Preventing Falls Among The Elderly

Preventing Falls Among The Elderly

Posted on Monday, December 31st, 2012 at 7:23 pm by Life Matters Media

Falls are still a leading cause of death and hospitalization among elderly Americans, according to a new article published in the Journal of the American Medical Association. Centers for Medicare and Medicaid Services now classify institutional falls as ”serious reportable events,” as systematic reviews estimate only 20 percent of falls can be prevented within hospitals.

“In the past decade, the prevention of falls, particularly involving older institutionalized patients, has become a focus for practitioners, researchers, policy makers, and accreditors,” write Samir K. Sinha, M.D., and Allan S. Detsky, M.D.

They continue: “Falls represent a leading cause of hospital admissions for trauma and deaths in older adults. Furthermore, 1 in 5 inpatients falls at least once during a hospitalization, and these falls can result in injuries, increased lengths of stay, malpractice lawsuits, and considerable incremental costs.”

Researchers suggest the easiest way to prevent falls is to reduce their chances of occurrence, mainly by limiting unsupervised patient movement and activity within care settings. High fall rates hint at poor care within hospitals for elderly patients.

However, manufacturers have begun to create new devices that severely limit the free movement of seniors in hopes they may avoid accidental falls. These devices replace the once common physical restraints.

Difficult to get out of chairs, enclosed beds, and even sock alarms now circumvent guidelines against the use of traditional restraints, Sharon K. Inouye, M.D., wrote for the New England Journal of Medicine.

Bedridden seniors lose physical functionality, and this loss increases their risk of falling. Environments that don’t encourage a patient’s ability to periodically transfer out of bed and promote walking can contribute to the rapid loss of function, at a rate as high as 5 percent a day.

Instead of providing unsupervised activity or limiting patient movement with technology, the researchers suggest a more balanced approach: focus on early and safe mobilization.

Since the elderly have more free time to partake in exercise classes, it is easier for them to engage in exercise regimens- especially group classes where they may socialize. Early mobilization may help improve seniors’ quality of life.


Spirituality At End Of Life

Posted on Friday, December 28th, 2012 at 5:07 pm by Life Matters Media

Spirituality

Physicians and nurses at Boston medical centers cited a lack of training as the main reason why they rarely provided spiritual care for their terminally ill cancer patients, even though most patients considered it important to their end of life care.

A new study published in the Journal of Clinical Oncology reports that out of the 204 physicians from four medical centers who participated in the three year study, just 24 percent reported providing spiritual care. Among the 118 nurses, only 31 percent reported providing care.

“I was quite surprised that it was really just lack of training that dominated the reasons why,” senior author Dr. Tracy Balboni, an oncologist at the Dana-Farber Cancer Institute in Boston and researcher of spirituality, told Reuters Health.

Spiritual care may range from prayer with a physician or nurse to recommendations for a hospital chaplain.

Spiritual care “is considered by patients to be an important aspect of end of life care and is also associated with key patient outcomes, including patient quality of life, satisfaction with hospital care, increased hospice use, decreased aggressive medical interventions, and medical costs,” Balboni said.

Even though current palliative care guidelines encourage medical practitioners to mind religious and spiritual needs that arise during a patient’s end of life care, most medical practitioners remain silent. Ninety-four percent of patients with advanced cancer had never received any form of spiritual care from physicians.

Stanford School of Medicine

Stanford School of Medicine

Spiritual care may become more common in the future, however. “There was a time when nurses and physicians may have said, ‘That’s not my job,’ but I think the tides are changing,” said palliative care researcher Betty Ferrell of City of Hope, a cancer research center in Duarte, California.

“I think we are realizing we can no longer ignore this aspect of care,” Ferrell told Reuters. She’s a professor of nursing who was not involved in the new study.

Study researchers suggest more spiritual care training for physicians and nurses. The study found only 13 percent of doctors and nurses reported having such training. However, those who received training were almost 11 times more likely to provide spiritual care to their patients than those who had not.


Hospitals Fear Medicare Cuts

Posted on Saturday, December 22nd, 2012 at 7:30 pm by Life Matters Media

With fiscal cliff” negotiations stalling and entitlement cuts and changes pending in Congress, some hospitals fear they’ll be left to fill in gaps left by Medicare cuts. Both President Obama and House Republicans have proposed raising Medicare premiums and savings of at least $400 billion over 10 years.

The New York Times reports: “[T]here is already discussion of cutting special payments to teaching hospitals and small rural hospitals. Lawmakers are also considering reducing payments to hospitals for certain outpatient services that can be performed at lower cost in doctors’ offices,” although final details may not be worked out until next year.

Hospitals already face $155 billion in cuts over a decade as part of the Affordable Care Act, they now must deal with the prospect of losing billions more, the Times reports.

Some hospital executives and provider groups argue large cuts will affect beneficiaries- especially seniors and the poor. “There is no such thing as a cut to a provider that isn’t a cut to a beneficiary,” said Dr. Steven M. Safyer, the chief executive of Montefiore Medical Center.

“It is not particularly honest to say that provider payment reductions won’t affect beneficiaries. They’ll affect staffing, they’ll affect services, they’ll affect access,” Rich Umbdenstock, president of the American Hospital Association, told the Wall Street Journal. ”The cost of care does not go away.”

Illinois’ News-Gazette reports hospital executives already tightening up spending as much as possible to get ready for cuts on the way- either the 2 percent across-the-board sequester or possible debt deal. But they can’t plan for everything, they say.

“It’s hard to know what to be concerned about,” said Craig Sheagren, vice president of finance at Sarah Bush Lincoln Health Center, Mattoon Ill. “It’s kind of like crying, ‘The sky is falling. The sky is falling.’ ”

If no meaningful legislation passes to extend the federal debt limit, Medicare payments to hospitals and doctors will suffer deep cuts anyway, although much less than the current proposals of the President and Speaker Boehner, an estimated $123 billion from 2013 to 2021; doctors will face a 26.5 percent cut in their Medicare fees.


Obesity And End Of Life

Posted on Tuesday, December 18th, 2012 at 4:39 pm by Life Matters Media

As the U.S. continues to campaign against what some call “the obesity epidemic,” research shows that weight may affect the quality and costs of end of life care. By 2030, at least 60 percent of Americans in 13 states will be obese, according to the Centers for Disease Control.

Obesity’s effect on economics and health care

The CDC recently gave the nation an “F” for its obesity epidemic. More than 35 percent of adults and some 17 percent of children age 2 to 19 are obese.

Dr. Dean Griffin, Surgery Professor at LSU Health Shreveport, said as those numbers rise, costs of care rise and quality of care diminishes. “The cost goes up dramatically because these patients tend to stay in the hospital longer and because they have more complications, there are additional costs,” he told Louisiana’s KTBS. ”Surgery is much more difficult in patients who are overweight, that makes it very difficult, for example, to gain exposure.”

CDC

CDC

The CDC analysis found combined medical costs associated with treating preventable obesity-related diseases will increase between $48 billion and $66 billion per year in the U.S. by 2030. The loss in economic productivity could be as much as $580 billion annually by 2030.

Obese struggle with transitions from hospitals

Hospital case managers, nursing home and home care agency directors report patient size impacts transitions from hospital settings, according to a study by East Carolina University’s College of Nursing. This study is one of the few done on the issue.

“The increase in obese patients within the hospitalized patient population has become a challenge for nurses. Providing care for obese patients necessitates the use of assistive equipment and requires more staff members and more time for nursing procedures,” researchers explain.

Even home care is sometimes deemed inadequate for an obese patient due to lack of caregiver support or inappropriate facilities. Nursing home placement is often difficult for the obese due to the inability or unwillingness of some facilities to accommodate them. Patients can become “stranded in the hospital,” the report states, and “experience subsequent deterioration of vigor as well as increase in cost.”

Similarly, a recent study published in the Journal of Palliative Medicine determined obesity creates significant challenges to palliative medicine, leading to premature death and poor quality of life. U.K. researchers found privacy, handling and transfer to hospice more difficult for the obese.


More Latinas Need Advance Care Plans

Posted on Friday, December 14th, 2012 at 2:52 pm by Life Matters Media

Little is known about the advance care plans of Colombian, Mexican and Puerto Rican women living the in the U.S., according to a new study commissioned by the University of South Florida. Researchers sought to identify decision-making patterns among Latinas and found language proficiency and health care access make it harder for them to plan for their end of life care.

Advance care planning involves learning about the types of decisions that might need to be made in case of a medical crisis or the end of life and aims to ensure an individual’s desires are carried out. Advance care planning is especially important for Latinas who experience social inequalities, discrimination and language barriers, the researchers note.

Researchers recorded Spanish language interviews with 45 Latinas in Central Florida who had been diagnosed with cancer. The majority of women, 35 in all, identified obstacles to information about planning, including insurance and financial factors. Only 10 women had completed at least one form associated with advance care planning. Only three of those 10 women had completed a living will, designated a health care surrogate and an enduring power of attorney.

Of the ten women who had taken steps to plan, four were Colombian, five were Puerto Rican and one was Mexican. Among the Colombians, three had only a living will and one had a living will, a designated surrogate and an enduring power of attorney. Two Puerto Rican women had a living will, a designated surrogate and an enduring power of attorney, two had just a living will, and one had both a living will and power of attorney.

Advance care planning among Colombian, Mexican, and Puerto Rican women with a cancer diagnosis

Advance care planning among Colombian, Mexican, and Puerto Rican women with a cancer diagnosis

Another 13 women stated they knew of advance care planning but had not completed any forms. According to researchers, “none [of the 13] were able to satisfactorily articulate the definition of ACP,” hinting at miscommunication within care settings.

A living will is a written document that tells doctors how a patient wants to be treated if permanently unconscious or incapable of making decisions about emergency treatment, according to the National Institute on Aging. A power of attorney is a legal document that names a healthcare proxy, someone to make medical decisions on behalf of a patient unable to do so.

Some Mexican women acknowledged the nature of their cancer diagnoses and informally discussed their wishes with family members, an unrefined form of planning. They trusted that their desires would be fulfilled, indicating a preference for family discussions instead of clinical ones.

The study, also supported by the Division of Population Sciences and the H. Lee Moffitt Cancer Center and Research Institute, aims to remedy the lack of information available on Latinas.

“The rapid growth among these three groups in the USA highlights the urgency of addressing ACP and decision making, given the increased risk of cancer among Colombians, Mexicans, and Puerto Ricans residing in the USA,” the researchers wrote. Cancer is the second leading cause of death among Latinos in the U.S., accounting for some 20 percent of deaths.

Researchers conclude that knowledge gap exists between the Latinas they studied. This gap stems perhaps as a result of immigration/migration history and lower levels of education, English language proficiency and income. Latinas who have been in the U.S. for a longer period of time knew more about advance care planning. More Spanish language forms and simpler language, they say, may help more Latinas create advance care plans.