The Ohio State neurology team are pioneers in the use of DBS in Parkinson’s disease, and are also testing the devices on people with traumatic brain injuries and obesity.

Copyright © AgeWise, 2013 reporting on Ohio State University Wexler Medical Center study

In situations when it becomes clear that an older person is no longer able to live alone entirely unassisted, the person and family members may be unsure of what services are available in the community to help. They may wonder how best to take advantage of those services. A geriatric care manager can help.

Most professional care managers have experience in either nursing or social work. Many have special training in issues involving eldercare. Their job is to assess a client’s individual needs, then match those needs with services available in the community.

A care manager will usually begin a client relationship by doing an assessment of the client’s health status, living situation and needs. In the course of an extensive interview, the older adult’s physical and mental condition, social situation, and daily activities are evaluated. Usually a written report of this assessment is provided, with suggestions as to services available to meet identified needs.

Care managers can locate support services such as meal programs, transportation, help with the activities of daily living, assistance with bill paying, in-home health care and other support for independent living. If the client and family wish, the care manager can then arrange for the needed services, and provide follow-up care and monitoring to see that necessary services are being effectively and professionally delivered, and to make sure that the client’s needs are being met over an extended period of time. If moving to an assisted living or nursing facility is appropriate, a care manager can help in identifying and evaluating the various options available.

When caregiving starts to get complicated, care managers are a wonderful resource to manage and balance several concerns. They can schedule assistance and keep multiple family members informed. They can serve as an “on the scene” surrogate for long-distance caregivers. They can help with family communication and meetings, and help settle disagreements. They can also serve as an advocate in dealing with the health care system, insurance plans and so forth.

How to Choose a Care Management Professional

Private care management services are largely unregulated. The qualifications of groups or individuals offering to act as private geriatric care managers vary widely. So, be careful who you select for this role. This means asking questions before making your selection. Things to ask include:

• What are the person’s qualifications, education and experience? How long has the person been providing geriatric care management services?
• Will the person provide references? Ask for two or three references from past or current clients—or if that’s not possible because of confidentiality, ask for the names of professionals in the community who are referring new clients to this person, such as physicians or elder law attorneys. Then, call the references you’ve been given and gather as much information as you can about the care manager and the services he/she provides.
• Is this person or firm affiliated with a particular organization? If so, what are that organization’s values and commitment to service? Will the care manager be able to be objective in making recommendations?
• What is the range of services provided?
• What are the charges, and what particular services are covered by the charges?
• Are the charges competitive with other services in the community?

How Do I Find a Care Manager?

Private geriatric care managers who are members of the National Association of Professional Geriatric Care Managers are listed at their website, www.caremanager.org.

It is often difficult to juggle caregiving responsibilities in already complicated lives. The emergence of a new group of service providers—geriatric care managers—is a welcome development for busy family members, especially those living far away. Geriatric care managers can evaluate care needs and coordinate services, making sure that your loved one’s care needs are met on a one-time or ongoing basis.

Copyright © AgeWise, 2013

This month’s puzzle, “Let’s Eat Healthy,” is all about good nutrition. Download your copy and give your brain a workout. Bon apetit!

For More Information About Senior Nutrition

The U.S. Department of Agriculture Food and Information Center offers information about the dietary concerns of older adults.

Read “Eating Well As You Get Older” and watch a short video on healthy eating on the NIHSeniorHealth website

Copyright © IlluminAge AgeWise, 2013

What happens to memories in your brain while you sleep? And how does lack of sleep affect your ability to learn and remember? National Institutes of Health (NIH)-funded scientists have been gathering clues about the complex relationship between sleep and memory. Their findings might eventually lead to new approaches to help students learn or help older people hold onto memories as they age.

“We’ve learned that sleep before learning helps prepare your brain for initial formation of memories,” says Dr. Matthew Walker, a sleep scientist at the University of California, Berkeley. “And then, sleep after learning is essential to help save and cement that new information into the architecture of the brain, meaning that you’re less likely to forget it.”

While you snooze, your brain cycles through different phases of sleep, including light sleep, deep sleep, and rapid eye movement (REM) sleep, when dreaming often occurs. The cycles repeat about every 90 minutes.

The non-REM stages of sleep seem to prime the brain for good learning the next day. If you haven’t slept, your ability to learn new things could drop by up to 40%. “You can’t pull an all-nighter and still learn effectively,” Walker says. Lack of sleep affects a part of the brain called the hippocampus, which is key for making new memories.

You accumulate many memories, moment by moment, while you’re awake. Most will be forgotten during the day. “When we first form memories, they’re in a very raw and fragile form,” says sleep expert Dr. Robert Stickgold of Harvard Medical School.

But when you doze off, “sleep seems to be a privileged time when the brain goes back through recent memories and decides both what to keep and what not to keep,” Stickgold explains. “During a night of sleep, some memories are strengthened.” Research has shown that memories of certain procedures, like playing a melody on a piano, can actually improve while you sleep.

Memories seem to become more stable in the brain during the deep stages of sleep. After that, REM—the most active stage of sleep—seems to play a role in linking together related memories, sometimes in unexpected ways. That’s why a full night of sleep may help with problem-solving. REM sleep also helps you process emotional memories, which can reduce the intensity of emotions.

It’s well known that sleep patterns tend to change as we age. Unfortunately, the deep memory-strengthening stages of sleep start to decline in our late 30s. A study by Walker and colleagues found that adults older than 60 had a 70% loss of deep sleep compared to young adults ages 18 to 25. Older adults had a harder time remembering things the next day, and memory impairment was linked to reductions in deep sleep. The researchers are now exploring options for enhancing deep stages of sleep in this older age group.

“While we have limited medical treatments for memory impairment in aging, sleep actually is a potentially treatable target,” Walker says. “By restoring sleep, it might be possible to improve memory in older people.”

Source: National Institutes of Health

Researchers from the University of California, San Francisco and University of Alabama at Birmingham worked with volunteer participants in the Program to Reduce Incontinence by Diet and Exercise (PRIDE). The study subjects were all overweight or obese, and experienced up to 10 episodes of incontinence per week. They went on a six-month program of diet, exercise and behavior modification. At the end of the six month period, participants had lost on average 17 pounds, and had cut their incontinence episodes in half.

Study author Dr. Leslee Subak said that weight loss should be a first-line treatment for incontinence when patients are significantly overweight. Co-author Dr. Frank Franklin said, “Earlier research has shown that behavioral weight loss programs have many benefits, including decreasing blood pressure and helping to fight off diabetes. Here we’ve shown that weight loss has measurable impact on reduced incontinence.”

Copyright © AgeWise, 2013 reporting on University of Alabama Birmingham news release

Yet many people, even seniors who are at high risk for osteoporosis, are unaware of the dangers of the disease and their own risk factors. Osteoporosis is sometimes called “the silent disease.” As it develops, it is often painless, with no obvious symptoms. In many cases, a fracture is the first symptom!

The American Academy of Orthopaedic Surgeons recently conducted a groundbreaking study showing that even though osteoporosis can lead to debilitating fractures, pain, spinal problems, loss of independence, and even death, many at-risk seniors have little knowledge about the disease. Even if they suffer an osteoporosis-related fracture, they may not realize they have the condition. “Many people who sustain a fracture don’t connect it to osteoporosis,” said study author Dr. Angela M. Cheung of the University Health Network/Mount Sinai Hospital Osteoporosis Program in Toronto, Ontario. Cheung points out in contrast, “A person who has a heart attack knows that there’s a problem with his or her heart, but a person who fractures thinks, ‘The floor was slippery’ or ‘I’m clumsy’ and doesn’t look at it as a symptom of a more serious medical condition.”

What you should know about osteoporosis

What causes osteoporosis?

To understand what causes osteoporosis, it’s important to know that our bones are actually a living tissue. All through our lives, bone is constantly being replaced by new bone. In young people, the bones become denser and stronger. But when we are around age 35, bone building no longer keeps up with bone loss. For persons who have a strong bone mass, this gradual loss of minerals from the bones may not cause problems. But when loss of bone density is so great that bones fracture easily, the person is said to have osteoporosis.

As it develops, osteoporosis is often painless, with no obvious symptoms. In most cases, the first sign is a fracture, most often of the hip, spine or wrist. The person with osteoporosis may develop a noticeably curved spine (sometimes called a “dowager’s hump”). Another sign is a decrease of height, which is caused by loss of bone in the spine. It is important that osteoporosis be diagnosed early, so that measures can be taken to slow the bone loss. A bone mineral density test—a painless test similar to having an x-ray—is the best way to measure bone health.

What are the risk factors?

Several risk factors increase the likelihood of osteoporosis:

• aging
• a family history of the condition
• women past menopause (who have a lowered amount of estrogen, a hormone important in building bones)
• inadequate intake of calcium and Vitamin D
• an inactive lifestyle
• small-boned and/or underweight body type
• excess abdominal fat
• use of certain medications
• medical conditions such as liver or kidney disease, diabetes, or thyroid problems
• smoking or alcohol abuse.

Can osteoporosis be prevented?

For the most part, once bone has been lost, it cannot be replaced. So the goal in treating osteoporosis is to maintain existing bone and to stop further loss. Here are some things you can do:

Get enough calcium. Some good sources of calcium are dairy products, dark leafy green vegetables, dried beans, canned sardines and salmon, sesame seeds, tofu, tortillas and soy flour. Some foods that are not rich in calcium may be fortified with calcium and vitamin D; check the label on breakfast cereals, breads and orange juice. Your health care provider may also recommend calcium and Vitamin D supplements.

Maintain a healthy weight. Being underweight raises the risk of osteoporosis. On the other hand, a recent study from Harvard Medical School shows that excess abdominal fat is also detrimental to bone health. Remember that prolonged weight loss diets are dangerous: the dieter may be losing bone right along with the weight.

Get enough exercise—and the right kind. Staying active encourages bone growth and strengthens muscles to protect the bones. Seniors who have osteoporosis should consult their healthcare provider before beginning an exercise program. Certain types of exercises are most beneficial; others may actually be dangerous. A physical therapist can train the patient to use good “body mechanics” during daily activities—even during sleep.

Limit alcohol and quit smoking. Alcohol and tobacco can both contribute to weakened bone in a variety of ways. Drinking too much alcohol also increases the risk of falling and fracturing a bone.

Take medications correctly. Some osteoporosis patients take medication to slow the loss of bone. Other drugs help control pain, or manage healthcare conditions that can make osteoporosis worse. Take these medications exactly as prescribed. Some prescription and over-the-counter drugs can increase fall risk or actually weaken the bones, so have medications reviewed regularly.

Make fall prevention a priority. Reduce the risk by having regular eye examinations, keeping the house free of clutter and other hazardous conditions, and talking to your healthcare provider about a balance training program. If you use a cane, walker or other assistive device, be sure it is properly fitted and you have been trained in its use.

While some of the risk factors for osteoporosis—such as body type, family history, and age—are beyond our control, others are lifestyle choices. People who follow the above suggestions lessen the likelihood of developing osteoporosis. And though in most cases lost bone mass cannot be replaced, the same preventative measures can also slow the loss.

Seniors Helping the Next Generation

The National Osteoporosis Foundation, sponsor of National Osteoporosis Month, recently rolled out the Generations of Strength campaign to encourage parents and grandparents to talk to their children and grandchildren about the importance of building strong bones. Foundation experts say, “Many people do not realize that osteoporosis is often considered a pediatric disease with geriatrics consequences—approximately 85 – 90 percent of adult bone mass is acquired by age 18 in girls and 20 in boys.” The NOF reminds grandparents, “It’s never too early or too late to take steps to improve bone health.” Young people are least likely to think about the importance of nutrition. A conversation with Grandma might be the best way to help grandchildren develop awareness of bone health. Learn more about the campaign at www.nof.org/connect.

Copyright © AgeWise, 2013

Is this a safe practice? Recently, the Food and Drug Administration (FDA) warned that these devices can lead to infection if used improperly. The agency released information about safe practices for using all nasal rinsing devices, including neti pots, bulb syringes, squeeze bottles and battery-operated pulsed water devices.

The FDA’s Dr. Steven Osborne says that while these devices are generally safe and useful, consumers should take care to clean them properly. He cautions that plain tap water is not safe for use as a nasal rinse. Tap water that is not filtered, treated or processed in specific ways may contain low levels of organisms such as bacteria and protozoa—including the type of amoebas that caused two deaths in Louisiana in 2011. These bugs are safe to swallow because stomach acid kills them. But they can stay alive in nasal passages and potentially cause serious infection.

Osborne says that the manufacturers’ instructions that come with these devices may lack proper guidelines for safe water. He recommends that consumers using nasal cleaning devices use:

• Distilled or sterile water, which may be purchased in stores
• Tap water which has been boiled for 3-5 minutes and then cooled; this may be stored in a clean, closed container for use within 24 hours
• Water passed through a filter with an absolute pore size of 1 micron or smaller

Users should also practice proper hygiene by washing their hands before use, and washing the device thoroughly, keeping it clean and dry.

It’s best to talk to your healthcare provider before using nasal rinsing devices. If your symptoms worsen after nasal rinsing, report them to your healthcare provider, especially if you experience fever, nosebleed or headaches.

Copyright © AgeWise, 2013, reporting on information from the U.S. Food and Drug Administration

The news isn’t all good. Facebook has received much negative attention because of the phenomenon of online bullying—and indeed, Yale School of Public Health researchers recently cautioned that older adults are not immune. Negative comments about seniors are common, posted by trolls or just by thoughtless younger people. Chief researcher Becca Levy, Ph.D., suggests that while Facebook forbids hate speech directed at racial and other groups, perhaps ageist comments should be added to that list! Says Levy, “Facebook has the potential to create new connections between the generations. Instead, it may have created new obstacles.”

While the thought of seniors encountering the occasional ageist comment is distressing, larger dangers may loom. You have probably heard of the Grandma Scam, where a senior receives a phone call purporting to be from a young relative who is in jail or in some other trouble, and asks that money be wired to help out. Once the money is sent, the impostor is never heard from again, and the grandparent discovers that their real grandchild is just fine. This old scam is still going strong, with many victims out thousands of dollars every year—and the crooks have now taken their act onto Facebook.

With all the publicity about keeping children safe online, it’s easy to forget that people of any age can fall prey to hackers, identity theft and fraud—and seniors who are just starting out may be less aware about the pitfalls of online social networking. So if your parent or other senior friend is new to online communication, it’s a good idea to have a conversation about security. When it comes to online safety, knowledge is power. Here are 10 key points to share with senior loved ones:

1. Get to know the privacy settings of social networking sites where you participate. You can choose who can and can’t see your information.
2. Don’t post information or photos that you wouldn’t want shared with the world. Even if you intend for only a select group to see a post, someone in your network might pass something along that you would rather keep private.
3. On Facebook, Twitter and other social networking sites, don’t indiscriminately “friend” anyone who asks. Verify the identity of people who want to see your information, or request to join an online community where you discuss personal matters.
4. If you are in doubt that an e-mail or post is really from a person you know, pick up the phone and verify it. Hackers can set up a fake account or even take over the account of someone you know. And it is very easy to create a false “persona” online. Be cautious about giving out personal information or meeting in person with an acquaintance from a chat room or online community.
5. If you receive an email or post from a friend that seems to be selling something or just doesn’t sound right, don’t feel hesitant to ask them about it; your friend’s account may have been hacked without them realizing it.
6. Never respond to a request for money from someone claiming to be a friend or a stranger in need. Scammers can pretend to be someone you know, or may create a false identity to appeal to your sympathy.
7. In email, online community and social networking sites, be cautious clicking on links, even from friends. If you click on a link that asks you to download a “viewer” or other software, don’t!
8. Use a hard-to-hack password for Facebook, Twitter, email and other accounts. Don’t select your birthday, your pet’s name, or anything else that could be easily guessed. Include a combination of numbers, letters and special characters.
9. The creators of viruses and other malware (malicious software) are constantly refining their attacks, so be sure to install anti-virus software and keep it up-to-date.
10. Learn about some of the most common scams you might encounter. See the website at the end of this article for some good resources.

Having the talk about safe social networking

Many older adults hesitate to go online because they feel apprehensive about hackers, scammers and identity theft. How can family talk to senior loved ones about the subject without scaring them away from these new socialization tools? Remember: the goal is to empower older adults, not to scare them offline. Here are some ideas for having a productive conversation:

• Talk about “we” rather than “you.” Anyone can fall prey to online con artists. Open the discussion with, “Here are some things I’ve learned to keep myself safe that I’d like to share with you.”
• Remind your loved one that the same cautions he or she practices in everyday life will also be useful online. Do a bit of role playing: “What would you do if someone asked you for money? What if they told you that you’d won a contest and only needed to send a ‘fee’ to collect?”
• Establish a no-judgment zone. Reassure your loved one that if something seems suspicious or just doesn’t feel right, it’s fine to give you a call for advice, without embarrassment.
• Think intergenerational! Many families report that grandkids and grandparents bond over tech support, and this can include computer security. Grandparents benefit from the knowledge and experience of the younger generation, and grandkids can feel good about helping their senior loved ones.
• Encourage your loved one to share what he or she has learned with other seniors in the community. Many older adults have volunteered with AARP and other groups to spread the word and keep the online world safe for the millions of seniors who are enjoying friendship and healthier aging in this new way.

For more information, visit On Guard Online (www.onguardonline.gov), a consumer information website jointly sponsored by the Federal Trade Commission, Homeland Security, the U.S. Postal Inspection Service, the Internal Revenue Service and a number of other government agencies.

Copyright © AgeWise, 2013