GeriTech

In Search of Technology that Improves Geriatric Care

challenges in providing care

Using Technology to Balance Safety & Autonomy in Dementia

I know, it’s been a little quiet here at Geritech…mainly because things are busy over at Better Health While Aging (BHWA).

But I haven’t forgotten about tech tools to help older adults and families. In fact, the more the audience at BHWA grows, the more I feel a need to find useful tools that can help them.

Unsurprisingly, a big need is for help with cognitive issues and dementia caregiving.

In particular, people often want to know what technology I can suggest to help their older loved one stay safe at home, or be found if lost outside the home.

My own panel of consultation patients is currently too small to enable me to have a lot of hands-on experience with these types of tech tools.

So last month, I invited my former VA colleague Mary Hulme to join me on the BHWA podcast.

Mary is a geriatric social worker who is an expert in dementia care. She also developed a particular interest in technology tools several years ago, and co-authored the book “Caring from Afar: A Guide to Home Sensor Systems for Aging Parents” in 2014.

On the podcast, we discussed the ever-present challenge of balancing safety and autonomy, and then we talked about several different types of technology that families can use.

If this is a topic of interest to you, you can find the podcast episode here:

061 – Interview: Using Technology to Balance Safety & Autonomy in Dementia

Have you used any home sensor, personal emergency response, or GPS-tracking systems for someone with Alzheimer’s or another dementia?

If so, I’d love to know what you tried and how it worked out for you. Please post a comment here, or on the show notes page for the podcast episode!

 

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

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…] about Care Coordination Around Hospitalization, Part 2

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…] about Care coordination when patients go to ED or hospital

How many phone calls & faxes does it take to evaluate a common complaint in assisted living?

If we are going to provide compassionate and effective care to an aging population, at a cost we can all afford, we are going to have to get better at dealing with health concerns that come up often.

I am perpetually struck by how much effort and friction is involved, when I have to address certain common health issues.

Today I’m going to share a recent example: new confusion in a 90-year-old elderly woman who lives in assisted-living. Goals of medical care are to avoid hospitalization, and to focus on optimizing function and comfort.

Brief backstory: this elderly woman has Parkinson’s disease, but generally has very good cognition. She has private 24-hour caregivers because she can’t get up out of chairs on her own, needs stand-by supervision when she gets around her apartment with a walker, and needs to be taken by wheelchair to the dining hall and other locations within the facility. She also needs help with continence care. And, she’s been getting home health services for the past few months, for a sacral pressure sore.

As you can see, lots of people involved in her health and care: private home aides, home health agency RN, assisted-living facility staff (which includes their own RN), and an attentive adult child who visits often. This lady is essentially home-bound but very occasionally gets out to see her neurologist or another healthcare provider.

And now for what happened with confusion. For me the story started when the woman’s son sent me a message, saying his mother was now having delusions and crazy thoughts, and that her paid caregiver said she hasn’t been herself for the past 36 hours.

So this sounds like delirium: worse than usual mental functioning, generally brought on by an illness, stress on the body, or sometimes by a medication side-effect.

In other words, this is a common concern that comes up for many older adults, especially if they have a chronic condition that can cause cognitive impairment, such as Parkinson’s.

And cognitive impairment is apparently very common among assisted-living residents. Here’s what a 2014 Health Affairs paper says:

Estimates derived from national data indicate that seven out of ten residents in these residences have some form of cognitive impairment, with 29 percent having mild impairment, 23 percent moderate impairment, and 19 percent severe impairment. More than one-third of residents display behavioral symptoms, and of these, 57 percent have a medication prescribed for their symptoms. Only a minority of cognitively impaired residents reside in a dementia special care unit, where admission and discharge policies are more supportive of their needs.

Given this data, delirium must be very common in assisted-living, and you’d hope that a clinician would be able to evaluate and manage without too much hassle. But let’s see what happened in my case.

Evaluating a worsened confusion complaint in the real world

[Read more…] about How many phone calls & faxes does it take to evaluate a common complaint in assisted living?