- Factors Associated With Perceived Quality of Life Among Rural and Urban Elders in Kentucky
- Three Questions About Aging-in-Place
- Tres Preguntas Sobre el Envejecimiento-en-Casa (Three Questions About Aging-in-Place)
- The Lack of Access to Health Care for Many Older Adults
- New Grant Expands Benefits of Medication Management to High-Risk Elders Living at Home
- Vital Aging Current Trends
Archive for the ‘ Vital Aging ’ Category
Vital Aging Current Trends
Vital Aging Current Trends – Expanding Benefits of Medication Management
New Grant Expands Benefits of Medication Management to High-Risk Elders Living at Home Cost-effective Medication Management Interventions for Low-income Seniors in Home Care Minimizes Drug Errors, Saves Lives, Raises Standard of Practice
and human costs, are largely preventable with intervention among vulnerable elderly
(San Fernando, Calif., September 28, 2006) — Older adults, especially low-income seniors living at home, are seven times more vulnerable to drug errors than any other age group. According to several studies, medication problems among elders, whose error rate increases as they are treated by more doctors and prescribed more drugs without coordinated care, are the 5th leading cause of death and enormously costly, amounting to between $85 billion and $177 billion annually in direct medical costs. America spends nearly $200 billion annually treating the results of these errors. Yet, these medication problems are largely preventable.
In response to the high human and economic cost of these errors, The John A. Hartford Foundation has awarded $1.7 million to fund the national expansion of Partners in Care Foundation's innovative Medication Management Model (http://www.homemeds.org) announced W. June Simmons, president and CEO of the San Fernando Valley, California-based non-profit. “This next-step grant underscores the importance of expanding Partners' evidence-based model of care for the vulnerable at-home elderly population to an additional three states.”
Building on the success of previous Partners in Care (www.picf.org) projects in medication management, the new grant will complement and extend work funded by the Administration on Aging. This program will use interventions originally developed for older patients receiving home health services and adapt them for use with low-income elders living at home who would qualify for admission to a nursing home. The model introduces a computer-based tool that alerts care managers when a potential drug error is found. After consulting with a pharmacist, they communicate with the patient, family, and physician to eliminate the problem. This computer-based alert system is being developed by RTZ Associates in San Francisco, California.
Expanding Medication Management for High-Risk Elderly at-Home
“It's a major issue of equity,” notes Dennee Frey, PharmD., the grant's co-principal investigator. “Older adults living at home are acutely vulnerable to medication problems, largely because they lack the kind of medication management that can help prevent errors. Residents of skilled nursing facilities receive federally mandated monthly drug reviews by consultant pharmacists. However, equally vulnerable seniors remaining at home in their communities do not have the same benefit.”
Ms. Simmons, who serves as principal investigator, points out that, in a defining study led by Vanderbilt University and supported by The John A. Hartford Foundation between 1994 and 2001, the medication management model significantly reduced medication errors among home health care recipients aged 65+. “More recently, Partners in Care replicated this model among a population of frail elders living at home who are at even higher risk for medication errors, in a project funded by the Federal Administration on Aging.”
To date, the Partners project has tested the medication management intervention in three Los Angeles-area nursing home alternative Medicaid waiver (MSSP) care management sites, with a sample of 615 elderly clients. Prior studies and Partners' previous work had demonstrated the high prevalence of potentially serious and life-threatening medication errors among elders. In the most recent study, the incidence of medication errors was much higher than expected among Medicaid waiver clients. Almost 50% of the 615 clients screened presented with evidence of potentially harmful medication errors; almost 40% confirmed with problems. “This error rate is well over double the 17% incidence rate reported in the previous Vanderbilt home health study. Ms. Simmons points out, “The benefits of an intervention to identify and significantly reduce these errors are to prevent harm and enhance health and well-being.”
In addition, more than 100 home health agencies have adopted the Partners model. Dramatic preliminary findings have validated the need for continued efforts to improve medication management among the expanding elderly population.
Demonstration, Dissemination, Adoption are Major Grant Outcomes
In partnership with the National Council on Aging (NCOA), the new grant will demonstrate and support adoption of the evidence-based Medication Management Model in programs that oversee home care for low-income elders who otherwise would need nursing home care.
Targeting eight geographically dispersed and diverse home care management programs in three states, the Project engages the Diffusion of Innovation Expert System to create a Medication Management Diffusion Tool that will screen and provide feedback to potential sites to increase their likelihood of success.
To further disseminate the model, the Partners Medication Management team will pilot-test and implement an innovative online workshop that provides Medicaid waiver programs across the country with the education, guidance, and support needed to implement this medication
management intervention in their sites. The team will then broadly disseminate the intervention to home care agencies and other community-based care management programs using a proven strategy that includes web-based methods and the NCOA System.
Finally, the Project will measure and evaluate the impact of the intervention implementation, including a comparison and control group in California, provide technical assistance to additional programs nationally and disseminate the findings and observations to the professional community.
Establishing Higher Practice Standards for Home Care Medication Management
“These demonstration, diffusion and dissemination activities will assist waiver programs for elders in building capacity to efficiently identify and resolve their clients' widespread and potentially dangerous medication errors,” observes Ms. Simmons. “In doing so, the project will help establish new, stronger, and much needed practice standards for medication management in waiver programs throughout the nation. The long-term goal of the Project is to integrate into waiver programs a national practice standard for medication management that will dramatically reduce medication errors and related health problems, thereby keeping very frail older adults in their homes and out of nursing homes.”
For additional details on the medication management project, contact: W. June Simmons at (818) 837-3775, ext. 101; email jsimmons@picf.org.
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Vital Aging Tip Sheet – Questions and Answers About Depression in Older Adults
Introduction
Depression is very common in our senior population. Depression affects about six million Americans age 65 and older. Unfortunately, only 10 percent receive treatment. Below are answers to some of the most frequently asked questions about depression in the older adults.
Q: Isn’t depression a normal part of getting older?
No. It is not a ‘normal' part of getting older. Depression is a very serious problem among the older adults. Older individuals with significant symptoms of depression have roughly 50 percent higher health care costs than seniors who are not depressed.
Q: What are the causes of depression among the older adults?
Getting older is often accompanied by loss of key social support systems, such as the death of a spouse, siblings or significant others, retirement, or a change of residence. Financial concerns can also contribute to depression.
Depression can also be triggered by long-term illnesses that are common in later life, such as:
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diabetes | |
chronic lung disease |
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stroke | |
Alzheimer’s disease |
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heart disease | |
Parkinson’s disease |
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cancer | |
arthritis |
Q: What are the symptoms of depression?
Symptoms of depression include:
- sleeping either too much or having trouble sleeping
- change in appetite — weight gain or loss
- feeling sad or hopeless
- loss of interest or pleasure in things previously enjoyed
- trouble concentrating or memory loss
- lack of energy not attributed to a medical problem, and other possible symptoms.
Q: Can a person who is depressed snap themselves out of it?
Everyone has their "down" days that may resolve on their own. However, if the symptoms of depression continue most of the day for 2 weeks or more, the person may be suffering from a depression that needs treatment. A person can not just will themselves to "snap out of it."
Q: Is depression treatable?
It is important to realize that depression is very treatable. No one should have to suffer without trying to take advantage of the help that is available.
Unfortunately, doctors and family often miss the diagnosis of depression in older adults. This may result in no treatment or delays in treatment. Sometimes, symptoms of depression — such as decreases in mood, interest, energy, sleep, and concentration – are attributed to age-related medical conditions or to aging itself.
Q: What is the treatment for depression?
It has been consistently shown that a combination of antidepressant medication and counseling (also called "talk therapy") work better than either option alone. Talk therapy is a process in which a trained professional enters a relationship with a client to help the client address his or her issues. For instance, meeting with a clinical social worker may provide an opportunity to receive emotional support and to express feelings in a safe environment with a person who is objective. Often people prefer not to share their personal feelings and thoughts with family or friends.
Exercise has also shown to be helpful as has support groups and other ways to decrease the isolation that sometimes accompanies depression.
Q: I don’t want to take any more medications and risk the side effects. What can I do?
Some people do not have any side effects from antidepressant medications. Other people do experience side effects initially and may find the side effects diminish as their body gets used to the new medication. If, after talking to your doctor you decide you’d rather avoid medications totally, you can try seeing a clinical social worker for counseling. This can give you the opportunity to talk about the changes and/or stressors in your life and other factors that may be contributing to your depression.
Q: Who can prescribe antidepressants?
Many primary care physicians and nurse practitioners will prescribe antidepressants. Unfortunately, if the initial prescription does not work, the medication is often discontinued rather than being adjusted as needed. If this is the case, seeing a psychiatrist may be helpful. Psychiatrists are medical doctors who specialize prescribing in these types of medications. They can start you on a suitable dosage and monitor you for any side effects. They can then adjust the medications accordingly to give maximum benefits.
Q: How long does it take to feel better with antidepressant medication?
Results of treatment using antidepressant medications vary depending on the individual. Treatment works gradually over several weeks. It is important to realize that you will not feel better 30 minutes after taking a pill for depression like you might with medications for other things. It may take a month before you and your doctor can begin to see the benefits of medication and how they are working for you. Ongoing monitoring is recommended.
Q: I am receiving a ‘happy pill' from my primary care doctor. Do you think I have to worry about it?
It is a good idea to keep your physician informed of how you are doing on this medication. Often the dosage may need to be adjusted in order to receive maximum benefit. Sometimes several medications need to be tried to find the best one for you.
Q: I’ve been taking an antidepressant medication for a few months now and don’t want to take it anymore. Can I quit taking them on my own?
As with most medications, you should consult the prescribing doctor before stopping the medications.
Q: What can you do if someone you care about may be depressed?
Let them know you are concerned about them and what changes you have noticed. Help them realize that it is not a sign of weakness to accept the assistance of others. Tell them that help is available.
Q: How can I get help? Who can help me?
There are several sources of help in the area. It may be a good idea to discuss how you feel with your primary physician who can check to see if there are any underlying medical issues.
Clinical social workers experienced in counseling are available to meet with seniors either in an office or in their own homes. Many accept Medicare assignment. Some people also find support from their clergy. If you decide to try medications, seeing a psychiatrist specifically experienced in working with the older adults is suggested.
The National Institute of Mental Health considers depression in people age 65 and older to be a major public health problem.
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Vital Aging – Your Options: Alcohol and Aging: Myths, Realities, and Treatment Options
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Introduction | |
Mr. Collins |
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Seniors and Problem Drinking | |
Mrs. Carlson |
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How Many Are Too Many Drinks? | |
Receiving Treatment |
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Alcohol’s Effect on the Body |
Mrs. Jones, age 76, is unsteady on her feet, has tremors in her hands and is malnourished. She is also forgetful, often disoriented and has difficulty staying on track in a conversation. What do you think her problem is? A variety of medical illnesses come to mind, as well and depression and dementia. What might you think about Mrs. Jones if she were 42-years old and had the same symptoms? If you are like most people, the possibility of an alcohol problem would occur to you in the latter case but not in the former.
Who Has an Alcohol Problem?
The good news is that 60 percent of older people in this country drink very little or not at all. The proportion of people over 65 who have a drinking problem is approximately 10 percent. However, among older people who have chronic health problems or are often seen in medical and health care facilities, the proportion is closer to 50 percent!
It is also true that most cases of alcoholism are overlooked by primary care doctors, regardless of the patient's age. This is particularly likely with older patients. Doctors have little time to ask specific questions that would tease out an alcohol problem, and a senior is unlikely to volunteer the information. Older people may not realize they are drinking too much for their age, or they may be ashamed to bring it up.
How Many Are Too Many Drinks?
Older adults don't metabolize alcohol and other substances as quickly as younger people. Generally, an at risk older drinker is someone who drinks over one to two drinks per day or more than seven to fourteen drinks per week. That is one drink per day for an older woman, and two drinks per day for an older man, recognizing the differences in male and female bodies. And a senior who consumes four or more drinks in 24 hours is biologically in real trouble. One can of beer, one glass of wine, a single shot of spirits or a small glass of sherry: these all equal one drink.
Alcohol’s Effect on the Body
Alcohol is a toxic substance that adversely affects every organ in its path. It damages not only the liver, but the kidneys, the intestines, the stomach, the throat, the mouth and the brain. Problem drinkers increase their risk for Alzheimer's disease and other forms of dementia. Additionally, alcohol causes loss of calcium and contributes to osteoporosis (the bone disease), and it impairs the body's immune system which helps fight off disease. Weight loss, malnutrition, dehydration, metabolic imbalances, insomnia and insensitivity to pain are common side effects of drinking.
Mr. Collins
Meet Mr. Collins. He is a retired construction worker and lives alone in a downtown apartment. He spends his time watching tv and playing pool or just hanging out with a couple of buddies. Married and divorced twice, he has little contact with his grown children, and his daughter won't trust him with her children.
Worried about chest pains, fainting spells and constipation, he finally goes to a doctor. Mr. Collins tells the doctor he had a tough start in life, had a "mean drunk" for a father. Mr. Collins left home at age 17 to join the army, where he spent time in Vietnam, "seeing and doing some pretty bad things." He also admits he drank and drugged in the army but proudly reports he quit all the drugs himself when he returned to the States.
When asked by the doctor about his drinking now, Mr. Collins says he has cut back a lot over the years, just has a few beers with his pals now and then. He has provided us with a number of red flags for a drinking problem, including family history, past abuse, isolation from family, and medical symptoms.
The good news is that he does not want to "drop dead alone in the apartment", and he would really like to convince the daughter to let him spend time with his grandchildren. A savvy health care professional could help Mr. Collins make the connection between his drinking and his concerns. He may not know how a six pack of beer every couple of days is hurting him.
Mrs. Carlson
Or consider Mrs. Carlson, a sixty-year-old homemaker whose busy husband is still practicing law and traveling out of town to give speeches. For years it has been their custom to have a cocktail or two with dinner each night that he is home.
During the past year, she has had difficulty going to sleep at night and has been taking a sedative prescribed by her doctor. She believes taking the sedative along with a few cocktails is helping her get to sleep. Mrs. Carlson's problem with alcohol and medication comes to light after she has some elective surgery.
When in the recovery room, she experiences agitation, an elevated pulse and respiration and nearly has a seizure. No one had thought prior to surgery to ask her if she drank regularly. Now she feels embarrassed and humiliated, and her husband and grown children are shocked to discover that her nightly cocktails have made her a problem drinker.
Approximately one-third of older problem drinkers are like Mrs. Carlson who didn't have an abuse problem earlier in their lives. They generally have good coping skills and good relationships with others, and they are likely to deny or hide the problem. Others are likely to miss it, too.
Receiving Treatment
Once a drinking problem is recognized in an older person, the prognosis for improvement is good, provided the person receives interventions tailored to the needs of older people.
Researchers at the University of Michigan have developed and tested a brief intervention program specifically designed for use with older Americans experiencing a drug or alcohol problem. This approach relies on what is commonly termed motivational interviewing, with an educational slant.
It is important to Focus on a concern for the person's health and well-being while avoiding the use of accusatory language and labels. It works better to weave questions about alcohol use into a discussion of daily self care, including diet and exercise. The client receives educational materials about the effects of alcohol on the older body and then there is a discussion of the older person's own goals and how drinking might be a barrier.
For Mr. Collins, that means letting him know that most men his age drink considerably less than he, if at all, and expressing genuine concern for the impact of drinking on his health and his inability to see his grandchildren. He decides not to drink on weekends as a start; as a result of his commitment to his decision, he is soon able to visit the grandchildren on Sundays.
To learn more about alcohol and aging, visit the U. S. Department of Health and Human Services web site at www.csat.samhsa.gov or call 1-800-729-6686 to order free literature. And there is a national hotline to help connect older people experiencing alcohol problems with appropriate treatment providers: 1-800-662-4357.
Related Articles:
Vital Aging Current Trends
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Statistics and Trends on an Aging Population |
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The Myth of the Sick, Frail, and Feeble-Minded Older Adult |
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Lessons from Centenarians (age 100 or older) |
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Important Factors of Successful Aging |
Statistics and Trends on an Aging Population
- In 2003 there were 36 million adults age 65 and older, accounting for 12 percent of the American population. The number of older adults grew from three million to 35 million in the 20th century.
- This population is expected to double by 2030 to a total of 72 million, or 20 percent of the American population.
- The older Hispanic population is projected to grow faster than any other minority group, from two million in 2003 to 15 million in 2050. By 2028, the number of older Hispanic adults is expected to exceed the number of older African Americans.
- Lifespan is increasing. Adults who live to age 65 can expect to live an average of 18 more years. Women who reach age 85 can expect to live another seven years.
The Myth of the Sick, Frail, and Feeble-Minded Older Adult
- Only 10 percent of women and 19 percent of men reported ever wearing a hearing aid in 2002.
- Poor vision affects 18 percent of the older population. In the age 85 and older population, 33 percent reported having trouble with their vision.
- Only 15 percent of men age 65-74 and 11 percent of women experienced moderate or severe memory impairment.
- Chronic disability has declined from 25 percent of older adults in 1984 to 20 percent in 1999.
- In 2002, 73 percent of Americans over age 65 rated their health as good, very good, or excellent.
Lessons from Centenarians (age 100 or older)
Various studies of centenarians show that, in general, they:
- Maintain a healthy weight
- Do not smoke
- Have delayed chronic health conditions, such as heart disease, stroke, cancer
- Handle stress effectively
- Have an ability to cope with loss and get on with their lives
- Have a high degree of self-sufficiency and are resourceful in overcoming problems
- Have a sense of humor
- Look forward to the future with hope
- Stay engaged in a hobby, volunteering, or interest
Important Factors of Successful Aging
In a 2000 survey, adults age 75 and older rated the following as important aspects of aging in order of priority:
- Family and friends
- Health and well-being
- Spirituality
- Community involvement
- New learning experiences
Sources:
- Center for Healthy Aging
- Federal Interagency Forum on Aging-Related Statistics, Older Americans 2004: Key Indicators of Well-Being
- National Council on the Aging
- U.S. Census Bureau
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Vital Aging Resources
AARP
AARP is a nonprofit, nonpartisan membership organization for people age 50 and over. AARP is dedicated to enhancing quality of life for all as we age. The organization leads positive social change and deliver value to members through information, advocacy and service. AARP also provides a wide range of unique benefits, special products, and services for its members.
www.aarp.org
The Alliance for Aging Research
The Alliance for Aging Research is the nation’s lading non-profit organization dedicated to supporting and accelerating the pace of medical discoveries to vastly improve the universal experience of aging health.
www.agingresearch.org
The American Society on Aging’s “Live Well, Live Long” Project
The American Society on Aging has created strategies and materials to enhance the capacity of national, state and local organizations in serving the health promotion and disease prevention needs of older adults. Funded through a grant from the Centers for Disease Control and Prevention, these strategies and materials are designed to increase understanding of the changing health and social service needs of an aging and more diverse population.
www.asaging.org/cdc/index.cfm
Geriatric Social Work Initiative
The Geriatric Social Work Initiative (GSWI) is collaborating with social work programs, organizations and other funders around the country to prepare needed, aging-savvy social workers and improve the care and well-being of older adults and their families.
http://www.gswi.org/current_issues/links_aging_resources.html
Vital Aging Network
The Vital Aging Network is sponsored by the University of Minnesota College of Continuing Education to provide resources for just about any issue “vital agers” (loosely defined as anyone age 55 or better) may encounter. In addition to providing resources that link people to opportunities for meaningful and productive activities, this Web site is also intended to be a forum where individuals and organizations can work collaboratively to promote self-sufficiency, community participation and quality of life for older adults.
www.van.umn.edu
