Monday, February 8, 2016

Loneliness: Another Older Adult Stereotype (Research, Video 1:22)

People often don't realize that loneliness is another older adult stereotype in the same way that beliefs about their having no sex drive, being helpless, boring, unproductive, and in poor health are. This doesn’t mean loneliness isn’t real when it is experienced. In fact, too much loneliness can be destructive. But it’s still one of many ageism stereotypes that are assumed to be necessary parts of aging.

A common belief is that the majority of older adults are lonely and abandoned by families and friends, but this is not true. While family and friends may help influence whether or not they are lonely, older adults are very rarely abandoned by society. A University of California study on the growing trend of older people living alone determined that 1in 4-5 older adults lives alone mainly due to the loss of a spouse. There are 3 times as many women as men who live alone, and 2 out of 3 experience loneliness.

But what about the loneliness stereotype? The English Longitudinal Study of Ageing (ELSA) research project on loneliness studied the  association between expectations and stereotyping of loneliness in old age and actual self-reported loneliness status 8 years later. Researchers used data from 4,465 participants over age 50. Results showed that stereotypes and expectations related to loneliness in old age were significantly associated with reported loneliness 8 years later. They also concluded that interventions aimed at changing age-related stereotypes in the population may have more impact on reducing loneliness than individually based services. While there are conditions in our lives that we can’t control as we age, we can still be more positive in our expectations. Eliminating the self-fulfilling prophecy of loneliness and other older adult stereotypes can greatly impact how we age. We often get exactly what we expect. 

The following video has 10 quotes about being alone that have nothing to do with being lonely. They are all by famous people. Think about them. Be the person you want to know best. Solitude can be a good friend.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Tuesday, February 2, 2016

Therapy Dog Talks About Healing People (Research, Video 2:30)

Many animals play important roles in enhancing health. Results of positive exchanges between animals and people are scientifically measurable with documentation of animals improving traditional medical therapies dating back as early as the 9th century. The American Heart Association verifies that heart failure patients who spent 12 minutes with a dog or cat had lower stress hormones and blood pressure levels. 

Animal-assisted therapy research was done on the use of therapy dogs in the postoperative recovery of patients after parts of an arthritic or damaged joint were removed and replaced with a device called a prosthesis. Evaluation of the dogs’ roles was documented in relation to patients’ perceptions of pain and patients' satisfaction with their hospital stay. Results concluded that the use of therapy dogs has a positive effect on patients' pain levels and satisfaction with hospital stays after total joint replacement. 

There are many organizations dedicated to regulating, testing, and registration of therapy dogs and their volunteer handlers for the purpose of visiting nursing homes, hospitals, other institutions, and wherever else therapy dogs are needed. You can view a list of therapy dog training organizationsDogs of various breeds are being certified to improve patients’ health. They seem to know instinctively that they are there to help patients.

Meet Galion, one of three therapy dogs at Shepard Center, a nationally ranked spinal cord and brain injury rehabilitation hospital in Atlanta, GA. Galion will tell you in his own words how he brings joy and healing to patients:

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Friday, January 29, 2016

Hospice Live Discharge Problems (Research, Video 1:36)

Sometimes people really do leave hospice alive. That may or may not be a good thing. Discharges include patients deciding to resume curative care, improved patient conditions beyond hospice guidelines, or hospices inappropriately using live discharge to avoid costly hospitalizations. Discharges vary among hospices and geographic regions. Connecticut has the lowest rate, and Mississippi has the highest. Not-for-profit hospices and older hospices have lower rates of live discharge.

Not much has been known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. This lack of knowledge prompted research to characterize hospices with high rates of problematic patterns of live discharges. Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. They were the following:

1)  “Burdensome transition” including a high rate of patients discharged, hospitalized, and readmitted to hospice and considered to have a problematic live discharge pattern
2)   Live discharge patterns in the first seven days of a hospice stay
3)   Live discharge after 180 days in hospice

Research results conclude that each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains. Not-for-profit providers had the lowest rate of burdensome transitions. Clearly, this problem needs to be continually addressed at governmental levels, particularly in terms of patient care and questionable practices regarding discharging patients to save money or enrolling them to make money.
This video presents reasons why burdensome transitions are exactly what they are called. Healthcare transitions, such as moves from a nursing home to a hospital, can result in medical errors, lack of care coordination, and emotional distress and agitation for persons with advanced dementia. These transitions are not consistent with goals of providing dying patients with comfort care.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, January 25, 2016

Cameras: Should Caregivers Wear Them to Videotape Dementia Behavior? (Research)

One of my favorite quotes is this: “The bear and the rabbit will never agree on how fierce the dog is.” It all really depends on each one’s perspective of the dog. In the above photo, some people will see a duck, while others will see a rabbit. Many may eventually see both. Depending on the questioning, their stories may differ on what they really saw at a particular time. Recently in the news, we have been reading about more police departments investing in cameras for officers to wear while on duty. The purpose is to provide more visual and audio evidence to further validate what really did happen in addition to what eyewitnesses say they saw and heard. 

This leads to a discussion about cameras and caregivers of persons who have dementia. When caregivers describe to healthcare staff the behaviors of those who have dementia, would it be better if they also had a video or photo in addition to their version of what they saw? Some people think this additional description would be beneficial, particularly if caregivers might be biased or unintentionally selective in their own explanation of behaviors.

Research on caregivers and wearable cameras was done to discover how useful it would be if they used camera systems to record 79 events over a total of 140 hours of data captured from 3-7 days. How did the caregivers rate this procedure? While they thought the system was easy to learn to use, even though cumbersome, they had few negative reactions. Overall, the research suggested that caregivers of people with dementia “can and will wear a camera system to reveal their daily caregiving challenges to healthcare providers.”

What do you think about this kind of surveillance? Would you wear a camera as a caregiver? What do you think about this kind of observation from the point of view of the person with dementia?

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Friday, January 8, 2016

Widowed Fathers Raising Children (Research, Video 1:30)

Bertie and Alexandra Wells were married with two children when the rhythm of their lives changed drastically. Alexandra was diagnosed with a rare and aggressive form of breast cancer that raced through their love, leading to a mastectomy, chemotherapy, radiation, and finally death, all within 16 months. Bertie, pictured above reading to his young son and daughter, found himself heartbroken while thrust into a whole new parenting lifestyle. 

Bertie is one of America’s estimated annual 20,000-30,000 widowed fathers raising children. In need of ongoing support as they carry the demanding weight of personal vulnerability and loss, widowed fathers' unique concerns should be addressed by society far more than they are. Maintaining jobs to provide for their families, many widowed fathers suppress their own needs while struggling in silence as everyday dads fostering the well-being of their children.

Widowed fathers’ perspectives are important in determining positive end-of-life practices for families living with terminally ill loved ones. Their views help establish effective coping strategies after mothers have died leaving dependent children. This study, which focuses on those outcomes, included 344 men who identified themselves through an open-access educational website as widowed fathers. They all indicated that their spouses had died from cancer and that they were parenting dependent children. Participants completed surveys including their wives’ cancer history, end-of-life experiences, and their own depression and bereavement. Their views on how parental status may have influenced the end-of-life experiences of mothers with advanced cancer were emphasized. These were the results:

1)  Fathers stated that 38% of mothers had not said goodbye to their children before death, and 26% were not at peace with dying.
2)  Among participants, there were 90% reporting that their spouses were worried about the strain on their children at the end of life.
3)  Fathers who reported clearer prognostic communication between their wives and physicians had lower depression and bereavement scores.

These data clarify the need for more family assistance related to terminal illness and death impacting widowed fathers and their children. Additional research and helpful resources such as books, videos, support groups, counseling, etc. can assist them further in untying knots of grief as they create their new normal.
1) The National Widowers Organization was founded by Sam Feldman whose wife of 53 years lost her year-long battle with cancer. Promoting the development of support groups for men to manage their grief and adjust to new lifestyles, this organization also advocates for research about men's unique needs concerning spousal loss and grief. 
2)  Single Fathers Due to Cancer is located at the University of North Carolina- Chapel Hill. Dr. Donald Rosenstein, director of the UNC Comprehensive Cancer Support Program, started the support group a few years ago with his team, including Dr. Justin Yopp. They meet monthly with child care provided by students. The following video titled “Support for Single Fathers Due to Cancer” features Bruce Ham, a widowed father who shares his story.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.