Category: Health in Aging

Culturally Sensitive Care Celebrates Diversity in All its Forms

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Manuel A. Eskildsen, MD, MPH, CMD, AGSF
Associate Chief of Geriatrics for Education
Director, Emory Geriatric Medicine Fellowship Program
Associate Professor of Medicine
Division of General Medicine and Geriatrics
Emory University School of Medicine

 

Taking care of older adults is extraordinarily rewarding to me—I’m always moved by the fascinating life stories and challenges my patients share. In particular, I find it especially fulfilling to help simplify an older adult’s care when he or she is coping with complex problems. That’s an especially satisfying part of my job.

But sometimes, when you’re dealing with older adults who have unique health needs—like members of the lesbian, gay, bisexual or transgender (LGBT) community—you run into different kinds of issues that aren’t just about simplifying medical solutions. For example, I especially remember the death of an older gay man whose story stuck with me because he died alone. Sadly, his death spoke to a truth that exists for many older LGBT people: they are more likely to be socially isolated than their heterosexual peers. Many don’t have children, and significant numbers of LGBT adults may also be estranged from their biological families. There are many factors that have contributed to this reality, but principal among them is the fact that many older LGBT people grew up at a time when their sexuality was a stigma they didn’t feel comfortable sharing. In those days, there was very little—if any—social support for someone who identified as LGBT.

One of the great fears I’m sure many of us share is that we’ll die alone—unfortunately, like that patient I remember so clearly, this is a particularly heightened concern for older LGBT adults. That’s what makes our job as geriatricians and geriatrics healthcare professionals all the more important—especially as we commemorate culturally sensitive care during national awareness events like Minority Health Month. We as elder care providers—and informed patients—can start helping to change how older LGBT adults are treated, especially at the end of their lives, by being sensitive to their needs and respectful of their health, care, and personhood. This is why I’m so gratified by the recent AGS position statement covering the care of older LGBT adults. It will help health professionals and older adults alike pioneer fairer and more equitable treatment for LGBT people who can be subject to discrimination in health care and society. Continue reading →

Supporting who we are, what we need, and how we age as individuals — Ethnogeriatrics & Minority Health Month

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Sharon A. Brangman, MDVJ_Periyakoil
Professor of Medicine
Division Chief, Geriatrics
SUNY Upstate Medical University


VJ Periyakoil, MD
Director,
Stanford Successful Aging Program
Clinical Associate Professor
Stanford University School of Medicine

 

While each person is unique and wonderful, no two bodies are the same—and no two people will age in identical ways. That’s one of the joys, and also one of the challenges, in caring for older adults.

Geriatrics, the healthcare field specialized in caring for older people, has given us great knowledge about the health issues commonly seen in older adults and guides how to provide high-quality care to aging Americans. Even so, we also know that there will be twists, turns, and uncharted destinations along every person’s journey toward healthy aging. However, if older adults work in partnership with their healthcare team and family, life with quality is an attainable goal for all. In fact, that’s one of the critical life lessons we can take away from National Minority Health Month this April.

What is National Minority Month?
National Minority Health Month helps raise awareness for disparities in health and care among specific groups of people known as minorities. Minority groups like American Indians, Alaska Natives, Asian Americans, African Americans, Hispanics/Latinos, Native Hawaiians, and Pacific Islanders account for more than 35% of the U.S. population. Health and care aren’t completely different from one of these groups to the next, but minority health experiences do help highlight how certain conditions, concerns, and challenges may impact some of us differently than others. That’s an important distinction—so important, in fact, that an entire field of geriatrics known as “ethnogeriatrics” has developed around ways to provide culturally competent care to older adults from diverse ethnic and racial backgrounds.

Ethnogeriatrics is about finding important intersections between ethnicity, aging, and health to provide high-quality care. A perfect example of this type of work is a new tool that the American Geriatrics Society (AGS) developed with AARP to help a specific group of older adults who are Chinese Americans better understand and drive their own well-being.

“Chinese American Older Adults: A Guide to Managing Your Health”
This free resource highlights the most common health concerns in the Chinese American older adult community and ways that patients and caregivers can talk to healthcare providers about addressing them.

Health concerns like hepatitis B, certain types of cancer, depression, tuberculosis, cardiovascular disease, diabetes, and some genetic diseases are common among Chinese Americans. Many of these conditions require not only expert care but also sensitivity to cultural norms that can help or hinder care depending on how they are addressed. Continue reading →

How much sleep do older adults need?

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Belinda Setters, MD, MS, AGSF, FACP
Director, Mobile ACE & Transitional Care Programs
Associate Clinical Professor
Geriatric Medicine & Palliative Care
Robley Rex VA Medical Center

When most of us talk about sleep needs, we usually think about children. We know children need a certain amount of sleep to stay active and healthy and to grow into adulthood. Children have a bedtime and parents (and grandparents!) work hard to ensure they are in bed on time and get the sleep they need every night. But most of us don’t think about how much sleep we get or need as we grow older. And yet, sleep is just as critical to our health as we age.

As we age, our brains may tell us to go to sleep earlier. This is likely why so many folks fall asleep right after the evening news or dinner. Despite this, most older adults don’t always get a full 8 hours of sleep or awaken feeling refreshed. This may be because our brains don’t cycle through deep sleep as well or as much as they did when we were younger. Restless legs, arthritis, and breathing disorders can also keep us awake. And then there is the bladder. Older adults with prostate or bladder disorders often get up at night to use the bathroom. This disrupts sleep as well. Our bodies adapt as we age to adjust to these changes and as a result our sleep patterns adapt as well.

But do we really need 8 hours of sleep as we get older? Does napping make up for this lack of sleep at night? Is it possible to sleep too much?

The National Sleep Foundation says yes—to all of those questions. In an expert panel convened by the Foundation, sleep experts and other specialists reviewed extensive research on sleep needs by age groups, including older adults. Their February 2015 report reflects the most up-to-date recommendations on sleep needs. The panel found that while sleep patterns change with aging, adults 65-years-old and older still need between 7-8 hours of sleep nightly, and ideally over a continuous period of time.

The panel further determined that—while this range is ideal for older adults—some people may need slightly less or more sleep to meet their individual needs. Some people may have a sleep pattern that results in feeling fully refreshed with only 6 hours of sleep, for example.  Meanwhile other people may need an extra hour or so, for a total of 9 hours nightly. To account for these variations, the panel noted a range just outside the recommended hours most folks need. This can be seen in the diagram released with the report below. Continue reading →

Slashing Budgets Could Cut More Than Just Costs

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Ask any mayor, business person, or volunteer coordinator what they’d find most valuable to help their organization grow and their answers would probably focus on a single word: resources. The “three Ts”—time, talent, and treasure—go a long way toward allowing individuals, groups, and even whole communities to operate to their fullest potential. And they’re increasingly important in cases where “demand” must keep up with “supply.”

That’s certainly true for healthcare professionals who are working to keep innovation apace of growth for the older adult population in the U.S. By 2030, the number of people 65-years-old or older in America will exceed 70 million—double the number of older adults in 2000. These men and women will need specially trained professionals who understand how to address the complex healthcare needs of older adults.

Unfortunately, federal budget cuts have impacted not only the number of opportunities for current and future health professionals, but also the research needed to increase and improve our knowledge of aging.

Results of an American Geriatrics Society survey1 reveal how these budget cuts have created serious problems for geriatrics health professionals and the older adults they care for:

  • Job Loss. Nearly 60% of professionals who responded to the survey reported that, in the last five years, federal budget cuts or breaks in grant programs resulted in faculty or research staff lay-offs or the elimination of certain research programs. Specially trained researchers, statisticians, administrative staff, and research nurses were among those most affected. Sadly, these men and women are essential to pushing science and research forward.
  • Investigator Anxiety. The AGS survey indicated that 87% of respondents were also “very” or at least “moderately” worried that funding issues would prevent them from maintaining labs or research programs in the next 10 years. These concerns could discourage experienced and promising young researchers from pursuing careers in geriatrics.
  • Decreased Full-Time Positions. The vast majority of survey participants reported that the number of full-time positions they could offer for people committed to aging research decreased or stayed the same compared to 2008 levels. Little or no job growth can put important advancements at risk and result in fewer young scholars dedicating themselves to working with older adults.

Investments in Aging Research Yield Success
Despite these concerns, federally funded research continues to improve the health of older Americans by creating new models for healthcare, diagnostic methods, and treatment options. Respondents to the AGS survey cited many examples of advances arising from federally funded research, including: Continue reading →

Supporting a Healthcare Culture Free From Inequality

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Joseph Shega, MD              
Director of Hospice and Pallative Medicine Research
Section of Geriatrics and Palliative Medicine
Department of Medicine
University of Chicago
Chicago, Illinois

I’m pleased to let our readers know about an important new position statement from the American Geriatrics Society focusing on equitable treatment for lesbian, gay, bisexual, and transgender (LGBT) individuals subject to unfair discrimination in health care and society. The statement takes a look at current issues of prejudice due to age, sexual orientation, gender and other personal characteristics that can lead to stigma and discrimination—even in health care. It makes recommendations for better and equal care in the following ways:

  • Advocating policies for equal treatment
  • Training for healthcare professionals on LGBT needs
  • Raising awareness of the unique circumstances facing LGBT older adults
  • Enhancing research supporting the above

Check out this infographic and visit AmericanGeriatrics.org for the press release and the full position statement on how institutions, healthcare professionals, policy makers, and members of the public can help support a healthcare culture free from inequality.

About the Author
Dr. Joseph Shega is a geriatrician and the Chair of the American Geriatrics Society’s Ethics Committee—the group that lead the effort for the development of the “Care of Lesbian, Gay, Bisexual, and Transgender Older Adults” statement.