Category Archives: Questioning Aging Answers

Re-examining and redefining aging and aging ethics for a new era

Questioning Aging Answers

Aggressive Medical Treatment- A Crisis Point for the Family Caregiver

Family caregivers of an elder with serious health conditions can often be made to feel that they must assist the elder in obtaining aggressive medical treatment for worsening conditions. In the USA, the use of aggressive medical treatment for patients in the final months of life is increasing significantly. 1

Are the physicians who recommend aggressive medical treatment near the end of life generally helping the elder or are the outcomes of aggressive treatment generally undesirable?

Studies find undesirable outcomes

According to studies published by Medicare News Group 2 and by the Journal of the American Medical Association, JAMA 3, aggressive medical treatment for Medicare patients at the end of life has been on the increase with more people receiving care in intensive care units and more people being shuffled between hospital, home and skilled nursing care in the final months of life.

Unfortunately, according to the same studies, it appears that aggressive medical care is not helping the people who receive it live longer or enjoy a better quality of life than people who receive more conservative treatment. Consumer Reports 4 has reported that “too much healthcare” can actually shorten a person’s life.

In fact, aggressive treatment can cause stress and pain for the elder and for the family caring for that elder. Consumer Reports notes that families who have lost loved ones after aggressive treatments often say they regret not having recognized sooner that treatment was not beneficial, and adjusting plans and expectations accordingly.

How do physicians fit into this problematic puzzle?

Some experts note that fee for service Medicare rules can lead physicians to pursue more treatment because fees are paid per service. This idea may have some validity, but it may be more illuminating to look at physicians’ attitudes towards aggressive care in general.

Interestingly, a new study from Stanford School of Medicine 5 and a recent poll on the physician social media site SERMO 6 both indicate that regarding their own medical care, physicians would very rarely choose aggressive treatment, but for their patients facing the same prognosis, they tend to pursue aggressive treatment.

The Stanford study noted that advanced healthcare directives had little impact on aggressive treatment even though, “more than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life.”

Finding the Physician’s Blind Spot

Physicians have a laser focus on diagnoses and treatment of disease, but this laser focus can also cause a major blind spot. A whole person is much more than his or her body’s condition or disease, and yet in the medical treatment process, the person can be “lost” in favor of a focus on a  particular physical condition.

Physicians are trained to provide technical services based on specific and technically definable perimeters. They are not trained or paid to deeply examine a patient’s personal life philosophy, personal history and life experience, emotional life, cultural influences, spiritual beliefs, or family and personal relationships.

To put it another way, what doctors know about a patient may represent very little of what a patient may consider to be essential to “who they are.”

In this context it makes sense that a physician, who knows herself as a whole person, would choose less aggressive treatment for herself and pursue more aggressive treatment for her patient, whom she knows primarily as a condition or disease. This outcome is probably unrelated to whether or not the physician is a caring or compassionate person and is rather a result of the constraints of time, function and capacity.

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What can families do?

Firstly, patients and their families need to recognize the limitations of physicians and medical systems in general. These systems and professionals do not have a complete understanding of patients’ personal lives and issues.

When faced with significant medical decisions, it is essential to seek out as much family, friend, professional and spiritual support as is needed.

Taking the time to draft a well considered Advanced Directive for Health Care (ADHC) is a key step. Realize most “check the box” ADHC forms pertain solely to life support and tube feeding. Preferences regarding other aggressive medical treatment must be written out separately. Therefore, multiple conversations will probably be needed with a primary care provider as well as other medical specialists to draft an effective document.   

Discussing the ADHC with the persons who may act as authorized representatives is essential.  The representative must understand the principles and desires outlined in the ADHC as issues may arise in practice that are not directly addressed in the document. Choosing a representative who has the mental and emotional maturity and capacity to be an effective advocate is also extremely important.

Having an authorized representative who can successfully advocate for the principles of the ADHC to be followed may be as important as the ADHC document itself.

Anne Conrad-AntovilleAnne Conrad-Antoville has worked with hundreds of families regarding senior healthcare issues and is CEO and a founder of Champion Advocates LLC, a geriatric case management firm serving elders is Portland, Oregon and  family caregivers across the USA and Canada.

References

1 Changes in End-of-Life Care Over the Past Decade:More Not Better  Grace Jenq, MD; Mary E. Tinetti, MD; JAMA.

2 The Cost and Quality Conundrum of American End-of-Life Care Medicare News Group, (reprinted by HealthManagement.org

3 Change in End-of-Life Care for Medicare Beneficiaries; Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009, JAMA

4 Too much treatment? Aggressive medical care can lead to more pain with no gain Consumer Reports

5 Most physicians would forgo aggressive treatment for themselves at the end of life, study finds Stanford Medicine News Center

6 How Doctors Die: Only 7% Choose Extraordinary Measures; SERMO

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Questioning Aging Answers

2015 McGinty Alzheimer’s Conference- Portland Oregon

This year’s annual McGinty Conference on Alzheimer’s will be held November 3 at the Oregon Convention Center. It is open to family caregivers and professionals.

Register at: alz.org/oregon

Be sure to attend breakout sessions presented by dementia and aging experts including:

The Action-Compassion!Technique Series:
Redefining the Assessment Process for Improved Outcomes
Session B2 from 12:45-2:15PM

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Champion Advocates LLC

Geriatric Case Management Services

 

The Action-Compassion!Technique is a dynamic methodology in long term eldercare management focusing on the multi-level challenges of the diagnosed elder through the lens of the family caregiver. Effective assessment processes are the first step to good care planning and worthwhile service implementation. By better understanding the full range of challenges faced by the family, it is possible for the professional to save valuable time and energy for everyone involved. This technique is designed for the case manager within a private practice, yet can be used across multiple service fields, including medical, social, legal and financial services to better
serve elders and their families when facing the many issues of long term care for dementia.

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Questioning Aging Answers

Advanced Directives May Not Prevent Aggressive Medical Treatment

Aggressive medical treatment for Medicare patients at the end of life has been on the increase according to studies published by Medicare1  and by JAMA2.

This aggressive treatment leads to more people receiving care in intensive care units and more people being shuffled between hospital, home and skilled nursing care in their last several months of life.

Unfortunately, the aggressive medical care is not helping those patients studied to live longer, nor are they experiencing a better quality of life than people who receive more conservative treatment.

When polled, people do not generally want this type of care. A Stanford School of Medicine Study3  found that more than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life.

In fact, aggressive treatment can cause chaos and pain for patients and their families. Consumer Reports4  notes that families who have lost loved ones after aggressive treatments often say they regret not having recognized sooner that aggressive treatment was not beneficial.

Are physicians working with the intention of Advanced Directives?

Interestingly, both the Stanford study and a recent poll on the physician social media site Sermo5  both indicate that physicians, regarding their own medical care, would very rarely choose aggressive treatment. On the other hand, these same physicians tend to pursue aggressive treatment for their patients facing the same proposed prognosis.

The Stanford study noted that advanced healthcare directives had little impact on aggressive treatment:

“In fact, the type of treatments they (the patients) receive depends not on the patients’ care preferences or on their advance directives, but rather on the local health-care system variables, such as institutional capacity and individual doctors’ practice style…”

Why are physicians pursuing aggressive treatment?

Physicians have a focus on diagnoses and treatment of disease, so this singular focus can also cause a major blind spot. A person is much more than his or her condition or disease, and yet in the medical treatment process, the person can be “lost” in favor of a focus on their condition.

As noted by Dr. Periyakoil, author of the Stanford study, “Patients’ voices are often too feeble and drowned out by the speed and intensity of a fragmented health-care system.”

Physicians are not generally trained or paid to deeply examine a patient’s personal life philosophy, personal history and life experience, emotional life, cultural influences, spiritual beliefs, or family and personal relationships.
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To put it another way, what doctors know about a patient may represent very little of what a patient may consider to be essential to “who they are.”

It makes sense that a physician, who knows herself as a person, would choose less aggressive treatment for herself and pursue more aggressive treatment for her patient, whom she knows primarily by condition or disease. This outcome is probably unrelated to whether or not the physician is a caring or compassionate person and is rather a result of the constraints of time, function and capacity.

What can you do to have your healthcare preferences followed?

Patients and their families must recognize the limitations of physicians and of medical systems, in general. These systems and professionals cannot have a complete understanding of patients’ personal lives and issues.

When faced with significant medical decisions, it is essential to seek out as much family, friend, professional and spiritual support as may be needed.

An advanced directive is an excellent starting point, but having a professional or family member who can successfully advocate for its intentions to be followed may be most important.

Anne Conrad-Antoville is CEO and a founder of Champion Advocates LLC, a geriatric case management firm serving Portland, Oregon and Northern California. She has worked with many hundreds of families regarding senior healthcare issues for the past 30 years.

1The Medicare News Group: “The Cost and Quality Conundrum of American End-of-Life Care”

2JAMA: “Change in End-of-Life Care for Medicare Beneficiaries
Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009”

3Stanford Medicine News Center: “Most physicians would forgo aggressive treatment for themselves at the end of life, study finds”

4Consumer Reports: “Too much treatment?
Aggressive medical care can lead to more pain with no gain”

5SERMO: “How Doctors Die: Only 7% Choose Extraordinary Measures”

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Questioning Aging Answers

Medical Alert Devices – Too Little, Too Late

An older woman cries out pleading for help from the bottom of a stairway in a large and empty house, and we are led to the conclusion that if only she had a medical alert device worn around her neck she could have emergency first responders there in minutes.

But what then…? How does the second half of this supposedly “averted” tragedy play out?

As reported by the Centers for Diseases Control and Prevention (CDC)*:

“In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized.”

“People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.”

So instead of lying on the floor for hours or days incurring additional life threatening conditions or worse, our female victim is whisked to the hospital and most likely will be treated and then discharged to a long-term care facility, either an assisted living or a skilled nursing facility for a year or more or until the end of her life.

The ability to lie on the floor and push a button may provide some level of comfort and security to seniors and their families yet when the fall has already occurred and resulting injuries sustained, the reality is your parent is lying there just pushing a button for help.

Now, a life will change in ways not to be desired by anyone. He or she will most likely be shuttled into a vast medical system to wind up in a bed that is not theirs and to no longer live in their own home.

This is the real fear older people live with. The fear of losing their independence and being institutionalized needlessly or prematurely.

If only the family had pushed beyond the simplistic notion that technology and telecommunications were all that was needed to keep mom or dad safe. If only our fear-based advertising could help us consider what happens after that last ditched effort is activated. Then, we could achieve compassionate aging for everyone concerned, senior and family caregiver alike.
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Like the CDC states*:

“Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable.”

Geriatric case managers are qualified professionals to identify and evaluate many safety risks based upon mobility, vision and other physical deficits, environmental factors around the home, medical and behavioral conditions. By providing comprehensive assessments including balance and gait and home safety assessments, appropriate provisions and safeguards can be allotted and falls and many other unrealized dangers can be truly averted.

Medical alert products and services are worthwhile, but they are the very last line of safety. If they are to provide comfort and security, they should be part of a much more comprehensive approach to an elder’s care – one where that button need never be pressed.

© Anthony Antoville 2014

Anthony Antoville is Care Manager, Certified and COO of Champion Advocates LLC in Portland, Oregon providing geriatric case management services. He is a recognized expert in eldercare and home safety, internationally published with The Edwin Mellen Press.

*The Centers for Diseases Control and Prevention (CDC) Website “Home and Falls Among Older Adults: An Overview” Last Updated: 9/20/2013

 

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Questioning Aging Answers

Pets: Mirroring Our Care and Our Fear

“Arthritis – How diet, supplements and alternative therapies can ease those aching joints; How to Care for Your ‘Super Senior’; Catching Cancer Early; Chiropractic Care for Your Senior.”

What reader is this table of contents written for?

Apparently, a popular pet magazine has keyed into our Western obsession with wellness and longevity. It appears to be encouraging us to transfer this obsession onto our pets. If it were not for the cover picture and the magazine’s title, I could very well have been looking at a periodical geared for the non-pet owning reader.

Eventually, some of the article titles returned me to the reality of the subject at hand: “Protect Your Dog’s Joints; Cognitive Dysfunction in Cats; Pancreatitis in Dogs and Cats.”

Now, don’t get me wrong. I have loved and cared for animals all of my adult life and have seen these animals as members of my family. I feed my cats the best foods that I can discern from reviewing nutritional content and food sources. When my Shepard-lab mix suffered from hip dysphasia in his mid-teens, I improved his bed, gave him a daily glucosamine chondroitin supplement and even cared for him through bouts of incontinence until he could no longer easily walk.

Clearly, we need to care for the animals that are dependent upon us to thrive and survive, but have we taken our society’s obsession for longevity too far by imposing it onto our family pets?

Is our fear of disease and death causing our pets to live with conditions and undergo therapies and surgeries primarily to make us feel better about ourselves?

Some parents suggest affixing a kids GPS device to the belt loop on the back side of your child’s free sample viagra pants. Many of men feel hesitate on buying viagra from canadian pharmacies from physical pharmacy store. Urology has various branches, such as endourology, where the urologist performs minor surgeries, neurourology, which covers order cialis the nervous system as it secretes lipase, amylase, and protease. Kamagra is also very effective in inhibiting PDE5 enzymes and lead to healthy erection of the penis. generic cialis 20mg In the book, Withrow & MacEwen’s Small Animal Clinical Oncology (Fourth Edition); the authors reveal that cancer in pets is on the rise due to increased longevity in pets. Furthermore, cancer treatments for pets are on the rise due to increased demand from pet owners, who are largely driven by media on the subject. The authors clearly state, “Pet animals with spontaneously developing cancer provide an excellent opportunity to study many aspects of cancer from etiology to treatment.” They further outline fifteen superior opportunities for studying human cancer and treatment through treatment of pets, over laboratory studies of mice and rats.* Therefore we might ask, Who is really benefitting here?

Pets are a primary connection between us and the natural world of animals and other forms of life. How do our societal obsessions affect our relationships with the natural world and to our own natural cycles of life? How far out of control have our fears become?

© Anthony Antoville 2014

Anthony Antoville is COO of Champion Advocates LLC in Portland, Oregon. He has been serving a wide range of elder needs since 1991. Anthony is a published author with The Edwin Mellen Press.

*Introduction: Why Worry About Cancer in Pets? Withrow & MacEwen’s Small Animal Clinical Oncology (Fourth Edition) Edited by: Stephen J. Withrow, DVM, DACVS, DACVIM (Oncology), and David M. Vail, DVM, DACVIM (Oncology)

Animal Wellness Magazine Vol 16 Issue 4

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Questioning Aging Answers

Illuminating Better Pathways for Aging

Compassionate Aging is a conscious and intent-driven approach to an inherent process of life. To move from an outward view of living, aging and eventually dying, to move towards a revitalized vision that seeks to gain deeper insights as to the inward journey of a life lived, requires us to individually pause, breathe and feel.

To feel beyond our basic physical pleasures and pains and to reach past our surface emotions is not often a practice in our daily lives. We are taught to subjugate, relegate and isolate our feelings and to conceal them from ourselves and others at all costs, except in the most banal forms of expression.

Look around at any moment in your day and you will find much you or I would rather choose to avoid to experience and feel. Our lives are surrounded by visuals and sound bites filled with pain, cruelty and misery. So why feel more deeply, when feeling anything at all touches upon such potential agony?

Because avoidance will only postpone what cannot be denied during the stillness that awaits each of us at that hour of death. Either, our own death or the death of a loved one will reveal regret, sorrow or guilt that has been repressed. Why then accumulate what can be released and recycled into more healthy emotions, thoughts and actions?

Buleylu oil reduces dullness of levitra uk the skin on skin, the softness, relaxing, tender time between mother and child forge a bond that can last a lifetime. Over the counter drugs have the benefit to choose from various brands and also the advantage of discounts and offers. viagra online online Ginkgo is said to be particularly useful for people who experience sexual dysfunction due to the side of the jet or a restricted leaflet motion on the side canadian viagra store of caution if you must. Maybe you never heard that natural cures and viagra tab the medical cures. CompassionateAging.org and the blogs posted on this site are intended to spark contemplation, consideration and conversation as to what each of us can discover at any point in a person’s life as sacred, why respect between generations should be a sustained practice and how compassionate aging is ethically and vitally interwoven with caring for our planet as a core principle for every generation.

If serious contemplations and considerations regarding aging issues emerge out of the din of the pervasive knee-jerk reactions to our current and ever burgeoning aging population scenario, then this website and its articles will have achieved an intended goal. And yet, it will be only a starting place from which to initiate this quest for compassionate aging.

© Anthony Antoville 2014

Anthony Antoville is COO of Champion Advocates LLC and Co-Founder of compassionateaging.org

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