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Anchor lead: Home visits by medical professionals could help seniors understand their own care, Elizabeth Tracey reports

What’s the top problem for older people with chronic health conditions? A report by the Kaiser Family Foundation identifies confusions about medications and healthcare regimens as number one. Alicia Arbaje, a geriatrics expert at Johns Hopkins, says she would address the problem with first gathering more information.

Arbaje: I would have older adults and their caregivers at home videotape what they’re doing, what the home looks like and where they’re keeping their medications so that we could really see with our own eyes. Then I would ideally have a pharmacist go into the home and really help people organize their medications or we could have nurses doing that as part of home health care. I’d really like for us to be able to do that every time a person is transitioning from one healthcare setting back to the other. Really understanding what their home environment is like before we start adding more medications. :32

Arbaje notes that video can easily be obtained with a smart phone, perhaps by a tech-savvy grandchild. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new report cites confusion about medical regimens as the biggest challenge to seniors, Elizabeth Tracey reports

Older people with chronic illnesses really don’t understand why they’re being prescribed certain medications or being told to adopt certain behaviors, a disturbing new report from the Kaiser Family Foundation states. Alicia Arbaje, a geriatrics expert at Johns Hopkins, comments.

Arbaje: Seniors reporting having difficulty understanding their medical instructions was actually the most frequent challenge they had even compared to paying for their own medical care. Patients really don’t understand why they’re taking a medication, what it’s for, and even whether it’s really doing them any good. I think that complicates medical instructions quite a bit and it tells us that we also need to be doing more in the home environment, when patients are actually doing this on a day to day basis.  :26

Arbaje notes that lots of research demonstrates that when people don’t get why they’re supposed to be doing things, they stop. And for management of chronic health conditions, that’s a decision fraught with danger. She recommends asking a lot of questions until you feel confident about care regimens. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Are you familiar with risk factors for cancer? Elizabeth Tracey reports

While some risk factors for cancer are known by many people, some common ones are less well-known, a recent Gallup survey for the American Society of Clinical Oncology found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes noteworthy findings.

Nelson: Seventy-eight percent of them said they understood that tobacco use could increase their risk for cancer. Somewhat disappointingly only about 30-31% displayed some understanding that alcohol use or overuse and obesity contribute to cancer risk. There are some estimates that this growing obesity epidemic in the country could be responsible for as many as 500,000 excess cancer cases over what would otherwise occur by 2030 in this country alone, so that only a third or less had that sense was concerning.   :33

Nelson says the numbers point to a clear need for better public awareness campaigns since the majority of these risk factors involve personal choice. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How aggressively should blood pressure be lowered during an operation in an older person? Elizabeth Tracey reports

A person’s blood pressure before surgery should be a consideration in how low to go during surgery, a recent study asserts, finding that the likelihood of delirium may be increased the more aggressively blood pressure is lowered in an older person. Kevin Gerold, an anesthesiologist at Johns Hopkins, comments.

Gerold: A healthy 80 year old is not the same as a healthy forty year old. Our ability to compensate around stressful events like surgery can be impaired. Our ability to maintain a normal perfusion state in response to a changing blood pressure may diminish. The exact numbers become difficult to predict but I think it’s safe to say that as we age we are probably less able to tolerate significant drops in our blood pressure without some change in cognitive function, at least temporarily.  :30

Gerold says families and loved ones can certainly include questions about blood pressure in their preoperative consult. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Frailty should be considered before any operation in an older person, Elizabeth Tracey reports

Frailty is not just an adjective but a measureable health metric that should be employed before any older person has surgery, a recent study asserts. Kevin Gerold, an anesthesiologist at Johns Hopkins, agrees.

Gerold: I think the frailty score is a very good idea. I don’t think it’s so much whether they should have an operation or not but it may dictate the objective of the surgery. The concept of frailty relates to the inevitable decline of physiologic reserve that occurs as a normal consequence of aging. We need to consider that a healthy 60 or 70 year old is not the same as a healthy forty year old.  When faced with the need to have surgery, the concept really is more what is the objective?  :28

Gerold notes that frailty can be simply assessed with a walking test, with very slow walk speed or an inability to walk very far giving a good approximation, but says the development of other assessments is underway. He says both patient and loved ones should consider the likely outcome of surgery before a procedure is undertaken, especially in the frail. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: More educated nurses help insure good outcomes, Elizabeth Tracey reports

Do you know what the education level of the nurses taking care of you if you’re hospitalized is? Turns out that the more educated a nurse is, the better the outcomes for patients in the hospital, a recent study found. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says in the midst of the nursing shortage, enticing registered nurses back to the workforce may help.

Davidson: What many countries have done is to try and look at nurses who are already licensed and have just chosen not to be active in the nursing workforce. We need to look at flexibility of scheduling, at the moment too there are so many more opportunities available for nursing, particularly in ambulatory and primary care, where the hours are more appealing, so I think trying to provide choice, to individuals to try to make them feel that they have some autonomy in planning their life.  :30

Davidson notes that such metrics as nursing education levels are increasingly available publically. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Your hospital nurse may hail from almost anywhere, Elizabeth Tracey reports

New cars, relocation allowances, free housing…perks for nurses willing to travel to understaffed areas of our country abound, a recent study looking at our national nursing shortage reports. Patricia Davidson, dean of the Johns Hopkins School of Nursing, comments.

Davidson: Without those traveling nurses beds will be closed, procedures will be canceled and people will be not getting the care they need. It really is a call to action to look at health workforce planning much more strategically, we know that there are issues in retaining nurses in acute care settings. Many of those reasons are complex and multifacteted, it’s a really hard job, it’s very taxing physically and emotionally.  :30

Davidson says for the most part people shouldn’t worry that traveling nurses won’t provide good care since they must be licensed, but says there’s no question that familiarity with how things are done in different hospitals also matters. At Johns Hopkins, I’m Elizabeth Tracey.

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