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| Q | How can I convince a senior that she needs to move into an assisted living facility for health and sanitary reasons? | |
| A | It can be very difficult to see a senior not doing well and needing extra help, especially if they are not willing to make a change. The loss of independence and the thought of moving somewhere new can be very difficult. Friends and family need to be as supportive as possible in assisting the senior make any changes to their environment. It would be important for the primary care physician (PCP) be alerted to your concerns. A visit can be scheduled to have the PCP assess the situation and evaluate if there are any reversible reasons for the decline in health and function. The PCP can also make recommendations regarding future planning or to involve a Clinic Care Coordinator to assist with obtaining resources. If possible, and the patient has given permission, it would be helpful if a family member/advocate is also part of that visit. An assessment with a Geriatric Nurse Practitioner can be very beneficial. This can be arranged with the senior's PCP. Sometimes a family meeting with the patient where concerns are voiced can be effective. It might be advantageous to visit some of the area facilities to have a sense of what is available. A few changes in the home may be enough to make the senior safe. This might involve the use of a private pay care provider, Heartline and/or Meals On Wheels to supplement care and increase safety. Adult Day Care is an option. It is also possible to hire a community case manager to assist with coordinating some the the care aspects. An intake evaluation with Senior and Disabled Services is recommended as the senior may be eligible for some in-home assistance. If there are real concerns for safety, and the senior is not open to any assistance, Adult Protective Services should be notified. In the Eugene area the phone number is (541)682-4038. I would highly recommend beginning with a discussion with the PCP to request the services of the PCP's Care Coordinator, who can discuss options with you and patient. | |
| Answered at 2/9/2006 | ||
| Q | Any recommendations for the 'life alert' type of emergency calling buttons seniors can wear? | |
| A | One of the organizations is HeartLine/Lifeline through PeacHealth Center for Senior Health, in Eugene. The phone number is 541-349-7272. If you don't live in the Eugene area, try calling the local hospital and ask for the social work department. They should be able to help you find the local service for personal response service. There is an installation fee and monthly fee for this service. If the senior is low income and has a Senior and Disabled Services caseworker, this person can authorize the service for the Senior who generally could not afford it. Key to the system is reinforcing that the senior needs to wear the button at all times. I've seen quite a few seniors admitted to the hospital after falls in the home. They had Lifeline, but did not have the button on. | |
| Answered at 10/18/2004 | ||
| Q | I have been trying for several years and several doctors to find a reason for my severe fatigue. It seems the physicians I have dealt with find no cause other than age (79 although I have friends, my seniors, who do not suffer likewise. Am I wrong to think my problem can be found somewhere other than the calander? | |
| A | I will assume from your question that the issue is fatigue and not weakness. Weakness is either a localized or a generalized lack of muscle strenth. Weakness is usually a fairly straight forward evaluation and therefore I will limit my comments to the topic of fatigue. The evaluation of chronic fatigue is complex, multifactorial and more often than not the result is less than satisfactory for the patient. The work up and treatment for this problem is still evolving. There's a detailed review of Chronic Fatigue Syndrome in Healthwise. To stay abreast of current developments and to make connections with others that are wrestling with this issue I would suggest that you consider touching bases with this group for Chronic Fatigue Support Good luck. This is a tough issue and gently put we all age differently - it is clear that the normal aging process can results in decreased stamina; how dramatic that change is for any individual can be variable. An appropriate exercise program focused on developing and maintaining lean muscle mass can be helpful; if you haven't pursued this course I would suggest consulting with your physician to see if this is an option for you. | |
| Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (6/22/2004) | ||
| Q | What should a hospital do when a patient does not have an advance directive and the family members disagree about what should medically be done for their loved one? For example, would the family members be encouraged to participate in mediation? What would PeaceHealth suggest? | |
| A | This is a complex question, so I got opinions from 2 people that work at SHMC and are knowledgeable on this topic. This from Dan Reece MSW who is the director for Social Work at Sacred Heart: It is not unusual for family members to disagree on medical decisions when the patient does not have an Advanced Directive, or even more importantly, when the patient has not discussed their feelings and beliefs with them. Physicians and SHMC staff, including social workers and chaplains, are available to assist families in coming to agreement. In addition, the SHMC Bioethics Committee is available on request to consult with both the family and the professional medical caregivers. The Bioethics Committee is not a decision-making body, but it can help the parties develop an ethical framework for making decisions. In cases where agreement cannot be reached, there is a legal hierarchy of family decision-makers. . . . and this from Bob Scheri of pastoral care services at Sacred heart. Dan's response is very good. Ultimately, the question family members must ask is not "what do we/I think should be done for my family member?" From an ethical perspective the better question is, "what would my family member want done if he/she could speak for themselves?" The answer to this question is more often than not, quite different from the answers given to the first question. This question often prompts a shift in thinking among family members. Conflict is still present, but the focus is on one person's values and feelings: the patient. As Dan stated, we have a variety of resources and supports available to families in such a conflict to think through the issues and discover the most helpful questions. Our goal would be to assist families in moving towards understanding and ultimate agreement. Within this process there is another key question that must be addressed: Who is the decision maker? Obviously, the patient is, but when the patient can no longer speak for themselves, who will voice or be the spokesperson for the patient's wishes? Ultimately, the law outlines who this would be without an advance directive. This person would be responsible in the end to reach a conclusion and make a decision consistent with the patient's values. While we prefer that we succeed in helping families come together, having clarity on who the legal decision maker is provides an ultimate framework for decision making. This also helps families in extreme conflict to realize that there is a legal framework within which they must work. What would PeaceHealth suggest? That the caregivers first clarify the question about who the ultimate decision maker is, and second to facilitate discussion about what the patient's wishes would be given the medical condition and prognosis. If conflict proves to be an obstacle, call a chaplain, social worker or request support from the ethics committee. | |
| Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (3/19/2003) | ||
| Q | What could cause an acute partial memory loss in an 84 old woman? No stroke or ministroke shows. She still recognizes people but seems lost in a time warp. | |
| A | The causes of sudden memory loss in seniors are numerous. Without complete knowledge of this particular patients history and medical situation, a good answer is practically impossible. Memory loss or confusion can be a symptom of not only stroke, as you noted in your question, but also from infections - urinary and lung being the most common; sudden change in kidney or cardiac function or from a change in medication. Sometimes a stroke too small to be easily detected can cause memory change. The only way to sort through these and come to a good answer is to get her to her doctor! | |
| Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (6/2/2001) | ||
| Q | Are there nursing homes in Eugene, OR which can care for mobile seniors who have severe short term memory loss? | |
| A | Here's what I hear from Sandy Sanders who is a Medical Social Worker at The Senior Health and Wellness Center here in Eugene. I hope this is helpful: "For mobile seniors with memory loss, this person could try: Applegate Care Center - 343-3445 Farmington Square - 344-7902 Gateway Living Center - 744-9817 Good Neighbor Eugene - 607-5025 Good Neighbor Springfield - 747-4858 Oaktree Residential Living - 607-0688 Sheldon Park - Kingswood Court - 344-1078 South Towne Living Center - 683-3618 Sweetbriar Villa - 726-5026 Alpine Springs is also building a new locked unit that will specialize in "memory care" - 607-9525. Florence really only has an Assisted living facility (Spruce Point) and they are full and you have to be pretty high functioning to be there." | |
| Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (4/24/2001) | ||
| Q | I am a 61-year-old woman, and I am concerned about getting Alzheimer's disease. I see lots of ads these days for Alzheimer's medications. Do these really prevent it or cure it? What can I do to reduce my risk of getting Alzheimer's? | |
| A | There is evidence thar avoiding narcotics and other mind-altering drugs, avoiding head injuries (don't take up boxing) and continuing to use your brain by learning will all delay Azheimer's disease or make it less apparent. There are promising preliminary reports that Vitamin E, estrogen, or anti-inflamatories may partially prevent the disease, but they are all in the research phase at the present time. If you are interested in participating in a study, I would contact Oregon Research Group at (541) 687-6382. | |
| Answered by Hugh Johnston, MD, Hematology, , (12/16/1999) | ||
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