Old Parents, Breast Cancer Surgery and Dental Work: Options–Do All, Less, or Nothing

Is it Better to do Nothing or–at least–Less?
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A Woman Rejects Mammograms at a Certain Age

A friend just drove to upstate New York to be with her 70-some-year-old mother who was having a lumpectomy. While her mother didn’t want her to make the trip, she was glad to do it so she could help out a bit. That’s what daughters do, right?

I thought about Sr. Advisor, R, who in her early 90’s, decided against any more mammograms–period. Her rationale: if they found something suspicious she wasn’t going to do anything about it anyway, so why impact her life with knowledge that would only cause stress and concern–for herself and for those around her. When R died in her sleep at 101, it was assumed old age was the reason.

What about Dental Work?

While keeping our own teeth as long as possible and having regular dental check-ups are important, one of my brother’s better decisions was to forgo taking Dad, age 92, to the dentist who wanted to pull a tooth. The tooth was not bothering Dad, but X’rays showed there was potential for problems according to Dad’s dentist. In fact, I had taken Dad to the appointment when that dentist first suggested the extraction.

Dad was very conscientious about taking care of his teeth.. To me–and my brother–it made sense to wait until Dad felt some problem, rather than expose him to anesthesia and all that was necessary for the extraction. Dad had no other teeth problems, and still had that potentially problematic tooth when he died at 94.

The point is (and this is not medical advice, simply our experience): Sometimes there’s a delicate balance between doing and not doing where the elderly are concerned. When we’re young we recover faster, heal faster, and adjust to whatever insults our body sustains–faster.

Doctors and others in the health professions, especially those whose patients are mostly middle-age and younger, may not think about the increased fragility of old people. It then falls to us to weigh all the factors, discuss them with elderly loved ones and–of course–their doctors and dentists.

We may not save lives, but we can raise awareness with doctors and dentists and hopefully choose the best timely options for aging parents when it comes to certain health issues. When procedures are elective and appropriate for the elderly and professionals understand the old age factor, it should help parents age well until the end.
Related: “Mastectomy vs Lumpectomy: Is Bigger Better? “–UCLA doctors’ Webinar October 2016

13 Tips for Surviving Hospitalization of an Aging Parent or Spouse

How many times have people said “You must take care of yourself?” when caring for an elderly loved one who’s hospitalized.

There’s stress….too many things to take care of; possibly many people giving advice; definitely emotionally draining. And then when we feel balance–if not control–we’re knocked down by a big wave of new problems: unexpected health changes or minor setbacks, hospital staff who are too busy to answer call buttons in a timely manner or worse.

In truth, the ongoing hospital experience with my husband gives me little to complain about. That said, after 2 weeks I’m convinced these suggestions ease the experience:

First and Foremost Remember the Goal–in this case 2 goals:

  1. To get him or her well and out of there asap
  2. To keep ourselves from getting dragged down by all the stuff–from people’s attitudes (including the patient’s and family members’) to pushing ourselves to meet every expectation. In short fend off–protect against–frustration and exhaustion.

Organize, organize, organize.

  1. Decide what’s controllable. Make the most of and gain strength from that. And act on it. We can wear ourselves out worrying about things that aren’t controllable in a hospital. (Confession: I like to think everything is within my control. My counseling kicks in–thank goodness–and I identify whether or not I can control. If I’ve tried everything (talking to anyone who can help, getting all information I can,) and it hasn’t worked, I’ve disciplined myself to “let go.”)
  2.  If not staying at the hospital, each night put everything in logical order and use a tote bag or equivalent for items that need to go–the next day–to the hospital for parents/spouse/ourselves. That way nothing is forgotten the next morning.

Example: It was bitterly cold in NYC and I tried to take the bus, rather than taxis (expensive) to the hospital. So I put my down parka on a chair near the door with bus pass in one pocket, lined gloves in the other, and placed the things that needed to go to the hospital next to them. That way if the phone rang while getting ready, I wouldn’t lose my train of thought and could sprint to the bus stop if necessary without leaving anything behind.

3. Take medications and vitamins on time. Place them where we can’t forget them. It’s easy to put this off when we’re rushing–or completely forget. We need all our strength.

4. Sleep/Rest: Get enough of it. We think more clearly and make better decisions when we’re rested.

5. Ask questions to learn the hospital routine in order to make the most of the visiting hour schedule and schedule our own “must-do’s” around it. I also asked where the hospital’s food offerings were located. (Fortunately there was a Starbucks close by.)

AT THE HOSPITAL

1. If surgery is scheduled, ask how long it should take. That enables us to control what we do during that time. There’s probably a waiting area for families. Some may find the large commonality of shared concern supportive. I don’t. We’ve always lived far from family. Although friends volunteered to wait with me, I decided being surrounded by anxious people in the waiting area for many hours would be overly stressful.

So I met a friend (who’s sensitive and fun to be with) at the hospital and we left, but didn’t go so far that I couldn’t get back quickly. My husband’s doctor said he’d call my phone upon completing the surgery, which he did, saying surgery had gone well and I had about 4 hours before my husband would be awake enough to know I was there. That worked well. His call was like a 4-hour time-out from stress.

2. Get the phone number of the floor/unit/ward before leaving the hospital on Day One. It comes in handy, It helps avoid visits to an empty bed when tests, scans etc are being done. Before my husband was able to talk on the phone–in the beginning days after surgery–it allowed me to get information and leave a message in the early morning, before I went to the hospital. I was careful not to overuse the latter.

3. Remember or write down the names of every healthcare person who attends your loved one and call them by name when you say “hello” or “thank you.”  It seems to create a small personal bond, which gets faster results when we have questions or need help (in the latter case remember the “I need your help” phrase).

4. “Thank You Kevin/Samantha/Whoever” can’t be said too many times.

5. Show interest–however brief, if you can do it–in every hospital person who comes into the room. Because I counseled high school kids, I often asked where the nurses, CNAs etc. got their training and explained reason for my interest. If they were from another country I asked where they were from and if family was there and if they went back to see them; and if I’d travelled to the country or wanted to, I told them. I know my interest  meant something to them and when we needed something, they never failed to come through quickly.

6. Fight infection. Mt. Sinai had hand sanitizer dispensers and signs about sanitizing hands everywhere–at the entrance, exit, by the elevators, at the entrance to each unit, and in each room. The rooms also had boxes of gloves. I was prepared to be a watchdog about this, but everyone was trained well and automatically put hands to dispenser upon entering and exiting the room.

Every hospital may not train as well–and monitoring everything is no easy responsibility. Yet we become the eyes and ears for hospitalized aging parents and our spouses. And doesn’t that buttress the case for why we need our rest!

                           to be continued…..

Related: Hospitalization Tips that Make a Difference for Grandparents. Parents, Children and Us
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Aging Parents: Smartphones’ Photos in Senior Healthcare

Smartphones’ photos in senior healthcare
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NYC 86th St. Subway ad 2016 (above). Close up of text under “The doctor will see you now” (below).

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Upon exiting the subway last week, this ad greeted me. We are to assume, I believe, that unknown medical diagnosticians, presumably MD’s, are at the ready to diagnose unknown people’s health issues after receiving photos taken by–and emailed from–a mobile device.

Over three years ago, my dermatologist’s assistant asked if I had an iPhone and could take a picture of something on my face, email it and perhaps save an office visit—and time (and money).

What an unexpected response to my calling to make an appointment to have her look at a little spot. It made so much sense. Indeed I had the “nothing-to-worry-about” reply from her office within the hour. How efficient–and reassuring–is that!

I’d forgotten that experience until I got off the subway and saw the above ad a few days ago. Coincidently yesterday, after calling the doctor’s answering service due to a health issue in my family, our doctor was caring enough to phone back asking: “Can you email a picture?” Of course we could. Almost immediate feedback–both ways–with resulting peace of mind at our end.

An emailed photo to a doctor would seem to be helpful to everyone in certain circumstances. Yet I’m wondering how often doctors instruct their staff to offer the option? Or whether they’ve thought of it? Are there times when we need to ask our doctors if smartphone-emailed photos are helpful in certain instances? (See Related below for some “instances.”)

While it may be difficult to envision people wanting to receive a diagnosis at a distance by an unknown doctor, the ad in the subway merits attention to this helpful possibility: When it comes to our parents’ doctors–or our own, it makes sense to ask their feelings about receiving smartphone photos under certain circumstances.

We know how much effort goes into helping older parents and the elders we care about. Doesn’t it make sense to use all available technology to help ourselves save time and energy, while helping our parents get advice without needing to visit their doctor’s office?
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Related: Aging Parents–visible wounds, cuts, bruises–connecting quickly with doctors; a different use for cell phones

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.

Help Aging Parents–Hospice: Why Wait To Call?

Call Hospice for Your Mom!

I meddled! A former neighbor sounded awful when I phoned the other night. She’s very old; has had cancer successfully treated over decades, but it sounds like the end may be near. There’s no “maybe” about the pain she says she has had for some time.  There’s an aide with her 24/7 so I didn’t think hospice was involved, although it sounded like they should be.

After speaking with a mutual friend, I talked myself into feeling comfortable phoning one of her two adult children. (I knew them from years ago–although I’d only been sporadically in touch since their mother moved away.)

Uncomfortable conversations immediately trigger my What’s the Goal? response. My answer to myself: Find out if hospice is involved. If not, respectfully and gently provide information.

Both children live far from their mother. Knowing the family dynamics from way back I understand one bears 99.9-100% of the responsibility and has been great. That’s the logical child to contact.

I made the call, leaving a simple message. It had three parts, the first–objective information: I phoned your mother several nights ago and she said she felt awful and could she call me back.” Next, the personal: “I haven’t heard back so I’m wondering how she’s doing.” Then conveying understanding: “It sounds like this is a rough time and I hope my phone call isn’t an intrusion.”

My call was returned within the hour, with appreciation. (We need to be careful not to make adult children feel defensive/judged. Easier said than done.) The simple, thought-out-beforehand sentence works.

I learned things were stressful. Doctors weren’t returning calls in a timely fashion; things got delayed, cancelled. A special trip to visit the mother in Florida 10 days earlier resulted in employing a geriatric care manager to move things forward. Approval from the insurance company was needed for an important test. They’re still waiting–it has been over a week.  Depending upon the test results, the plan is to check the availability of hospice care.

Bingo! The logical time to mention hospice was at hand. “Why wait to call hospice?” I asked, following up with the thought that hospice could provide some relief. Not knowing if hospice requirements differ by state, I made that known. Then I shared my parents’ experience when hospice became involved, made them more comfortable, and the relief I felt having the extra support. The response I got makes me think the message–why wait– got through. Calling hospice sooner, not later, seemed to be the new plan.

Bottom line: Calling hospice–or suggesting someone contact hospice–may be uncomfortable. But calling sooner–rather than later–offers professional, appropriate comfort to patient and family and a better chance for a satisfying ending. So many have said “I wish I’d called hospice sooner.”

Related: Aging Parents and Hospice: To Call, Not to Call, When to Call
               
A sample of what Googling  “who is eligible for hospice in Florida” provides.

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities. respected professionals and selected publications–to help parents age well.

Continue reading

What 90-year-olds Want From Doctors

Look at older patients instead of typing notes into a computer, take more time with them and answer their questions…

Periodically I go through the “Sites and Blogs I Like” (tab above)– reading, adding and updating. The Kaiser Health News site often has relevant aging articles: “Seniors Tell Medical Students What They Need From Doctors” (9/25/15) is one. (NPR picked it up.)

Sparked by the need for many more doctors (geriatricians) to meet the special needs of an aging population, Case Western Reserve Medical School recently held its annual panel discussion, “Life Over 90,”  for their 2nd-year-medical students. The 90+-year-old panel members shared experience and advice–equally instructive for anyone whose elderly loved ones go to doctors. And isn’t that everyone?.

I remember Sr. Advisor R’s last trip to NY, three years ago at age 98– making the effort to navigate airports and flying cross country alone. She had two goals:
1. to see our new apartment and
2. to get a second opinion from our ophthalmologist.

The second was a disaster. After many tests, we went into the doctor’s office. He sat on the other side of the desk, his swivel chair in the right angle between his computer and R, who sat directly across from him. I was on R’s right. Perfect–in terms of where he sat and his ability to glance at the images on the computer then turn to talk. But he flunked the conversation by looking past R–to me–when he spoke.

My instinct was to redirect the conversation but before I could, R announced: “Dr. I pay my own bills, kindly address your remarks to me.” Granted, R didn’t achieve living independently, alone– in her home of 70+ years –by being a pussycat! She knew how to advocate for herself. But what about many elders who either never had–or have lost–that assertiveness?

Initially I faulted myself for not speaking up quickly enough. Then I decided it was much better that R advocated for herself, once again confirming she was in control. (Key Thoughts–right sidebar: Do actions empower or diminish? or Don’t do for aging parents what they can do for themselves.)

R’s experience highlights the fact that while doctors may be tops in their field, far too few have been trained to understand the special needs of older people now–and there will be even less as boomers and those younger age.

Past posts (several years back) emphasize the value of geriatricians for older people’s health care. Read Karen’s short letter re: her mother’s appointment with a geriatrician at Mt. Sinai in NYC.

Case Western Reserve and no doubt other medical schools realize that geriatrics is a relatively low-paying, underpopulated specialty. Even when medical students have interest, most incur huge debt from student loans that will need to be repaid, so they select a higher paying specialty.

Efforts are being made to encourage medical students to specialize in geriatrics–or at the least better understand the needs of older people. That said, a severe shortage of doctors, with an understanding of the special needs of those 65+ exists. It affects not only aging parents and older loved ones now, but portends pitfalls for us in the years ahead. While sobering, check out Related below.

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Related:  When do you need a geriatrician?
                American Geriatrics Society–Find Health Care Providers
                Castle Connolly Finding the Best Geriatric Doctors
                Healthgrades Geriatric Medicine-State Directory
                US News– Health: Find Geriatricians-US Doctors


Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities. respected professionals and selected publications–to help parents age well.
               

Aging Parents: Maintaining Mobility into Old, Old Age–The Dangers of Sitting Too MuchCONTACT SUSAN at: helpagingparents@gmail.com

Sedentary Seniors and Couch-Potato Elders—Walk More. Sit Less

How limiting is life for those with curtailed mobility?

Look around…so many people with canes and walkers as our population ages. Based on the Tufts U. publication–reprinted below–it seems their numbers would lessen if the elderly couch potatoes we care about (as well as those of us who now spend hours sitting at a desk), make it a point to take breaks for a brief walk. What could be easier?

The importance of older peoples’ walking is nothing new to longtime readers of my blog.  “If you begin a daily walking program at age 45, you could delay immobility to 90 and beyond. If you become a couch potato at 45 and remain so, immobility can encroach as early as 60.” So says Mark Lachs, author of Treat Me, Not My Age.   (Dr. Lachs is Chief of the Division of Geriatrics and Gerontology at Weill Medical College in NY among other positions, and first written about in my 2010  post featuring Jane Brody’s NY Times columnWhat to Do Now to Feel Better at 100.) 

Sr. Advisor R, was living proof. She didn’t use a cane (didn’t own one as far as I know) until she was 97–after her broken hip episode. instead R walked daily on a treadmill from age 50 (as written previously–not the plug in kind, your feet make it go). And R continued using that treadmill daily–until she died.

(R’s best friend [93] is the beneficiary of that treadmill and phoned last week, laughingly saying she knew it was bequeathed to her and she’d send a strong young relative over to pick it up if that was OK.)

Further proof was my dad, who was 94 before I ever saw him use a cane….and then he used Mom’s old cane, which probably wasn’t the right fit; but he said he only used it when he felt weak. Out of respect, I never pushed him on the subject. (His mind was good.) That said, he not only walked a lot, he had to walk upstairs to his bedroom and down the basement stairs to get into his car. Thus, many leg muscles were exercised daily and mobility was never an issue other than that he walked slower than in his younger days.

A well-respected chiropractor in Westchester County, NY told me that he could always tell which patients wintered in Florida because they didn’t get the exercise walking stairs provided. Enough said. Here’s the latest  on “sedentary sitters”–

Tufts Health & Nutrition Letter

August 24, 2015

Brief Walks May Counter Health Dangers of Too Much Sitting

Multiple studies have warned about the health risks of sitting too much. Hours spent sitting, whether at desks or in front of the television, have been linked to increased odds of cardiovascular disease, type 2 diabetes and kidney problems. But modern life can make it difficult to stay out of chairs, and alternatives such as “standing desks” don’t appeal to everyone.

A new study may offer hope to sedentary sitters: Using data on more than 3,600 adults, researchers found that brief periods of simply walking around the room substantially reduced mortality risk among people who spent long periods sitting. As little as two minutes of gentle walking per hour was associated with a 33% lower risk compared to non-stop sitting.

“We know that exercise is good for us and yet, despite this, our society has become more sedentary than ever,” says Miriam E. Nelson, PhD, associate dean of the Tisch College and a professor in Tufts’ Friedman School, author of the “Strong Women” series of books. “We are built to move, and when our bodies move on a regular basis, they are healthy; when they don’t, when we’re largely sedentary, our bodies deteriorate.”

MEASURING MOVEMENT: In the study, published in the Clinical Journal of the American Society of Nephrology, Srinivasan Beddhu, MD, of the University of Utah, and colleagues analyzed data from the annual National Health and Nutrition Examination Survey (NHANES). In recent surveys, selected participants have supplemented their questionnaire answers by wearing activity monitors called accelerometers; this gives a more accurate record of a person’s movements than depending on individual recall. Most of the participants were generally healthy, although a subgroup of 383 people had chronic kidney disease.

Researchers divided participants into four groups based on minutes per hour of different levels of accelerometer activity: sedentary/sitting, low (such as standing up but not walking around much), light (such as strolling around a room or walking into another room), and moderate/vigorous (jogging or other exercise). The study then compared activity levels to records of deaths three or four years after the assessment.

ADDITIVE ACTIVITY: There was little difference in mortality between the sedentary and low-activity groups. But people who interrupted their sitting with light activity were at significantly lower mortality risk than those who were completely sedentary; this difference was even sharper among the kidney-disease subgroup (41%). As little as two minutes an hour of light activity was enough to be associated with lower risk.

Boosting activity levels to moderate/vigorous further reduced risk, but the number of such active participants was too low to be statistically significant. Adding additional minutes of light activity, however, did make a significant difference. Getting up from your chair for two minutes or five minutes more light activity rather than sitting time, Dr. Beddhu said, could further reduce risk of premature death.

He cautioned that the study was observational, and so can’t prove cause and effect. And Tufts’ Nelson notes that a quick walking break from your chair is no substitute for regular physical activity. But if you’ve been worried about the health risks of sitting too much, apparently every little bit helps.”

Last January (2015) Time magazine’s online article discusses the sitting dangers and recommends “standing up and moving around every half hour

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.

Related: Helpful information from his book in ABC 2010 interview with Dr. Lachs.
Jane Brody’s NY Times columnWhat to Do Now to Feel Better at 100
Time Magazine online, 2/
2015 . It Doesn’t Matter How Much You Exercise if You Also Do This
USA Today 2/2014. Don’t just sit there! It could be harmful in later life.

US News Best Hospitals 2015-16 Ranks Mayo Clinic (Rochester) #1 in Geriatrics

Massachusetts General Hospital-courtesy Mass General

Massachusetts General Hospital [Massachusetts General]

Massachusetts General Hospital in Boston is ranked #1 Hospital in US News’s Best Hospitals 2015-16 issue, published July 21st.

In Geriatrics Mayo Clinic in Rochester (not to be confused with their other sites) ranked #1, followed by  UCLA Medical Center (Calif.) #2; Mt. Sinai (NYC) #3; Massachusetts General (Boston) #4; and Johns Hopkins (Maryland) #5

How is this information helpful? There’s a wealth of information in the issue, most of which is available by using the search box after clicking the links above. Nationally ranked and regionally ranked hospital information provides a standard and helps with questions to ask when considering procedures for aging parents and the elderly we care for and about.

While “garden variety” procedures shouldn’t require the top experts in the field, we know it makes sense if doctors have performed the procedure hundreds of times a year vs. a hundred times a year. In the case of complicated procedures and illnesses, it makes sense to have the tops in the field. They should be the most experienced (and thus, have successfully dealt with more of the unexpected problems that can arise). That said, spending time doing the research also makes sense.

One result of doing research is finding that some of these excellent doctors have opted out of Medicare. Don’t be completely discouraged as long as your parents have Medicare Part B coverage. The no-longer-Medicare-participating doctor’s office isn’t allowed to send in Medicare claim forms, but you/your parents can do this –and be reimbursed. It most probably means there will be reimbursement, but at a lower amount than the doctor charges.

For details about Medicare reimbursement for bills from doctors who have declined Medicare participation, go to these previous posts:

Getting Reimbursed When Doctors Don’t Take Medicare

Getting Reimbursed When Doctors Don’t Take Medicare–The Form You Fill Out

When we help parents age well, we make it better for ourselves too–in so many ways.

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.