Take 3 Actions to Fight Flu

Bridges_C_CC_91cc

Carolyn B. Bridges, MD, FACP
CAPT., U.S. Public Health Service
Associate Director of Adult and Influenza Immunizations
Immunization Services Division, NCIRD
Centers for Disease Control and Prevention

Flu and You

Flu activity is still elevated in the U.S., and is expected to continue for several weeks. Most people who get the flu will have mild illness and recover in less than two weeks. However, some people are at high risk for complications that can result in hospitalization and sometimes death. These high-risk groups include adults 65 years of age and older, and adults with certain medical conditions.

During most flu seasons, people 65 years and older make up the group in the population most likely to become ill with severe flu. It is estimated that between 54% and 70% of seasonal flu-related hospitalizations occur among people in this age group.

Furthermore, diabetes and chronic heart disease are among the most common long-term medical conditions that place people at higher risk for serious flu complications. Diabetes and heart disease are among the leading causes of death in people 65 years and older. However, only 63.4% of people in this age group reported getting a flu vaccine during the 2015-16 flu season.

Even if these medical conditions are well managed, the flu can make long-term health problems worse.

Take 3 Actions to Fight Flu

The good news is you can stay in control of your health.

Take 1: The best way to prevent the flu is with a flu shot. As long as flu viruses are circulating, vaccination should continue throughout the flu season. Several flu vaccine options are available for people 65 years and older, including high-dose and adjuvanted vaccines to create a stronger immune response to vaccination. Talk to your doctor or other healthcare provider about the best option for you.

Take 2: Good health habits also help stop the spread of flu.  These include things like avoiding close contact with people who are sick and washing your hands often. Also, make sure to clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

Take 3: Seek medical advice quickly if you develop flu symptoms and you are in a high risk group.  This will allow you to see if you might need medical evaluation or treatment with antiviral drugs. CDC recommends that people at high risk of serious flu complications be treated early with influenza antiviral drugs. Continue reading

Older Adults and Medication: A Geriatrician’s Experience

ST picStephanie Trifoglio, MD, FACP
AGS Member
Private Practice Internist & Geriatrician 

As a geriatrician, I see all of my patients myself, carefully take their history, and review all of their medications, both prescribed and over the counter (OTC).  One patient’s story highlights why this is still very important and worth the time and effort.

A new patient, Mrs. B, came to me for help in managing her dementia. Her husband was remodeling their home to make it accessible as she was now barely able to walk.  She was becoming more confused.  She had previously seen an internist and two neurologists.  Her husband gave a history of Parkinson’s disease, along with a several-year history of colitis and longstanding diarrhea.

The initial history revealed that Mrs. B. had progressive weakness, unsteady gait, and confusion.  She had muscle jerks at night.  She had three recent car crashes and subsequently stopped driving.  She had even lost her ability to do sudoku. This was significant as she had been a doctorate-level biologist.  A review of her medications showed that she had four years of taking Pepto-Bismol, two tablets, four times per day, prescribed for collagenous colitis.  She took this dose consistently.

The active ingredient in Pepto-Bismol is bismuth, and I have never before had a patient take this much bismuth.  Being naturally curious, and always looking for potentially reversible causes of dementia, I did a bit of research and ran basic blood tests on Mrs. B.  I also instructed her to stop taking the bismuth. Continue reading

Recovering after Surgery: Perspectives from a Patient and Healthcare Professional (Part Two)

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Professor
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

Introduction

This is the latest in a series of blog posts by Barbara Resnick, PhD, CRNP, written from her perspective as both a healthcare professional and as a patient during the course of intensive treatment for esophageal cancer.  This two-part article was written about two months following her surgery. Part One discusses the importance of preparing for going home throughout the course of a hospital stay following surgery.  Part Two addresses managing ongoing recovery at home.  These blog posts will be helpful to older adults undergoing surgery and their families, as well as to hospital administrators and healthcare providers.

Part Two: Healing, Getting Stronger, Eating and Sleeping Better – Trial and Error and a Pinch of Patience

Because everyone’s recovery from surgery is different, your healthcare team can only give you basic information and guidance based on what they see and hear from other patients. Knowing what to expect in terms of wound healing, fatigue following surgery, physical activity, and eating and sleeping—all things which are essential to the healing process—is where trial and error and waiting may come into play.

Wound healing takes time. You can aid the health process by getting enough protein and calories, treating any anemia you might have, and keeping the wound and the surrounding area clean. These are all things that you can do with the help of a caregiver. Protein intake should ideally include 30 grams of protein with each meal for an average size adult male and less for a smaller female (30 grams includes a piece of meat, chicken, or fish the size of your fist, or several eggs). If you continue to feel unusually tired at home, tell your healthcare provider. They may do a blood test to check for anemia (an insufficient number of red blood cells, sometimes called “iron-poor blood”). If you have some anemia, your provider may have you take an iron supplement. Eating iron-rich foods is always a good idea when healing. Try dark leafy greens, dried fruit, beans, enriched breads and cereals, meat, eggs, and some fish. Keeping your wound clean with soap and water and showering as soon as you are able to will also help with healing. Then sit back and let the healing take place! Continue reading

Taking the Keys Away: A Geriatrician’s Perspective

okhraviHamid R. Okhravi, MD
Associate Professor of Medicine/Geriatrics
Director, Driving Evaluation Clinic
Director, Memory Consultation Clinic
Glennan Center for Geriatrics and Gerontology
Eastern Virginia Medical School

As geriatricians, we often need to have difficult conversations with our patients, their families, and/or their caregivers. One of the most difficult of these is when we have to tell a patient that he or she is no longer capable of driving safely.

Not so long ago, I had this discussion with a patient of mine, Mr. M, a 79-year old with mild dementia. His daughter brought him to our Memory Clinic when she became worried about his driving skills.

According to Mr. M, he’s a good driver. But his daughter told me that Mr. M had caused two minor accidents within the last year. She also said that he occasionally got lost when driving outside his familiar routes.

I gave him tests to gauge his ability to think and make decisions, and he did poorly on all three of them.

When I discussed his test results with Mr. M and his daughter, I explained that his impaired performance didn’t necessarily prove that he’s an unsafe driver. However, his scores did show that his driving skills needed further evaluation. I suggested that medical disorders, such as cognitive impairment, could worsen his skills and increase the risk of driving errors that can lead to vehicle crashes.

Naturally, Mr. M was unhappy to hear what I had to say. He told me that he’s always been a safe driver, and he refused to stop driving. He told me that not being able to drive would change his life for the worse, and that it would be terrible not to be able to shop for groceries or attend the two weekly social activities he enjoys with his friends.

Despite his concerns, with his daughter’s encouragement, he agreed to have his driving evaluated. Continue reading

Recovering after Surgery: Perspectives from a Patient and Healthcare Professional (Part One)

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Professor
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

Introduction

This is the latest in a series of blog posts by Barbara Resnick, PhD, CRNP, written from her perspective as both a healthcare professional and as a patient during the course of intensive treatment for esophageal cancer. This two-part article was written about two months following her surgery. Part One discusses the importance of preparing for going home throughout the course of a hospital stay following surgery. Part Two addresses managing ongoing recovery at home. These blog posts will be helpful to older adults undergoing surgery and their families, as well as to hospital administrators and healthcare providers.

Part One: Preparing for Life at Home throughout Your Hospital Stay
My recent experience in the hospital following surgery for esophageal cancer has made me aware that healthcare professionals (of which I am one) have much they can learn to support their patients’ day-to-day recovery following surgery, as well as to help them prepare for going home. This learning can be enhanced by acknowledging that patients know a lot about their own bodies and preferences, and by valuing the knowledge and experience patients and caregivers gain each day in the hospital. Therefore, you and your caregivers can be a valuable source of information to your healthcare team.
Although people’s responses to surgery are individualized, there are some basic approaches that can be applied to most types of surgeries and hospital stays. My experience was rather intensive, as the original surgery was an esophagectomy. This is a procedure where the esophagus (the tube that moves food from your throat to your stomach) is removed and then rebuilt from part of your stomach or large intestine. I had several complications and had to have a second surgery, all of which resulted in almost five weeks in the hospital!

My experience taught me the importance of thinking ahead and preparing for life at home while I was still in the hospital. Patients and families need to take an active part in this process, because the hospital care team is understandably often more focused on their patients’ immediate medical problems and needs. Patients and families need to ask and remind the healthcare team to teach them things that they’ll have to do when they go home, such as how to care for surgical incisions, what to do with a wound drain, or how to use a feeding tube. Patients and families need to practice these things while in the hospital, under the guidance of their care team. The healthcare team should also explain each medication when it is first given, including the name, what it’s for, how to take it, and what possible side effects to watch out for.

Also, practicing basic daily activities while you are still in the hospital is key to your recovery and in helping you know what you can do safely once you home. These activities include things such as bathing, dressing, eating, grooming, and walking, I was fortunate to have a family caregiver with me throughout my hospital stay. I made sure that I bathed and dressed daily with someone standing by me to help as needed. I walked through the hallways at least a few times a day because my family member could help carry tubes and push the IV pole. If you don’t have someone with you in the hospital, it’s important to ask the nursing staff to help with you these activities. On the actual day of my discharge, I insisted that the nurse teach me and my family how to set up the tube feedings I needed when I first went home and to practice with us.

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