Category Archives: Seniors (65+)
I live in rural Minnesota, and my passion is to make a significant contribution to improving dementia care in our society and to be an advocate for all seniors with dementia in their quest to maintain their basic human right to dignity, choice, and quality of life until their death.
My mother, Evelyn Holly, passed away 16 years ago. She spent the last seven years of her life being bounced from one nursing home or residential dementia facility to another, and in and out of hospital geri-psych units, all because of her so-called “challenging and aggressive behavior.” She spent the last year of her life strapped in a chair and drugged so she would be “compliant.” I imagine many of you have had similar experiences. Click on this link to view a video about my personal struggle with dementia care—a struggle that has fueled my passion to improve it.
After many years of heartache and frustration in my struggle to find appropriate care for my mother, and after being told repeatedly by others in the health care industry that the kind of dignified care that I visualized was impossible because it was too expensive, I discovered that I could not find any financial support for trying something different. I decided to use my own life savings to try to develop a model of specialized dementia care that would focus on the unmet emotional and spiritual needs of persons with dementia, many of whom are unable to communicate those needs, and to meet their physical needs as well.
Barbara Bricoli, MPA, is executive director of Nurses Improving Care for Healthsystem Elders (NICHE), an international program based at New York University’s College of Nursing that is designed to help improve the care of older adults. The program was developed by Terry Fulmer, PhD, RN, FAAN, chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
The rapid expansion of the aging population is a national concern. Nearly 20 percent of the U.S. population will be over age 65 by 2030, according to the U.S. Administration on Aging. And our aging population will place a heavy burden on our health care system; older adults, in fact, are hospitalized at three times the rate of the general population.
Yet health care providers lack adequate training in geriatrics and gerontology to care for older patients. Nurses Improving Care for Healthsystem Elders (NICHE) is working to change that.
Based at New York University’s College of Nursing, NICHE aims to better enable hospitals and health care facilities to meet the unique needs of older adults and embed evidence-based geriatric knowledge into health care practice. Hospitals and organizations that adopt NICHE report improved outcomes, decreased lengths of stay, better patient and staff satisfaction levels, and higher success in building systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice.
Management of low-risk prostate cancer varies widely among urologists and radiation oncologists, with characteristics of the physicians who provide treatment playing a significant role in decisions about care, according to a study published online by JAMA Internal Medicine.
Researchers found that urologists who did not graduate from medical school recently, and who care for patients with higher-risk prostate cancer, are more likely to pursue up-front treatment for patients with low-risk prostate cancer than other urologists, who choose to observe and monitor the disease. In many cases, low-risk prostate cancer does not cause symptoms or affect survival if left untreated.
The prevailing approach in the United States, the study says, for men with low-risk prostate cancer is treatment with prostatectomy or radiotherapy, which can cause complications such as urinary dysfunction, rectal bleeding, and impotence.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the July issue.
Nurses Lead Innovations in Geriatrics and Gerontology
As the nation becomes older and more diverse, and more people are living with chronic health problems, nurses are developing innovations in geriatric care. They are finding new ways to improve the quality of care for older adults; increase access to highly skilled health care providers with training in geriatrics; narrow disparities that disproportionately affect older minorities; avoid preventable hospital readmissions; and more. Nurse-led innovations are underway across the nation to improve care for older Americans.
Improving Care for the Growing Number of Americans with Dementia
By 2050, 16 million Americans—more than triple the current number—will have Alzheimer’s disease. RWJF Nurse Faculty Scholars are working now to get ahead of the problem. “We’re all well aware of our aging population and how we’re going to see more individuals with Alzheimer’s disease or some other form of dementia,” says alumna Elizabeth Galik, PhD, CRNP, who is researching ways to improve functional and physical activity among older adults with dementia.
Amal Trivedi, MD, MPH, is an alumnus of the Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Physician Faculty Scholars program. He is an assistant professor of health services, policy and practice at Brown University and a hospitalist at the Providence VA Medical Center. His co-author, Danya Qato, PharmD, MPH, is a pharmacist and doctoral candidate in health services research at Brown University. They recently published a study that finds older patients are routinely prescribed potentially harmful drugs, particularly in the South.
Human Capital Blog: Why did you decide to look at this particular topic? And why are some drugs considered high-risk for elderly patients?
Danya Qato and Amal Trivedi: Adverse drug events are an important public health problem. For the elderly, such events are often precipitated by use of potentially inappropriate or high-risk medications. Over the past several decades, clinicians and researchers have sought to identify medications that should be used with caution in the elderly. These high-risk medications should be avoided among people 65 years of age or older because the associated adverse effects outweigh potential benefits or because safer alternatives are available. Elderly patients are susceptible to these medications because they have more chronic illness, greater frailty, and an altered ability to metabolize drugs. The Centers for Medicare and Medicaid Services now require all Medicare Advantage plans to report on the use of high-risk medications among their enrollees.
We undertook this study because successful efforts to reduce high-risk medication use in the elderly require knowledge of how prescribing of these agents varies geographically and the factors that predict their use. Half of persons aged 65 and older use three or more prescription medications a day. Therefore, potentially inappropriate use of medications in the elderly has important implications for health care spending and quality.
Tootsie’s Story, Continued: A Family Wonders Whether Nurse-Led Care Coordination Might Have Prolonged a Life
Jennifer Bellot, PhD, RN, MHSA, is an assistant professor at Thomas Jefferson University and a Robert Wood Johnson Foundation Nurse Faculty Scholar. Yesterday, she blogged about the death of her beloved grandmother, Tootsie, due to complications from medical error that began with an overdose of Synthroid. This is Part Two of Bellot’s blog post.
In 2010, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) joined resources and released The Future of Nursing: Leading Change, Advancing Health. This landmark report included many recommendations, and a full-scale Campaign for Action is in place that will transform nursing for years to come. Among the many themes advocated in this report is the tenet that nurses should be the very core of reinventing the American health care system. The report encourages the health care system to lean, and lean heavily, upon the skill set and resources of nurses to facilitate access to higher quality care at a lower cost.
At present, we have a health care system that is technology and intervention heavy when we know our population demographics are rapidly changing and technological intervention is not always the right answer. We have a growing need for a system that instead focuses on addressing chronic disease management, prevention and wellness care. Nurses are well positioned to support a system with these foci, managing care of the older adult in the community before inpatient care becomes necessary. Specifically in the outpatient setting, nurse coordinated care that is, by definition, proactive, holistic and comprehensive will help shift the focus of care from acute and episodic to chronic and preventive.
Comilla Sasson, MD, MS, FACEP is an attending physician at the University of Colorado Hospital and Assistant Professor in the Department of Emergency Medicine at the University of Colorado. Sasson was a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan from 2007 to 2010. Her latest study is published in the October 25th, 2012 issue of the New England Journal of Medicine.
Dead. How do you make someone “undead?” How, with just your two hands, can you prolong the time that paramedics have to restart a person’s heart? How can a normal, ordinary person make a difference and literally save a life?
We know that a person’s chances of surviving an out-of-hospital sudden heart arrest decreases by 10 percent for every one minute he/she does not get CPR (cardiopulmonary resuscitation). I had learned about hands-only CPR in my medical training. Hands-only CPR is where all you have to do is push hard and fast (to the tune of “Staying Alive”) at a 100 times a minute until helps arrives.
But time and time again, I cared for African-American patients in Atlanta who had laid in their families’ homes for critical minutes as their brains slowly died from a lack of blood supply from the heart. Their hearts had stopped and no one called 911. No one placed their hands on the chest and started doing hands-only CPR.
Maybe this is just Atlanta? Is it the color of a person’s skin or is the place where he or she collapses that makes the difference?
In my Robert Wood Johnson Foundation Clinical Scholars Program (RWJCSP) at the University of Michigan (2007-2010), I learned about the importance of neighborhoods in determining a person’s health. After wading through the literature, my a priori hypothesis was that having someone stop to provide CPR is completely dependent upon others; therefore, the neighborhood plays a large role in whether or not someone does CPR.
After consulting with my two RWJCSP alumni mentors, David Magid, MD, MPH, and Arthur Kellermann, MD, MPH, FACEP, the question became clear: What role does the racial and socioeconomic composition of a neighborhood have on an individual’s likelihood of receiving life-saving bystander CPR?
Cleopatra M. Abdou, PhD, is an assistant professor of gerontology at the University of Southern California, and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program. This post is part of a series on the RWJF Health & Society Scholars program, running in conjunction with the program’s tenth anniversary. The RWJF Health & Society Scholars program is designed to build the nation’s capacity for research, leadership and policy change to address the multiple determinants of population health.
Gerontology, the study of aging, is a diverse field that integrates the biological, social-behavioral, and health sciences, as well as public policy. This means that gerontological research addresses a vast range of questions. One type of question asked by gerontologists, including myself, has to do with intergenerational processes. My own research investigates the intergenerational transmission of culture, social identities, conceptions of stress and success, and, ultimately, health. For example, how do our notions of, and relationships to, family affect our health at critical points in the lifespan? More specifically, how do familial roles and responsibilities, such as marrying, reproducing, and caring for grandchildren, correlate with life satisfaction and longevity?
My four siblings and I are the first American-born generation in our family. Our parents came to the United States from Egypt in 1969, and I am strongly identified as both an American and an Egyptian. Anyone who has complex or competing identities knows that it’s a mixed bag—a blessing and a curse. Recently, as I boarded a plane in Cairo to return to the United States, I found myself sobbing with what I think was a kind of homesickness. As happy as I was to return to my immediate family and orderly life in The States, I mourned leaving the land of my parents and all of our parents before them, especially during this important time in Egypt’s history.
Cautiously Optimistic about the Affordable Care Act - If Older Americans and Their Advocates Speak Out as It Is Implemented
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Margaret P. Moss, PhD, JD, RN, FAAN, is associate professor, Yale School of Nursing and an alumna of the RWJF Health Policy Fellows program (2008 – 2009).
As I reflect upon the monumental decision by the Supreme Court to uphold the Affordable Care Act, I can’t help but be awed by how the branches of government are alive and well and operating just as they were designed to work. But as I filter what this decision will mean for the groups I am most closely tied with professionally and personally, I am struck at how the ‘system’—public and private—has largely let them down.
My professional focus has been in aging, and in particular American Indian aging. My profession is nursing, with a background in law. I am optimistic that these groups, both patient and provider, will be lifted and solidified by the spirit of this law. But I am cautious that the letter of the law must be handled with an eye toward impact, unintended consequences, short-term pilot and demonstration projects, and authorized but unfunded rules.
There can be no question that there are provisions in the Act that no-one would dispute are positive. The most cited are: 1) no more pre-existing condition exclusions, 2) the ability to keep adult children under parents’ plans until after college age, and 3) widening the net for coverage to include those now uninsured. The opposing point being moot now with the Supreme Court’s decision, we must look forward and responsibly carry out the law before us. Unfortunately, the devil, as they say, is in the details.
Hospital units designed specifically for the care of older patients could save as much as $6 billion a year, a study from the University of California at San Francisco (UCSF) finds. In a randomized controlled trial, patients in “acute care for elders units” had shorter hospital stays and incurred lower hospital costs than patients in traditional inpatient hospital settings. At the same time, patients’ functional abilities were maintained, and hospital readmission rates did not increase.
The Acute Care for Elders program (ACE) relies on a specially trained interdisciplinary team, which can include geriatricians, advanced practice nurses, social workers, pharmacists, and physical therapists. The team assesses patients daily, and nurses are given an increased level of independence and accountability.
“Part of what ACE does is improve communication and decrease work. And that’s a strategy that’s generally popular with lots of folks involved,” Seth Landefeld, MD, senior author and chief of the UCSF Division of Geriatrics, said. “What we found was that ACE decreased miscommunication and it decreased the number of pages nurses had to make to doctors. Having people work together actually saved people time and reduced work down the line.”
The study was published in the June 2012 issue of Health Affairs.