House Calls a practice of the past? [Photo Credit: (1946) U.S. National Archives and Photo Administration]

Are house calls a practice of the past or the future? Well, it depends on who you ask.  An article in the Ottawa Citizen recently write that “Doctors’ house calls aimed at seniors poised to make a come back”.  However, the Times of India stated that “The number of doctors visiting patients’ homes is declining steadily.   The Reader’s Digestagrees that “the centuries-old tradition of the house call is ailing and many experts believe it will die out altogether unless something is done.”

Prominent among those who welcome the return of house-calls are the elderly, many of whom have lost hope in the medical system and who don’t want to go to hospitals where they feel they will be prescribed unnecessary tests.

There are many benefits to reviving house calls:

  • The terminally ill or disabled have difficulty getting out of their home to commute
  • The care is more personalized and thorough
  • The practice renews trust in medical treatment and care
  • Helps avoid future visits to the emergency room
  • Less stress for patients and caregivers in organizing the trip to the doctor

However, there are also some disadvantages:

  • House calls are typically significantly more expensive
  • House calls are timely – the shortage of doctors and nurses in some regions would mean less time to see as many patients on a given day
  • The technology and tools used to conduct certain screenings and tests cannot be easily transported
  • Visits are often less structured outside of the office

The demand for home medical care is increasing, says the Times of India, and perhaps this is due in part to the global initiatives to age in place.   There are also new technology devices that allow people to be treated at home and be cared for without leaving their comfort.

Physicians in Australia observe that there has been a cultural shift in doctors wanting to spend more time at home with their families and for themselves as well.  For instance, Dr Tim Woodruff of the Doctors Reform Society of Australia says “Society has changed. I think people realize that doctors are people too and they’re not the only port of call, especially after hours.”

Dr. Samir Sinha, director of geriatrics at mount Sinai Hospital in Canada, is not losing hope.  He is among several doctors that continues to make house calls and is working with government to expand the house-calls program.

So are house calls one foot in or one foot out of the future of bedside practice?  Please share your thoughts with us.

The Madrid International Plan of Action on Ageing, adopted in April 2002, marked a turning point in how the world looked at ageing.  The report had delineated guidelines for policy development and implementation, made suggestions for mainstreaming ageing issues into government agendas, and helped promote dialogue in the information exchange.

The United Nations Department of Economic and Social Affairs (DESA) and the Division for Social Policy and Development (DSDP) have been focusing on social development issues including ageing, disability, employment, social integration and social protection, as a means to implement the Madrid Plan.

After 10 years of implementation, DESA and DSDP are conducting a questionnaire to assess the need for support and servicing in order to facilitate agreement on international standards and resolutions.

With your help and experience, the Departments can strengthen their work while considering the challenges you face in your hard work and dedication to ageing care.

Organizations sometimes overlook participation in such opportunities because it is hard to feel the impact on the ground, in the every-day care giving.  However, with every bit of input and recommendations from experts in the field, the UN can help improve the use of information and communication, and fulfill their role in the international arena.

On October 1, organizations around the globe will celebrate the UN International Day of Older People, bringing countries together to share their achievements, raise awareness and support communities. For instance, HelpAge International will be running a campaign “Age Demands Action” to help celebrate this day.  October 1 will be both a celebration of Old People, and a celebration of our accomplishments over the last ten years.

To Participate:  https://www.surveymonkey.com/s/ngo-questionnaire-csocd

Due: September 17, 2012

Questions: Contact Mr. Amine Lamrabat at ngo@un.org and Ms. Nan Jiang at jiang2n@un.org

Unisphere

[Photo Credit: *Muhammad*, Flickr]

many faces of the Hopi [Photo Credit: wikimedia commons]

In honor of the UN International Day of the World’s Indigenous Peoples, it’s essential to pause and consider the social fabrics that dictate our understanding and perception of the field of ageing. An article from Indian Countryon North American indigenous peoples’ reaction to dementia within their communities helps us learn from one another.

While Alzheimer’s occurs at about the same rate among older Native Americans/Alaska Natives as it does within the continental United States, the approach to treatment is unique.

David Maes, of Hopi/Apache descent, is establishing a nonprofit in Denver, Colorado called Taawa Energy Center (Taawa) – meaning “sun” in Hopi.  The center will care for elders living with dementia through an approach that seeks and uses ‘the essence of the person’ for healing.

His focus in treatment changes from management of disease to caring for the whole person. “Specialists think they are treating the whole person, but in fact they’re fragmenting the person,” says Maes.

There is something that everyone around the world can learn from the Native approach.  Native Americans do not share the stigma and ageism associated with caregiving to elders.  In fact, it is associated with normal aging in the Indian community.  The community shares their input and support, traditional healing practices and traditional medicine with the elderly.

Maes says “among aboriginal and Native people, those with dementia [of which Alzheimer’s is one form] are the spiritual people, beginning to leave this world to enter a world where everything is positive and good. There’s no judgment in that world.”

To read the full story, visit: http://indiancountrytodaymedianetwork.com/2012/07/23/native-approach-to-dementia-stresses-human-spirit-124684#ixzz234x1rUBr  

Doctors have been saying all along that physical exercise is essential for healthy ageing, better moods and fewer accidents.  But it’s not just aerobic exercise like walking – the exercise of choice for the majority of seniors – that keeps the doctors away.  While walking is “beneficial to heart fitness [it] does little to protect the exerciser against falls or loss of bone mass” says the Sydney Morning Herald.

The Australian Journal of Science and Medicine featured a study “Walking not enough for older Aussies” that looked at Australians over 65 years of age using the Exercise Recreation and Sport Survey.  Not only applicable to Aussies, this study gets at the heart of the overload of information out there on what’s healthiest, what seniors should be doing, and how best to do it.  Every person holds different interests, ability and fitness level that might work best for them.  What is important is that seniors seek out the regiment that works best for them while integrating various forms of exercise.

Key findings from the study are applicable no matter what the choice of fitness may be:

  • Varying exercise routinely increases your health
  • Combining aerobic, strength and balance exercises is key to maximizing health benefits
  • Exercising in groups increases motivation and reduces loneliness
  • Combining exercise with healthier eating habits optimizes your health
  • Some physical exercise is better than none at all

“Raising awareness on the types of activities that can most benefit the elderly, including those that achieve several fitness dimensions all at once, given that few older adults choose to participate in multiple activities is certainly warranted,” says Dr Dafna Merom, lead author of the study.

Old Runner A3

[Photo Credit: Maxwell GS, Flickr]

An article about the challenges faced by home care providers in the United States was recently published by the Associated Press.  Facing low wages, lack of benefits, and no leave options, care givers have little incentive to fill the growing demand expected to add 1.3 million positions over the next decade.  The real staffing challenge is finding individuals who can provide quality, invested care-giving for minimum wage while avoiding high turn-over rates.

This care giver workforce dilemma isn’t unique to the U.S.  Only one month ago, in July 2012, the UK Department of Health published a White Paper “Caring for our Future: Reforming Care and Support”.  In its most comprehensive overhaul of the care and support system since 1948, the DH is recognizing the attention required for carers, improving quality of care, and the integration of services.

Following the release of the White Paper, IAHSA member, National Care Forum, issued a survey to identify obstacles in recruitment and retention of care providers in the U.K and solutions to overcome this.

In its 9th year running, the NCF annual survey of staffing drew on data from 40 organizations and 55,622 staff.  It represents a considerable workforce survey and one of the largest regular surveys undertaken in the care sector.

Like in the US, health care staffing is a concern.  NCF found that “[staff] vacancy rates are slightly higher, as is sickness absence. The average staff turnover in care homes (older people) is 19.6% and in domiciliary care (older people) is 27.7% – both represent a slight increase on each of the last 2 years.”

The survey also uncovered that there is evidence for concern that the workforce is ageing and we have fewer young people working in care.

“The survey shows that the workforce is ageing with 45.6% of staff aged 46 and above – confirming a steady increase over the last 3 years. There is a corresponding decrease in younger staff with a 3.6% fall in those aged 35 and under over the last 3 years and a 1.5% drop in those aged 25 and under in the same period.”

Last station nursing home

[Photo Credit: urlichkarljoho, Flickr]

IAHSA and its chapter in China, the China Association of Homes and Services for the Ageing (IAHSA-China) are pleased to announce the joint sponsorship of IAHSA’s 10th International Conference.

The conference theme, Connecting our Global Community, provides an excellent opportunity to showcase the most diverse programmes from around the world, along with an exciting forum for the exchange of both practical knowledge and new strategies focused on the provision of care and services for older adults.

The conference will take place in Shanghai, a bustling international city, full of multicultural flair. Shanghai also offers exciting travel opportunities and cultural attractions. From historic landmarks like the Yuyuan Garden and the Jade Buddha Temple to modern marvels like the Oriental Pearl TV Tower and Jinmao Towere, there is something for everyone.

Faced with a fifth of its population that is 60+ years old, Shanghai has been developing its nursing home care industry rapidly. The country itself is at a climactic point in understanding and deciding how to manage population ageing, housing and pensions for their greying population.

This is a great opportunity to showcase your interest areas, learn about innovations, technology, research, design and practices from around the world and to interact with care models in ageing care from around the world.

 
Submit a proposal for consideration.

Dates To Remember:

30 October 2012 Call for Presentations submission deadline
December 2012 Submitters notified of status of their submissions
17-20 November, 2013 IAHSA/IAHSA-China Global Ageing Conference
Illumination [Yuyuan Garden / Shanghai]

Shanghai [Photo Credit: d. FUKA, Flickr]

My photography project evolved from a good idea into an amazing journey. I knew I would enjoy taking pictures of the elder residents of Frasier Meadows, but I had no idea the special gifts this experience would give me. After every shoot I would be inspired by each resident and their willingness to share their talents with me as I shared my talent with them.

–Heidi Wagner

Heidi Wagner, a professional photographer and Exercise Therapist at Frasier Meadows in Boulder, Colorado, embarked on a photographic journey she titled The Passions Project.  Heidi began to capture the love for life, talent, art and adventure of the many talented residents at Frasier Meadows.

Heidi took nearly 100 photos of each resident, who then got to select their own final picture.  The residents were invited to come to Heidi with interest in having their photograph taken and the collection in black and white really captures the big hearts of the people willing to share their life passions.

There is Clint Heiple on his motorcycle, Pat Doughty with the masks she makes, Bill Ardourel playing the mandolin and many more inspiring images.  Each photo is accompanied by a quote from the resident.

The project came together in a collection of photographs which will be displayed at the LeadingAge Annual meeting in Denver, October 21-24, 2012.  IAHSA will offer several international sessions and an IAHSA reception.  To register for the event, please visit the conference registration page.

To view some of the photos, visit The Passions Project blog page.

Betty [Credit: Heidi Wagner Photography]

The month of Ramadan is about compassion and giving for Muslims around the world.  This makes it an especially important time to reach out to the elderly who are lonely, without companionship or family.

In Qatar, as part of the Reach Out to Asia (ROTA) initiative, volunteers are reaching out to the elderly at the Qatar Foundation for Elderly Care.  Last weekend, ROTA volunteers shared iftar (meal breaking the fast) and interacted with residents.

A UK based organization is donating food packs for iftar to vulnerable people in the community or those who cannot attend events on their own.

In Indonesia, the Jakarta Family Welfare Movement (PKK) in cooperation with the Red Cross is providing donations for the elderly in Jakarta and is offering a venue for socializing.

Even if you yourself do not observe Ramadan, perhaps your loved ones, elders or caregivers are fasting during this month.   It is important to note that the elderly do not have to fast.  According to the Emirates Home Nursing Senior Care Service, “The Quran exempts sick people from the duty of fasting – Muslims with chronic diseases may not perceive themselves as sick and are eager to fast.”  Diabetes, high blood pressure and heart problems are common ailments which increase health risks during fasting.   Find out if any of the elderly in your community will be fasting and offer guidance and support.

The holiday this year spans from around July 20 to August 19. (These dates vary from country to country depending on traditions, the lunar calendar, and by region.)

Celebrating or not, take this opportunity to connect with the elderly in your community.

1er plat de ramadan

Traditional Ramadan Feast [Photo Credit: amekinfo, Flickr]

As the International AIDS Conference winds down, the culmination of the event anticipates that one message is clear: Ageing with HIV is an urgent matter that requires a lot of attention.

As one man put it, “I fear that if I need to be cared for, the carer would be as ill-informed and prejudiced about HIV as the general public.”

A number of integral sessions were conducted with regards to HIV and ageing. Andrea Beal of Grandmothers Advocacy Network (GRAN) in Canada presented “One Day an Army of Grey-Haired Women may Quietly Take over the Earth”.

Global experts from around the world served on a panel on “HIV and Aging: The Challenge of the Epidemic’s Fourth Decade” covering topics such as ageism, stigma, prevention and the critical role of caregivers.

Judith Currier presented on the “Intersection of non-communicable diseases and Ageing in HIV” discussing a global action plan.

Here is what we learned from the AIDS2012 conference:

  •  It is expected that 50% of all persons with HIV in developed nations will be age 50 or older as early as 2015
  • Increased life expectancy for treated HIV now approaches survival rates similar to the general population.
  •  Older people with HIV have twice as many age-related health conditions as their HIV negative peers
  •  Discrimination, ignorance and poor clinical treatment continues to ensue about AIDS illness
  • Many health systems are not ready to cope with the influx of ageing HIV-positive people requiring medication and care
  • Older adults accounted for 15% of new cases of HIV in the US
  •  HIV positive people are at a greater risk for illnesses common in old age
AIDS awareness in Chimoio

AIDS awareness ad in Chimoio, Mozambique [Credit: Ton Rulkens, Flickr]

Antipsychotics

Dr. Cheryl Phillips, geriatrician and senior VP or LeadingAge, blogged about the very serious dangers of over-medicating dementia patients.  This issue is seen as critical around the world and sends a global message for change. Rather than paraphrase, here is Dr. Phillips’ blog in her own words:

Federal officials are working to place compassion at the center of how our nation aims to treat elderly patients suffering from dementia.

The Centers for Medicare & Medicaid Services (CMS) has announced that they’ll coordinate an effort to dramatically reduce the use of antipsychotic drugs among dementia patients in nursing homes. The agency’s plan acknowledges that these powerful pharmaceuticals are often overused — and represents a valuable first step toward improving the way we treat people with this condition.

But government alone shouldn’t dictate how we deal with dementia. Families and caregivers must also recognize when medication is appropriate — and when it’s not.

More than five million Americans are afflicted with Alzheimer’s and related dementias. Coping with a loved one suffering from the disease is an immensely trying experience — one that can leave even the most stoic among us desperate to try anything to alleviate a family member’s suffering.

It’s no surprise, then, that nearly 40 percent of dementia patients living in nursing homes receive antipsychotic drugs. Overall, some 14 percent of nursing home patients are on antipsychotics. These are alarmingly high numbers, given how ineffective — or even dangerous — the drugs can be.

For starters, antipsychotics have not been approved by the federal Food and Drug Administration to treat dementia. No drugs have. Only about 20 to 30 percent of elderly dementia patients who take an antipsychotic drug show even marginal improvement.

For such unimpressive results, the potential harms are significant. For every 53 patients treated with such a pharmaceutical, one will die. And for every nine to 25 patients that benefit from an antipsychotic, one will die.

As a result, the FDA has issued a rare “Black Box Warning” stating that patients administered the drugs face a risk of death 1.6 to 1.7 times greater than those who take a placebo.

And yet, a blind faith in the effectiveness of antipsychotics that’s not borne out by the science remains. Abandoning this belief is a necessary first step toward improving the way we treat dementia — and saving lives.

To do so, we must first change the way we think about the illness. Many view dementia as the cause of a number of behaviors that need to be corrected or controlled. This misconception fits our cultural penchant for pills quite nicely. For instance, Grandpa George’s loud incoherence or Aunt Esther’s refusal to calm down are symptoms that need to be alleviated through medicine — or so the thinking goes.

But folks displaying the disruptive behaviors associated with dementia are more often trying to communicate with those around them. Their “acting out” signifies their frustration at their inability to do so.

Consequently, people interacting with them — whether family members or professional caretakers — ought to try first to understand what the patient is trying to convey. Then, they can take appropriate action.

For instance, yelling, wandering, or resisting care are not symptoms of psychosis and will not be resolved through the use of antipsychotics or other medications.

But if a drug is judged necessary, keeping close tabs on it is imperative. A checklist can be helpful. Is the person showing signs of improvement? Are they better able to engage with others and with their surrounding? Can that individual get by on a lower dose? Is the medication even working at all?

All too often, families and caregivers fail to ask these questions. That’s a mistake. Given the risks associated with antipsychotics, determining how to address dementia-fueled behaviors without drugs is vital.

Fortunately, there’s a growing body of evidence that supports the effectiveness of behavioral modifications and non-pharmacological interventions to treat dementia. This new approach isn’t just something for nursing home staffers or professional caregivers to consider — it’s important for us all. Odds are that we all know someone who suffers from the condition — or someday will. Decisions about their potential paths of treatment may fall to us.

CMS is right to try to reduce the use of dangerous antipsychotics in dementia patients. But it will not succeed without a shift in the way we all think about this debilitating condition.

[Photo Credit: dvortygirl, Flickr]

About this blog

IAHSA’s Global Ageing Network Blog was created because of you!! We got your message loud and clear – “Provide us with a quick and nimble communications vehicle so we can stay connected and create community across borders".

Questions? Email us at iahsa@leadingage.org.

Authors

Virginia Nuessle, Study Tour Director

Majd Alwan, Director, CAST

Alla Rubinstein, Program Administrator, IAHSA

Twitter Feed

Connect with us on Facebook

IAHSA - Global Ageing Network

Connect with us on LinkedIn

IAHSA - Global Ageing Network

Archives