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Posts Tagged ‘elderly’

The Return Of The Little Black Bag In Healthcare

August 17, 2011 Leave a comment

Right around the same time some private physicians are refusing to accept new Medicare patients in fear of lower government reimbursements, another physician based concept is taking hold. The Academy of Home Care Physicians has a mission statement that promotes the art, science and practice of medicine in the home. Established in 1988, the Academy “envisions a healthcare system in which any patient who needs it can receive comprehensive primary care in their home.” Research shows that for every elderly person in a nursing home, there are three more patients equally as sick and fragile who are living at home. In a recently article published in The New England Journal of Medicine on “Why Health Care is Going Home,” Dr. Steven H. Landers stated that, “Our financing system, malpractice laws, and consumer culture all encourage utilization of costly services and have contributed to unsustainable increases in the cost of care. In home care is often less costly, and since it is highly desirable for patients, it offers a potential win–win solution.”

He added that, “The transformation of patients’ homes into central venues for health care may take years or decades, depending on how the national and institutional politics play out. New payment models are needed to cover services that haven’t previously been offered at home and to realign physicians’ incentives. Yet, ultimately, health care organizations that do not adapt to the home care imperative risk becoming irrelevant.” In today’s generation of physicians, few have been educated in medical school or continuing education to provide the kind and level of care that could be made available. Few have been educated to provide home health agencies with professional support as medical directors; fewer still have learned the advanced team techniques that allow them to work with other health professionals, nurse practitioners, physician assistants, pharmacists and others by providing continuity of care across the care continuum. Concerns over reimbursement also have been a barrier.

The American Academy of Home Care Physicians serves the needs of thousands of physicians and related professionals and agencies interested in improving care of patients in the home. Members and volunteers work to reduce barriers and enhance practice education. Notable successes include fostering increased reimbursement, sponsoring multiple educational and scientific seminars and providing the practice community with a variety of helpful publications. Academy members include home care physicians who make house calls, care for homebound patients, act as home health agency medical directors or refer patients to home care agencies. Specialties include internal medicine, family practice, pediatrics, geriatrics, psychiatry, emergency medicine and more.
Other members are directors of agencies actively planning for future home care organizations, medical directors of managed care plans, nurse practitioners who make house calls, physician assistants, and administrators of medical groups interested in home care. The services provided by home care agencies and physicians are billed under a set of codes designated by the Centers for Medicare and Medicaid. Physicians, nurse practitioners, clinical nurse specialists and physician assistants are required to oversee or directly provide progressively more sophisticated and more frequent home visits.

Beyond the licensure and certification processes, no similar evaluation mechanism exists for skills obtained through continuing education and practice experience. The Home Care Credentialing Examination fills this gap and enables home care medical providers to demonstrate their proficiency. Patients also benefit from proficiency testing and the Academy’s recognition of those who receive the credential since the exam assesses the knowledge and skills identified by respected experts as necessary to provide safe and effective medical care in the home. Upon the completion of this educational activity, the participant should be better able to:
Discuss and apply knowledge of clinical problems, effective approaches to end of life/palliative care, functionality, social services and legal/ethical concerns related to home care. Attest to his or her added competency in home care medicine by demonstrating knowledge, skills and proficiency in managing common problems faced in home care. As a public service, The American Academy of Home Care Physician’s website provides a list of its members and medical groups that provide home care.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care Chicago, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Facilities and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

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New Alzheimer’s Scan For Early Diagnoses

August 17, 2011 Leave a comment

Alzheimer’s is the most common form of dementia, a brain disorder that primarily affects the elderly. It is named after a German doctor, Alois Alzheimer, who in 1996 noticed anomalies in the brain tissue of a woman who had died of a strange mental illness. There were abnormal clumps called amyloid plaques and tangled bundles of fibers, both of which are the most common signs of Alzheimer’s. Other brain changes can occur as well. Nerve cells die in areas of the brain vital to memory and other mental abilities, and the connections between nerve cells are disrupted, impairing thinking and memory. The disease is slow moving and in its earliest stages, may merely appear to be mild forgetfulness and be confused with age-related memory change. There may be problems remembering recent events or activities, or the names of familiar people or objects. As the disease progresses, the forgetfulness becomes more severe, interfering with daily activities, such as brushing one’s teeth. There are problems speaking, understanding, reading or writing, and eventually the brain damage becomes so severe as to require total care.

In January, the FDA’s Drug Advisory Committee voted unanimously to recommend approval of a new imaging agent to detect early Alzheimer’s disease. The agent, florbetapir, is produced by Eli Lilly and Company under the name Amyvid. Amyvid would be injected into the patient and used in conjunction with PET (positron emission tomography) scans to illuminate and detect the beta amyloid plaques in the brain that cause Alzheimer’s disease. PET scans performed with Amyvid would allow physicians to provide prognostic information to patients and their families even at a time of limited therapeutic approaches to treat Alzheimer’s disease. In addition, the availability of imaging agents that can reliably detect amyloid plaques will be an absolute prerequisite to select patients that may benefit from future specific anti-amyloid based Alzheimer therapies. Experts agree the test could become a critical part of detecting Alzheimer’s before symptoms take hold, but a clinical reality is far from imminent.  Although years away, researchers envision the amyloid PET scan could join the ranks of other routine mid-life surveillance tests such as colonoscopy and mammography for early detection. Before FDA approval, manufacturer Eli Lilly and Company must demonstrate that standards for interpreting brain scans can be made consistent enough to routinely guarantee an accurate diagnosis.

Because there is currently no cure for Alzheimer’s, Dr. Sam Gandy, the Mount Sinai Chair in Alzheimer’s Disease Research in NYC acknowledges the test may not be considered worth the cost even if the FDA approves the recommendation. He added that, “”Medicare may decide that the added value does not merit reimbursement without a meaningful intervention.” Since 2007, molecular imaging has been utilized in improving diagnoses of Alzheimer’s and other dementias with PET scans using other imaging agents such as FDG. FDG stands for fluorodeoxyglucose, a short-lived radioactive form of sugar injected into people during PET scans to show activity levels in different parts of the brain. In Alzheimer’s, low activity is mostly in the back part of the brain; while frontal lobe dementia occurs in the front. In 2008, researchers in France developed an automated system for measuring brain tissue loss using magnetic resonance imaging (MRI) technology to help doctors diagnose Alzheimer’s disease and mild cognitive impairment. In Alzheimer’s disease, the buildup of certain proteins in the brain leads to brain cell and brain tissue death; the hardest-hit part of the brain is the hippocampus, which affects memory.The automated MRI system helps in diagnosing Alzheimer’s by speeding up the process of visually measuring shrinkage in the hippocampus consistent with the disease.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care Philadelphia, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Facilities and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

Caring Gracefully for Family Members With Dementia

August 17, 2011 Leave a comment

A few nights ago, while tossing and turning in bed, too restless to quiet my mind and fall asleep, my husband stirred beside me. I told him I couldn’t sleep. His answer? “Why don’t you get up and go in the other room?” When I lamented that I was hoping he would comfort me, he rephrased his advice as such, “Why don’t you get up and go in the other room, sweetie?” Grrr, what a jerk I thought, but said nothing and turned over. Then I think of my elderly mother, the way she mixes everything up, and doesn’t believe me when I tell her something. I consider myself a patient person, especially with children (because they haven’t yet learned better) and the elderly, but when it comes to family members, I’m not so sure. Often times, many of us seem to reserve a large part our saintly patience and courteous behavior for total strangers.

How would you rate yourself?
On a scale of 1-10 (10 being saintly), how patient are you?
Do you extend the same grace, mercy, and forgiveness to your own family as you do to strangers and co-workers?
Are you more patient with children or the elderly?

If your honest answers to these questions touch a nerve, it may indicate that you are not a good candidate for becoming the sole caregiver of your elderly parents, particularly when the signs of dementia begin to appear. Of course, most of us feel justifiably responsible for helping our elderly parents and treating all of our loved ones with the same patience and respect we afford strangers, and when we struggle with doing so, most of us make an effort to improve. In trying to understand the phenomena, maybe we grow too accustomed to the unconditional love family members provide. We come to depend on their support, understanding, insight and guidance on everything from inconsequential day-to-day events, to important topics such as safety or a family crisis. When our family members don’t come through in a way we expect, albeit from the sleepy stupor such as was with my husband, or the devastating, gradual loss of cognitive skills in the case of my mother, we feel hurt and disappointed. We are insulated from hurt inflected by strangers because we lack a heightened level of intimacy with them.

Understanding the intrinsic layers of decline that accompanies dementia and its effect on a human being may provide us with the knowledge to help us deal with it  our elderly family members more gracefully. The Alzheimer’s Association regularly distributes articles that provide insight for helping family members and outside caregivers deal with those affected by the disease. A recent one, published in the Huffington Post, says, “It is so easy to think that there is no one there anymore when the person in front of you does not talk, or when they make unintelligible sounds, or say things that don’t seem to make sense, or don’t remember what happens from one minute to the next.” Although it may be a normal reaction, talking as if the person is not there or addressing them as you would a child and assuming that your interactions with them do not matter, can create an even more frustrating situation.
The article offered eight truths to help change the way we relate to persons with Alzheimer’s or other dementias.
The fact that the person doesn’t speak does not mean that they do not hear or understand.

No matter how withdrawn or unresponsive aperson may appear, one should act and speak as if they were completely cognizant. This precludes talking about the person in front of them, or ignoring their presence, or using language that is disrespectful. The person should be treated as we want to be treated, only using simpler language and talking more slowly so as to maximize the chances of being understood. Not recalling facts does not mean that the heart does not know or does not remember. To the contrary, persons with forgetfulness are extremely attuned to the quality of their relationships, and carry with them the emotional imprint of prior interactions, whether positive or negative. A parent may not remember that you called them earlier, but the positive effect of the phone conversation could linger for hours afterwards. The loss of abilities, no matter how severe, does not mean that all abilities are lost. Research shows that the following abilities remain, even into advanced stages of dementia: experiencing pride, maintaining dignity, experiencing shame and embarrassment, feeling concern for others, communicating feelings with assistance, maintaining self-esteem and manifesting spiritual awareness. What appears as nonsensical behavior actually makes a lot of sense from the person’s perspective.

Making sounds can be a desperate way of soothing oneself in the face of extreme alienation. Pacing is a way to channel one’s anxiety or boredom. Wandering can be viewed as a search for something missing, like one’s old home, or a lost sense of connection. Crying out is a plea for help. Aggressive gestures are expression of anger from one’s needs not being met adequately, or from one’s frustrations with the many losses attached with the Alzheimer’s or dementia experience. These behaviors are attempts to cope with very real distress. The person is not a child or a baby, although some of their behaviors may cause us to treat them that way.
The person may need assistance with basic activities such as eating, getting dressed, taking a shower and grooming, or they may engage in pre-verbal modes of communication –  behaviors that we normally associate with very young children. But they are not children. They are adults, with years of experience and accumulated wisdom, much of it stored in their heart and spirit. No matter how well intentioned, infantilizing the person will only cause them to feel worse.

It is not all downhill from here, at least not always. The journey through dementia is nonlinear with some remarkable breakthroughs here and there, often precipitated by the right context. Stories abound of persons who start speaking or smiling again after they are moved to a different environment, one where they feel safe, engaged and loved. The fact that a person struggles with initiating tasks does not mean that they are incapable of making any decisions. When in doubt, err on the side of exploring the person’s range of abilities. Preserving the ability to make choices, no matter how small, is especially crucial. Many times  partners or caregivers take over all aspects of a person’s life, unwillingly depriving that person from the opportunity to make even such a simple decision such as which clothes to wear. Which dress, the blue or the red one? All of us want to feel that we are still in control somehow. Asking “what to do” with the person can be the wrong question. We are part of a “doing” culture. Sometimes, all that is required of us is simply to “be” with a person, as in sharing moments sitting, walking, listening to music, watching a sunset or gently touching the person’s hand after we have asked for their permission. The more we understand, the easier it will be on the caregiver and the person in our care, whether we are caregivers of a family member or a stranger.

800Seniors is a distinguished nationwide Senior Healthcare referral service. They are based in Southern California, located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors offers seniors citizens a range of different health care options. Based upon their needs they can opt for Home Care, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Care Homes San Jose and Assisted Living nationwide. 800Seniors makes life easier by taking away the confusion and hassle. For more information about 800Seniors call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

Seniors In Assisted Living Communities Have Great Opportunity For Friendship

August 8, 2011 Leave a comment

When poet, Ralph Waldo Emerson, was quoted as saying, “He who has a thousand friends has not a friend to spare, and he who has one enemy will meet him everywhere,” I doubt he was imagining the modern day Facebook phenomenon of literally having thousands of “virtual friends.” It is more likely he was romanticizing about the value of real friendships in our lives. Making friends can be costly, according to behavioral ecologists. While it might not be a very romantic view of friendship, making new friends involves an investment by committing time and energy to another person in the hope that they will provide reciprocal benefits in the future.

Dr. Will Reader of Sheffield Hallam University says online networks are somehow reducing the investment necessary to make new friends by lowering the perceived risk. His online survey, which forms the main part of his ongoing research, has revealed that face to face encounters are, not unsurprisingly, still the most important factor in close friendships. According to Dr. Reader, the importance placed on face to face encounters is a result of the necessity to base an investment on honest information. “The importance of honest signals is a fundamental concept in behavioral ecology. For example, the female songbird invests in a mate based on the quality of his voice, as this is an honest signal indicating the fitness of the bird. In the same way, people choose friends based on their ‘quality’, and this can only be assessed when there are honest signals being given,” says Dr. Reader.

James and Bea by *Dtellesen on deviantART

While using the computer to “network,” share written words, thoughts and photos can provide many tech savvy seniors the opportunity to stay in touch with not only “virtual friends,” family and the more traditional type of pals, it doesn’t seem to be enough. Researchers at Brigham Young University and the University of North Carolina at Chapel Hill have found that people with strong social connections live longer than those without. Their studies suggest that social isolation is as much a risk factor for mortality as the more frequently cited reasons such as smoking and obesity.
The basic logic is that friends stimulate the brain and force people to get out and interact with others. Many times elderly people experience social isolation and loneliness as they age and when family and friend networks become smaller. Social contacts usually decrease after retirement and may continue to decline with the deaths of family members and friends and changes in residence following widowhood, mobility difficulties and ill health.

Social isolation is defined as being separated from one’s environment to the point of having few satisfying and rewarding relationships. Loneliness, on the other hand, is one’s feeling of dissatisfaction with social contacts in terms of quantity of contacts, quality of relationships or both.
Social isolation and loneliness have consistently been found to be associated with health. Declining physical health may lead to social isolation and associated feelings of loneliness. Perceived loneliness is one of the strongest predictors of health. Loneliness has also been found to be associated with diabetes, heart disease, ulcers, respiratory conditions, headache, low back pain and abdominal pain. Perceptions of intimate, personal relationships affect feelings of physical and emotional health. People who are not lonely may have a more positive view of their relationships, accept aging and its changes and therefore feel happier and healthier. Research has shown that people in poor health coupled with high anxiety tend to feel more isolated and lonely.

Other studies have shown that elderly people in declining health who feel socially isolated and lonely are more likely to move to a senior residence or an assisted living community. Such moves frequently increase their social participation and delay further health decline. A comment by Janice E. Brown, an end of life, hospice chaplain in Orange, CA, summarized the trials of aging most it eloquently when she said, “Sometimes death is not the most difficult. It is the ‘little dyings’ of aging that are the most difficult.” Residents of assisted living communities are considerably less likely to experience isolation and loneliness. Not only do the communities have planned activities and group centered, family style mealtimes, they also provide residents with a relaxed, worry free setting where they have the opportunity to develop genuine interest in others that result in intimate friendships. Ralph Waldo Emerson went one step further on the subject of friendship when he said, “A friend may well be reckoned the masterpiece of nature.”

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Chicago and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

Seniors Get Emotional First Aid In Assisted Living Communities

August 8, 2011 Leave a comment

It was around six in the morning when she burst into our room. With tears streaming down her cheeks and a look of fear and sheer panic on her face, my mother, who just the night before had returned from vacation with us, informed us that, “New York city is being bombed, that fighter jets were flying over the city.” Of course, it was September 11, 2001 and although the facts streaming from her radio were not interpreted completely accurately, they began to unfold a series of horrific events that 9 years later still causes goose bumps. The hours, days, weeks and years that followed this horrid, hate filled atrocity left emotional scars that still haunt so many people today.

Sadly, natural, accidental and planned disasters happen around the world all of the time. Most news reports focus on the environmental devastation, physical illness, injury and death, while long term emotional distress takes a back seat as the headlines fade. The New England Journal of Medicine writes that, ”as the recent Deepwater Horizon oil disaster enters its next phase, consensus is emerging that among its most profound immediate health effects are those on the emotional and psychosocial health of Gulf Coast communities.”  “State mental health and substance abuse agencies report an increase in emotional distress and demand for assistance. Calls to domestic violence hotlines are increasing.  Fishermen fear for their families’ economic future, and communities wonder how the influx of cleanup workers and volunteers will affect their way of life.”

Davy in Therapy by *warrioronlydude on deviantART

Most major disasters, including the Exxon Valdez spill, Hurricane Katrina, and the 9/11 attacks, have been followed by increases in the prevalence of mental illness, domestic violence, and substance abuse.1,2 Emotional distress manifests itself at increased rates of driving while intoxicated, theft, domestic violence and assault. Many independent and assisted living communities help their residents in dealing with the psychological and emotional responses to national or world disasters by organizing discussion groups. People of all ages and from all walks of life are affected by horrific events, but sometimes the elderly feel more isolated when disaster strikes.  Symptoms such as apathy; a sense of hopelessness; recurrent somatic complaints; and excessive irritability and anger frequently appear long after the media clips disappear.

After disaster strikes, assisted living communities frequently arrange for guest speakers from state and local agencies and community based organizations that can offer psychological first aid. They are trained to address emotional distress, build coping skills, connect people with support services, and promote a return to normal routine, as well as counseling and psychiatric services if necessary.
The immediate community based discussion groups give residents the chance to express and share their fears, concerns and feelings of sadness.  The groups also encourage residents to ask questions but in most instances, just having the opportunity to share their feelings with others and realize they are not alone, helps them in the healing process.

References:
1S Galea, CR Brewin, M Gruber, Exposure to hurricane-related stressors and mental illness after Hurricane Katrina. Arch Gen Psychiatry 2007;64:1427-1434
2LA Palinkas, MA Downs, JS Petterson, J RussellSocial, cultural, and psychological impacts of the Exxon Valdez oil spill.. Hum Organ 1993;52:1-13

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Chicago and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

Probiotics – The Big Cheese In Improving Elderly Immune Systems

August 3, 2011 Leave a comment

Probiotics, often referred to as the “good” bacteria, are live microorganisms thought to be healthy for the host organism. Probiotics are most often consumed as part of fermented foods with specially added active live cultures such as in yogurt, soy or in dietary supplements. They are thought to aid in the alleviation of chronic intestinal inflammatory diseases, prevention and treatment of pathogen induced diarrhea, urogenital infections and atopic or allergic disorders. Profound and complex changes in the immune response occur during the aging process. Age related deterioration of the immune system is known as immunosenescene. This deterioration means the body is unable to kill tumor cells and reduces the immune response to vaccinations and infections. Infectious diseases, chronic inflammation disorders and cancer are hallmarks of immunosenescene. This can leave elderly people more vulnerable to infection and disease because it is harder for the body to kill cancerous cells and reduces the immune response to vaccinations and infections.

Scientists at the University of Turku in Finland discovered that probiotic cheese can tackle the age related deterioration. Dr. Fandi Ibrahim, lead author of the study published in the medical journal FEMS Immunology & Medical Microbiology said, “The increase in the proportion of aged individuals in modern society makes finding innovative ways to thwart the deterioration of the immune system a priority. “The intake of probiotic bacteria has been reported to enhance the immune response through other products, such as yogurt and certain milks, and now we have discovered that cheese can be a carrier of the same bacteria.” The team asked volunteers aged between 72 and 103, all of whom lived in the same care home, to eat either one slice of probiotic Gouda cheese or a slice of placebo cheese with their breakfast for four weeks. The study said the fact that all the volunteers were living in the same building helped to reduce any differences caused by variations in diet and other environmental factors.

I LOVE CHEESE. by *bendwater88 on deviantART

Both the Gouda cheeses used in the experiment were commercially available, said the scientists. The probiotic Gouda cheese was rich in the bacteria Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus NCFM. Blood tests were carried out to discover the effects of the probiotic bacteria contained within the cheese on the immune system. Ibrahim said the results revealed a clear enhancement of natural and acquired immunity. “The aim of our study was to see if specific probiotic bacteria in cheese would have immune enhancing effects on healthy older individuals in a nursing home setting,” concluded Ibrahim. “We have demonstrated that the regular intake of probiotic cheese can help to boost the immune system and that including it in a regular diet may help to improve an elderly person’s immune response to external challenges.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Phoenix and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

Tube Feeding Depends On The Attitude Of The Facility

July 6, 2011 Leave a comment

By the year 2030, the number of people in the United States over 65 will soar to 71.5 million. The healthcare industry is keeping pace by providing communities with the housing and care resources needed to accommodate the nation’s aging population. Independent, assisted living and memory care facilities are oftentimes located on the same property and are known as Continuing Care Retirement Communities.  At a CCRC, residents can move within the tiers as their conditions may change over the years. Many assisted living facilities are also stand alone homes that frequently have wings for providing memory care to those residents with loss of cognitive skills such as those with Alzheimer’s disease or other forms of dementia.

Tube feeding is a procedure used in acute care hospitals for patients recovering from certain surgeries, those with neurological problems, some going through intense chemotherapy or for any reason, are unable to receive proper nutrition by swallowing. Feeding tubes, or the medical term, Percutaneous Endoscopic Gastrostomy, (PEG), are frequently utilized to provide nutrition for the elderly. Many of these elderly patients reside in assisted living facilities and skilled nursing facilities. Though the procedure is fairly routine medically, there are many complex issues surrounding PEG use, particularly for patients near the end of life, where the decision to use or not to use a PEG is frequently made without the participation of the patient.

The ethical picture is further clouded by several studies that question the medical benefit of PEGs in elderly demented patients, a group that receives a high percentage of the PEG procedures currently done. Other studies have found a surprisingly high death rate for those patients within one month of a PEG insertion. Tube feeding has been shown to have no demonstrable benefit in assisted living or skilled nursing patients with advanced cognitive impairment, yet its use within this population reveals a striking and unexplained variation within the United States.

Half complete memory by *Jangmai on deviantART

The Journal of the American Medical Association has published a report on a study of patients with advanced cognitive impairment and found that 70% of feeding tube insertions were done in the acute care hospital prior to the patient being moved to an assisted living facility. The study suggests that higher insertion rates are associated with the following acute hospital factors:

For profit ownership vs. government owned
Larger size vs. smaller size (more than 310 beds vs. less than 101 beds)
A more aggressive approach to end of life care, meaning greater use of the intensive care unit in the last 6 months of life as opposed to a memory care facility or hospice.

A field study was also done in two South Carolina assisted living facilities. Field studies are based on the idea that humans are best understood to the fullest possible context if it includes the place where they live, the improvements they’ve made to that place, how they are making a living and providing food, housing, energy and water for themselves or others, what language(s) they speak and so on. The study revealed a startling variation in the culture of the organizations and its influence on attitudes toward tube feeding. Key features in assisted living facilities with low use of feeding tubes:

A more home like environment in which food, mealtimes, and family are central.
Administrative support in solving feeding problems.
Emphasis on the value of, and sufficient staff for hand feeding.
Family inclusion in decision making.

In contrast, the high use feeding tube facility had an impersonal, institutional atmosphere with strictly scheduled and poorly staffed mealtimes.  Staff attitudes favored tube feeding, and though the decision making process was not clear, it emphatically did NOT include family. If you are considering a Continuing Care Retirement Community or a standalone assisted living facility that most often includes a memory care wing for the cognitively impaired, it is essential to ask about their policy on tube feeding. Using an experienced, qualified referral service to assist you in the process, can help you determine the attitudes and policies of the organization where you or your loved one will reside.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Philadelphia and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

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