Wednesday, March 30, 2016

Children Learn About Dementia, Alzheimer's: School, Family Support (Video 3:51)

An educator who has been actively involved with introducing children to the nursing home world and dementia for many years, I have always been impressed with the sensitive ways they embrace knowledge about this disease. Too often children’s comprehension levels are underestimated by adults. When explained to them in age-appropriate ways that support them in their learning, children are generally capable of understanding many important and unusual situations.

Trips with children (elementary-middle) to nursing homes followed a great deal of preparation that was integrated into the regular curriculum. This form of teaching-learning is called service-learning. During nursing home visits, I witnessed children's enthusiasm when older adults sang with them, even when a few residents fell asleep or looked dazed. Although these words were not on the statewide school assessment test, “dementia” and “diversity” became cool words on our classroom vocabulary list. They further described the human family in which everyone is connected and respected. When I led my class to leave a nursing home one day, a woman reached for my hand and licked it a few times. It was a child who calmly reassured the class, “It’s okay. She has dementia.” My pleased mind did an aha dance.

Dementia and Alzheimer’s are topics that many adults avoid. This leaves children at a serious disadvantage in terms of being informed about them and in seeing adults modeling positive, proactive, dementia-related behaviors. By engaging children with information about these topics at school and at home, adults can impact future generations of healthcare recipients, service providers, and caregivers. Listening to young people’s concerns and encouraging them to become involved are major steps toward transformation. Family discussions can be helpful for everyone, particularly as more family members are becoming caregivers for loved ones with cognitive decline.

Children have meaningful stories to tell that can help others understand their candid and sincere perspectives. Meet Dan, a boy who shares his heartfelt story about his Nan before and after she developed dementia. He explains his confusion and distress when he didn’t know what was happening to her. Now, he has learned more about the disease and enjoys visiting her at the nursing home. Dan has adjusted to his new Nan, one of his “most important people.” Many say, “It takes a whole village to raise a child.” But it also takes a whole village to make a village whole.


Tribute to a Nun with Alzheimer’s Dementia

At the link below, you can read my tribute to a nun who positively impacted my life as a child and later died from Alzheimer’s disease.

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.

Thursday, March 24, 2016

Doctors’ End-of-Life Language, Impact on Patient-Caregiver Decisions (Research, Video 5:23)

Some call it “framing” the conversation a certain way that heightens the odds of a particular response. No matter what the procedure is called, end-of-life decisions about treatment options for critically and terminally ill patients can be influenced greatly by how doctors present information to patients and caregivers.

In a study about doctors’end-of-life language, a simulation involving an older adult with end-stage cancer and life-threatening hypoxia (deficiency of oxygen reaching the tissues ) was followed by a debriefing interview. Doctors participating were hospitalist, emergency medicine, and critical care physicians from three academic medical centers. Their encounters regarding presentation of treatment options were observed in real time and analysed.


1)  Among 114 physician subjects, 106 discussed life-sustaining treatment, 86 discussed palliative care, and 84 discussed both.

2)  Doctors framed life-sustaining care as necessary (53%), while framing palliative care as optional (49%).

3)  Among doctors who framed life-sustaining care as imperative, 16 (30%) felt intubation (insertion of a tube through mouth and airway to assist with patient’s ventilator breathing) would be inappropriate in this clinical situation.

The majority of doctors framed end-of-life patient options by implying
that life-sustaining treatment was the expected or preferred choice.
Framing options in this way can greatly influence treatment decisions
made by patients and caregivers.
The following video is an excerpt of a televised edition of Frontline. It features patients, families, and doctors facing complicated end-of-life decisions at the Mount Sinai Hospital intensive care unit in New York City:

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, March 19, 2016

Urinary, Involuntary Incontinence (Research, Video 3:56)

If you have any leakage of urine, you may have what is known medically as urinary or involuntary incontinence. For many people, this problem which may cause them to avoid laughing, sneezing, and coughing may have a profound impact on their quality of life. Over age 50? One out of four women and one out of ten men have this problem. Aging can increase its frequency and severity.

Among nursing home residents, the frequency is between 43% and 77%. The risk for urinary incontinence among women with cognitive deficits is 1.5 to 3.4-fold higher than for women without mental disorders. The most common form is stress incontinence (50%), followed by mixed stress-incontinence, followed by mixed stress-urge incontinence (40%) and purely urge incontinence. The cause remains unclarified in 80% of the cases. In addition, it is often difficult to treat. Most forms of incontinence do have psychological consequences such as shame and insecurity due to uncontrolled loss of urine. This can lead to depression and social isolation.

Contrary to what many believe, incontinence does not have to be a natural part of aging. This brief televised video of The Doctors explains incontinence and the importance of getting help.

 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, March 12, 2016

LGBT (Lesbian, Gay, Bisexual, Transgender) Healthcare Education for Service Providers (Research, Video 2:43)

Discussions of the LGBT older population and healthcare disparities often conclude with recommendations for more education of healthcare service providers. But how successful has that approach been? This research study on LGBT cultural competency training focused on the unique challenges of sexual and gender minorities provides evidence regarding whether attitudes, beliefs, and intentions of service providers improved. Included were data collected at four Massachusetts training events piloting a cultural competency workshop using surveys about lesbian, gay, bisexual, and transgender (LGBT) aging for mainstream older adult service providers.
Findings revealed significant improvement in numerous aspects of service providers' knowledge, attitudes, and behavioral intentions as a result of the training sessions. Benefits included these:
1)    Awareness of LGBT resources
2)    Policy disparities
3)    Spousal benefits for same-sex couples
4)    Intention to challenge homophobic remarks
Recommendations included long-term follow-up of participants, the inception of agency-level surveys to appraise institutional culture change, and increased curriculum on transgender older adults.
UC Davis Medical Center, formerly known as Sacramento Medical Center, is a major academic health center located in Sacramento, California. This video shows strategies used there to improve healthcare and decrease national LGBT disparities:

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.