Older adults are a vulnerable population when there is a natural disaster and often will need help long after the crisis has passed. We like this map for locating senior services in areas where older adults and caregivers have been affected by Superstorm Sandy. The map flags services in affected areas, and notes which locations need volunteers and donations. Our kudos to AGS member Wen Dombrowski, MD, for working on this.
When you hear the words “family caregiver” what image comes to mind? Odds are, you envision a woman. We tend to assume that family caregivers are wives, daughters, sisters, nieces, and granddaughters. But here’s a surprise: According to a recent Pew Research Center report, 45 percent of relatives caring for older adults in the U.S. are men.
What accounts for the growing percentage of men caring for older family members? According to a recent Wall Street Journal article, decades-long declines in family size, and increasingly far-flung families, are likely contributors. If your aging mom needs help, and you’re the only nearby, you step up to bat. Period.
So this month—National Family Caregiver Month—and beyond, we at the American Geriatrics Society Foundation for Health in Aging (HIA) hope you’ll show your support for the women and men you know who are caring for their aging relatives. While growing numbers of husbands, sons, brothers, nephews, and grandsons are now playing this role, they may be less likely than women to reach out for help with caregiving when they need it, according to a recent Wall Street Journal article. This means we need to do more to reach out to them.
Organizations and services for family caregivers are already doing this. The Journal story, for example, spotlights a Colorado home care service that created a virtual community just for men—www.malecaregivercommunity.com—thinking it would be more appealing to male caregivers . It has been. “Since it started in June, more than 84 discussions have developed,” the paper reports.
In addition to support, family caregivers also need top-notch information. And that’s where Healthinaging.org comes in. Among other things, it offers comprehensive information about caring for even the most medically complex older adults—those with multiple, chronic health problems. Just as important, it offers information about caring for yourself if you’re a caregiver. We hope you’ll mention the site to the family caregivers you know— men and women alike.
It’s not easy to contemplate the end of your life and consider what kind of care you do, and don’t, want when that time comes. And it’s equally difficult to talk with a loved one about the kind of end-of-care care he or she would prefer. My guess is that discussions like these are particularly difficult for us in the US, where we tend to shy away from discussions about death in general. “We Americans don’t like limits, we don’t like boundaries, (and) death is the ultimate boundary,” the journalist Bill Moyers recently pointed out. “So why talk about something we don’t want to happen?”
The answer to that question is this: As uncomfortable as discussions about what we and our loved ones want at the end of life may be, these are among the most important conversations we will ever have. Deciding in advance what care we do and don’t want, while we are able to weigh the benefits and drawbacks of our options and share and discuss our choices with those we love and our healthcare providers, can make the difference between a good death and one that is less so.
Encouraging these essential conversations—with both your loved ones and your healthcare providers—is the focus of The Conversation Project, an important new initiative of the Institute for Healthcare Improvement. I hope you’ll visit the initiative’s website, and encourage others to do the same.
The Conversation Project was the inspiration of Pulitzer Prize winning journalist Ellen Goodman, who conceived of it after her mother’s death. “My mother and I talked about everything,” she explained in a recent interview. “But when she was no longer able to make her own decisions, I realized we hadn’t talked about her wishes for the end of life. I understood only after her death how much easier it would have been if I had heard her voice in my ear as these decisions had to be made.”
Among other things, The Conversation Project website includes an extremely thoughtful and thought provoking feature, “Your Conversation Starter Kit.” It begins with some truly attention-getting statistics about what people tell pollsters they want at the end of life and, in contrast, what many of us actually get. It also includes thought-provoking questions that can help you clarify what you want, what roles you’d like your loved ones to play at the end of your life, and what your healthcare providers need to know. It also helps you figure out with whom, when, and where you want to have The Conversation, and tips for introducing the subject in a non-threatening way. Just as important, the site urges readers to take time to make these decisions, formulating them over the course of many, not one, conversation. I encourage you take a look at the starter kit and let it help you find where you want to go.
More than half of all older Americans have “multimorbidity,” a medical term that means having multiple chronic health problems like heart disease, arthritis, and diabetes. It can be challenging for healthcare professionals, older adults and their friends and family to manage multiple health problems. There are many more factors to think about. For example, treating one health problem may make another health problem worse. And having multiple health problems often requires taking more than one medication, which can result in unwanted drug interactions and side effects.
To help healthcare providers and patients better manage multiple health problems, the American Geriatrics Society (AGS) recently asked leading experts in the field to develop “guiding principles” for the care of older adults with multiple medical conditions.
The principles don’t specify what kind of care clinicians should provide a given patient. Instead, they outline steps to care that is tailored to each patient’s unique needs. You can read more about these principles and living with multiple health problems here.
Here is a very short summary of ways patients and their caregivers can work with healthcare providers to enhance care when dealing with multiple health problems:
Get informed – Learn as much as you can about your healthcare problems and treatment options. Ask your healthcare providers for information and advice, and get family and friends to help you with research.
Make sure your healthcare professionals understand what’s most important to you – For many older adults, for example, remaining as independent as possible is a top priority. Find out how different treatment options will affect your priorities.
Ask bout “trade-offs” – Ask your healthcare provider how the benefits of different care options compare with their risks.
Call if there are problems – Because there isn’t a lot of research examining how older adults with multimorbidity respond to different treatments, clinicians may not be able to predict exactly how a treatment will affect you. So let your healthcare provider know if you’re having unwanted side effects or aren’t getting the desired results from a certain treatment.
Ask for something simpler if you need to – The more complicated treatments are, the more likely patients are to stop following them. Ask for a simpler treatment plan if necessary.
Make sure your care plan does three things – Your healthcare providers should:
With autumn just around the corner, now’s the ideal time to get your flu shot. Influenza season can start as early as October, and it takes your body about two weeks to respond to the vaccine by creating the flu-fighting antibodies you need to fight off the virus. That’s why healthcare professionals recommend getting the shot as soon as it becomes available in your community— usually early September. I’m planning to get my shot when I see my healthcare provider this month.
If you’re 65 or older, it’s particularly important to get vaccinated. Older adults run an increased risk of potentially serious complications of the flu, such as pneumonia. Some people, however, should talk with their healthcare provider before getting a flu shot, especially if you’ve experienced any of the following:
And if you have a fever, hold off until it’s gone before getting your shot .
Though some vaccines protect you for years, the flu shot is only effective for one year. Why? The flu virus is constantly changing, so the vaccine that worked against last year’s virus won’t take care of this year’s. Don’t skip a year!
Good news: Medicare covers annual flu shots, and there’s no copay. You can get the flu vaccine from your healthcare professional, or at senior centers, urgent care clinics, and health departments. Many retail pharmacies also offer the flu shot for a small fee. As of late August, the vaccine was available in many communities throughout the U.S. To find where you can get a shot near you, visit the frequently updated Flu Vaccine Locator on the Center for Disease Control and Prevention’s website.
And for more information about the flu and other essential immunizations for older people, take a look at these tipsheets: “Flu Prevention and Treatment Tips” and “Essential Vaccination Information for Older Adults.”