Thursday, March 4, 2010

March 2010 Eldercare Notes

A round-up of the some eldercare-related articles and blog posts from the last few weeks:
  • The GeriPal blog posts about a study in the Journal of the American Geriatrics Society by researchers at the University of Cambridge that examines functional status during the last year of life in the very old.
    The study illustrates a point we have recently stressed on GeriPal: The vast majority of older persons will have some degree of significant disability in the last years of life. This is in contrast to the popular perception that disabiity can be prevented if one does all the right things. Encouraging good health habits is a very good thing. However, suggesting that if you become disabled, it must be because you did something wrong is a very bad thing.


  • The New York Times' Economix blog writes about the staggering expenses of old age:
    A new study, from the Center for Retirement Research at Boston College, estimates that at age 65, the typical married couple should expect to spend $197,000 on uninsured health care costs over the rest of their lives. This total includes insurance premiums, out-of-pocket costs and home health care costs, but it does not include nursing home care. Including the cost of nursing home care, typical lifetime health care costs shoot up to $260,000.

    Not everyone spends “just” $197,000 though. According to this new study, about 5 percent of these households will spend more than $311,000 on their uninsured health care costs, not including nursing home care. Including nursing home care, there is a 5 percent risk that cumulative health care costs increase to $570,000.

  • The Eldercare Support Group blog writes that sometimes a family member may need to use 'sneaky' ways to get a senior to accept a respite carer, in order to give the primary caregiver some needed assistance. The author writes about her attempts to have her father accept someone else being in the house:
    The first few times I left my father while I did errands, I left him with a “senior companion” – this is a person, usually a senior citizen who volunteers their time to sit with an elderly person and talk, play cards, watch a movie, etc. Unfortunately, this companion didn’t work for my Dad. He felt insulted that he had to be cared for and irritated that he had “to entertain” the companion.

    In another trial, I invited a lady to come over under the auspices that she wanted to learn to play Cribbage. My father loved to play cribbage and could do so until the last couple of weeks of his life. This worked well at first but he soon figured out that when she came over, I left the house and he began to resent her visits and started calling her “the babysitter”.

    So I decided to hire a “housekeeper”. Fortunately I had had one in the past when I was busy with my kids in school so it was not completely out of the ordinary. This “housekeeper” swept the floor, put the dishes in the dishwasher, made my Dad a sandwich if he wished and generally just watched to make sure he stayed home and helped him up if he fell. This way, my Dad could lie down and watch his TV or sit out on the patio and not feel compelled to “entertain” the caregiver.

  • In this New York Times' Cases column, a geriatric psychiatrist talks about imposing one's view of old age on seniors.
    She sat silently in a wheelchair, her 93-year-old silhouette stooped in the bathing light. . . . I asked her why she had come to the nursing home, and she described the recent passing of her husband after 73 years of marriage. I was overwhelmed by the thought of her loss, and wanted to offer some words of comfort. I leaned in close and spoke.

    “I’m so sorry,” I told her. “What has it been like for you losing your husband after so many years of marriage?”

    She paused for a moment and then replied: “Heaven.”

    Seeing my bewilderment, she smiled and went on to describe how she had endured decades in an unhappy marriage with a gruff, verbally abusive man.

    As she spoke, I realized why my instincts were so completely off. In my misguided empathy I had committed what William James called the psychologist’s fallacy, assuming incorrectly that one knows what someone else is experiencing. With this newly widowed patient I imagined that only a life of sadness and decrepitude remained, and I felt bad about it.

  • Susan Brink wrote a three-part series for Kaiser Health News that appears on MSNBC. The first part looks at the difficult medical decisions a family faced when their 87-year-old mother had a stroke.
    Her sons said that before her stroke, they had believed that they understood her wishes. Yet when they examined the decision-making grids and flow charts of her written instructions, they were confused about the details of the many complex options. She had decided that she didn’t want to be intubated or put on life support. Did that preclude temporary nasogastric tubes for nutrition? A respirator was against her wishes, but what about a short-term oxygen mask?
    The series also includes pieces on living wills, and hospice and palliative care.

  • ABC's Good Morning America did a series of segments in January on adult children discussing tough topics, such as living conditions and driving ability, with their aging parents.

  • Jane E. Brody writes about the importance of regular exercise to benefit the mind and body of people at any age. She cites studies that show the impact of regular exercise on diseases such as cancer, osteoporosis, cardiovascular disease, diabetes and dementia.

  • Paula Span shares some products shown at the Consumer Electronics Show that are targeted to seniors.