How to Help Your Care Receiver Manage Their Healthcare
Contributed by Roberta Carson, Zaggo
Managing a serious medical condition is tough for anyone, but it’s particularly difficult for seniors. Many seniors have complicated health issues that require time and attention. Yet as we age, our ability to remember medical information and manage complex care diminish.
In fact, in one study, researchers concluded that almost 40% of seniors (65+) could not manage the complexities of navigating the healthcare system.
Specifically, the study found:
- It was “sometimes” or “often” hard for these patients and their families to manage healthcare activities.
- Older patients sometimes delayed, or even skipped, recommended healthcare activities.
- Dealing with everything involved in managing healthcare was too much for many.
Fortunately, there are steps you can take to help your parents better manage their healthcare. But first, I suggest you learn about the 4 obstacles your parents face.
Older patients often struggle to understand medical information.
Health literacy is the ability to obtain, process, and understand basic health information. Patients of any age with low health literacy can find it difficult to self-manage a medical condition.
However, seniors are more likely to have low health literacy. In fact, according to The National Assessment of Adult Literacy, only 3% of those 65+ years old have proficient health literacy skills. Unsurprisingly, health literacy is very difficult for seniors coping with cognitive declines.
Medications pose health risks for seniors.
Seniors face two medication-related concerns: the medications themselves, and the difficulty following prescribed regimens.
Medications are riskier for seniors.
Although all medications can cause harm to patients of any age, seniors are at higher risk. Generally, older age is associated with increased blood concentrations of drugs and altered metabolism, reduced effectiveness, and an increased risk of adverse reactions for many medications. What was safe at 40 might be harmful at 75.
Moreover, many seniors take medications that increase their risk of falling, which can lead to serious health consequences and even death. In 2017, about 94% of adults 65+ years old received a prescription for a drug that increased the risk of falls.
Older patients struggle to follow medication regimens.
Not taking medications as prescribed can lead to a substantial worsening of health with increased disability, or even death. Although following medication regimens is hard for many patients, seniors may struggle even more, for the following reasons:
Seniors take a lot of drugs.
Polypharmacy, the use of multiple drugs or the use of more drugs than are medically necessary, is a growing concern for seniors. Experts estimate people aged 65-69 take an average of 15 prescriptions a year. Moreover, those aged 80 to 84 take 18 prescriptions a year.
The number of medications taken is an important indicator of potential harm. One study found that the risk of an adverse drug interaction is 82% for patients who are taking seven or more medications.
Surprisingly, research shows that almost 50% of older adults take at least one medication that isn’t medically necessary. Unsurprisingly, polypharmacy increases the risk of drug interactions and adverse drug reactions. There is a strong established relationship between polypharmacy and negative health consequences.
Drugs are expensive.
Even with insurance, seniors must pay out of pocket for at least a portion of their medications. Clearly, when taking 10-15 medications, the costs add up quickly, which can lead seniors to skip medications, which obviously can impact health.
Thinking skills decline with age.
As we age, our memory and thinking skills decline, even more so for people with cognitive impairment. To make matters worse, many medications make it harder to concentrate and think clearly. These cognitive changes can easily cause seniors to forget to take a medication, to take the wrong dosage, to take a medication at the wrong time, and/or make other medication mistakes.
Hospitals pose risks for seniors.
Unfortunately, seniors’ health is at risk both during and after hospital stays, due to the following factors:
- Limited physical activity, common for hospitalized seniors, leads to deterioration.
- Seniors are more susceptible to pressure sores.
- Hospitalizations increase the risk of dangerous blood clots.
- Seniors are particularly impacted by sleep loss.
- Seniors are susceptible to adverse drug reactions.
- Hospitalizations can lead to an increase in the number of medications taken.
- Falls in hospitals among seniors are common and dangerous.
- Dementia patients face more complications and worse outcomes.
Additionally, when seniors leave the hospital, they are more susceptible to “post-hospital syndrome”, a short-term period of increased susceptibility to disease and adverse events.
Surgery is risky for seniors.
Unsurprisingly, older patients are more vulnerable during and after surgery. Common health problems related to aging (e.g., high blood pressure, clogged arteries, and heart and lung disease) increase the risk of side effects or complications during or after surgery. Unfortunately, research shows that increasing age itself can increase the risk of complications and deaths following surgery.
Importantly, research shows that nursing home residents have significantly higher mortality rates and a higher use of invasive interventions (e.g. mechanical ventilators and feeding tubes) after major surgery, as compared with similarly aged adults with the same number of chronic illnesses. Therefore, if your parent is a nursing home resident, talk to the doctor specifically about this issue and carefully consider risks before deciding on surgery.
The risks of anesthesia in seniors.
Unfortunately, the aging brain is more vulnerable to anesthesia. Therefore, seniors are more likely to develop two common anesthesia-related conditions – postoperative delirium and postoperative cognitive dysfunction.
Invasive interventions bring risk.
Invasive interventions after surgery, such as ventilators, central lines and feeding tubes, make it harder for seniors to recover. These interventions increase the risk of infection and often keep patients in bed – both of which can lead to deteriorating health.
What can you do to help seniors manage their healthcare?
It’s important that you engage in the process to help your parent get the best care and outcome possible. Consider the following recommendations:
Find the right doctor and hospital.
Look for a doctor’s practice that provides “patient-centered” or “person-centered” care.
Whenever possible, use a hospital designated as an “Age-Friendly Health System”. These hospitals are committed to providing appropriate, evidence-based care for seniors, and causing no harm. Additionally, these hospitals pledge to consider the desires of seniors and their families. Visit the IHI website to see the list of the thousands of hospital systems deemed “age-friendly” friendly to seniors. You can also search online using the term “acute care for elders” and the name of your city or hospital to learn about programs and policies regarding senior care.
Get the most out of medical appointments.
Whenever possible, attend appointments with your parent, providing a second set of ears, asking questions, and providing support.
If you cannot attend in person, try to attend via phone. Your parent can call you at the beginning of the appointment, allowing you to listen in and ask questions as needed. Note: it’s a good idea to let the doctor know about these plans.
You, or your parent, should record each medical appointment with a phone or recording device. Listening to the conversation later will help everyone remember the details discussed. Additionally, you can share the recording with others who couldn’t attend. But ask for permission before recording.
Prepare for appointments by writing down questions before you go. Write down your parent’s “story” to describe anything pertinent to his/her health. For instance, if your parent feels sick after eating, or gets dizzy in the heat, write it down and share it with the doctor.
Stay organized. You or your parent should take careful notes at appointments and keep all health-related documents, such as test results, organized and accessible. Share these notes and documents with each medical provider you see. And don’t forget to bring them to the hospital for admission or an emergency room visit.
Ask your parent to share his/her login for each doctor’s portal so you can see notes from appointments, test results, medications, etc.
Get a HIPAA release form for each doctor so he/she can speak freely to you. You can get a form online (search for forms in your parent’s state) or from a doctor’s office.
Get an advanced directive so you can make medical decisions on their behalf if they cannot.
Pay close attention to medication.
Taking medications as prescribed is an important part of maintaining health, so consider these steps to make sure your parent takes his/her medications properly.
- Ask the doctor why, how, and when to take each new medication. Write this information down.
- Ask each doctor if any particular medications, or a combination of medications, could increase the risk of falling. If so, ask about safer options.
- Tell the doctor if your parent cannot afford his/her medications. The doctor may have suggestions for similar medications, generics, or discounts.
- Ask each doctor if all the prescription and over-the-counter medications taken by your parent are medically necessary.
- Keep an updated list of your parent’s medications (including over-the-counter) with you and give one to your parent one to carry at all times. Be sure to include dosage information.
- To reduce the risk of dangerous drug interactions, make sure each doctor has an up-to-date list of all medications.
- Whenever possible, use the same pharmacy for all medications – it can help catch potential adverse interactions.
- Help the person you care for organize their pills with a simple pill sorter you can buy at any pharmacy. (You may need to sort the pills for them each week.) You can also purchase pills in pre-packaged packets based on the time/day needed, making it easier to organize pills (try CVS or PillPack).
- Help them set up a reminder system, such as cell phone alerts. If they struggle to take their pills even after a reminder, consider an automated pill dispenser. There are many systems available that dispense pills at a designated time and remind patients it’s time to take medication (note these have monthly user fees).
Take steps to avoid medication errors if your loved one is in a hospital or long-term care facility.
Unfortunately, medication errors are common among in-patient facilities, such as hospitals and nursing homes. In fact, a 2006 landmark report by the Institute of Medicine estimates at least one medication error per patient every day in hospitals and long-term care facilities!
To reduce the risk of medication errors for your loved one in a healthcare facility, follow these suggestions:
- Make sure every nurse and doctor know if your parent has had any past medication-related allergies and/or side effects.
- Make a chart of all medications, with the time each one should be taken, on the bedside table.
- You or your parent should speak up if a medication doesn’t look familiar.
- Ask the nurse or doctor if your care recipient will be given any “high-alert” medications that must be given the right way at the right time. If the answer is yes, ask how they assure that staff give these high-alert medications in the proper manner and time.
Reduce the risk of hospital-related issues.
Since older patients are more at risk for harm during and after a hospital stay, it’s best if you can be involved. Whenever possible, participate in the bedside rounds when the medical team discusses your parent’s care and condition. And ask the staff to call you with regular updates and/or when your parent’s condition changes. And find out how you can reach them!
Reduce the risk of harm due to a surgical procedure.
Clearly, it’s important to learn about potential risks and steps that can reduce the risk of harm before scheduling a surgical procedure. For more information on this topic, plus a full list of questions to ask doctors, read Questions Seniors Should Ask Before Surgery.
We hope this information is helpful to you in the important work you do as a family caregiver.
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