Slow medicine for the old

Time to "rescue the elderly from standard medical care"? Geriatrician Dennis McCullough says it is in his new book, My Mother, Your Mother. Embracing "Slow Medicine," the Compassionate Approach to Caring for Your Aging Loved Ones. I haven't read the book but the New York Times review makes me want to.

The book is aimed at children and relatives who, McCullough says, are the best medicine--along with a slower, simpler, less expensive, family based approach to medical care. In interacting with the medical system, frail older people need an advocacy team of friends and relatives for protection and moral support.

Among the changes to consider for people at advanced ages: manual breast exams instead of mammography, stool tests for blood instead of colonoscopy, revisiting hypertension medication that works differently in the very old, companionship instead of antidepressants.

Reviewer Abigail Zuger, also a physician, calls the book valuable, "chilling and comforting in equal measure."

The topic is especially timely as we think about our July member meeting. We'll be building on the dialog with discharge planners in January. This time, we'll be considering how family members can talk about "advance directives" that go beyond end of life hospitalization. As McCullough says, hard conversations about topics like when to stop driving and what to do when you can't manage at home anymore need to start early, while the parent is still vital and lively.

It's about anticipatory guidance. The Library Journal's review says that the book will help readers:

—form an early and strong partnership with your parents and siblings;
—strategize on connecting with doctors and other care providers;
—navigate medical crises;
—create a committed Advocacy Team;
—reach out with greater empathy and awareness; and
—face the end-of-life time with confidence and skill

Please let us know your experiences and thoughts about how professionals in aging might help families talk about and plan for all of the transitions from fully independent to needing a wide circle of concern and care!

Ageism and drug safety

The Need for Drug Safety-the Older Person and Ageism grabbed me when it came across my desk through the Badgeraginglist. The listserv is a wonderful source of information for professionals in aging, and the source of many reports the Milwaukee Aging Consortium describes in our newsreel or information links.

Drug safety is not just an abstract good idea to me: it’s personal.

At Christmastime, my 87-year-old mother’s slow deterioration accelerated. It turns out that one of the prime causes was prescription medication toxicity. Another was electrolyte imbalance, a medication side-effect.

I haven’t looked at the bill yet to see what this episode cost in dollars. I won’t try to figure in the days lost from work and from our children for my sister and me. But I have a good sense of what it cost in pain and suffering, not just for my mother but for all of us.

The issue brief from the International Longevity Center-USA points to problems resulting from rapid approval of new medications and the lack of long-term “postmarketing surveillance”—research on what happens to 30,000 users, not just the 3,000 studied before release to the market. In 2007, the report says, the pharmaceutical industry “conducted only 7% of the studies they had promised.”

Drug problems affect older people disproportionately. Only 12% of the population, they use 40% of all prescription medicine. Physiologically, older people process drugs differently. They have the most problems with drug interactions. And yet there is no requirement that older people be included in clinical drug studies.

Report author Robert Butler, MD, uses some strong language: “Because medicines in the United States are disproportionately used by older persons, we must conclude that failures in drug safety are due in part to the belief that older persons, having lived their lives, are expendable. This is a manifestation of ageism.”

The brief calls for significantly increasing FDA funding and power to monitor drugs on the market and in older adults. The up-front cost, Butler says, “will likely save time, energy, and money, not to mention lengthening and improving the quality of lives.”

After a couple months of emergency rooms, hospitalization, skilled nursing facility stays, and rehabilitation, Mom's doing beautifully in an assisted living facility. In fact, she’s doing better than before. I wonder if, had her primary physician been monitoring her better, she could have stayed in independent living. But that’s a moot point now.

We’d love to hear your responses, ideas, experiences. Please comment here or send a message to cmclaughlin@milwagingconsortium.org.

Everybody's doing it: Caregiver help sites

You may have noticed a proliferation of all kinds of websites for caregivers. According to Mass High Tech: The Journal of New England Technology, the surge is partly a response to need--and partly a response to commercial opportunity.

“All of a sudden, it’s like caregivers have money,” said Gail Hunt of the National Alliance for Caregiving. “The baby boomers have to care for their parents, and there’s money to be made.”

Some of the sites, in other words, are all about the advertising.

But folks who run “altruistic” sites with no profit motive can learn some lessons from the often young entrepreneurs who understand social networking. Chief among these: the term “caregiver” doesn’t resonate with Boomers. We don’t see ourselves as caregivers but as family members—or even “baby sitters.” Caregiving is a market with more than one niche.

Realizing that, some sites are including services for the other side of the Boomer sandwich: childcare and tutoring, for example.

One site is called Lotsa Helping Hands. Developed in cooperation with the National Alliance for Caregiving, it has “created 6,000 ‘communities’ for users, mostly networks focused on a specific patient’s circle of caregivers,” according to article author Christopher Calnan.

Sites that list providers often offer a free basic service and charge monthly rates for “premium” services as well as using advertising.

Hunt warns that most of these businesses will disappear like the dot.coms – unless they develop the “Holy Grail:” comprehensive information combined with a database of local resources for users.

In Milwaukee, the Family Caregiver Support Network offers diverse help and information and a social support network for caregivers--for free.

Other excellent noncommercial sites include the Family Caregiver Alliance, and Hunt's organization's website Caregiving.org.

Strength for Caring is a great site owned by a commercial enterprise, Johnson & Johnson.

We’d love to hear about the best websites for caregivers—and what’s needed but not there. Comments and guest blog entries are most welcome!

What's your priority for making communities elder-friendly?

In the newsletter Connections, American Society on Aging (ASA) members identified as their top three policy priorities to make communities more elder friendly:

• 59% Public transportation improvements
• 25% Universal design requirements in building codes
• 10% Walkability mandates in urban planning

Public transportation improvement has been a chronic need for older people in this community since the days of the Older Adult Service Providers Consortium, the Milwaukee Aging Consortium's predecessor organization.

Are those the priorities you'd list, too? What could we do to fix the problems of getting around? We'd love to hear from you.