Saturday, May 29, 2010

Predicting Death of the Terminally Ill: End-of-Life Care (Research and Video 2:55 mins.)

Consider that almost half of the people over 85 years old die annually in nursing homes across America. Even when they don’t share what they think, family members, friends, and the nursing home staff often develop their own individual perspectives about when terminally ill patients will actually die. Unfortunately, because it is not always easy to predict how close to death someone is, inaccurate guesses are made that may deny end-of–life care to those who might benefit from it. Although the predicted time of death for hospice patients is within six months, I have had hospice patients ranging from dying immediately after being assigned to hospice to those staying in hospice for years.

What do people consider when they set out to predict death? A research study that included 45 residents was set up to create a framework for organizing social interactions related to end-of-life care and to characterize the social construction of dying in two nursing homes. The resulting framework included five categories related to the possibility of death:

1) Dying allowed
2) Dying contested
3) Mixed message dying
4) Not dying
5) Not enough information

Based on predictions, over half the resident cases were classified as mixed message dying or not enough information. This indicates the ambiguity regarding residents’ care plan goals found in the two nursing homes in the study. These results imply the importance of residents, family, staff, and physicians working together to determine the dying status of residents as it relates to social interactions and healthcare the resident receives. Shared conversations about goals of care, and how these goals will be reached are important in determining the quality of care residents receive. You can read more about this research study from the "Gerontologist."

While on the subject of predicting death, many of you probably remember reading in the news two years ago about a cat named Oscar that predicted deaths of nursing home residents. Oscar has even received a hospice award. In this video titled Cat Is Harbinger Of Death (CBS News),” Oscar’s death predictions are discussed.

Many healthcare staff members who work with dying patients will tell you they have had patients share stories about seeing dead people, ghosts, spirits they recognize, and angels. View this post for my personal story and an informative 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.

Saturday, May 22, 2010

YMCA SilverSneakers Senior Fitness Program: Research Shows Benefits (Video 2:20 mins.)

Several of my friends are big fans of the YMCA SilverSneakers fitness program for seniors. SilverSneakers, which originated in 1992, is the nation’s leading exercise program designed exclusively for older adults. Held three days a week at many YMCAs, classes provide excellent opportunities for seniors to reap all the rewards of staying fit while reinforcing relationships with other participants.

Research shows that SilverSneakers benefits participants in general, especially those who have diabetes and or depression. These studies were funded by Centers for Disease Control and Prevention (CDC) and conducted by Group Health and the University of Washington (UW). Over 5,000 participants were studied. Among results of the studies are these important conclusions:

1)    Lower total health care costs

Older Medicare beneficiaries with diabetes who participated in SilverSneakers had notable reductions in total annual health care costs after both one year in the program (-$1,633) and two years in the program (-$1,130) compared with non-participants. Even those who visited less frequently in year two still saw health benefits.

2)    Lower risk of depression in year two

At least two visits per week to SilverSneakers classes during the first year were significantly associated with a lower risk of depression in year two.

3)     -29% Lower hospitalization rate
The cost savings were largely attributable to fewer hospital admissions and lower inpatient care costs with those hospitalizations.
4)    Greater savings with more participation

SilverSneakers participants who made an average of two or more visits a week in year one had significantly lower adjusted total health care costs in year two (-$2,141) than those who made fewer than two visits per week.

5)    Increased preventive care

SilverSneakers members utilized more preventive services.

This video highlights rewarding experiences seniors have while participating in the SilverSneakers program.

Frances Shani Parker, Author

Tuesday, May 18, 2010

Physician-Assisted Suicide: Interview with Dr. Jack Kevorkian (Research and Video 4:59 mins.)

Feb. 6: 1991: Physician-assisted suicide advocate Dr. Jack Kevorkian poses with his “suicide machine” in Michigan. (Northwestern University Library)

Dr. Jack Kevorkian, also referred to as Dr. Death, is best known for his public support of patients’ right to physician-assisted suicide. He admits to having participated in at least 130 suicides. After being tried in court several times and shown on national television deliberately causing a man to die, Kevorkian was ultimately convicted of second-degree murder. In prison, he served eight years of a 10-25-year sentence. His parole includes not helping anyone else die.

Dr. Kevorkian has been a very controversial public figure for many years. A popular HBO movie titled “You Don’t Know Jack” is based on his life. His ideas about euthanasia have important implications in discussions about end-of life care and medical ethics.

In a   research study done in Oregon,  where the Oregon Death with Dignity Act allows terminally ill patients to obtain physician aid in dying, it was reported that these persons were motivated by worries of “future physical discomfort and losses of autonomy and function.” Healthcare workers can help patients who have these concerns and express an interest in physician-assisted suicide by bolstering their sense of control, educating them, and reassuring them about managing future symptoms.

The following video includes CNN interviewer John Roberts and Dr. Jack Kevorkian. Discussion includes prison life, physician-assisted suicide, and Michael Jackson’s death.

Hospice-palliative volunteers bring a unique perspective to the ongoing debate about physician-assisted suicide. You can read their views here:

Frances Shani Parker, Author

Sunday, May 9, 2010

Seniors and Casino Gambling: Who’s Really Winning?

Across the country, the numbers of seniors visiting casinos are growing faster than any other age group. Casinos are estimated to take as much as 65% of their revenue from those aged 65 and older. Detroit, Michigan has three major casinos that get plenty of business from seniors in Michigan and beyond. They love to take field trips to casinos as a social activity, but is it really just social?

Research from the Institute of Gerontology at Wayne State University in Detroit causes serious concerns about seniors and casino gambling. Including 1,410 randomly selected adults, aged 60 and older, the study concluded that one in five older adults who enter a casino eventually displays problem gambling behaviors. Peter Lichtenberg, Ph.D., director of the Institute of Gerontology and one of two authors of this study published in the “Journal of Aging Studies” said, “Urban elders are especially vulnerable to problems because higher percentages of them have low income, few social supports, and poor mental and physical health.” Symptoms of problem gambling include compulsive gambling and lying about  time and money spent.

Findings from this study should be taken very seriously, particularly when considering serious health and financial problems among older adults in the future. Expected consequences related to seniors’ increasing participation in casino gambling are “financial loss, the erosion of personal relationships, depression, suicide, substance abuse, and personality disorders.” No winners there.

Full Article Citation:  
Zaranek, R. & Lichtenberg, P. (2008).  Urban elders and casino gambling:  Are they at risk of a gambling problem?  "Journal of Aging Studies," 22, 13-23.

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.

Saturday, May 1, 2010

Hospice Care in Assisted Living Facilities (Research, Video 2:51 mins.)

Many people have told me that they didn’t know hospice care exists in nursing homes. Even more would probably be surprised to know that it also exists in assisted living facilities (ALFs). I can’t emphasize enough that hospice care is available no matter where a person lives.

Reported in the “Gerontologist,” a study of hospice care in assisted living facilities was done to get detailed descriptions of end-of-life care provided by ALF medication aides, caregivers, nurses, and hospice nurses in urban and rural settings. Interviews were used to gather information. Having worked as a hospice volunteer in urban nursing homes for several years, I was interested in the results. They were very similar to what I would have expected from an urban nursing home or any other institutional care:

1)  The quality and nature of resident-staff and assisted living-hospice staff relationships are critical in promoting good end-of-life care for ALF residents.

2)   Length of the resident's stay in the facility and how well staff knew the resident were associated with the quality of the resident-staff relationship.

3)  Respectful collaboration, clear communication, use of complementary knowledge and skills of staff, and shared expectations about the care were associated with positive staff relationships.

4)  ALF administrative support for hospice patients was important.

Basically, ALFs and hospice organizations that are committed to working together with hospice programs must both support staff, patients, and families. If this sounds like an obvious conclusion, it is. Unfortunately, it is a reality that is still unrealized too often. There is a need for more successful models of this partnering system of care at both nursing homes and ALFs. From my own observations in nursing homes, especially regarding staff turnover, I know that the non-curative philosophy of hospice care requires ongoing staff inservice and monitoring to be implemented successfully.

This video relates the positive and negative transition concerns of an  elderly man (age 95) moving to an assisted living facility.

Frances Shani Parker, Author