Effectiveness of Hands-Only CPR Good News

An article on MSNBC reports,

two new studies conclude that "hands-only" chest compression is enough to save a life. They are the largest and most rigorous yet to suggest that breathing into a victim's mouth isn't needed in most cases.

This is really good news for a number of reasons.  The first is that it is easier to perform, requiring less skill and training.  A second major factor is that most folks who are not medical or healthcare professionals are far more willing to perform chest compressions than the mouth-to-mouth procedure.

At Support For Home In-Home Care, we require that our Home Care Aides are CPR certified, at the health professional level.  That is very unusual, however, even in the industry, much less in the general population.  The studies appear to indicate that 911 Dispatcher directed, hands-only CPR was most effective.  Bystanders operating under the Dispatcher's guidance were highly successful, even if they had not been trained in CPR techniques.  The simplicity of the hands-only approach contributes a lot to that.

The results confirm the American Heart Association's own recommendations, which have been hands-only for the last two years.  We still will require CPR training for our Home Care Aides, but this is still really good news.

Best wishes, Bert

Social Engagement Critical in Senior Care

Thanks to Marc Onigman in National Senior Living Providers Network for bringing a medical study to my attention.  The information is not really "news" to those of us in the senior home care industry, but it is always good to spotlight it.

When we do an assessment (free, of course) of a new client at Support For Home, we cover three areas:

1. Homemaker Services -- Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) in the home
2. Companion Services -- ADLs and IADLs that involve our interfaces with others and outside the home
3. Personal Services -- ADLs and IADLs such as bathing, dressing, toileting

As we discuss the second category, we frequently observe a much smaller social calendar and circle of friends and acquaintances than is "healthy."  Of course, that is not surprising, since, as we age, we tend to lose family members and friends.  The challenge is for our clients, hopefully with our help, to renew and rebuild that circle.  If my friend Joe and I never get together any more, because neither one of us drives, that can easily be and must be "fixed."  A truly Comprehensive Plan of Care must be as focused on number 2, above, as on 1 and 3.

The study is as cautious as all of them are, in terms of cause and effect, but reports,

In a pooled analysis of 148 studies, having strong social relationships was associated with a 50% greater likelihood of surviving through follow-up (OR 1.50, 95% CI 1.42 to 1.59), according to Julianne Holt-Lunstad, PhD, of Brigham Young University in Provo, Utah, and colleagues.

The magnitude of the association puts social relationships on a par with quitting smoking and beyond obesity and physical inactivity in terms of relationship with mortality, the researchers reported in the July issue of PLoS Medicine.

In the senior care industry, we must all put even more emphasis on this issue and look for creative ways to increase social interaction and relationships for our clients and patients.  It is not just a matter of quality of life.  It looks pretty clear it is about quantity of life.
Best wishes, Bert

Federal Study on Aging Good, But ...

There are some very interesting data points in the recently published study, "Older Americans 2010: Key Indicators of Well-Being."  The study was put out by
The Federal Interagency Forum on Aging-Related Statistics.

As most of us are aware,

Americans are living longer than ever before. Life expectancies at both age 65 and age 85 have increased. Under current mortality conditions, people who survive to age 65 can expect to live an average of 18.5 more years, about 4 years longer than people age 65 in 1960. The life expectancy of people who survive to age 85 today is 6.8 years for women and 5.7 years for men.

That is, on its face, a wonderful thing.  However, there are many implications that are a bit more complicated.  When one begins to look at the size of the senior population (including me), one's eyebrows begin to rise:

In 2008, 39 million people age 65 and over lived in the United States, accounting for 13 percent of the total population. The older population grew from 3 million in 1900 to 39 million in 2008. The oldest-old population (those age 85 and over) grew from just over 100,000 in 1900 to 5.7 million in 2008.

The implication for Social Security is old news, but still a valid concern.  Less intuitively obvious, however, are some of the other issues.  For example, 42% of women 65 years of age or older are widowed (much smaller number for men).  76% of women over the age of 85 are widowed and 38% of men that age are widowers.  This has very significant meaning, socially.

Another set of issues involves the chronic medical conditions which face us as we age.  The chart below, from the study, has a great deal to say about that:

The number of seniors with multiple chronic conditions is clearly evident when one looks at the percentages for each.

One of the areas that the study clearly fails in, at least in my judgment, is dementia, including Alzheimer's.  Statistics are really not reported and analysis is missing.  As the study itself says,

While there are several studies which report estimates of the prevalence of Alzheimer’s, one of the major barriers to reliable national estimates of prevalence is the lack of uniform diagnostic criteria among the national surveys that attempt to measure dementia or Alzheimer’s. A meeting convened by the NIA in 2009 to describe the prevalence of Alzheimer’s concluded that most of the variation in prevalence estimates is not driven primarily by the reliability of the measures or instruments per se but by systematic differences in the definition of dementia.

This is very, very disappointing to all of us involved in senior care.  Until we really gain an understanding of what it means and what the impact is, we will not do the best job of addressing the problems of dementia and Alzheimer's.

An area that the study better addresses is the need for assistance with Activities of Daily Living (ADLs).  That need is the real basis for non-medical home care existing in the first place:

It is interesting that the largest growth in meeting ADL needs is in the area of equipment.  That is one reason we work so closely with mobility and durable medical equipment suppliers for our own home care clients.  We have to understand and be able to address the total universe of need.

All in all, it is a very good and interesting study.  Check it out.

Best wishes, Bert

Dementia and Alzheimer's Series #5: Driving

There is an excellent, on-going  series of in The New York Times, called The New Old Age.  Written by Paula Span and Jane Gross, the blog series covers a wide variety of topics involved in aging and senior care.  All of the topics are important, but one that concerns us very much, at Support For Home and Senior Care Solutions, is driving.

In an April 2010 article, titled "Driving While Demented," Paula Span points out that "several studies had shown that a considerable number of those with mild dementia — 41 percent to 76 percent, depending on the study — could pass an on-road driving test."  We absolutely believe that.  It does not, however, mean that folks with dementia should be driving.  Rather, it means that we do not have good driving tests!

Every one of us who drives has "gotten away" with periods of inattention or bad judgment.  Some one else avoided the accident we might have caused or there was no one else around.  The point is, even without dementia, driving is extremely dangerous.  When families look at Dad or Mom and consider whether they should be driving, they either forget that or do not want to face it.

One reason they do not want to face it is they might then have to be the "bad guys" and take the keys away from someone who has been an authority in their lives forever.  They do not want to hurt their parent(s).  In our view, this is simply making the wrong choice.

Paula Span includes two very important points in her article, including the standard used by the American Association for Geriatric Psychiatry, as stated by their past President, Dr. Gary Kennedy:

“Our recommendation is that you stop driving once you have a dementia diagnosis.”

Less formally, he relies on “the grandchild rule”: If a patient’s children don’t want the grandchildren in the car when the patient is driving, he or she needs to relinquish the keys before hurting someone else’s grandchildren.

We think that is a good approach.  Assume that there are children who are at risk -- because they always are when we drive -- and let that guide you.

Too often, we talk to seniors with dementia and family members who think that driving is OK, as long as it is just in the local area.  Our response to that is to ask where most non-driving accidents happen: answer, at home, with the bathroom the most dangerous location.  So, being close to home does not improve our safety.  Why would it do so while we are driving?

Another reason that some families want Dad or Mom to keep driving is that they see it as therapy.  "It keeps him stimulated and sharper," we actually heard from one daughter.  With all due respect, NO!  This is part of a larger problem we will talk about in another article, which is that some families are unable to absorb that dementia is truly a disease; that their parent(s) cannot help their behavior; and that it is not going to get better simply by expecting the parent(s) to work at it.
 
Best wishes,
 
Carol Kinsel, Senior Care Solutions

 
 
 
 
 
 
 
Bert Cave, Support For Home

 
 
 

Dementia and Alzheimer's Series #4: Hospital Stays

The following great set of guidelines comes from the Alzheimer's Aid Society of Northern California.  We thank them sincerely for all of the support they provide to Alzheimer's patients and their families and friends.

Almost everyone who has ever had the experience of being a patient in a hospital knows that it can be frightening. It is even scarier for persons with dementia.  Unfamiliar surroundings, food, and caretakers can be devastating
when one is confused and disoriented. Confusion and disorientation affect how quickly and how well a patient recovers.  Providing useful techniques for staff and family visitors can mitigate resulting problems such as anxiety and wandering.  Some suggestions include: 

• Have a caregiver advocate on behalf of the patient. If possible, a family member should remain with the patient at all times. This person can help distract and soothe the patient during medical procedures.

• Use non-verbal techniques and simple language to communicate. Gestures, facial expressions, pictures, and signs are all examples of non-verbal communication. These can be used when cuing the patient to eat or bathe.

• Have a list of patient’s likes and dislikes. Favorite items can provide comfort and distraction. Knowledge of dislikes can help the staff avoid negative reactions and minimize anxiety.

• Studies have shown that the use of restraints tends to increase injuries and causes distress for the patient.  Other methods that can keep the patient safe are distraction, soothing touch, music, or prayer.

• Be sure the patient is not over or under-stimulated.  Patients with dementia have more difficulty communicating when over-stimulated by television or multiple conversations. Conversely, insufficient stimulation may increase anxiety. 

• Be aware of changes that may be occurring in the patient. Some patients won’t express pain or other feelings. Note any physical or mood changes which may indicate a complication or new illness.

• Allow the patient to make as many decisions as he or she can. Guided choices providing some control can limit distress.

Best wishes,

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

Dementia and Alzheimer's: A Series

In senior care, one of the most frequent conditions we encounter is dementia, in one of its 1000+ forms.  The most "famous" is Alzheimer's, but in any form it is very serious, for the individual and his or her family.

Over the next few weeks, we will be talking about this issue from a number of perspectives: the client / patient, family members, including family caregivers, professional caregivers at home and the facilities who serve people with dementia, including those that provide memory care.  We will talk about the dignity of those suffering and the immense respect we have for them, as well as for those helping.

One of the topics we will be spending time on is the many resources that are available to us on the topic of dementia.  Thankfully, this is a condition that we take very seriously as a society, and there is a great deal of study going on and helpful material that has been published.  We will just mention a few of the "biggest" in this first article:

1. One of the most significant sources is the National Institutes of Health's  National Institute on Aging.  This site has many helpful sections.  One of the most important is their Alzheimer's Disease Education and Referral (ADEAR) Center.  The Center has many publications and links to tools and services that can be very helpful to everyone affected by or supporting someone with Alzheimer's.  The site is updated frequently and well maintained.
2. Also part of the National Institutes of Health is the National Institute of Neurological Disorders and Stroke.  They have an excellent section called Dementia: Hope Through Research.  That Institute has a separate "page" called Dementia Information that is also very useful.
3. The third resource we will mention today, as we get started, is one all of us concerned about this topic should be aware of and with which we should be involved.  That is the Alzheimer's Association.  They have great information, but, even more than that, they are at the heart of the fight.

In future articles, we will include other resources, including some you might tell us about.  We will also have some stories from our own collective experience.  If you have a story to share, let us know.  Thank you.

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

Parents Driving and Other Conversations

Forbes magazine has a good article, entitled "Boomers' Burden: Aging Parents Who Shouldn't Drive".  Driving is only one issue, as our parents age, of course, but it is an emotional and important one.

The article launched a discussion on LinkedIn, with a posting from Dr. Mikol Davis:

Imagine that the phone rings, and it's the police department in the city where your 85-year-old mother lives. She's been in a car accident. She hit a pedestrian, the officer is saying, and your mom is hurt. You feel a rush of fear and guilt. You saw the warning signs, the forgetfulness, the lack of ability to concentrate. Mom really shouldn't have been on the road. You're afraid to ask what happened to the pedestrian. Could you have prevented this?

Our thoughts at Support For Home?

This is an incredibly important question, but it is, of course, part of a much broader discussion that we all have had or will need to have with our parents, as they age.


My own parents' situation was actually one of the drivers (if you'll forgive the pun) for my wife and I leaving Intel Corporation to found Support For Home, our own in-home care company.


Our preference would be that parents continue to be parents, even as we age. They should be driving this discussion, not waitiing with trepidation for "the kids" to bring the issues of driving and support for other ADLs and Instrumental ADLs. If that does not happen in a family, then yes, the offspring must step up in a timely fashion to initiate the conversation and establish some parameters that parents and children can support. Most of these are readily set, in a very objective fashion.


Our parents need to know that their value has nothing whatsoever to do with whether they have a driver's license and that our respect and love is for their lives and character and accomplishments over the course of their lives, not about their current medical state.


So, if you have to have a difficult conversation that will protect your parents and others, even if it may bring on a tear or two at the time, "just do it."

"Five Wishes"

If you are not familiar with the "Five Wishes" document, you want to find out about it.  There is an excellent discussion of it in Wikipedia.  Basically, Five Wishes is a living will that allows you to address not just your medical wishes for care if you are seriously ill, but also your emotional and spiritual needs.

The Five Wishes involve:

• The Person You Want to Make Care Decisions for Me When You Can't
• The Kind of Medical Treatment You Want or Don't Want
• How Comfortable You Want to Be
• How You Want People to Treat Me
• What You Want Your Loved Ones to Know

Five Wishes is accepted in 42 states, including California, as well as the District of Columbia.  We are starting to see more Five Wishes documents with our home care clients at Support For Home.  Your financial wishes are not covered, of course, so you will probably still want a good trust attorney.

Five Wishes is also not a substitute for a Do Not Resuscitate (DNR) order, for those folks who do not wish to received CPR. 

Check it out.  It's simple, clear and can save a lot of anguish later.

Best wishes.  Bert

We Talk About Comprehensive Plans of Care

One of the most important concerns for us at Support For Home is that when we do a (free) assessment of new clients that we do a comprehensive assessment, looking at all areas of need, not just non-medical home care.

It is because of this focus, knowing that we can only provide a slice of the services pie that most of our clients need, that our Director of Client Services is an MSW (Masters in Social Work).  Providing great service starts with understanding need.

Over the years, we have managed to identify great allies who can provide services that address other slices of the pie within a comprehensive plan of care.  Some are local; some are national.  Some we know personally; some we know by reputation.

From time to time, we will list a few providers of services or products that folks who need assistance with ADLs (Activities of Daily Living) might find useful.  We would be delighted to hear your comments and suggestions on this topic.

Assistive Technology Services - These folks have a great variety of products in the areas of Mobility, Vision, Hearing, Security Home Automation, and Communicating.

Rebuilding Together - This is a national non-profit organization.  Their message is that they create "affordable, safe and efficient housing. Our vision is that all homeowners, particularly low-income seniors, live independently in comfort and safety in their own home. We accomplish our mission through home repairs and modifications on existing homes."  The Sacramento office is fantastic in terms of home safety for our clients.

Bay Alarm Medical - Most of the technology of various companies providing emergency alert products, including bracelets and pendants, is pretty standard.  The responsiveness to and cost for our clients is what separates one provider from another.

We will have more "useful resources" in future blogs.  Again, we would be delighted to have your opinions and suggestions.

Best wishes, Bert