Making Healthcare Decisions for Me, Part 1

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Nancy E. Lundebjerg, MPA
Chief Executive Officer
American Geriatrics Society
Health in Aging Foundation

Have you ever imagined a time when you are unable to make decisions for yourself? Who knows how you would make decisions? What information would you want? What do you think about life-prolonging treatments? Who knows how you feel about dying? Who knows you?

Have you looked at that moment through the eyes of family who may have no—or every—legal authority to make decisions for you? Have you thought about the range of decisions that might need to be made for you—each decision likely leading to another decision and accompanied by concern that someone might not be doing what you would do if you were making this decision for yourself?

We don’t like thinking about those types of things—at least my family doesn’t, and I wouldn’t be surprised if yours didn’t as well. You might, like me, have an advance directive gathering dust in some corner of your home with another copy in the hands of your proxy and yet another copy stapled into a chart for a doctor you haven’t seen in more than fifteen years because you’ve moved on and so have they. You may have completed an advance directive as a part of writing your will, as someone recently told me they had, so you can mentally check it off your to-do list. Health Care Proxy/Advance Care Directive. Done.

But maybe we should start thinking about this as a conversation as one addressing how we would want to live rather than one focused on how we would want to die. I know how I want to die–without a long decline into disability and dementia. I also know that kind of death can be hard to come by. Simply put, in this day and age, we can live for much longer than we could before.

If you look at Advance Care Directive forms, you’ll see that most ask for some specificity. As an example, my home state of New York allows me to check off that I don’t want blood transfusions—just one of the 11 examples that the New York form provides. It’s enough to make my head spin.

To be honest, I am not sure I could outline every possible scenario in a way that would be a road map for my proxy. The thing I know from being a caregiver is that there will be a lot of decisions and a lot of nuances to those decisions. I know they will start small and build to a crescendo. And, at least for me, it’s been helpful to balance sharing my wishes with remaining flexible—not trying to control everything with a lot of instructions. That’s one of the most helpful parts of selecting a healthy proxy when completing an advance directive—you can identify a person you trust to do whatever is in your best interests.

It’s important to have an Advance Care Directive form completed and a decision-maker identified. No less important is empowering your decision-maker to act on your behalf. More on that in my next post.

 

How much sleep do older adults need?

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setters

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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Speaker-Shega Joseph1

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.

 

HIV: Not Just a Young Person’s Disease

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Sangarlangkarn

Aroonsiri Sangarlangkarn, MD MPH
Geriatrics Fellow
Brookdale Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
New York, New York

Did you know that by 2015, fifty percent of people with HIV (human immunodeficiency virus) in the United States will be over 50 years old? Or that 17% of new HIV infections happen to older adults?

People living in the 1980s would be surprised to hear these facts. When HIV was first discovered in 1981, we did not have effective medications to treat HIV, and many people died young, soon after they were diagnosed.

The good news is that healthcare has come a long way since then. Today, we have effective medications for HIV, called antiretroviral therapy, and people rarely die from HIV anymore. Now that people with HIV are living longer, we have more and more older adults who have HIV.

The bad news is that we still cannot cure HIV, and aging with HIV is not easy. Chronic HIV infection and long-term effects of HIV medications can lead to other health problems. For example, patients with HIV may be at higher risk for bone loss, making them more prone to getting osteoporosis compared to people without HIV. Osteoporosis is just one of the problems— chronic HIV infection increases risks for many other chronic diseases. It can also carry a stigma that can make it hard for older adults to make new friends or keep their social network.

So, what can you do to protect yourself from HIV as you age? Here are some tips:

Stay updated on safe sex practices: Unprotected sex with an infected partner is the most common way people get HIV.Practicing safe sex is a must. Even if you no longer worry about unwanted pregnancies, you still need condoms to protect you from sexually transmitted diseases, HIV included. If you are recently rejoining the dating scene, make sure to stay up to date with new information on HIV and safe sex practices—information might have changed from the last time you heard about it.

Get more information from HealthinAging.org’s section on Sexual Health and the Safe Sex Tip sheet.

Get tested: Knowing your HIV status is important, and everyone should get tested. This is because HIV infection is hard to detect without a test.  Its symptoms mimic many other diseases, including symptoms related to advancing age. Moreover, after the initial infection passes, you might not have any symptoms until it is too late.  Untreated HIV weakens your immune system and leaves you open to getting  sick from infections.  Do not wait until it is too late—get tested today.

If you have HIV:

  • Find a healthcare provider and a pharmacy that specialize in HIV. HIV is a complicated disease, so you want to make sure your healthcare professionals have experience dealing with HIV.
  • Take your medications as prescribed. If you do not take medications correctly, your HIV pills may be less effective in the future.
  • Exercise and eat a healthy diet. This helps your immune system stay healthier and keep HIV under control.

Aging with HIV is a new experience, and it is an important topic in medical research. In fact, the American Geriatrics Society has partnered with other organizations to develop a website about HIV and Aging to help provide updated research and treatment guidelines to HIV doctors. Feel free to share this website with your healthcare provider, and visit it often to find out the latest updates on this topic.