A.M. Post Issue 8 - Lifespark

The A.M. Post

An eNewsletter for Aging Magnificently — ISSUE 8

At Lifespark we’re all about helping you stay healthy at home, navigating your health options with confidence, and living a fuller, more independent life. That’s what The A.M. Post is all about, too. Read on — we hope you enjoy!

Is your health at risk if your primary care isn’t a geriatric expert?

There’s an underlying assumption that geriatrics, or senior-savvy care, is already part of what primary care delivers. The reality is, it’s not. Read on for what we mean…

Kids have pediatricians, seniors have geriatricians. Except it’s not that simple. Two of Lifespark’s primary care providers had a conversation during a recent webinar about how to get more from your primary care team (more on that later). The irony: if yours doesn’t specialize in geriatrics, you may not be getting what you need. There’s an underlying assumption that geriatrics, or senior-savvy care, is already part of what primary care delivers. The reality is, it’s not.

With only one geriatrician for every 10,000 older Americans, most seniors across the Twin Cities don’t have access to a team of geriatric experts. It’s why the New York Times brought attention to this highlighting how the decline of geriatricians is hurting seniors.

According to Dr. Nick Schneeman, Lifespark Chief Medical Officer, traditional primary care is missing the geriatrics part and that’s a big deal to seniors’ long-term health. “There’s not enough training about how to care for the unique needs of older adults,” said Dr. Nick. “Today’s clinic visit is time-limited and it’s not uncommon for seniors to leave an appointment with another medication, more labs, and a referral for a specialist. Every geriatrician knows a 90-year-old shouldn’t be on 18 medications, but more often than not, they are.”

When we were younger, our parents took us to a pediatrician because they were trained specialists who understood the unique needs of our growing bodies. The reality is, from birth we’ve been aging all along and just like we did in those early years of infancy to teenagers, seniors deserve a specialized approach to how they age with the same emphasis on vitality and strength.

Pediatricians and geriatricians, or primary care providers with the right level of geriatric expertise, approach the care of their patient similarly. They look at all factors surrounding their life, ask the right questions about ‘what matters,’ and include family as a big part of the visit. The same goes for how they approach each individual.
As an example, a pediatrician wouldn’t prescribe the same dose of Amoxicillin to a 2-year-old as they would an 11-year-old. For most of us, that seems obvious. We don’t often apply that same theory to those in later life assuming they are all adults and therefore get the same dosage or regimen.

“What most primary care providers aren’t trained in recognizing is that while a 65-year-old and an 82-year-old are both adults, how the body metabolizes medications as we age can be vastly different,” explained Dr. Nick. “It’s the same reason why blood sugar and blood pressure levels vary so greatly. It’s important to treat according to the individual and where they are in that moment rather than segmenting them into one particular age group. Which means, you may not need all those medications as you thought.” That’s the expertise a geriatrician brings and knowing that can make a significant difference to your health.

Dr. Wendy Laine, Lifespark Medical Director, pointed to a recent call she received from a Lifespark COMPLETE member’s specialist who called to say her member needed an antibiotic for a UTI. “UTIs are a common misdiagnosis in seniors and as a clinician with geriatric training, I know to probe deeper for the root cause of symptoms. I sent our urgent response team out to visit this member to confirm diagnosis before writing a prescription,” said Dr. Wendy. “We soon discovered that UTI was actually a stroke. Having this level of training allowed us to react and treat quickly.”

Is your health at risk if you don’t have a primary care provider trained in geriatrics? “For those seniors with a singular health concern, you would be fine seeing a traditional primary care clinic,” explained Dr. Nick. “When it comes to caring for seniors who have more than one health problem, those with a bit more complexity like hypertension or diabetes, or who are on more than 5 medications, then yes, absolutely you should be seen by a team of geriatric experts. This level of complexity needs more than the 15-minutes allotted during a visit to address their whole health and without it, can lead to unnecessary ER trips or worse, drug cascading, overtreatment, or incorrect diagnoses.”

Bringing to light this issue is timely. For the first time ever, we have a demographic shift, and the number of seniors will surpass the number of people under 18. Geriatric training will be a critical part of what every primary care provider will need if we are going to serve our seniors well. Perhaps some of those pediatricians should consider an added expertise – they already have a strong foundation.

For you, there’s good news. As a Lifespark COMPLETE member, you already have a team of geriatric experts at your fingertips as part of your health plan. Choosing them as your sole primary care team is the best way to restore health, support your wishes, and transition to the right late life experience for you.

Ask Ethel

Can you graduate from hospice

Dear Ethel,

I thought hospice was only for when you’re nearing the end-of-life, but a friend told me how her mom graduated from hospice. Is that possible?

~ Questioning hospice in Shakopee

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Dear Questioning hospice in Shakopee,

First, I want to acknowledge that these are emotional decisions. It’s really difficult to hear that a cure is no longer possible. You are doing the right thing by understanding what options exist so that this next phase of your loved one’s life can be filled with meaning. Take heart. What’s most important is that both of you get the support you need.

There’s no one-size-fits-all answer when it comes to hospice, it really depends on the person’s goals, how they want to live the life they have left. I’ll answer your questions in a few ways.

Hospice was not designed just for the last days of life but of course it’s available to those who need it.
A common misconception is that hospice is only for when death is imminent. Often, those who enlist hospice wish they had called hospice sooner. There are many services and benefits built into the hospice benefit that help to enhance life and create less stress and more opportunities for a meaningful experience for everyone.

Eligibility for hospice is made by a physician who determines your life expectancy is 6 months or less, and when your goals become focused on comfort rather than curative treatment. Hospice goals shift to symptom management and quality of life. The additional benefits of hospice are brought to the individual through their Medicare hospice benefit at no cost to them and provides a mix of medical, emotional, and spiritual support from a team.

Can you graduate from hospice? The short answer, yes, and many do. Because of the depth of services available to the person entering hospice, many find their condition stabilizes or improves enough to no longer qualify for hospice. You can come off and on hospice as your condition changes.

Lastly, I appreciate your candidness around this question. The more we talk about hospice, the more people will know it is not as scary as it seems. It’s not about death but about having the right conversations to choose how you want to live whether that’s within 6 months or 10 years. I will be thinking of you through your journey and wishing you and your dad the best.

In health,
Ethel

Listen to a Nurse on WCCO to learn more

DID YOU KNOW:

The fear of falling can lead older adults to limit their activities, which can result in more falls, further physical decline, depression, and social isolation.

A study in the National Council on Aging found that three million adults 65+ are treated in emergency departments for unintentional fall injuries each year. Once there is one fall, it’s often the fear of doing it again that prevents seniors from Aging Magnificently. Here’s what to do…

“If a client is having falls, I always recommend a thorough evaluation by a physician to rule out other possible factors, like electrolyte imbalance, low blood pressure, or the side effects of medication,” said Julie Varno, Lifespark Physical Therapist Case Manager. “Unfortunately, many of the drugs commonly prescribed for diabetes, high cholesterol, hypertension, overactive bladder, and anxiety can cause dizziness and sometimes muscle weakness.”

It’s not always the smoking gun, she said, but it’s definitely worth exploring. “Once a client is cleared medically, the physician can prescribe PT or OT,” Julie said. The first step in preventing falls is knowing what conditions increase the risk. Some surprising contributors can be:

Certain medications
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Vitamin D deficiency
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Dehydration
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Tripping hazards
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Difficulties with walking and balance and muscle weakness
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Poor vision and hearing
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Health conditions such as Parkinson’s Disease, stroke, low blood pressure, or dementia

Although it might seem counterintuitive, clinical studies have shown, and Julie’s experience confirms, that older adults who are afraid of falling have a higher risk of falls than those who have a history of falls. The fear triggers an insidious spiral, Julie explained, that starts with the individual becoming less active, which leads to muscle weakness and joint stiffness. That, in turn, affects balance and the ability to react quickly. “A poorly placed rug or an attempt to reach outside their base of support can end up in a fall,” she said.

What should you do? Start by checking in on your overall health and wellness regularly to self-identify red flags or concerns that could lead to a fall or a health care crisis. We suggest printing out a copy of the Whole Peron Wellness Checklist as a guide to bring with you to your next appointment or visit with your primary care team. Talk to them about your concerns and ask for ways you can remain healthy at home.

Also, check out Ginny and Doug’s story – they know a thing or two about falls and checking in on your wellness.

Download our Wellness Checklist

Watch the video: get more from your primary care

As Lifespark COMPLETE members, you have access to a complete senior health team who comes to you, on your terms. As we’ve shared in this newsletter, that is a lot to celebrate as you are one of the few seniors in the Twin Cities who have access to this highly sought after expertise. In case you missed the webinar, we’re sharing with you the full webinar so you can meet the docs on your primary care team – Dr. Wendy Laine and Dr. Nick Schneeman – who share how you can get more from your primary care team. Get your pen and pad ready to write down some of your follow-up questions. If you have any after watching this, reach out to the clinic team at 952-345-3215 or email sparkon@lifespark.com.