Elderly

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Living With Grace in a Nursing Home

PhyllisEditor’s Note: Eighty-three-year-old Phyllis Donner Wolf figured she would live on her own until the end of her life and die peacefully in her sleep. But last spring, she fell and broke her neck, leaving her paralyzed from the chest down. She went from living independently in her apartment in Palo Alto to a nursing facility in San Francisco called the Jewish Home. As part of our ongoing series of first-person health profiles called “What’s Your Story?” we talk to Wolf about what it takes to live a life of grace in a nursing home.

By Phyllis Donner Wolf

I was very active. I did yoga. I did yoga for 40 years. I was in an exercise class that met every morning at quarter to 8. I drove the car for friends to go to the symphony in the city. I was the one who took someone’s walker and put it in the trunk. So when I fell it was unbelievable. I didn’t dream I would wind up in a wheelchair.

I stood up in the middle of the night, which I often would just walk to the bathroom, and this time when I stood up I found myself on the floor. I think I heard a crack, which meant that my neck and spine, the bones just were brittle and broke. And I knew I had done great damage because I could not move the lower part of me.

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Loneliness is Bad For the Elderly

By Alvin Tran

There is a 45% increased risk of death in people who are lonely compared to not lonely, according to a UCSF study.

There is a 45% increased risk of death in people who are lonely compared to not lonely, according to a UCSF study. (Photo: Getty Images)

Do you feel left out? Isolated? Or lack companionship? Answer ‘yes’ to any of these questions and you may be at risk for adverse health outcomes, says Carla Perissinotto, MD, an Assistant Clinical Professor at UCSF.

Perissinotto’s latest study, which found a link between loneliness and serious health problems among the elderly, was the main topic of Wednesday’s Forum with Michael Krasny.

The study, published this week in the Archives of Internal Medicine, followed over 1,600 elderly individuals for six years. These individuals completed surveys that measured whether they felt left out, isolated, or lacked companionship — all of which are components of loneliness.

“We cannot continue to ignore the psychosocial distress that our patients are experiencing. It is, in fact, just as important as traditional medical risk factors.”

“We demonstrated that [loneliness] is also a risk factor for poor health outcomes, including death and multiple measures of functional decline,” said Perissinotto. “[There is a] 45 percent increased risk of death in people who are lonely compared to not lonely.”

Perissinotto says medical professionals also need to put more emphasis on the role of psychosocial distress on health. “We cannot continue to ignore the psychosocial distress that our patients are experiencing,” Perissinotto said. “It is, in fact, just as important as traditional medical risk factors.”

According to Perissinotto, medical schools currently emphasize the role of traditional medical risk factors such high blood pressure, cholesterol and obesity and pay less attention to factors such as social support and loneliness. “There needs to be a slight shift where we don’t ignore the traditional medical risk factors but we also incorporate things like loneliness into the general assessment of our patients,” Perissinotto urged.

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Who Will Care for the Caregivers?

By Kamal Menghrajani

Some paid caregivers are barely making ends meet. (Getty Images: Justin Sullivan)

Some paid caregivers are barely making ends meet. (Getty Images: Justin Sullivan)

Some people who care for vulnerable older adults are in dire economic straits, according to a new study [PDF] from the UCLA Center for Health Policy Research.

Hundreds of thousands of people provide care – from cooking and cleaning to bathing and dressing – for adults with disabilities or long-term illnesses who receive benefits from Medi-Cal. As it turns out, those who get paid for this work may not be pulling in enough money to make ends meet.

Geoffrey Hoffman, a researcher at the Center and lead author of the report said, “These paid Medi-Cal caregivers have incomes that are quite low compared to other Californians, about half as much monthly household income.”

“This aging population [of caregivers] is going to lead to great burdens on the health care system.”

He continued, “A third of them do not have health insurance. A number of them live in poverty or near-poverty, and, among those, a third of them have what is called ‘food insecurity’ – not enough food to put on the table every month.”

At issue is the amount that Medi-Cal is paying these caregivers. Even if you add income from other jobs, they earn a little over $11 per hour on average — close to minimum wage, and about two-thirds of the median income in California — making it difficult for them to live on their earnings. Many believe that the value of the care they provide is much greater than what they earn, but monetary constraints have led California lawmakers to decrease financial support for these services.

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Diagnosis, Treatment … and Maybe a Prognosis?

(Adrian Clark: Flickr)

(Adrian Clark: Flickr)

Back in the days when modern medicine started, around the turn of the 20th century, the practice of medicine was roughly divided into  thirds: diagnosis, treatment and prognosis.

That’s what Alexander Smith, palliative care expert at the San Francisco VA Hospital, told me in an interview. He attributed the approach to the illustrious William Osler, one of the founding professors of Johns Hopkins Hospital, back in the late 19th century.

But things have changed since Dr. Osler ruled in Baltimore. “Prognosis has really waned,” Smith says. “Now in textbooks, there’s just a few lines. The focus is on diagnosis and treatment.”

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