How to address the “#1 health issue” in aging?

  1. healthy-aging-older-womenWhat is the #1 health issue that threatens quality of life as we age?
  2. And what is the #1 thing that can be done to prevent that health concern?

These are two questions I received by email recently, on behalf of a woman who is part of the “health and healthy lifestyles subcommittee” for a “village information network” that aims to support older adults in her community.

She also asked the following related questions:

  • Do you know of a best practice somewhere, that could serve as a model for that prevention of that health issue?
  • Do you know of a small town somewhere that is doing a great job with livability for older adults?
  • Do you know of any inter-generational healthy lifestyle programs that might work well in our college town?

I was invited to provide very short one sentence answers, presumably for my convenience but also perhaps to keep things simple for the committee, who surely doesn’t want to wade through long dissertations on barriers to better aging and better approaches.

But I found myself unable to promptly respond with short answers. To begin with, because I have a health services research background, my initial reflex is to want to check on the “evidence” rather than fire off a response related to my own hunches or personal experience.

But any evidence related to the first two questions will depend on which population is being studied. How old, and with what underlying health conditions? Urban, suburban, or rural? Socioeconomic status and ethnicity? Community-dwelling or in facilities?

And how to define “quality of life as we age”? Quality-adjusted life years? Or perhaps other metrics that take into account autonomy, purpose, and social connectedness? (See here and here for scholarly articles addressing this issue.)

As you see, it’s easy to fall down a rabbit hole when considering the “simple” question of what is the #1 threat to quality of life while aging.

Still, the questions are compelling, especially when considered in light of the practical needs at hand. A community group is trying to support the older adults living in a small college town. When it comes to health, what should they focus on?

Three top health issues that threaten quality of life as we age

I don’t have time to research this in depth right now, so, for now, I am going to go with my hunches and personal experience.

My initial hunch is to suggest these three issues, when it comes to threatening quality of life while aging: [Read more…]

Families Caring for an Aging America: a key report just released by the National Academies

caregivingcover_rgbAt last. Last week the National Academies of Sciences, Engineering, and Medicine (NASEM, formerly known as the Institute of Medicine) released a report on my very favorite topic: family caregivers of older adults.

The official title is “Families Caring for an Aging America.” Hence this report is indeed specific to caregiving for older adults, defined in this report as aged 65 or older. (In comparison, last year’s Caregiving in the US 2015 report considered a broader range of caregiving recipients.)

So if you have any interest — personal or professional — in the families and friends who are helping older adults, this report is a must read. The full report also addresses the role and potential of newer technologies, especially in Chapter 4.

As with many NASEM reports, the main report page provides the following:

Some data highlights

I haven’t read the full report yet, but here are some interesting data highlights I’ve come across so far:


Statistics on how many older adults are getting help. These seem to be mainly drawn from 2011 data. fig-2-1-older-adults-getting-assistance

  • 6.3 million older adults (17% of those age 65+) received help with household tasks and/or “self-care” (meaning ADLs such as bathing, toileting, dressing, eating, or mobility).
  • An additional 3.5 million older adults received help due to having dementia.

[Read more…]

Omron home blood pressure monitor 786N: Good hardware, bad app design

omron home blood pressure monitorIf there is one device that I think most older people should have at home, it’s a home blood pressure monitor. So a few years ago, I wrote an article for the Geriatrics for Caregivers blog with tips on choosing and using a home BP monitor.

At the time, I didn’t recommend a specific device because I hadn’t tried any. But recently I decided it would be much better if I could suggest a specific device to patients and families.

So I looked on Amazon and looked for a home BP monitor that could meet my specifications:

  • Measures BP at the arm
  • Easy to store, review, and share BP readings, which means some type of wireless data transmission capability
  • Smartphone/tablet not mandatory to use the device

When I wrote a blog post in April 2014 about my specifications, Omron did not seem to offer a device with wireless data transmission.

But earlier this year I noticed a Bluetooth-enabled Omron monitor on Amazon.  So I bought an Omron 786N earlier this summer and have been trying it out.

Pros & Cons of the Omron 786N Home Blood Pressure Monitor with Bluetooth

Here are my thoughts so far: [Read more…]

Still In Search of a Personal Health Record & Trying Healthvault

Recently I completed a consultation on a new patient. This person had moved to San Francisco a few years ago, and was not sure he was satisfied with the care he was obtaining from his new PCP.

The consultation was a bit challenging for me, because I had no past medical records available to review. Nothing from the old cadre of doctors on the East Coast, nothing from the current PCP, not even anything from a recent hospitalization. No laboratory results, no studies.

(In truth, I usually decline to schedule an initial consultation until some of this information is available. I need this type of information in order to do my work assessing the person’s health and the current medical management plan.)

As I often do, I encouraged this patient and his family to start maintaining a personal health record (PHR): some kind of collection of his key medical information, all in one place and under their control. I explained that this would be a huge help if they wanted to

  • Obtain second opinions when necessary
  • Transfer to a new PCP
  • Be able to check on how the chronic conditions were being managed and consider other options
  • Get better medical care in the event of an emergency or possibly even while traveling

In its simplest form, a PHR is a collection of papers kept in a binder or perhaps file cabinet. Paper can be hard to keep organized, however, and can only be searched effectively if everything was first filed in an organized fashion.

So a digital approach would seem to be in order. Digital information is easier to search, and often more portable than paper information.

But I was annoyed to find that yet again, after recommending this family set up and maintain a PHR, I couldn’t actually recommend a specific product or service. This was surprising to me, because it was almost three years ago that I wrote this article for the Geriatrics for Caregivers Blog: Tools for Caregivers: Keeping & Organizing Medical Information.

Yet today, I still cannot recommend a tool that will do the following: [Read more…]

Getting & transferring a person’s health information: still slow and inefficient

I have been thinking again about people’s medical information recently.

First of all, most people have no copy of their own health information. Recently a family member went for an annual physical, and the clinician dutifully addressed the question of colonoscopy. My relative thinks she had one in the past few years, but the doctor doesn’t have a record, and no one is sure how to find it.

I told my relative that when they do locate the results, she should get a copy and keep it. And keep copies of her laboratory results too, for that matter. “Why would I do that? Doctors keep those things.” was her response.

Sigh. Hasn’t she noticed how often doctors can’t find something, or don’t have it?

When I take my car to the shop to have something serviced, I keep a record of what was done. Same goes for any work done on my home. And many people I know do the same.

However, those same people generally don’t think to keep records of what was done to their bodies. Even though it’s arguably more important than what was done to their cars.

Furthermore, if you decide to take your car to a new mechanic — maybe you weren’t sure about the old one, or maybe you moved to a new town — would you show up with no records of the work done on your car so far?

Well, you might, but it’s not a great idea. When assessing the state of a car — or a person’s health — it’s extremely useful to know what has happened in the past, and what other professionals have done or attempted, when it comes to diagnostics and treatment plans.

So really, why don’t more people maintain at least a rudimentary personal health record? [Read more…]

GeriTech’s Take on AARP’s 5th Health Innovation @50+ LivePitch

On Wednesday April 27, 2016, AARP hosted its fifth Health Innovation@50+ LivePitch event, an event that allows 10 chosen start-ups to pitch to a consumer audience and a panel of venture capitalists.

This year the event’s description seemed a bit different than in prior years, with a new emphasis on caregiving: “Innovation@50+ is a one day pitch competition for emerging startups in the healthy living space with a focus on caregiving.”

As in prior years, there did not seem to be much judging or input from anyone whose primary work and expertise is to improve the health of people aged 50+, or to improve the lives of family caregivers for that matter.

In this post, I’ll list brief descriptions of the finalists, comment on how promising they seem to me — in terms of improving the healthcare of older adults and the lives of family caregivers— and tell you which products I’m most interested in. To see what I’ve thought of past LivePitch finalists, here’s my coverage of the first, second, third, and fourth cohorts.

GeriTech’s quick take on the AARP LivePitch finalists

Here are the AARP descriptions of the companies/products presented at the LivePitch event, along with my initial reactions. I took a quick look at everyone’s websites, and for certain web-based products tried them out for a little bit, but have not tried any of these products in depth.

Cake: “Cake is the easiest way to do end-of-life planning. We break down a daunting and difficult task into simple, bite-size chunks, and provide experts who can answer your questions. Your online CAKE profile is a living document of your end-of-life preferences that is easy to access, update, and share.”

GeriTech’s comments: [Read more…]

Care Coordination Around Hospitalization, Part 2

You may be wondering what happened with Ken, whom I wrote about in my last post.

Well, he stayed in the hospital for 4 days. At the end of his first day, a palliative care consultant called me and left me a voicemail with recommendations related to pain and constipation. He left me a cell phone number. He didn’t answer when I called him back, so I left a brief message and thanked him for the update.

But no hospitalist ever called me and no updates were faxed to me. On the fourth day (a Monday), I called the floor and again asked to speak to his doctor. His nurse came to the phone, explained to me the discharge plans, and then asked if there was anything else I needed.

Well, yes. I need to know what happened to him medically, not just what facility they were planning to discharge him to. Why did they keep him for so many days? Ken himself had left me messages saying the doctors were doing a lot of tests but not telling him the results. (Patient-centered hospital care, where art thou?)

The nurse was unable to answer these questions. I said that I wanted results of the tests faxed to me, and that I’d also like to talk to his doctor.

Several hours later, a doctor finally called me. He sounded young and harried. “So, what do you need to know?” he asked me. [Read more…]

Care coordination when patients go to ED or hospital

My patient, who lives in assisted-living, went to the Emergency Dept and then was hospitalized last night. (We’ll call him Ken.)

So once again I get to see what works well and what works less well, when it comes to care coordination. As usual, I’m not impressed, although things could be worse.

In part, they are not so bad because I’m the one who urged Ken to go the ER. Whereas my patients are often sent to ER without anyone even calling me first, in this case, I knew he was going, and was even able to take action to smooth the process.

An added bonus: Ken has a  long-time care manager who I connect with regularly, and she arranged for the transportation there and stayed with him for the first few hours.

Furthermore, to help Ken get the right care from the ER and to facilitate coordination of care, yesterday I wrote a note for the ER doctors. Ken’s care manager brought this with them to the ER, along with a medication list from the facility.

In my note, I summarized:

  • The most important aspects of Ken’s past medical history
  • Recent changes to his health — including recent lab and radiology results — and why we were sending him to the ER
  • Information on Ken’s background, including the fact that he’d been living at the facility for a few years, that he’d had the same care manager for years, and that he’d been homebound due to a psychiatric condition, which caused him to refuse to leave the facility to see his assigned PCP
  • Information regarding Ken’s preferences for medical care, including the fact that he’d consistently refused medical care meant to extend his life, and had repeatedly emphasized a desire to have pain and comfort addressed
  • Information regarding Ken’s usual mental capacities and decision-making capabilities
  • My contact information (phone and fax)

In short, Ken arrived at the ER better equipped than most to facilitate care coordination.

Now here is what has happened so far:

  • I have heard nothing from the ED, by phone or fax. It was Ken’s care manager who sent me an update last night, and then this morning informing me he’d been admitted.
  • I called the hospital this morning and left a message saying I wanted the nurse or doctor to call me. That was over 4 hours ago and nothing yet.

I’m not surprised by this, but it’s still disappointing. If I send a patient to the ER, with a note that includes my fax number, is it crazy to expect the clinicians to fax me something about what they found and did??

How I did get an update on my patient’s ER course and hospitalization

[Read more…]

New PCAST Report on Independence, Technology & Connection in Older Age

Yet another major report was released this month: “Report to the President: Independence, Technology, and Connection in Older Age,” from the President’s Council of Advisors on Science and Technology (PCAST).

PCAST convened a blue-ribbon working group for this report, which included several prominent experts who have done terrific work in improving the health and wellbeing of older adults.

So I was a bit surprised to find myself a bit disappointed by the report and the recommendations. Every now and then I read something that leaves me thinking “Wow, this really clarifies what’s happening, what’s important, and points towards solutions that are viable and likely to improve the problems we face.”

This report did not leave me with that feeling. But perhaps it will do more for you? In this post I’ll summarize some key highlights from the report, and then I’ll share a few thoughts on what I’m hoping to see in future expert reports.

How PCAST framed its report

PCAST identified four areas of change in aging, which offer opportunities for technology to help: [Read more…]

Aging in Place: What are the problems to solve?

I came across a thought-provoking report recently, titled “Technology for Aging in Place 2016,” by Laurie Orlov, a market analyst for aging technology. The report seems to be an update to her 2014 report on aging and technology, which I commented on in this post.

As always, I’m interested in how business people conceive of needs and approaches to solutions, and how that compares to our view of the needs and issues as aging health professionals.

A striking fact which I hadn’t previously appreciated is that many older adults remain in their homes while aging because they can’t afford to move elsewhere. Per Orlov:

Median net worth of the 75+ age range is now $156,000, inclusive of home equity (see Figure 1). This is deferring moves to assisted living – its move-in age now a mid-80’s and frailer demographic. But boomers are right behind them – and even less able to move in. They have simply not saved enough – holding an average retirement savings portfolio of only $136,000 – enough for just two years of a private assisted living community like Brookdale.

Orlov also cites this AoA data summary, which reports that

  • About 28% (12.5 million) of noninstitutionalized older persons live alone (8.8 million women, 3.8 million men).
  • Almost half of older women (46%) age 75+ live alone.

In short, we have a growing population of older adults, many of whom have limited financial resources, and many of whom live alone in the community.

What percentage of older adults are living in their own homes was unclear to me; Orlov states “Eighty percent of older adults today live in their own homes,” however the reference provided does not address this particular statistic.

To me, “living in your own home” means you own the home. I did find a very good report on aging and housing from Harvard’s Joint Center on Housing Studies, which notes:

Among those aged 80 and older in 2011, fully 60 percent had lived in the same residence for 20 or more years. Another 18 percent had occupied their homes between 10 and 20 years.

However this data is from the American Housing Survey, so presumably it is referring to older adults who are already in community housing, as opposed to all older adults.

The NIA report “Growing Older in America” does provide data on living situations and says 79% of older Americans live in their own homes, however this report is based on Health and Retirement Study data from 2002, and 2002 is starting to feel like a long time ago. Hence, I am still left wondering just where older adults are living, and it would be nice to see updated data addressing this issue.

The most important questions to ask, to address aging-in-place

[Read more…]