Thursday, June 27, 2013

Sensory Changes

Sensory changes that people experience as part of the aging process are often misunderstood and lead to false stereotyping or labeling of a person as confused or failing.  Sensory changes can include vision, diminishing taste or smell, or the focus of this week’s column, hearing changes.  If you are an individual with reduced hearing, my hope is that this information will provide some tips to aid you in your daily functioning, happiness, and independence.  If you are family or friend of a person with reduced hearing, my hope is that you too will gain some ideas about how to help your relatives and/or friends with their hearing loss.

Be aware that as people age, there is a decline in their ability to hear.  This age related hearing loss is usually greater for men than for women.  The reason for this is unknown, but it is suspected that men have been exposed to more damaging noise during their lifetimes in the military service or in their jobs. People with hearing losses must depend upon others to speak clearly to them because they cannot compensate for their hearing loss themselves.  When speaking to a hearing impaired individual, speak clearly and slowly and do not change the topic abruptly.  Be sure to face the person at eye level and have light on your face so lip reading is possible.  Ask the person what you can do to make hearing easier.

People with normal hearing have a wide range between the quietest sound they can hear and the loudness which will be painful or irritating. For the hard of hearing, this range will be much smaller.  Sounds may have to be quite loud to be heard, but if the sounds are even a little louder they may be too loud and become painful. Hearing loss is worse for high frequencies; some sounds will be heard while others will not.  Sounds may be distorted, heard incorrectly, or misinterpreted.  Talk to hard of hearing people to find out what tone is best to use with them.  Do not assume that simply making things louder will resolve the problem.  Try not to allow your voice to become high and shrill – women should be especially careful about this.  When there is a sound system being used for music or an oral presentation of any kind, it should be adjusted so that the base and lower tones are predominant.  This will make it easier for hard of hearing people to enjoy the music or understand what is being said. 

Hearing loss is greater for consonants than for vowels. S, Z, T, F, and G are particularly difficult to tell apart, causing difficulty in hearing words correctly.  Similar words such as cat and sat can be difficult to discriminate.  People should be aware that even if the sounds can be heard, they might not always be heard correctly.  It is helpful to choose a quiet private place with out background noise for conversations.

Some hearing deficits can be helped by the use of hearing aids.  They must be worn and adjusted correctly in order to help. Here are some tips on making smart hearing aid purchases.  It is always wise to have a doctor test your hearing so you can find out the cause of your hearing loss and your specific needs.  Get a referral from your doctor or friends who were satisfied with the services received from a hearing aid dealer.  And, select a seller who promptly responds to your concerns and works with you to resolve fitting and volume adjustment problems.  Look for a seller who will teach you how to use the device and be available to service it. 

Some hearing deficits cannot be helped by hearing aids and the hearing is so poor that verbal communication is difficult.  In this case, encourage use of nonverbal communication such as big smiles, waving or demonstrating.  Provide items which can be seen and handled as conversation starters.  Also, do not overlook the potential for writing to communicate.  Provide opportunities for people to participate in activities that are enjoyable but require little conversation; playing cards, doing puzzles, preparing food and taking walks for example.

When people cannot hear what is being said, be sure that they know what is going on and what the conversation is about.  If there is a conversation that does not concern them, tell him/her the topic so that he/she will not feel left out or talked about. 

Hearing is important to more than communication.  It is also a way of getting signals from the surroundings and therefore relates to safety.  People who work or live with a hard of hearing person should keep this in mind.  People in the community should also consider that an older person crossing the street may or may not hear a car horn. 

Hearing loss affects several aspects of a person’s life and the lives of their family and friends.  Learning how to handle the hearing loss can be beneficial to everyone.

Thursday, June 13, 2013

Elder Abuse: Signs, Symptoms, Solutions

Elder abuse in domestic settings is a serious problem.  Every year an estimated 2 – 5 million older Americans (depending on the study you read) are victims of physical abuse, emotional or psychological abuse, intentional or unintentional neglect, financial or material exploitation, abandonment or sexual abuse.  June 15th is World Elder Abuse Awareness Day.  The day aims to focus global attention on the problem of physical, emotional, and financial abuse of elders. It also seeks to understand the challenges and opportunities presented by an aging population, and brings together senior citizens, and their caregivers, national and local government, academics, and the private sector to exchange ideas about how best to reduce incidents of violence towards elders, increase reporting of such abuse, and to develop elder friendly policies.

Before you decide not to read this article because you don’t believe it to be in our community, please read on.

Elder abuse is extremely complex.  Because it is largely hidden under the shroud of family secrecy, elder abuse is grossly under-reported.  Experts estimate that for every incident of elder abuse authorities are aware of, as many as five to fourteen more are not reported.

Elder abuse is largely a women’s issue.  Female elders are abused at a higher rate than males.  While making up 58% of the total national elderly population in 1996, women were victims in 76.3% of emotional/psychological abuse, 71.4% of physical abuse, 63% of financial/material exploitation, and 60% of neglect. 

Intergenerational and marital violence can persist into old age and become factors in elder abuse.  In some instances, elder abuse is simply a continuation of abuse that has been occurring in the family over many years.  If a woman has been abused during a 50 year marriage, she is not likely to report abuse when she is very old and in poor health.

Our oldest elders (80 years and over) are abused and neglected at two to three times their proportion of the elderly population.

Almost half of substantiated abused elderly people were not physically able to care for themselves.

Most elder abuse takes place at home.  In almost 90% of the cases the perpetrator is a family member, with adult children or spouse inflicting the abuse most often (67% of the time).

What is Elder Abuse?
Physical Abuse: hitting, kicking, pushing, beating, slapping, choking, punching, burning or restraining.
Sexual Abuse: forcing the victim to perform unwanted sexual activities or degrading treatment.
Emotional Abuse: making humiliating remarks, name-calling, yelling, mocking, blaming, swearing, interrupting, threatening, harming pets, withholding affection and/or not respecting the victim’s feelings, rights and opinions.
Financial Abuse: stealing money or property as a way to maintain control.
Neglect: withholding or failing to provide food, water, assistive devices, shelter, clothing, medical treatment or personal care.  Can be self imposed or imposed by others.

Signs and Symptoms of Elder Abuse

Physical Indicators

                        Injuries not consistent with lifestyle, or various stages of healing
                        Pain from touching
                        Cuts, puncture wounds, burns, bruises, welts
                        Dehydration or malnutrition without illness related cause
                        Poor coloration
                        Sunken eyes or cheeks
                        Inappropriate administration of medication
                        Soiled clothing or bed
                        Frequent use of hospital or health care/ doctor shopping
                        Lack of necessities such as food, water or utilities
                        Lack of personal effects, pleasant living environment, personal items
                        Forced isolation

            Behavioral Indicators
                        Anxiety or agitation
                        Isolation or withdrawal
                        Non-responsiveness, resignation or ambivalence
                        Hesitation to talk openly
                        Confusion or disorientation, wandering
                        Change in social activities

            Environmental Indicators
                        Lack of utilities (heat, water, electric)
                        Fecal matter about living space
                        Extremely cluttered to point of unsafe
                        Inappropriate or unsafe use of appliances
                        No food
                        Spoiled food in refrigerator, expired perishables
                        Unkempt exterior
                        Physical deterioration of property
                        Accumulated mail

What are some preventative measures that can be taken?
            Take care of your health; see a doctor regularly, exercise, eat healthy and follow doctor’s instructions.
            Seek professional help if there are any concerns (substance abuse, depression, urge family members to get help)
            Plan for your future.  Seek advice about Power of Attorney, living will and health care proxy from someone you trust.
            Stay active in community.   Avoid social isolation.
            Know your rights.
            Watch for symptoms above.
            Be involved.  Volunteer with older adults in the community and support initiatives that help prevention and intervention of elder abuse.
            Get mad when you are scammed, not embarrassed.
            Use “Do Not Call” registry.

Sometimes, older adults harm themselves through self-neglect.  Of all of the types of abuse, self-neglect is the most controversial and sometimes the hardest to deal with once identified.  The question that we face concerning self-neglect is a question of competency.  If a person is competent and chooses to neglect their needs, do we have the right and responsibility to take action.  Many families and health providers face this question on a regular basis.  Self-neglect according to Linda M. Woolf of Webster University represents the highest percentage of cases of elder abuse.  AARP believes the figure could be as high as 40 to 50% of all cases reported to State Adult Protective Services.

Potential factors to be considered when evaluating the situation are:
Is the person repeating a pattern that has existed all of his/her life? As we age and face increased impairments, the lifelong pattern of neglect increases.  This type of individual may be most resilient to services.

Early stages of dementia that is undiagnosed can lead to self-neglect.  The first step is obtain a diagnosis and treatment.  Families sometimes dismiss the early signs of dementia as normal aging.  Normal aging is not a time of life in which we forget to eat or forget what we did last night.  Repeated evidence of this type of behavior should be taken seriously and medical opinion should be sought.

Illness, malnutrition and over medication are also problems that lead to self-neglect.  These problems can look like early dementia and need medical attention also.

Depression is a serious issue in older adults and often leads to self-neglect.  The good news about depression is that it is treatable.  Rapid diagnosis and treatment is very important so the risk of suicide can be reduced.  This is particularly true for older white males.  Their suicidal rate is as much as 12 times higher than any other group.  Two signs of depression are self-neglect and dementia like symptoms.

Substance abuse is self-neglect regardless of age.  Intervention is important because some people can overcome their addiction with appropriate treatment.

Poverty causes older adults to have to make choices such as, food, housing, medications, regular doctor visits, etc.  In this situation the older person is forced into self-neglect behaviors as a survival mechanism.  Obviously connecting the older person with appropriate resources such as food stamps, rental subsidies, etc. can modify this problem.

Isolation is also a factor that can lead to self-neglect.  Assisting the older person find social outlets such as senior centers, travel groups, church activities can be the real solution to isolation.  Sometimes a family member or friend needs to accompany the person on the first trip, or the first visit to the center.  Walking in alone and not knowing anyone can be overwhelming for anyone of any age.

Self-neglect can be treated if we are willing to offer help and support to the older person in a non-judgmental way.

As the population of older Americans grows, so does the hidden problem of elder abuse, exploitation and neglect.  One out of five residents in Niagara County is 60 years of age or older and we can assume that the likelihood of elder abuse occurring would be similar to national trends. The first and most important step toward preventing elder abuse is to recognize that no one should be subjected to violent, abusive, humiliating or neglectful behavior.  Education is the cornerstone of preventing elder abuse. 

Monday, June 10, 2013

Patient Safety and Empowerment

When Mary Brennan-Taylor lost her mother, Alice Brennan to a series of preventable medical errors, she wasn't interested in suing the healthcare facilities where the mistakes had been made; she was interested in making a difference for future patients so that they would not suffer the same fate as her mother.

We have the benefit of learning first hand from Mary and her experience. She will be presenting information about how to take control, educate yourself and advocate for your own safety when anticipating a hospital stay. This is a message she has taken nationwide as a featured speaker at multiple United States Department of Health and Human Services conferences, the Maryland Patient Safety Annual conference and is an active member of the Centers for Medicare and Medicaid Service Partnership for Patients initiative and the Patient Centered Outcomes Research Institute .

Brennan-Taylor says, "It is vitally important for all healthcare consumers to be their own advocates when dealing with a complex and often times intimidating healthcare system; but it is even more critical for seniors with multiple health issues to be empowered, engaged and educated about practical and effective ways to keep themselves safe when hospitalized."

And, by turning grief into action, Brennan-Taylor is bringing that culture change directly to medical and nursing students at Niagara University and the University at Buffalo, collaborating with the Department of Family Medicine on a unique program that educates future doctors and nurses about the human impact of medical harm and the actions they can take to prevent such harm.

The public is invited to hear first-hand from Brennan-Taylor, learn how her personal experience can help educate you and avoid the unfortunate outcome of unnecessary medical errors, and promote your own personal safety. The session is free and will take place on Wednesday, June 12th at 10:30am, at The Dale Association Centre, 33 Ontario Street, Lockport, NY.
Brennan-Taylor is the Vice President of Programs for the YWCA of Niagara and is a Consumer Reports Patient Safety Advocate, an adjunct research instructor of family medicine at the UB School of Medicine and Biomedical Sciences, a Niagara Hospice Board member and Lay reader and Eucharistic Minister at Christ Episcopal Church.

What: Patient Safety and Empowerment
When: June 12, 2013
Time: 10:30am
Place: The Dale Association
33 Ontario Street, Lockport, NY