living your best to the end

Four medications cause most hospitalizations

Blood thinners and diabetes drugs – alone or in combination –  cause the most hospitalizations in older adults. This is a really enlightening report picked up by  New York Times, ‘Well’ editor, Tara Parker Pope. Aspirin, clopidogrel and other antiplatelet drugs that help prevent blood clotting were involved in 13 percent of emergency visits. And just behind them were diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations. Two things from the article that struck me:  The medications were all difficult: they require constant monitoring and adjusting. The other thing that struck me: It’s hard to get it right, and downright dangerous to get it wrong.  It’s very delicate business, making adjustments. All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. One problem they share is a narrow therapeutic index, meaning the line between an effective dose and a hazardous one is thin. The sheer extent to which they are involved in hospitalizations among older people, though, was not expected, said Dr. Dan Budnitz, an author of the study and director of the Medication Safety Program at the Centers for Disease Control and Prevention. SafeMedicationUse.ca – The Institute for Safe Medication Practices Canada’s(ISMP-Canada) medication incident reporting and learning system for consumer has further warnings about insulin : The consumer had recently picked up some boxes of insulin at a pharmacy. Most of the boxes were correct, but one box contained a fast-acting brand of insulin. No one had noticed that the wrong box was mixed in with the other boxes. The consumer reported...

Myths about aging, proud octogenerians

Jack Pinkus in action at Baycrest Jack Pinkus, retired pharmacist with 17 years on the Board on the Ontario Pharmacists Association opened his educational session at Baycrest by exploding the following myths: • Age will inevitably bring illness • Damage is already done, so why bother taking care of my health • Getting old means losing mental sharpness • Getting old means being sad, lonely and inactive. This was good news to the group aged 70+. He then explained succinctly the difference between normal forgetfulness and signs of dementia: “Everybody forgets their keys. That’s not a problem. That’s normal. It’s when you forget what the keys are for – that’s when you’ve got a problem.” Medication messages specific to getting older: • Aging makes the body more sensitive the effects of medication. • Having trouble with the small type on your prescriptions? Ask your pharmacist for a larger easier to read label. Messages relevant to everyone: • Natural does not mean safe. The worst places to store medication are: • Bathroom: humidity affects chemistry. • Fridge (unless specifically indicated): cold and humidity affects chemistry • Window Sill: sunlight affects chemistry. We’re always instructed by have a list of what we’re taking. I puzzled about what to use when making and keeping up a list of meds: Brand or generic (not to be confused with what happens when brand names become generic) I mean, how much easier to say Prozac (nothing to disclose) than Fluoxetine Hcl. The answer: Wise to have both, especially traveling outside Canada when brand names may be different. During the session, another example of how much...

Pew Research Center:Views on End-of-Life Medical Treatments

 Staying Alive: what more of us want to do  “The share of the public that says doctors and nurses should do everything possible to save a patient’s life has gone up 9 percentage points since 2005 and 16 points since 1990. From Pew Research Center forum “Views on End of Life Medical Treatment.” That more adults want everything done to keep them alive at life’s end does not surprise me. Doing everything vs dying peacefully But, this may come as a surprise in light of reports saying we want to die peacefully, at home, which assumes fewer interventions. It also seems to fly in the face of numerous initiatives encouraging discussion – with the underlying hope that talking and normalizing the topic will have the effect of reducing the ‘give me everything’ approach. Where’s the disconnect? As I continue to talk about life’s end whenever I get the chance, I am constantly confronted with the reality that explains the disconnect: the assumption, presumption and possibly the expectation that we who are not immersed in the world of health specific to end of life will understand the context and repercussions of ‘give me everything’. Even healthcare professionals in areas other then end of life often don’t have a sense of or focus on effects of interventions, beyond the intervention. On the surface it makes sense: the promise of medical advancements combines with the medical professional’s mandate to heal and cure – often resulting in unrealistic hopes, expectations and goals. Dr Ken Murray‘s How Doctors Die lets us in on the fact that his colleagues adamantly forgo ‘futile treatments’. Then too,...

Organ and Tissue Donation: a learning experience

Donna Renzetti (left, standing) Vice President, Corporate Services and Chief Financial Officer at West Park Healthcare Centre came in on a Saturday to make sure there were plenty of chairs at the ready for the Trillium Gift of Life Network (TGLN) presentation on organ and tissue donation and transplant. She needn’t have worried: the gathering group were all wheelchair bound – or rather, wheelchair liberated (depending on your point of view) with the range of wheelchairs equivalent to a high-end car collection, complete with customization. I’m a public member on West Park Healthcare Center’s Palliative and Supportive Steering Committee, and am always up for attending education sessions that can increase my knowledge and understanding of end of life concerns and issues for their residents. Donation is not just for the able-bodied These good folks, for whom day to day living is their first priority, were interested in learning about organ and tissue donation. Their home is the complex continuing care section of West Park Health Center and many live with terminal degenerative conditions like Lou Gehrig disease (ALS) , Lung Disease (COPD), stroke, traumatic brain injury. Restricted and diminished though these West Park residents may appear to me – it’s clear they know exactly with whom they want to sit and are affectionate and caring with one another – communicating by various means. This is a substantially different crowd than the week prior, when I’d attended an Ontario Hospital Association conference on Ethics and Legalities in End of Life, where TGLN also made a presentation, encouraging discussion, decisions and making wishes known. That group, from various healthcare organizations, heard:...

Dr Paula Rochon: Medications and the Elderly

Dr Paula Rochon, Geriatrician,Vice-President Research–Women’s College Research Institute; Adjunct Scientist Kunin-Lunenfeld Applied Research Unit I heard Dr Paula Rochon speak to a small but extremely attentive group of senior seniors. The topic: Medications and the elderly. Rochon is a Geriatrician by training, and her research focus and passion is medication. My take-away: don’t underestimate the impact of medications – the time and effort and challenges required to take ‘em, and the potential effect on other functions. I spoke with Dr. Rochon afterwards, and she clued me in to specific issues related to medications and aging, and a message to pass along to fellow females: Women have to be particularly diligent because so much medication research is done with men. Here’s what I learned: Even if your parent’s been taking the same medication(s) forever, it’s still a good idea to get them reviewed every 4 -6 months. Why? Because aging bodies may not need as much of any one medication. Ask if all medications are necessary, or if any medications can be eliminated If new medication is prescribed, find out what it’s for, if it’s replacing something else, and how it’ll interact with other medications food and drink. Much as weight plays a huge role in how much medication infants are given, as an aging body shrinks, they may not need as much medication. Know your parents weight and height Many medications, or combination of medications can cause confusion, which can lead to a mess o problems: confusion, losing balance and falling, misplacing glasses, dentures, and often –are you ready for this: misdiagnosis of dementia or early Alzheimers. Many pills...

Substitute Decision-Makers Suffer Post-Traumatic-Stress

Surrogates suffer in their role as patients’ decision-makers “A Systematic review: the effect on surrogates of making treatment decisions for others“– published in the Annals of Internal Medicine – was the topic of discussion on Pallimed: A Hospice & Palliative Medicine Blog.1 Substitute decision-makers, described as “a solution to a problem created solely by advancing medical technology,” often help make treatment decisions for patients who cannot do so themselves. There is an effect on the surrogate that has not been assessed. Surrogates are mostly family members The authors researched 40 studies of 2,854 surrogates and found that in more than 50% of cases, the surrogates were members of the patient’s family. In one study, the surrogates, who were relatives, felt guilt about their treatment decisions. At least one-third of the surrogates felt “a negative emotional burden” such as anxiety or stress from the process Symptoms of posttraumatic stress disorder among family members who had participated in making decisions were also present in several of the reviewed studies. Study authors wrote:, “Our evaluation of more than 2,800 surrogates indicates that this practice places emotional stress and burden on at least one-third of surrogates, which is often substantial and lasts months or, in some cases, years.”2 A group in Munich, Germany, also looked at the role that family members play in making decisions about life-prolonging treatment in seriously ill patients. The researchers followed 70 patients with terminal cancer in whom physicians were considering whether to limit life-prolonging treatment. They recorded the patients‘ wishes about end-of-life care, the roles of their family members, and how both groups felt about limiting treatment. Although the...