Monday, June 27, 2016

Hospice Inpatient vs. Home Care: Family Views (Research, Culture Video 2:26)

No matter where people receive hospice care, the quality will always depend on the context in which the care is given. Families consider communication and support when they evaluate the kinds of experiences they and their loved ones have had. In order to determine family experiences in evaluating care in inpatient hospices such as nursing homes vs. home hospice care in their own homes, research of the two settings was done with comparisons made. The following study was done to compare inpatient and home care hospice family satisfaction in the two settings.

Survey data from bereaved family members of approximately 1600 patients from a nonprofit, midsized hospice in western Pennsylvania were used. Responses were separated into two groups including general inpatient hospice care and routine home hospice care. Both settings indicated three variables associated with greater overall family satisfaction:

1)   Being kept informed about the patient's condition
2)   Being provided with clear/consistent information
3)   Having the perception that patients were provided with  adequate treatment for anxiety

The following two variables indicated greater satisfaction in routine home hospice care only:

1)   Having sufficient discussion with hospice team members  concerning family members' religious or spiritual beliefs
2)   Being provided with the correct amount of emotional support  after the patient's death

 These results conclude that good communication is strongly associated with greater family satisfaction across hospice care settings. Hospices must ensure that they provide patients and families with consistent information and support.
An important part of communication includes the culture of the hospice families. In a society increasing rapidly in diversity, hospices and other healthcare providers must make every effort to be sensitive and proactive in providing ways to improve communication so a common language can be facilitated. VITAS Innovative Hospice Care demonstrates that in this video in which a patient's family talks about what it means to have a Creole-speaking caregiver bring home care to their 116-year-old patriarch.

Are you curious about who leaves hospice alive? Discharges can occur for several reasons:

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, June 20, 2016

Childhood Sexual Abuse Health Impact on Older Adult Survivors (Research, Video 3:29)

"If you tell anyone, I will kill you." Childhood sexual abuse is an extremely under-reported crime that often includes a threat of serious harm to victims or their families. Many victims choose not to discuss the abuse with anyone. A major concern is that 90% of these sexual abusers target children they know. The stigma and shame of sexual abuse fester inside, impacting females and males for years as they age through adulthood. 

Numerous older adults live with long-term mental and physical repercussions from being sexually abused as children. According to the Centers for Disease Control and Prevention, children who are abused or neglected are at higher risk for health problems as adults. These problems include alcoholism, depression, drug abuse, eating disorders, obesity, high-risk sexual behaviors, smoking, suicide, and certain chronic diseases.

This study reported in International Psychogeriatrics examined the long-term association between childhood sexual abuse and mental and physical health of 8,178 older adults. These were the results:

1)  Six percent of respondents reported childhood sexual abuse with little variation by gender.
2)  A significant association was found between childhood sexual abuse and mental health with victims more likely to have depression, anxiety, worry, loneliness, and low quality of life. Poor self-reported health, lung disease, arthritis, peptic ulcer, chronic pain, and high levels of total cholesterol and low-density lipoprotein were associated with childhood sexual abuse.
3)  Those who reported childhood sexual abuse were more likely to report doctor and hospital visits than those without that history.

This study concludes that childhood sexual abuse can have long-term mental and physical consequences for older adults. RAINN (Rape, Abuse, and Incest National Network)  is the nation’s largest anti-sexual assault organization. The National Sexual Assault Telephone Hotline  800-656-HOPE (4673) can connect callers with trained staff members from sexual assault service providers in the callers’ areas and provide a range of free services.

Sexual abuse of boys has particularly been neglected by the media and in general conversations. Pressures from society teach boys that real men are not victims. But 200 brave men came forward on the Oprah show to publicly acknowledge that sexually abusive adults who were often relatives or friends of their families victimized them as children. The men share their stories in this video:

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, May 30, 2016

Clowns in Dementia, Alzheimer’s Care (Research, Video 4:59)

For years, I never thought anyone couldn’t love a clown. I finally met such a person in my neighborhood. She has coulrophobia, an irrational fear of clowns. Doctors and scientists say that the fear comes from not knowing the identity of the person behind the excessive makeup. The clown’s makeup and ability to break social behavior norms create a state of panic causing the observer to have difficulty in breathing, irregular heartbeat, sweating, nausea, and feelings of fear. My friend has explained her fear to me, and it is very real. She refuses to go to McDonald’s restaurant for that reason. I mention this to emphasize that successful engagement between patients and clowns does not apply to everyone.

However, for many long-term care residents with dementia, elder clowning brings numerous rewards. This research on elder clowns focused on residents with moderate to severe Alzheimer’s disease in nursing homes. A pair of elder clowns visited all residents twice weekly for 12 weeks. They used improvisation, humor, empathy, and expressive modalities such as songs, musical instruments, and dance to individualize resident engagement. After measuring outcomes, researchers determined that elder clowning reduced moderate to severe behavioral and psychological symptoms of dementia (BPSD) of nursing home residents primarily with Alzheimer's. Elder clowning is a promising intervention that may improve Alzheimer's care for nursing home residents.

This video highlights the dynamic elder clown program of the Humour FoundationElder clowns are highly skilled professional performers trained by the Humour Foundation to work in aged care and dementia facilities. Using the healing power of humour, elder clowns aim to improve quality of life by working in partnership with facility staff and residents: 

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, May 23, 2016

Transgender Veterans’ Healthcare Disparities, Veterans' Benefits (Research, Video 6:37)

Healthcare disparities are inequalities that exist when members of certain populations do not benefit from the same health status as other groups. Although transgender veterans served proudly, they suffer as a result of significant disparities. The Veterans Health Administration is the largest healthcare system in the United States, an ideal place to do research on how equal medical and mental health services are between transgender veterans matched with non-transgendered veterans. Transgender veterans’ healthcare research is particularly important because no large controlled studies like this one existed before.

This study included 5,135 clinically diagnosed matched transgender veterans and non-transgender veterans. The purpose was to determine whether medical and/or mental health disparities existed with the transgender veterans. 

Results indicated that statistically significant transgender disparities were present in all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. Transgender veterans were also more likely to have been homeless, to have been incarcerated, and to have reported sexual trauma while on active duty. Significant disparities in the prevalence of medical diagnoses for transgender veterans were also detected, with HIV disease representing the largest disparity between groups.
On a global level transgender veterans were also found to have disparities in psychiatric and medical diagnoses compared to matched non-transgender veterans. The Transgender AmericanVeterans Association (TAVA)is an organization that acts proactively with other concerned gay, lesbian, bisexual and transgender (GLBT) organizations to ensure that transgender veterans will receive appropriate care for their medical conditions. Unfortunately that equality does not exist. In terms of policy, healthcare screening, and service delivery in Veterans Health Administration and other healthcare systems, it is critical that corrective policies are implemented and monitored to eliminate these inequalities in treatment of transgender veterans.
This following informative video produced by Erica Elizabeth Ravenwood, a former veteran, was created to give transgender veterans and the public a better understanding of the Veteran Administration benefits and procedures as they relate to transgender veterans starting the transition process which does not include reassignment surgery, follow-up care, and review of their rights.

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.
Hospice and Nursing Homes Blog

Monday, May 16, 2016

Empathy: Do Your Healthcare Providers Express Any? (Research, Video 4:23)

You expect that your medical needs should be addressed by your healthcare providers. But what about your emotional needs for understanding and support as a whole person? Shouldn’t your providers also be able and willing to express feelings about what you are going through? If they don’t, why don’t they? And what can be done to improve their responses? Empathy research studies have repeatedly found that healthcare providers miss 70-90% of opportunities to express empathy. These are high percentages. 

In this research study on healthcare provider empathy, there were 29 empathic opportunities within 21 visits. Provider responses were categorized as ignore, dismiss, elicit information, problem-solve, or empathize. Empathic statements occurred in only 13 of 29 opportunities (45%). When problem-solving was the initial response, empathic statements rarely occurred in subsequent dialogue. Among the 16 instances with no empathic statements, providers engaged in problem-solving in 8 (50%). Like many studies in the past, providers missed most opportunities to respond empathically to patients’ emotions, even when problem solving was done.

Healthcare providers need to be able to better recognize situations where they can offer empathy in addition to problem-solving. Patient care is more than just physical healing. Good healthcare provider care includes building a connection that encompasses a patient’s mind, body, and soul. It includes standing in someone else’s shoes, feeling what that person feels and responding. This video is a reminder of the various emotional needs both patients and healthcare providers may have.

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.

Sunday, May 1, 2016

Want to Have a Baby in Your 60s? (Research, Video 2:58)

Are you age 50 or over and thinking about getting pregnant or fathering a child? If so, you are among an increasing number of older adults considering and making that choice. Are you planning to start a new family or extend a current one? According to AARP on births by older mothers in 2013, an average of 13 children were born every week to mothers 50 and older. The Centers for Disease Control and Prevention report that births by women ages 50 to 54 rose by more than 165 percent from the year 2000 (255 births) to 2013 (677 births). Most women used donor eggs fertilized by sperm and implanted in a womb. This process is known as in vitro fertilization (IVF).

Not that it should affect your decision, but how do you think your family and friends would react if you had a baby this late? Would they be happy and supportive that you have chosen this new direction in your life?  Or would they think you are too old to be effective parenting a child at this stage in your life when you should be taking it easy and certainly not taking on unnecessary medical risks for both you and your child. Complications such as hypertension, diabetes, organ damage, genetic defects, etc. are real, but good health and care can go a long way toward successful results.  After all, people are living longer and taking better care of themselves.

Some people think the government should have pregnancy limits on age in case older parents die before children are able to take care of themselves. Do you think it's fair for taxpayers to pay for raising your child? While everyone may not approve of your reasons or even the technology of the procedure itself, the decision ultimately belongs to you.

This CNN news video features a 60 year-old mother who may be the oldest in America to deliver twins. She and her husband have been married for 38 years and also have adult children and a younger child.

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, April 25, 2016

Attention-Deficit/Hyperactivity Disorder (ADHD) in Older Adults (Research, Video 3:17)

A former school principal, I have known many students diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). They often displayed behaviors such as inability concentrating on and completing tasks, mood swings, operating impulsively, and having low tolerance levels when interacting with others. I actually witnessed a father who was so frustrated with his seventh-grade son’s destructive and belligerent behavior that he asked him, “Son, why don’t you just run away?” This father also refused to put his diagnosed son on medication.

Many young people with ADHD age into adulthood never knowing why they act the way they do. They become older adults before they are even diagnosed. Imagine the anger and grief of discovering late in life that the sadness and madness you endured all those years went nameless, undiagnosed, and untreated. An increasing number of those who went many years undiagnosed with ADHD are now over 50 years old.

Unfortunately, ADHD research on older adults is limited. However, there is reason to believe that symptoms decrease with age and that medication can be helpful for them. Side effects of medicine may cause more problems after age 65. Different psychological therapies are also helpful alone or with medication for patients who are motivated. Most important is good support based on knowledge and understanding of how ADHD has affected health, quality of life, and function throughout their lives.

What’s it like being diagnosed with ADHD later  in life? In this video, Dr. Barkley explains the difficulties and the need for acceptance. 

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.
Hospice and Nursing Homes Blog