So the readings for this week focused on frailty and the journey towards frailty as one ages. Often it takes simply a accidental fall in one's house which eventually leads to the person becoming depressed and then maybe the hospital. It seems like it is a declining cycle and that one of the key ways in which to prevent is simply that, prevention (in the form of healthy eating, exercise, etc.). Yet, when one does begin the journey towards frailty, another key observation is motivation to getting better and overcoming your disability. How do you combat a physical and sometimes emotional disability with something not as concrete as rehabilitation? In other words, how do you motivate someone in the first place to begin exercise, when in essence it is a behavioral change that needs to occur? Another question is in regard to early detection and screening. It should be emphasized more to have seniors, who are still capable of safely driving, to visit their health care providers and request a yearly physical exam checking especially for things such as hearing and vision. Does Medicare cover these visits? And even more so, is mental health included?
How can medical professionals best coordinate care of a patient? For example, one person had a stroke and missed an eye appointment. Another person had a combination of medicines that caused balance issues.
The New York Times article told readers to "install grab bars" and use a "walking aid". How do seniors respond to these suggestions if they think the devices are ugly or uncomfortable?
How do you fight the sense that someone is "falling apart"? How can you reassure them that small changes will make them a lot happier?
-Mildred Snitzer was depressed but fought through it. Is there any data on depression in the elderly and how it is tied to dying (e.g. as a cause)?
-What types of general geriatric care is covered by insurance / federal programs vs. others?
-Are there any studies on how much they would have to raise the retirement age for Social Security and other federal programs for the elderly to be solvent?
Mildred defies almost every statistic we've heard about so far. She has age, cheerfulness, balance, muscle, resilience--what's her secret? Luck, attitude, both, or neither? Is there something else that we can do to help more people do as well as she does?
Gawande's article scares me. Geriatric care seems so obviously needed, and yet we will clearly need more than we have in the near future. It also surprised me that he says geriatric care loses money--it seems to me that it saves money overall, in keeping patients independent and relatively healthy. How is it that insurance companies don't see the benefits of preventative care? Dental insurance pays for cleanings and health insurance pays for prenatal care on the assumption that it costs the insurers less than complications would later--shouldn't geriatric care work the same way? And if not, what is it I'm missing?
I'm confused by the definition given for "frailty and failure to thrive." Are these two terms synonyms? The definition states that failure to thrive is the most extreme manifestation-- of what? The continuum/cycle that is "frailty"? Or are they both the extreme of low recovery?
• What can be done to break the cycle of frailty, or at least slow its progress?
• If finding people who want to become geriatricians is difficult, why not create incentives to get people to take that career path?
• Would sharing inspirational stories of people who recovered from serious falls encourage or inspire people to get moving after their own falls so that they can avoid the major problems that occur with these types of injuries?
1.) What diseases/conditions was Jack Simon afflicted by? How was he
able to adapt to these conditions? How did Margaret deal with his
condition?
2.) The Lifelines article addressed several diseases that
predominantly affect older people. What are these diseases, the
treatments, and how do these treatments affect the livelihood or
functioning of older people?
3.) What disease was Leyla Keribar afflicted by? What lessons can we
draw regarding the role of technology in "fixing the fixable?" With
respect to diseases common to older people, when is "fixing the
fixable" not appropriate?
1.)Jane Brody, New York Times: Dec 26, 2006
How should seniors balance their house design with elements of elegance, such as rugs, with the reality that such trappings could pose a risk? Additionally, how should loved ones convince people at risk that changes should be made in their house?
2.)Muriel R. Gillick, Lifelines
We are met with an example of getting surgery in order to improve the quality of life. What counsel should older people receive to know whether surgery is a good idea or when complications are too risky?
3.)Jamie Francisco, San Jose Mercury News
Mildred Snitzer is a great example of somebody who used activity and her zeal for life to make a speedy recovery from a broken hip. It doesn't seem like most patients recovering from a hip replacement surgery are as encouraged to push themselves physically. Should these patients be recommended to exercise shortly after hip surgery in order to improve faster both physically and mentally?
When patients have multiple conditions, as several of the patients in Lifelines did, how is their care coordinated? Does one doctor receive reports from the others that treat the same patient? If the patient fills prescriptions at different pharmacies, is there any way for the pharmacist to check for drug interactions?
At the end of the New Yorker article, a program is described where nurses will receive intensive training in geriatrics and then work in clinics around Baltimore and Washington D.C. It was also suggested that geriatricians turn their attention to teaching courses at medical schools so that all medical students are exposed to geriatrics. Which medical professionals are best poised to offer geriatric care for the next several decades?
Geriatrics is cursed by economics in that Medicare will not cover most geriatric care. Could there be a benefit for Medicare in treating the elderly in a more holistic fashion? The economics of smoking cessation programs and diabetic care programs have tipped in favor of them. Has geriatrics been examined in a similar context to these "prevention" programs?
I was amazed reading the story of the 95 year old who's hip fracture would heal so quickly. It really showed the importance of staying active, but the effects are often seen so far down in the future, how do we provide immediate feedback to people to let them know that their effort to be active is worthwhile?
How could one break the cycle of frailty?
As there are fewer and fewer geriatricians, are there ways to provide the type of care they provide directly to the elderly? From reading the articles, it seems like a lot of the things the geriatricians do are simple daily reminders, eg. to clip toenails, to eat well, to careful of potential tripping hazards. May be this could be done through a social work system or even a simple program that pops up reminders. How useful are these?
The readings attest to the importance of combating frailty and falls in older adults. All three of the main predictors of falls (poor balance, taking more than four prescription medications, and muscle weakness) can be seemingly reduced or eliminated if the person maintains a healthy lifestyle. The first reading suggests that a new generation of people is growing older that is more aware of the importance of physical activity, and the New Yorker articles title says that we are aging differently than we have before. Yet, we still face extremely high rates of obesity and it has been said that today’s young people may be the first generation to be less healthy than their parents. This made me think: what might happen if we truly do see a reversal in the trend towards healthier and longer lives? What happens if we greatly reduce falls for one generation only to find that those who are growing older just a decade later have problems we thought were eradicated? How can we try to be sure that we are progressing in our ability to provide people with longer, fulfilling lives?
I enjoyed the discussion of fixing the fixable. Clearly, as the article suggests, failing to fix a fixable problem can lead to a downward spiral that may be difficult or impossible to reverse, but how do we make things more fixable? How do we understand the limits between what is fixable and what is not? Do limits even exist? We are, as one of the article suggests, “freaks living well beyond our appointed time." To what extent do we want to test these limits?
In thinking about design, I was shocked by the statistics presented about teeth—that by the age of 60, Americans have lost a third of their teeth, on average, and that people’s age can be identified within five years by the age of their teeth. It makes me think: what sorts of designs may help people to continue to maintain their teeth? Clearly teeth are important to eating which is critical to combating frailty. This seems to be an important area for the understanding and development of new designs and practices.
1. The article about the dancing 95-year-old brought up a unique point. She has that harder than any of the treatments or preventions are "her own questions - about aging, how long she'll live, and what she wants that life to be." How might we take into account individual motivations when giving general advice about healthy living in old age?
2. Since the population chart is becoming rectangular, how do we address caregiving issues? How do we encourage the younger generations to take care of the growing elderly population, esp. in a time period that presents youth with more opportunities than ever before?
3. How useful would it be to have "invisible" (or very very small) sensors located at every "dangerous" beautiful item in the house? Like fancy rugs or china on display tables? Or even on tables or cabinets with sharp corners? This would allow elderly people to steer clear of these obstacles.
1. How do we attract more medical students into the field of geriatrics? It seems to me that our society is all about the young person and the "potential" we see in him; we place much less value or honor on elders than other cultures do. How do we shift this young-centric attitude and stress the importance of gerontology?
2. "We are, in a way, freaks living well beyond our appointed time" (The Way We Age Now: The New Yorker). How do we reconcile the field of gerontology with this view of old age? Why try to prolong life if it's unnatural? We have successfully lengthened life significantly, but for many the extra 20 years are ones troubled by disability, loneliness and financial difficulty. How do we rectify this disconnect?
3. The Mercury News article about Mildred Snitzer, who still dances at age 95, made me stop to think about elders and exercise. As a young person, Mildred was a dance instructor and exercise teacher much like the woman Leah and I interviewed earlier in the quarter: The 101 year old we met had also danced throughout her life and remained very active. Both of these women had early life experience with exercise --- many women of their generation may not. How do we motivate older women (who have never incorporated exercise into their daily lives) to pick up the habit?
“At 95, She’s Still Dancing”:
• The article claims that “falls are the leading cause of death among people over age 75”. Does this really mean that falls lead to other conditions that ultimately kill them, or is it the falls themselves that prove fatal?
• After her surgery, Mildred was moved into a nursing facility for recovery and was “prompted to speed up” the process of regaining her health and mobility. How might nursing homes be redesigned to encourage a more positive and encouraging environment for those individuals who do not operate with the same level of self-motivation?
“Lifelines”:
• The author’s anecdote about Jack Simon illustrates the irreplaceable value of strong social relationships in life, particularly with the onset of frightening medical and lifestyle changes. How might we design for the physical and mental comfort, safety, and happiness of older individuals who do not have Jack’s same level of companionship?
1. Based on the New Yorker, it seems that aging alone isn?t perceived as a medical condition to any physicians except geriatricians. How does Carol view aging? Is it a medical condition that can be ?cured??
2. Saying that one-third of elderly people who fall will die within the year seems like an awfully high number. Is this accurate? What and who does this number actually represent?
3. Since we have now come to eliminate deaths before thirty, we have failed to ensure the quality of life after 70. But if we start focusing on quality of life after 70, will we lost the reassurance of life after 30? Where is the balance?
Lifelines
1 – The people in these stories had a spouse or family member helping them discover the “fix”. What happens when the person has survived or never had family?
NY Times on Aging
2 – The lack of geriatricians seems appalling. What determines whether a doctor is well paid? Are we essentially saying older people aren’t worth helping?
Fall Prevention
3 – The statistic on as a leading cause of injury-related death is one of the most cited stats on aging I have seen. How does a statistic become “famous”?
In the cataract story: What happens when people do not have a loved one who can support them? What are the statistics on that?
Do cataracts "grow back' once they're removed?
what are common psych techniques to get people's minds off of scary events in the future? As in the story people get preoccupied with their surgery date and they worry, unable to do anything else. How can you alleviate that apprehension?
One of my interviewees was scared to go in for knee surgery. How prevalent is fear like that and what has been done to overcome it? How do you get them over the big painful hump to better improve their life?
Is there a large stigma in the aging community that surgery often results in death?
There are plenty of do's and do not's for preventing falls - how does someone know it's time to make a change? i.e. when is the age when you need to adapt your house to you?
A lot of my questions this week I think are psychological - how do people perceive threats, how do they decide to act on them, etc. It would be interesting to have a class on these psychological factors so we can implement them in our designs.