Across the rich world around half of covid-19 deaths have been in care homes. Countries need to radically rethink how they care for their elderly—and some innovative solutions are on offer.
This video has a lot of information that would be of help to anyone who has a spouse or parent who is aging, especially if their frailty includes dementia. There were several good, general points.
As hard as it is to get old, it is even harder to be a caretaker of someone whose aging includes memory loss. Hired caretakers burn out at a high rate. The video highlighted Indonesia as a location that is compassionate, and gives quality care at about half the cost in developed countries.
The percentage of the elderly population needing care may well be 50% in 2050. I would not have guessed it, but the video asserts that 50% of individuals over 65 years of age need some help.
It is much better to stay at home, and medical sensor technology is making this increasingly possible. AI would be able to detect changes in a person’s routine that could be flagged.
Of course, it is much better to stay healthy longer. My posting “growing old” addresses this.
Telehealth is defined as the delivery of health care services at a distance through the use of technology. It can include everything from conducting medical visits over the computer, to monitoring patients’ vital signs remotely. Its definition is broader than that of telemedicine, which only includes the remote delivery of health care.
Telehealth can be delivered in one of three ways:
- Synchronous—when the doctor communicates with the patient in real time via computer or telephone
- Asynchronous—when data, images, or messages are recorded to share with the doctor later
- Remote patient monitoring—when measurements such as weight or blood pressure are sent to the health care provider
What you can do with telehealth
All of the following activities and services are possible with the help of telehealth:
- Recording measurements like your weight, food intake, blood pressure, heart rate, and blood sugar levels either manually, or through a wearable device, and sending them to your doctor.
- Having a virtual visit with your doctor or a nurse over your computer or smartphone.
- Using an online portal to check your test results, request prescription refills, send your doctor a message, or schedule an appointment.
- Sharing information such as your test results, diagnoses, medications, and drug allergies with all of the providers you see.
- Coordinating care between your primary care provider and any specialists you visit—including the sharing of exam notes and test results between medical offices in different locations.
- Getting email or text reminders when you’re due for mammograms, colonoscopies, and other screenings, or routine vaccinations.
- Monitoring older adults at home to make sure they are eating, sleeping, and taking their medications on schedule.
Downsides to telehealth
Telehealth offers a convenient and cost-effective way to see your doctor without having to leave your home, but it does have a few downsides.
- It isn’t possible to do every type of visit remotely. You still have to go into the office for things like imaging tests and blood work, as well as for diagnoses that require a more hands-on approach.
- The security of personal health data transmitted electronically is a concern.
- While insurance companies are increasingly covering the cost of telehealth visits during the COVID-19 pandemic, some services may not be fully covered, leading to out-of-pocket costs.
You know you need to get enough sleep, but the question remains: How much is enough? Sleep scientist Matt Walker tells us the recommended amount for adults and explains why it’s necessary for your long-term health. Sleeping with Science, a TED original series, uncovers the facts and secrets behind our nightly slumber. (Made possible with the support of Beautyrest)
Check out more: https://go.ted.com/sleepingwithscience
From 2019 to 2020, there was a substantial increase in the proportion of older adults who reported that their health care providers offered telehealth visits. In May 2019, 14% of older adults said that their health care providers offered telehealth visits, compared to 62% in June 2020.
Similarly, the percentage of older adults who had ever participated in a telehealth visit rose sharply from 4% in May 2019 to 30% in June 2020. Of those surveyed in 2020, 6% reported having a telehealth visit prior to March 2020, while 26% reported having a telehealth visit in the period from March to June 2020.
Over the past year, some concerns about telehealth visits decreased among adults age 50–80 whether or not they had a telehealth visit. Older adults’ concerns about privacy in telehealth visits decreased from 49% in May 2019 to 24% in June 2020, and concerns about having difficulty seeing or hearing health care providers in telehealth visits decreased from 39% in May 2019 to 25% in June 2020. Concerns about not feeling personally connected to the health care provider decreased slightly (49% to 45%).
HARVARD MAGAZINE (SEPT – OCT 2020): From the book EXERCISED: Why Something We Never Evolved to Do Is Healthy and Rewarding by Daniel E. Lieberman, to be published on September 8, 2020 by Pantheon Books:
‘….many of the mechanisms that slow aging and extend life are turned on by physical activity, especially as we get older. Human health and longevity are thus extended both by and for physical activity.’
Exercise is like scrubbing the kitchen floor so well after a spill that the whole floor ends up being cleaner. The modest stresses caused by exercise trigger a reparative response yielding a general benefit.
In order to elucidate the links between exercise and aging, I propose a corollary to the Grandmother Hypothesis, which I call the Active Grandparent Hypothesis. According to this idea, human longevity was not only selected for but was also made possible by having to work hard during old age to help as many children, grandchildren, and other younger relatives as possible survive and thrive. That is, while there may have been selection for genes (as yet unidentified) that help humans live past the age of 50, there was also selection for genes that repair and maintain our bodies when we are physically active.
Daniel E. Lieberman is a paleoanthropologist at Harvard University, where he is the Edwin M Lerner II Professor of Biological Sciences, and Professor in the Department of Human Evolutionary Biology. He is best known for his research on the evolution of the human head and the evolution of the human body.
Daniel Lieberman, a Cultural Anthropologist from Harvard, makes the case that paleolithic hunter-gatherers Grandparents were helpful, in fact necessary to their families, and evolved to be active into old age. They did not evolve to sit in front of the TV, and modern men pay a penalty if they do.
INACTIVITY at ANY AGE is bad. If you put 20 year olds to bed, both weight and blood pressure go up. The book addresses a conundrum. Free radicals are bad. Exercise runs O2 through the mitochondria, which produces free radicals.
But EXERCISE REDUCES FREE RADICALS. A metaphor is introduced: you spill some tomato juice on the floor. But you clean it up, and the floor becomes cleaner than it was before. You exercise, the muscles suffer some microtears and injury. The REPAIR RESTORES the muscles to better than before, maybe with some extra mitochondria.
The Bodies MECHANISMS are MEANT TO BE USED. DIET is meant to supply the body energy and units for repair, EXERCISE is meant to use that energy, and keep the mechanism lubricated, and SLEEP is meant to allow for time to accomplish repair.
Sleep, Diet and Exercise can all be reconciled by recourse to Paleolithic man, whose activities imprinted our modern bodies.
Falling down is common on both ends of the Human lifespan. Little kids are always falling down, but there isn’t much energy to dissipate, since their mass is small and they don’t have far to fall. Moreover, their bones are pliable.
The Elderly also fall, increasingly, as they age. They have a lot further to fall, and their bones are often brittle and osteoporotic. Injury is quite common, they often break a hip, and may slide into a peogressive deterioration leading to their demise..
Ordinary walking, a “normal gait”, is a very complex activity and requires a lot of information and coordination by the nervous system.
VISION is critical, as you are often navigating through a minefield of stairs, rug edges, slippery objects, lamp cords, tubes and pets. Cataracts may be a problem to be corrected. Multifocal glasses can be a factor.
HEARING can warn of certain hazards or warnings and is important. A FINE SENSE OF TOUCH is required to give you cues as you are walking. Peripheral neuropathy can make walking difficult.
PROPRIOCEPTION, the positional sense of where your extremities are located in space, is a sense we take for granted, but which may deteriorate in time. Proprioception is very important for a normal Gait. The inner ear, with it’s semicircular canals and vestibular apparatus is necessary for proper BALANCE.
Balance can be PRACTICED in a number of ways, like standing on one leg, or merely WALKING a lot. These MULTIPLE SENSES must be COORDINATED by the Thalamus, Corpus Striatum, medulla, Cerebellum, and Cerebral Cortex and instructions sent to the muscles of your Legs, Arms, back and abdomen.
It is mandatory to keep these muscles, your Heart and your body, STRONG and FIT. Factors that make you more likely to have a fall are mostly the reverse of the above, and are called RISK FACTORS.
- –Previous Falls are the best predictor. More than 2 or 3 in a year is worrisome.
- –Balance Impairment is best treated by practice.
- –Decreased Muscle strength. –Visual impairment.
- –Polypharmacy (more than 4 prescription Meds), or a Psychoactive drug (look up)
- –Gait impairment, Walking difficulty.
- –Depression, which is often treated by antidepressants or sleeping pills- Psychoactive drugs.
- –Dizziness or orthostatic hypotension, which causes a drop in blood pressure on standing. and a number of other problems, often a function of age.
PREVENTION of falls is of course better than treatment of the resulting INJURY. Working on your HEALTH will help the INTRINSIC causes of falls, and that is what we have been discussing.
Preventing the EXTRINSIC causes of falls means working on: –Improving the household safety by putting in railings, getting rid of throw rugs, clutter, and maybe pets( a good friend went into a downward spiral after tripping over his Dog.
Adjusting or eliminating psychoactive drugs and antihypertensive drugs (which often include the beta blockers which worsen orthostatic hypotension.
Interestingly, VITAMIN D supplements were mentioned in 2 references I saw. Apparently Vitamin D reduces falls by increasing MUSCLE STRENGTH.
Please refer to the following Canadian article for a more complete discussion.
UCSF orthopedic surgeon Dr. Paul Toogood discusses the types and origins or Arthritis.
From the John A. Hartford Foundation:
While the benefits of telehealth are myriad and more apparent than ever, our survey revealed that 41% of older adults did not see telehealth as living up to the in-person experience. Providers must optimize the technology so that it caters to the less tech-savvy patient and caregivers—especially, if it is their only means of accessing health care—so that it replicates the in-person visit as close as possible.
A survey we recently conducted shows that more than half of US adults age 70 and older (55%) experienced a disruption in their medical care during the first month of social distancing due to COVID-19. These older adults were most likely to delay primary or preventive care, and that’s alarming. Even more worrying, 15% of older adults put off essential medical treatment because of the pandemic. We don’t need medical degrees to know that delaying necessary care does not make the outcomes better.
As older adults continue to delay getting needed care, the problem will compound—increasing pent-up demand for services will ultimately vex health systems as patients’ conditions worsen. We think about the 4Ms of age-friendly care – what Matters, Medication, Mentation and Mobility – and how the pandemic may be delaying the assessments and interventions needed to prevent medication errors or to preserve cognitive and functional status.