Senior “Profiling” in healthcare Today

As an RN Patient Advocate, I’m constantly aware of this, and know that public awareness and speaking out can change our “healthcare” system.
________________________________________________

Ageism in Health Care and How Dangerous It Can Be

by Val Jones, MD


(This article appeared previously on GetBetterHealth.com.)

We’ve all heard the saying, “age is just a number.” Nowhere is that more important than in the hospital setting.

Over the years, I’ve become more and more aware of ageism in health care — a bias against full treatment options for older patients. Assumptions about lower capabilities, cognitive status and sedentary lifestyle are all too common. There is a kind of “senior profiling” that occurs among hospital staff, and this regularly leads to inappropriate medical care. As a physician myself, I’ve seen it.

Misconceptions Prompt Misdiagnoses

Take for example, the elderly woman who was leading an active life in retirement. She was the chairman of the board at a prestigious company, was an avid Pilates participant and the caregiver for her disabled son.

A new physician at her practice recommended a higher dose of diuretic (which she dutifully accepted), and several days later she became delirious from dehydration. She was admitted to the local hospital where it was presumed, due to her age, that she had advanced dementia. Hospice care was recommended at discharge. All she needed was IV fluids.

Hospitalized patients are often different than their usual selves. As we age, we become more vulnerable to medication side effects, infections and delirium.

I recently cared for an attorney in her 70s who had a slow-growing brain tumor that was causing speech difficulties. She, too, was written off as having dementia until an MRI was performed to explore the reason for new left-eye blindness. The tumor was successfully removed, but she was denied brain rehabilitation services because of her “history of dementia.”

I recently wrote about my 80-year-old patient, Jack, who was presumed to be an alcoholic when he showed up to his local hospital with a stroke.

Not Their Usual Selves

Hospitalized patients are often very different than their usual selves. As we age, we become more vulnerable to medication side effects, infections and delirium. And so the chance of an elderly hospitalized patient being acutely impaired is much higher than the general population.

Unfortunately, many hospital-based physicians and surgeons — and certainly nurses and therapists — have little or no prior knowledge of the patient in their care. The patient’s “normal baseline” must often be reconstructed with the help of family members and friends. This takes precious time and often goes undone.

Years ago, a patient’s family doctor would admit him or her to the hospital and provide care there. Now that the breadth and depth of our treatments have given birth to an army of sub-specialists, we have increased access to life-saving interventions at the expense of knowing those patients who need them.

Tests Could Be Prevented

This presents a peculiar problem — one in which we spend enormous amounts of resources on diagnostic rabbit holes because we aren’t certain if our patients’ symptoms are new or old. Was Mrs. Smith born with a lazy eye or is she having a brain bleed? We could ask a family member, but we usually order an MRI.

My plea is for health care staff to be very mindful of the tendency to profile older patients. Just because Mr. Johnson has behavioral disturbances in his hospital room doesn’t mean that he is like that at home. Be especially suspicious of reversible causes of mental status changes in the elderly, and presume that patients are normally functional and bright until proven otherwise.

Going Strong at 103

Last month I hit a new age record at my rehab hospital — I admitted a charming, active, 103-year-old woman after a small stroke caused her some new weakness. She was highly motivated in therapy, improved markedly and was discharged to an independent living center. I bet she will live many more years.

When I joked that she didn’t look a day over 80, she winked and told me she had stopped counting birthdays years ago. She said, “It doesn’t matter how old you are, it matters what you can do. And I can do a lot.”

Melding Applied Improvisation With Medical Improv

The healthcare industry is in the business of selling services.  Why not make it more “human centered” for both the employees and patient-clients served?  Medical Improv can do that!

Defining Applied Improvisation

Andrew Tarvin
When clients hear that my training includes applied improvisation, they often have no idea what I’m talking about or immediately fear the worst. They worry that it means their employees will have to tell jokes, will be forced to do silly exercises, or will have to do some form of trust fall. Applied improv is none of the above.

WHAT IS APPLIED IMPROVISATION

At its basic level, applied improv is simply taking concepts, ideas, and techniques from the world of improvisation and applying them to business, relationships, and life. It’s not joke-telling, silly activities, or the theater equivalent of Minute to Win It challenges. It is effective, experiential learning that inspires, educates, and entertains. With this is mind, it’s important to understand that applied improv is a not a what, but a how. It’s how we train incredibly valuable business skills such as communication, collaboration, innovation, problem-solving, and leadership. It’s how we instill a culture of growth mindset, build psychological safety, and embrace authentic leadership. It’s how we learn to be more effective at what we do. As my good friend Kat Koppett says, improv is the gym. It’s a way to get reps building valuable skills in a low-risk, effective way.

THE BENEFITS OF APPLIED IMPROVISATION

Why is applied improv so important? Why do I, as an engineer obsessed with efficiency and effectiveness, incorporate applied improv into my programs? Because it works. There are five primary benefits to using applied improv in training and development: #1. Participants experience the learning.
Remember as a kid when your parents told you not to touch the stove because it was hot, but you touched it anyway and burned yourself? And after that, you never touched the hot stove again? You know that the things you learn from experience have a more lasting impression than the things you learn because someone told you. So much of today’s training is the equivalent of a parent telling you not to touch the stove. Lectures are great for introducing an idea like growth mindset, but it’s not how we learn to actually live it. Applied improv serves as the hot stove where you experience the lesson (but without the burn). Rather than be told what’s important, participants go through an activity that helps them come to the learning point on their own. It’s one thing to hear an idea, it’s another thing to experience it. #2. Participants practice the skills.
Imagine you’ve decided you wanted to become a violinist. To do this, you wouldn’t just read a bunch of books on what it means to play the violin and then immediately step on stage in front of thousands of people. Instead, you might do some of that reading, but mostly you would practice. A lot. Before you ever stepped foot on stage, you would have spent hours practicing scales, exercises, and songs. And yet, when we train business skills, we have people go sit in a lecture and then expect them to be able to implement those ideas immediately, without any practice or experience. Listening to a talk on communication is like listening to a talk on how to be a violinist–it won’t be effective unless you can practice what you’ve learned. Applied improv gives participants an opportunity to practice new skills so they can be more effective immediately. A trainer doesn’t just talk about the importance of listening to understand, the participants actually have an opportunity to build their skill in doing so. #3. Participants feel safe to try new things.
Think back to the first time you learned how to ride a bike. How did it go? Did you pedal to glory on your first attempt? Probably not. If you’re like me, you fell on your first few tries but eventually you got better and before you knew it, you were riding down the entire length of the street (only to realize you didn’t know how to stop). Failure is a key part of any learning experience; it’s how you learn to make adjustments and determine what works and what doesn’t. But failing in our jobs can have consequences. A first time leader can be at risk of demotivating their employees while trying to learn what it means to lead. Applied improv provides a safe environment for the participants to try new things and to fail in a low stakes environment. Participants learn what works and doesn’t work in a classroom instead of in the middle of an important project for their company. #4. Participants build relationships with each other.
Of all the people you work with, who do you have the best relationships with? Chances are it’s the people who you have something in common with: maybe you work in the same department, sat next to them at a training, or have bonded over your mutual love of the show Game of Thrones.  That’s how all relationships are formed, through shared interests and shared experiences. Relationships, both internal and external, are a vital part of any company; it’s why Google determined that the most important trait of an effective team is psychological safety. Applied improv creates a positive shared experience that helps build the relationships of the people in the room. You could learn about psychological safety by listening to someone talk about it, or you could do it through interacting with your fellow participants, learning about each other, becoming closer together, and actually building that safety in the room. #5. Participants have fun.
Which would you rather do: sit in a room and be bored or laugh with your peers and have fun? Which would you learn more from? Which would leave you with a more lasting impression? Which would you think more positively about and share with others? I’ll take “laugh with my peers and have fun” every time. Sadly, many of today’s corporate trainings are death-by-PowerPoint boring. Learning about a topic as interesting as innovation can still be heart-wrenchingly dreadful. The simple truth is that you quickly forget about boring experiences and become more invested in the things you find enjoyable (duh). Applied improv is fun. And not in a “corporate is telling us this is fun so it’s actually going to be awful” way, but in an actual “I haven’t laughed like this at work in years” way. The exercises are geared to be entertaining and the fun doesn’t come from cracking jokes, but by having authentic moments with the other participants. As a result, you learn the keys to something like being more innovative while staying actively involved in the learning experience.

Women With Highest Risk of Stroke

Women are at higher risk of stroke, and have a higher mortality rate.  Be aware if you are in this category, be closely monitored, and maintain the habits of a healthy lifestyle.

Women Who Are Most at Risk of Stroke

— Robert Preidt

woman face

THURSDAY, Feb. 8, 2018 (HealthDay News) — Stroke affects more women than men in the United States. And a new study pinpoints stroke risk factors unique to females.

“Many people don’t realize that women suffer stroke more frequently than men, and mortality is much higher among women,” said Dr. Kathryn Rexrode, the study’s corresponding author.

“As women age, they are much more likely to have a stroke as a first manifestation of cardiovascular disease rather than heart attack,” said Rexrode, who is with Brigham and Women’s Hospital in Boston.

The study attempts to better understand susceptibility, she said.

“Why do more women have strokes than men? What factors are contributing and disproportionately increasing women’s risk?” Rexrode said in a hospital news release.

Stroke affects 55,000 more women than men each year in the United States. It’s the leading cause of disability and the third leading cause of death in women, the researchers said in background notes.

Rexrode’s team analyzed the scientific literature and identified several factors that increase stroke risk in women. These include:

  • Menstruation before age 10,
  • Menopause before age 45,
  • Low levels of the hormone dehydroepiandrosterone (DHEAS),
  • Use of birth control pills.

A history of pregnancy complications can also indicate higher stroke risk. These problems include gestational diabetes and high blood pressure during or immediately after pregnancy, the researchers said.

Some of these risk factors are common, and the researchers stressed that few women who have one or more will suffer a stroke. However, they said it’s important for health care providers to be aware of any heightened risk.

“These women should be monitored carefully and they should be aware that they are at higher risk, and motivated to adhere to the healthiest lifestyle behaviors to decrease the risk of hypertension (high blood pressure) and subsequent stroke,” Rexrode said.

The paper was published Feb. 8 in the journal Stroke.

More information

The National Stroke Association has more on women and stroke.

SOURCE: Brigham and Women’s Hospital, news release, Feb. 8, 2018

Collaborating and Advocating for Your Health and Well-Being

Patients and their healthcare providers need a shared language.  There’s a distinction between achieving a strategy, objective, and goal.  For example, a patient-client wanted to use weight-lifting (strategy), to develop her upper body strength (objective), so she could easily pick up her grandchild (goal).

 

Achieving Your Personal Health Goals: A Patient’s Guide

John Henning Schumann, MD

Dr. James Mold, a family physician and author of Achieving Your Personal Health Goals, says doctors should work with their patients to set mutually agreed-upon goals throughout life.

Many of us make New Year’s resolutions. Few of us realize them. Maybe it would help to reframe how we handle our resolutions by thinking of them as goals instead.

What health goals will you reach for in 2018? And which, if any, will you discuss with your doctor?

A new book, Achieving Your Personal Health Goals, is a patient’s guide for setting life goals and also planning for the inevitable end. It’s a shift from the usual medical framework that looks at health improvement as a set of problems of sickness to be solved.

Family physician and geriatrician James Mold, who wrote the book, has spent more than a quarter-century thinking about how to use goals to improve health care.

Mold is one of only four Oklahomans ever to be inducted into the prestigious National Academy of Medicine. He’s now retired and living in his native North Carolina, so I was pleased to be able connect with him recently in an interview for Public Radio Tulsa’s Medical Monday.

Here are highlights from our conversation, edited for length and clarity.

Forgive me for asking, but isn’t all health care directed by goals?

You would think so. The concept is that people’s own attention to their health should be directed at some sort of goal that makes sense in how they view health.

If you think health involves living as long as possible, or at least living until life no longer seems worthwhile, then you should do things that help you achieve that goal.

Doctors tend to focus on strategies and not goals. The assumption is that if you do the strategies well — that is, if you cure disease and solve all the health problems — that the goals will take care of themselves.

It worked really well when most of the health problems that we saw were infections or injuries. But it doesn’t work as well for other things — particularly things we deal with these days, like diabetes, hypertension, obesity and alcoholism — those things that aren’t easily treatable.

What if someone had diphtheria and we cured it? Isn’t cure the goal?

A goal is something you want to have happen where it doesn’t make any sense to ask why would we want to have that happen.

Curing diphtheria is not really a goal but a strategy — the goal is to keep you alive. And keeping you alive is a goal because it doesn’t make sense to ask why would you want to stay alive.

We tend to view aging as inevitable and disappointing. So by reframing care as goal-directed aging, then getting old is less a problem than a part of life, right?

My mother, before she died, wanted to improve her balance (a strategy), so that she could get rid of the walker (an objective) so that she could go back to gardening (her goal).

It’s really important to be clear about what a goal is, because if you don’t understand what a goal is, then goal-directed care is no different from what we’re doing now.

Your book is written for patients. You make the point that goal-directed care is mutually agreed upon between doctor and patient. It’s the patient’s goal that the doctor can help the patient clarify and achieve, correct?

No, it’s a negotiated settlement, if you will. One of the nice things about goal-directed care is that it puts the doctor and the patient on equal footing so that they both have something to contribute to the discussion. So the patient knows what their values and preferences are, and what they’re able and willing to do, and the doctor knows what is possible to do. If you put that information together, you come up with something that’s reasonable.

I remember a patient vividly in a small town in North Carolina who came in every week to have her blood sugar checked, and it was always out of control. I did everything I could to advise her as to how to get it under control. So I put her in the hospital and her blood sugar came right down to normal. I told her she really didn’t need to come back every week until she did the things I told her to do. It wasn’t’ going to be under control. And she fired me!

I later learned the reason that she came in every week was because it was a social event for her; she knew everybody in the practice. She saw people in the waiting room and got some attention and she felt the only way she could do that was to keep her blood sugar out of control.

I totally misunderstood that. I think it would’ve been a lot clearer if we could have agreed on the goals up front. Whether I could have gotten that goal from her, if she would’ve admitted to that, I don’t know. But at least we would have had an opportunity to figure out what was going on.

What about goals near the end of life?

Since medical school, one of my missions in life is to try to make medical care more humane. I became a family physician because I thought that was the field that was talking the right talk. By the late 1980s it seemed that the revolution had moved to the field of geriatrics, so I became a geriatrician.

As a geriatrician, I was faced with lots of folks who had incurable problems, and who, as they aged, became less and less functional and less able to participate in meaningful life activities.

I worked at a rehab institute that I helped to establish. We worked with occupational, physical and speech therapists, and they were talking about goals. That’s the first I’d ever heard about the term “goal” in medicine, at least in the sense that I think of it now. That got me thinking, “Why don’t we think in terms of goals?”

Doctors didn’t understand why we needed to think that way. Geriatricians sort of got it.

Since 1991 I’ve been trying to convince doctors that this might be a better way to think, with very little success. One of my non-physician colleagues told me to write a book for patients — that they would get it, and perhaps they could demand a change in the health care system.