Health Archives - Page 10 of 10 - Fran Moreland Johns

July 31, 2009

Brain Fitness: The New Best Thing

At a program on Assistive Technology for Seniors sponsored by the Commonwealth Club of California yesterday, four panelists at least one generation away from 50 themselves discussed the technological wonders being perfected by their contemporaries for the likes of boomers and beyonders. (Devices that tell your children across the country how many times you open the refrigerator; nifty machines to compute and address your every need…) But for some of us, the handsome twenty-something geek talking about brain fitness made the most newly-revealed sense. OK, maybe he’s 30-something, but not very something if so.

“Exercising your brain in very specific ways,” said Eric Mann, Vice President of Marketing for Posit Science, ” will be recognized within the years ahead as just as important as cardiovascular exercise.” The brain is not an organ condemned to progressive deterioration, he explained, but something evolving every day. Pointing out that mind and body are the two assets with which everyone comes equipped, Mann urged his largely gray-haired audience to understand that both need to be maximized through ongoing exercise.

To that end, his company has thus far created programs titled Brain Fitness, DriveSharp (brain/foot/hand fitness?) and InSight.

The program went back and forth between those sorts of brain-governed assists for our rapidly aging population — the percentage of Americans over 65 increases every day — to the computer-assisted living which is coming, ready-or-not, onto the scene. In what would surely have been proclaimed la-la land a decade or two ago, assistive technologies at one’s fingertips already include personal emergency response systems (esthetically improved over the “Help! I’ve fallen and I can’t get up!” necklace, cell phones with a button that alerts your five first choices), medication management systems (electronic pillboxes that do everything but pop the right dosage into your mouth) and senior-friendly e-mail options for the internet-averse.

The thought of all that technological wonder was enough to induce brain-weariness in some audience members who occasionally wish they had the “Number, please” telephone lady back. But because such an attitude might fall into a category Mr. Mann referenced in passing as “maladaptive compensatory behavior,” most went home willing to hear it all as good news. And to ramp up the exercising of their brains.

More on those technological wonders in a following blog.

General interest/Health/Money/Politics & Causes

July 24, 2009

Palliative Care: Rush Limbaugh vs the Grannies

by Fran Johns

The patient was in four-point restraint, which means his hands and feet were tied to the bed. He was shouting over and over, in Spanish, “Help me!” but no help came. Until Diane Meier happened upon the scene.

The back story, she learned, was that the man had end-stage cancer for which he had declined treatment. After he fell at home, his adult children had found him on the floor and called 911, landing him back in the hospital. There, among other interventions that were put into play, a feeding tube had been inserted through his nose. When he repeatedly pulled it out, his hands were tied. After he then pulled it out three times with his knees, his feet were tied. You could say these treatments were being performed over the patient’s not-quite-dead-body.

“Why,” Dr. Meier asked, “is it important to have the feeding tube?” The attending physicians answered, “Because if we don’t, he’ll die.”

It was at this point that Diane Meier, M.D., F.A.C.P., already honored for her work in geriatrics and for her personal and medical skills, became a crusader for palliative care. “A light bulb went off,” she told a group of physicians and other professionals in the field today in San Francisco. “I realized it was an educational problem, and thus a solvable problem.” She saw that the doctors and nurses were only doing as they had been taught, and the results were distressing also to many of them. “All I did was say ‘It’s all right to care about your patient.'”

Meier’s pioneering efforts to shift care of critically ill patients from aggressive, often futile treatment to comfort care focusing on the patient instead led to formation of the Center to Advance Palliative Care, which she currently serves as Director. They also resulted in a MacArthur Fellowship she was awarded in September, 2008.

“The MacArthur,” says the self-effacing physician, “was in recognition of the tens of thousands of people working in palliative care.” But those tens of thousands are not enough to have eliminated the tragedies of patients such as the unfortunate man cited above. Walk the halls of almost any hospital, nursing home or similar institution in the U.S. and you will hear the incessant “Help me!” cries of people being treated over their almost-dead bodies.

Helping them with comfort care rather than aggressive treatment, though, is referred to by the Rush Limbaughs of the world as “Killing off the grannies.” It is a handy sound bite, and it is tilting the balance against sanity in our lurch toward health reform. Unless Mr. Limbaugh can convince me I’d rather be 4-point-restrained with a tube inserted in my nose than gently treated with comfort care when I encounter my next critical illness, this particular grannie would appreciate his butting out of my rights. Palliative care should be a right.

It is, unfortunately, a campaign of the political right to keep palliative care out of health reform. They will prevail, Dr. Meier said, unless voices of sanity are raised, whether Democrat or Republican. She urged her audience, representative of a wide variety of compassionate groups, to help get the message out and get the calls, e-mails and letters in. Legislators behind the three bills working their way through Congress, she said, need to hear from the citizenry.

The citizenry is unquestionably in favor of comfort, and where palliative care can be understood it is welcomed. Hosting Dr. Meier’s informal talk were the California HealthCare Foundation, the California Coalition for Compassionate Care, Archstone Foundation and the University of California, San Francisco, four of many organizations committed to making palliative care understood, available and effective.

The question of whether they or Rush Limbaugh will prevail is as yet unanswered. Having Mr. Limbaugh forming our health policy, though, is almost as scary to this granny as 4-point restraint.

General interest/Health/Money

July 20, 2009

Affordable Health Reform

by Fran Johns

It was actually spoken out loud on NewsHour Friday night: we could have a workable, affordable healthcare system if we would address the excessive costs that go into the last six months of life, particularly the last few days. The remark was immediately followed by the standard caveat: of course, no one is going to suggest doing this.

Good grief, why not? Everybody knows it, a few others have even said it out loud. Sure, it’s political suicide, but if someone were ever brave enough to fall on that particular sword there would be a lot of people around to pull out the sword, cleanse the wound and stand him or her back upright.

It could be done. If individual choice were encouraged and enabled. If physicians had to be honest about the quality of life (if any, usually for a few days or weeks) being bought with aggressive treatment at life’s end. If futile treatment were avoided. If protections were put in place for physicians and hospitals complying with the above, since fear of lawsuit is behind most of the mess. If all of us began to look at — and make clear — what extreme measures we would or would not want.

Big ifs. But the reward would be a workable, affordable system.

General interest

July 19, 2009

More on the Housing Choices Dilemma

by Fran Johns

This week’s earlier post about the multiplicity of housing choices for the post-Boomers (and often Boomers ready to downsize or make other shifts) touched on just a few of the possibilities out there. The staying put option is one that many, including my friend Berta whose current consideration of home changes was cited, would choose. The question is addressed at some good length in today’s New York Times:

Stay put or sell?

That’s the question many older people ponder as they move into their 70s and beyond.

Most older people settle on staying put, according to a recent survey by the Home Safety Council, a nonprofit organization dedicated to preventing home-related injuries. (From the source of the survey, you can see where this column is heading, right?)

Staying put makes economic sense. It is not only more comfortable to live out your life in your own home, it’s much more affordable.

Those posh retirement condos and assisted-living facilities might seem easy-living and attractive, but crunching their numbers can take the shine off their attraction fast.

The average annual fee at an assisted-living facility — a place where older people live independently but also receive a host of services like medication monitoring and meals — is $34,000. And in the nation’s most expensive metropolitan areas, including New York, the costs may be closer to $70,000.

The Times article goes on to cite the case of octogenarian Catherine Fisher, who chose to adapt her New Jersey home to her own needs rather than take those needs elsewhere. Sooner or later, countless Americans will face similar choices. Guidelines to what is becoming “an entire service industry… taking shape around the goal of letting people age in place” are worth a quick study now, for whenever “later” comes.

via Patient Money – Cost-Effective Ways to Make Homes Safer for Older People – NYTimes.com.

General interest

July 15, 2009

A Novel Idea for Healthcare Reform

by Fran Johns

Not long ago I attended an event at San Francisco’s Commonwealth Club, featuring a speech by the President’s Council of Economic Advisors Chair Christina Romer. Dr. Romer’s talk, “The Great Credit Freeze and the U.S. Economy,” was all about improving healthcare while slowing down the growth of its cost. We know we can’t reduce costs, she said; what we hope to do is reduce the rate of increase. And one way to contain healthcare costs might be to find out what the patient wants. Imagine.

This observation was not in direct response to a question, but could well have been. Dr. Romer was asked, by more than one audience member, about how to address excessive expenditures at the beginning and end of life. A grossly disproportionate share of costs, she conceded, “are spent on the last six months of life. And one thing we’re not doing enough of is letting patients express what they want.”

If the issue were not so grim and sorrowful it would call for a “Well, duh.”

It would be hard to find many people saying they’d like their last few days on this planet to be spent semi-conscious or in pain and distress, hooked up to a tangle of wires and tubes in a blue-lit hospital room (see Scott Bowen’s post 7/14.) But this is in fact the system we have created: we focus on prolongation of life without regard to quality, we aid and abet doctors who equate death with failure, we never talk about our own mortality as if in silence we can become immortal. Most of us would choose to die at home , properly medicated for pain and surrounded by our loved ones; most of us will die in an institution

Audience members had a wide assortment of questions, and Dr. Romer had plenty more to say. But finding out what the patient wants, and acting accordingly, is surely one excellent path towards better care – and even contained cost growth — and everyone in America could begin that process today.

It is an easy solution, even if only a small, partial solution, to this piece of the muddled medi-puzzle of our healthcare system: talk. Tell your doctors, caregivers, loved ones what you do or don’t want. Write it down. Use the forms universally available (Advance Directives, POLST, others.) You might even wind up with what you actually want in your final days. Christina Romer is on your side.