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Showing posts from December, 2013

Avoiding too high of a threshold for elder safety and self-neglect

My five-year old sons favorite show on TV is called Railroad Alaska.  Just in case you haven't figured out why by the title alone, may I just ask what self-respecting five-year old wouldn’t love a show whose protagonist is a train and whose antagonist is snowpack in various forms, including avalanches. I though despise the show, mainly because nothing really ever happens during any of the 60 minute long episodes (aside from the aforementioned avalanches). However, I do find it interesting that most of the semi-staged plots focus on older couples who are living off-the-grid, miles away from anything except a railroad line. There are often clips of their children talking about how their weekly/monthly visits are really the only help the older adults get in their rural homes. The children also talk about how far away their parents are from any medical care, and if she/he had “another” stroke, they would likely find him/her dead a week later. But they all seem comfortable with

What to give Uncle Ernie, Grandma Mabel and Great Aunt Rose?

I’m literally running out the door for last minute shopping. I wanted to make time, though, to share with GeriPal good gifts for older adults that my colleagues have been sharing with me in case you're still in gift buying mode. These suggestions are a mix of practical, helpful and more traditionally gifty. And it's meant to make you feel generous because giving makes your and your recipient's brains actually grow, sort of like this ! (Thanks for the tip, Don Berwick, who summarized the wonderful benefits of being social and giving during a recent speech ). Links are embedded in each description. Have a Very Geri Holiday! Need a hand? There are lots of products that help maintain independence at home by making little things easier. Jar Opener : There are jar openers that help a hungry jar owner open the lid by releasing the suction first. Ideal for people with reduced grip strength or wrist arthritis. Jar opener 1 or jar opener 2 . (Credit: Lousie Aronson an

How Your Name Can Influence Your Health

"We find ourselves in something of a quandary when it comes to making up our minds about the phenomenon which Stekel calls the 'compulsion of the name'. What he means by this is the sometimes quite gross coincidence between a man's name and his peculiarities or profession. For instance ... Herr Feist (Mr Stout) is the food minister, Herr Rosst√§uscher (Mr Horsetrader) is a lawyer, Herr Kalberer (Mr Calver) is an obstetrician ... Are these the whimsicalities of chance, or the suggestive effects of the name, as Stekel seems to suggest, or are they 'meaningful coincidences'?   Carl Jung What's in a name? Apparently a lot if you believe a paper published in a truly merry edition of the British Medical Journal (see here and here for previous very merry article Christmas Edition articles). As Carl Jung noted, there has been a longstanding belief that one's name may affect one's chosen profession and character (the theory of this is called no

The Dementia Caregiver: Improving their Mental Health and Quality of Life

There are few harder things than being a caregiver for a family member with dementia.   These caregivers are the unsung heroes of the US health system.   Because of family caregivers, 2/3 of persons with dementia are able to continue living at home, often avoiding nursing home care until dementia is very advanced.  Nursing home care is hugely expensive, and much of the cost in the US is paid by Medicaid.  Next time you hear about how Medicaid nursing home costs are big contributors to federal and state budget crises, remember that without caregivers these costs would at least double.  But while caregivers of dementia patients are unsung heroes, they are also forgotten heroes.   The US medical system does little to help them.  And they need help.  Dementia caregiving is very stressful and numerous studies have shown negative health consequences in caregivers.  Most prominent is depression.  Caregivers of dementia patients often meet clinical criteria for a diagnosis of ma

Communication training: is simulation enough?

A video example of palliative care communication techniques in the wrong hands  by: Alex Smith, @AlexSmithMD Major paper in JAMA about palliative care communication.  I think we all believe there are better and worse ways to communicate with seriously ill patients.  Tony Back, Bob Arnold, and James Tulsky have really led the way in creating a curriculum for training doctors how to have these conversations - first with  OncoTalk for oncologists, followed later by the spinoffs   IntensiveTalk for intensivists and GeriTalk for geriatricians.  The OncoTalk program has been shown to improve communication skills with simulated patients.  But no real world studies had examined the impact of communication skills training on real world (not simulated) patient reported outcomes. Until now. The well-known physician-researcher Randy Curtis teamed up with others from the University of Washington (including Tony Back) and the Medical University of South Carolina to investigate

Celebrating in Stillness

by: Brad Stuart MD Thanksgiving dinner at our place was loud, as only 3 generations of people can make it. Now, a couple of days later, only stillness remains. The celebration continues, but more quietly. I spent the weekend before last, November 16 and 17, with an old friend on the East Coast. We joked, told stories and drank wine like we had for over 40 years. At 3 AM on Friday, November 22 he woke up with chest pain. Not the relentless, sqeezing ache of coronary disease, but much worse: aortic dissection ripped through his chest and belly. Paramedics rushed him to a nearby academic center. He was awake and aware the whole way, without pain medication because his blood pressure was near zero. 3 teams of surgeons were waiting. It took them 10 hours to replace his entire aorta. Yesterday, one week later, the day after Thankgiving, he walked back into his house with a couple of minor visual field cuts and no other problems. Over the phone we marveled at his good fortune. He’s