Senior Health

Advance Care Planning: Reminder for YOU to Have the Conversation

By Cozzie M. King, National Coalition for Hospice and Palliative Care

The scenario generally plays out the same. A person becomes ill…too ill to make decisions for themselves…too ill to communicate with the attending medical staff. Nearby family rush to the hospital bedside. The physician explains what’s happening to the family. Things aren’t looking good or the medical terminology is not easy to understand. After some time, the family is left to make decisions for their seriously ill loved one. Decisions that have not been discussed or thought about prior to this point. What do we do? Who has the final say? Things normally go downhill from here. You’ve seen it. I’ve seen it. Medical staff dread it. No one wins. Making healthcare decision at the hospital bedside is not the right time. These conversations need to happen before the crisis, not during.

Speak Up

As a mom, sister, daughter, past and future caregiver, I understand the importance of having conversations about my future healthcare decisions with my family and friends. These conversations can be hard to begin. However, there are many resources, tools and games that help families have these talks in creative ways. Over the years, I have facilitated several talks on how to plan and communicate your future healthcare decisions.  One of my personal favorite resources is the Speak Up video. This video is one of the tools I consistently use when explaining why it’s so important to have the conversation and complete an advance directive.  I encourage you to post and share this video with your family and friends on Facebook. They’ll thank you later. The message is short and simple.  Check it out:

Click to watch NHDD Speak Up Video

As we advocate for more families to participate in advance care planning, keep it simple. I remind my family and friends that advance care planning is much more than completing a form. It really is more about the conversations you have before and after any document is completed.

Lead By Example

April 16th is National Health Care Decisions Day (NHDD) and this year’s theme is, “It always seems too early, until it’s too late.” NHDD is a call to action for EVERYONE to:

→Think about your beliefs and values,
→Write them down,
→Choose a healthcare proxy (someone who speaks for you if you are not able),
→Complete an advance directive, and
→Share with your healthcare proxy, family and doctors.

The purpose of NHDD is to inspire, educate and empower the public and providers about the importance of advance care planning – and most importantly, to encourage people to express their wishes regarding healthcare and for providers and health care organizations to respect those wishes, whatever they may be. As someone in the health care field,  be sure to complete your advance directive and encourage your colleagues and loved ones to do the same. Practice what you preach. Read related story in TMC News

 

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Another Reason to Avoid Heavy Drinking? Dementia

Dr. Arefa Cassoobhoy, a practicing internist, Medscape advisor, and senior medical director for WebMD in a recent Medscape Morning Report 1-minute news story for primary care, reported that heavy drinking can lead to many health issues. 

Dr. Cassoobhoy shared a new study[1] that looks at alcohol use and dementia. The French observational study included over 1 million adults diagnosed with dementia between 2008 and 2013. It found that of 57,000 cases of early-onset dementia, 39% were due to an alcohol-related condition like Wernicke-Korsakoff syndrome, liver disease, epilepsy, or head injury. And 18% had an additional diagnosis of alcohol-use disorder.

Overall, alcohol-use disorders were associated with a three-times greater risk for all types of dementia.

The researchers concluded that heavy drinking is the strongest modifiable risk factor for dementia. Dr. Cassoobhoy says this should motivate us to focus on early screening, brief interventions, and treatment to help our patients.

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Waiting Rooms Encouraged to Show Video with New Medicare Cards

Click for new video featuring the replacement IDs

Originally published in AARP’s Health Medicare Resource Center By Dena Bunis, AARP, March 2018

Medicare is asking doctors to play a new video in their waiting rooms to remind patients that the federal government will begin mailing them new identification cards next month.

The video gives beneficiaries a glimpse at what the new card will look like and explains why and how it was modified. Instead of a Social Security number, the cards will display an 11-digit Medicare beneficiary identifier, and they will no longer include gender and a signature.

Eliminating the personal details, Centers for Medicare and Medicaid Services (CMS) officials say, will better protect an enrollee’s identity and guard against fraud.

The Social Security Administration (SSA) urges Medicare enrollees to make sure the agency has their correct address on file. You can go to socialsecurity.gov/myaccount or call 800-772-1213 to update your address.

Scammers with various ploys have already started to target the 58 million individuals who will be getting new cards. The Federal Trade Commission (FTC) reports that con artists are calling beneficiaries and pretending to be from Medicare, then trying to talk them into paying for the revised card. Medicare will never call and ask for any personal identification or money for the new cards. The cards are free and will be mailed to members’ homes.

Medicare beneficiaries in Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia and West Virginia will be the first enrollees to receive the replacement cards. The mailings will continue through 2019.

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Family is biggest influencer of older adult housing and care preferences: study

Author: Lois A. Bowers, Senior Editor, McKnight’s Senior Living

Family support is the biggest influencer of housing and care preferences among older adults, according to a study published Wednesday (March 7, 2018) in the Journal of the American Geriatrics Society.

Often, the authors found, older adults changed their preferences based on the concerns of family members or a wish to avoid “being a burden” to others. This basis was especially true for preferences regarding the places where people wished to receive care — for example, at home or in a residential care setting, they said.

The researchers, all of whom were affiliated with the Cicely Saunders Institute of Palliative Care Policy and Rehabilitation at Kings College London, examined 57 previous studies about the preferences of older adults with advanced illness. They included research that investigated preferences for where people wanted to be cared for, the kinds of communication and decision-making they wanted and the quality of life they hoped to have over time.

Family involvement is key in care decisions

Although support from family was the most important influence on their care preferences, older adults usually formed their preferences based on several other factors, too, including their experiences related to previous illness and caring for others as well as having a serious illness, according to the study.

 

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Report: Senior Health Care Misses the Mark

Report Details Senior Health Care That Misses The Mark

By Michelle Andrews

Quality over quantity. As people get older, their health care goals may shift away from living as long as possible to maintaining a good quality of life. In key areas, however, the medical treatment older people receive often doesn’t reflect this change, according to a new study.

The wide-ranging report from the Dartmouth Atlas Project uses Medicare claims data to examine aging Americans’ health care. Among other things, it identified five key areas where too many older people continue to receive treatments that don’t meet established guidelines or, often, their own goals and preferences.

Two of the five have to do with preventive care that may not benefit seniors: screening for breast and prostate cancer. The other three address care at the end of life: late referral to hospice care, time in the intensive care unit in the last six months of life and placing feeding tubes in patients with dementia.

While the measures themselves are quite different, they each highlight the need for better communication and shared decision-making among patients, their families and their medical providers.

“Where there are harms and benefits and people judge them differently, that’s where the shared decision-making comes in,” said Dr. Julie Bynum, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.

Despite the simplicity of a mammogram or a blood test to check for prostate cancer, if the screening is positive for cancer, that can set off a cascade of further testing and treatment. Those efforts could cause harm to older patients, whose health may be fragile or who have multiple medical conditions.

In addition, older people may well die from something else before a cancer progresses, said Dr. Richard Wender, chief cancer control officer at the American Cancer Society.

“The single hardest concept for the public to understand is the natural history of finding a cancer through a screening process,” Wender said. “Many people have the sense that had it not been found that cancer would have threatened their life within a couple of years or maybe even a couple of months.”

Experts have cautioned older patients about both tests. The U.S. Preventive Services Task Force, an independent panel that weighs evidence and makes recommendations about prevention services, has concluded that prostate cancer screening isn’t beneficial at any age and said that there’s not enough evidence to know whether women benefit or risk harm by undergoing breast cancer screening after age 74.

Medical treatment older people receive often doesn’t reflect their wishes.

Still, the Dartmouth Atlas analysis found that 20 percent of male Medicare beneficiaries age 75 and older got a PSA test to screen for prostate cancer in 2012, and 24 percent of female beneficiaries that age had a mammogram to screen for breast cancer that year.

We Need To Make Decisions Based On The Patient’s Values

Guidelines aside, clinicians and their patients need to discuss the pros and cons of testing and make a decision based on the patient’s values and preferences, experts say.

For example, a 75-year-old woman who is willing to accept that she might actually die of breast cancer within 10 years but wants to avoid the anxiety and harms of treatment, might choose not to be tested.

“I ask people, ‘Do you think you’re going to be around in 10 years? Help me decide’ whether to order a mammogram,” said Bynum, whose work focuses on geriatrics.

As people near the end of their lives, it’s especially important for patients and their family members to discuss their goals and wishes with clinicians. Patients often want to be kept comfortable rather than undergo medical interventions, but physicians and nurses are still trained to do everything possible to prevent death, said Dr. Diane Meier, director of the Center to Advance Palliative Care and professor of geriatrics at Mount Sinai’s Icahn School of Medicine in New York.

The three end-of-life criteria that the Dartmouth researchers cited are areas that geriatrics experts agree are critical but have proven difficult to get providers, health systems and the general public to accept, said Bynum. Late referral to hospice and spending time in a hospital intensive care unit can adversely affect terminal patients’ health, result in higher costs and run counter to their hope for a peaceful death. Feeding tubes in patients with advanced dementia can lead to other complications.

Lost Opportunity: Hospice Comfort Care Services That Are Available For Months Are Not Utilized

The Dartmouth study found that in 2012, 17 percent of Medicare beneficiaries who died were enrolled in hospice only during the last three days of life. Medicare, however, will approve hospice benefits, which generally include comfort care rather than curative treatment, when the physician certifies that someone is expected to live for no more than six months.

The study also found that people spent an average of nearly four days in intensive care during the last six months of life, a figure that is trending upward.

Finally, even though it doesn’t prolong their lives to place feeding tubes in patients with dementia, who naturally lose interest in food and their ability to swallow in the final stages of the disease, 6 percent of Medicare beneficiaries with dementia received them in their last six months of life in 2012.

Communication is key, but the skills that are needed to counsel patients aren’t being taught, said Meier.

“If you unleash an oncologist who does not know how to say, ‘Your cancer has progressed,’ but they know how to say, “I know what we can try,’ that’s why people end up in the ICU and with feeding tubes” at the end of life, she said. “It’s easier than having a difficult conversation.”

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.

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