Managing chronic pain in older people

Managing chronic pain in older people

Pain management needs to be tailored for older people. The British Pain Society and British Geriatric Society produced guidelines specifically for this client group

This link is to a page summarizing an article from the professional journal Nursing Times. The article lists five key points:

  1. Pain is a risk factor for falls in older people
  2. It is thought that 50% of older adults living in the community, and 80% of those living in care homes, experience chronic pain
  3. Few studies look at the effects of pharmacological interventions specifically on older people
  4. Combination therapy using different classes of analgesics may be more effective with fewer side-effects, compared with higher doses of a single medicine
  5. Further research is needed on psychological treatments for pain in older people

You can see the entire two-page article by clicking on the link for the PDF file under “Related Files” in the middle of the page.

Life Is Too Short. Or Is It?

Life Is Too Short. Or Is It?

Liah Greenfeld, Ph.D., writes that medical advances in prolonging life may have unintended consequences. She offers as evidence the fate of her parents:

My mother, who will be 85 next month and whose mind is still sharper than a surgical scalpel, repeats now and then: one must die in time. She was a doctor, she watched many deaths. She believes that the ability of medical science in developed countries to prolong life into the 80s and beyond is nothing to celebrate and, in fact, actively contributes to unnecessary suffering.  My mother is tired of life – and since my father’s death eleven years ago, in 2002, has often wished she were dead. They were married for 53 years, with his death meaningful life ended for her – there was nothing to live for anymore. His death – sudden, on the operation table, at 75 — was a terrible loss for all of us. For two years I, his eldest daughter, 48 when this happened, was overwhelmed by grief. Yet, before that, I had been consciously happy, that is, I realized that my life was a truly happy one, full to the brim of love and passionate interest in the surrounding world, which make life worth living. My father knew that he was going to die: we have discovered this in his diary. He was a doctor too, and a very good doctor, in contrast to the young and eager to cut surgeons who operated on him. He knew that, given the regimen of medications he was on, if operated, he would die of the loss of blood; his doctors, who suggested an exploratory surgery, missed this essential detail. Signing the consent form, my father was, therefore, consciously signing his death warrant. He was a man interested in so many things, always excited about something, always full of projects. In fact, at the time of his death he was learning a new language. And he was afraid of dying, as he wrote in the last entry of his diary, adding, though, but can life after 75 be considered life? I understand now that he died, as my mother says, “in time.”

After his death, my mother suddenly became very old. Her health drastically deteriorated. She started dying and has been dying for eleven years.

She ends by asking: “When is the time? Shouldn’t we at least think of this before further advancing our ability to prolong physical existence, without at the same time being able to fill the additional years with meaning?”

On the Menu: Golden Raspberries

Aren’t they beautiful? I had never seen these before.

gold raspberries

We bought them at Metropolitan Market, located in Tacoma’s Proctor District.

In the Doctor’s Office, a Neglected Resource

In the Doctor’s Office, a Neglected Resource – NYTimes.com

When it comes to providing health care for an aging nation, the bad news is no longer news. We already lack sufficient numbers of geriatricians and other professionals — nurses, social workers, pharmacists, aides — trained to care for the elderly, and the shortage is projected to increase.

The good news, confirmed by a study in the Journal of the American Geriatrics Society, is that nurse practitioners can markedly improve the quality of care for older patients.

This article in The New York Times‘s health section “The New Old Age” reports on a recent study revealing that nurse practitioners can, in many cases, dramatically improve the quality of patient care.

Researchers from UCLA examined medical visits involving four common conditions among older patients: urinary incontinence, falls, depression and dementia:

When it came to treating depression, patients seeing a doctor and a nurse practitioner received about the same care as those treated by doctors alone. In both groups, patients received 60 percent to 63 percent of recommended care.

But when patients showed up with one of the other three conditions, the addition of nurse practitioners meant much higher scores. Patients who saw a nurse practitioner along with a doctor received 80 percent of the recommended assessments and treatments for falls (compared with 34 percent for those who only saw a doctor), 59 percent for dementia (versus 38 percent) and 66 percent for incontinence (versus a particularly dismal 19 percent).

Dr. David Reuben, director of geriatrics at the University of California, Los Angeles and lead author of the study, explains the benefits of a team approach to medical management that uses both doctors and nurse practitioners:

“There are certain things doctors do well, certain things they don’t do well, certain things nurse practitioners do better,” he said. He added that he sympathized with primary care doctors working with elderly patients who have many chronic conditions: “The job is too big. It’s too complicated. There’s too much to do.”

 

Dementia’s Signs May Come Early – NYTimes.com

Dementia’s Signs May Come Early – NYTimes.com

Studies presented Wednesday at an Alzheimer’s Association conference in Boston showed that people with some types of cognitive concerns were more likely to have Alzheimer’s pathology in their brains, and to develop dementia later. Research presented by Dr. Amariglio, for example, found that people with more concerns about memory and organizing ability were more likely to have amyloid, a key Alzheimer’s-related protein, in their brains.

And, in a significant shift highlighted at the conference, leading Alzheimer’s researchers are identifying a new category called “subjective cognitive decline,” which is people’s own sense that their memory and thinking skills are slipping even before others have noticed.

This article reports on a new interest in Alzheimer’s research, the subjective reports of aging patients, known as “the worried well,” who sense their cognitive abilities changing before standard testing procedures reveal definite signs of dementia:

leading Alzheimer’s researchers are identifying a new category called “subjective cognitive decline,” which is people’s own sense that their memory and thinking skills are slipping even before others have noticed.

However, it’s important to note that:

Some memory decline reflects normal aging, they say, and some concerns reflect psychological angst. People who forget what they wanted in the kitchen or the names of relatively unfamiliar people are probably aging normally. People who forget important details of recent events, get lost in familiar places or lose track of book or television plots may not be, especially if they have more problems than others their age.

European studies find dementia rate down sharply | Nation & World | The Seattle Times

Finally, a bit of good news:

European studies find dementia rate down sharply | Nation & World | The Seattle Times

A new study has found dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, a trend researchers say is likely occurring across developed countries and that could have major social and economic implications for families and societies.Another recent study, in Denmark, found that people in their 90s who were given a standard test of mental ability in 2010 scored substantially better than people who reached their 90s a decade earlier.

 

Retiring later may stave off dementia | Nation & World | The Seattle Times

Retiring later may stave off dementia | Nation & World | The Seattle Times

Baby boomers, take note: For every year you put off retirement, your chances of developing Alzheimer’s disease or other types of dementia are cut by 3 percent.

The findings are the result of a massive French study, which looked at the records of 429,000 workers. The scientists presented their results Monday at the Alzheimer’s Association International Conference in Boston.

. . .

The findings underpin the often-repeated advice to prevent mental decline: “Use it or lose it.” Doctors have said that keeping the brain mentally challenged is one way to prevent dementia and related diseases.

 

Seattle Sawdust: Bits and Pieces from the Seattle Collection

Seattle Sawdust: Bits and Pieces from the Seattle Collection.

If you enjoy the Pacific Northwest, you have probably encountered many tales of Seattle’s storied past. It is, after all, known in some parts as the “Emerald City,” and is full of tales of its rough-and-tumble Skid Row, pioneer settlers from Scandinavia, and a whole host of intriguing characters. This particular website from the Seattle Public Library offers a cornucopia of ephemera related to the city’s history. As the site notes, “This collection presents some of Seattle’s historical ‘sawdust’–unique and interesting materials.” Many of these documents have not been widely accessible for many years, a situation this archive remedies. There are 25 items here, including “A Survey of Comic Books in the State of Washington: A Report Made to the Washington State Council for Children and Youth” and a fascinating document on regrading projects in Seattle titled “How Seattle Changed Its Face.” Visitors can search all of the texts and browse at their leisure; those interested in urban planning and the like will probably end up whiling away a few hours enjoying these unique items.

From The Scout Report, Copyright Internet Scout 1994-2013. https://www.scout.wisc.edu/

Depression & Seniors: 5 Ways You Can Help | World of Psychology

Depression & Seniors: 5 Ways You Can Help | World of Psychology.

Depression can be easy to overlook in older people for a number of reasons, as this article explains.

If you know someone who might be depressed, don’t let that person brush off your concern. Here are some ways you might be able to help.

“Why Me?”

For several months now I have been working on my dissertation. I’m exploring a topic I love, and my committee members couldn’t be any more helpful and supportive. Nearly every day I’ve been learning new things that suggest projects for me to work on after I finish this degree. I had been moving joyously through the whole dissertation process.

But this week I hit a couple of those snafus that occasionally come our way and distract us from what we want—and need—to do. First, the Apple Mail program on my desktop computer suddenly stopped pulling in my email. It kept asking for, and rejecting, my password. I spent some time poking around the web site of my hosting service, then finally moved on to live chat tech support. Daniel, the support guy, spent a lot of time on the problem but couldn’t figure it out. He then asked his supervisor, who also had no luck. They ended up calling in the head email guru, who lived an hour away. They did finally fix the problem, but I lost several hours that I had intended to dedicate to working on that dissertation.

Second, one morning I came into my home office to find that Mac OS X was unable to write to the external hard drive that I use for daily backups. The helpful little box on the screen advised me to copy my data from that drive and reformat it. Since it’s an old drive, I figured replacement was a better bet then reformatting. Fortunately, I had a brand new 1.5 TB external drive that we had picked up recently on sale. But before I could use it, I had to check the company’s web site, find out how to format the drive for use with my Mac, then format the drive and copy the data onto it. I also had to edit my backup program to write to the new drive rather than the old one. So there went another couple of hours that should have been devoted to the dissertation.

As I was muttering and mumbling to myself while copying data files, a realization suddenly smacked me in the head: When things go badly, we often shake our fists at the sky and shout, “Why me?” But when things go well, we don’t ask, “Why me?” We simply accept the good, believing it to be our due. We take so many good things for granted, but we get all worked up over the bad ones.

From now on, I’ll try to remember to acknowledge the good things that happen instead of noticing only the bad. And I’ll try to be just as grateful for the good things as I am disgruntled about the bad—and grateful that, overall, the good far outweigh the bad.

© 2010 by Mary Daniels Brown