Archive for “EFLI” Categories

Elder’s Family Learning Initiative: Develop a POLST

By Lesley Sacks and Sarah Wheeler, Social Services Co-Directors

Robison Jewish Health Center frontA Physician’s Order for Life Sustaining Treatment is a shorter, more specific document than an Advanced Directive that asks individuals a number of pertinent questions about immediate care.

The POLST’s most pressing question relates to code status. It asks the person if she would want Cardiopulmonary Resuscitation (CPR) treatment that attempts to restore breathing and circulation if the staff of the facility were to enter the room and find the person with no pulse and not breathing.

Anyone who refuses or fails to sign this document is usually a full code in most facilities, meaning she will receive all treatments, paramedics will be called,
and she will be taken to the hospital. Other questions involve antibiotic treatment and tube feeding.

Compared to Advanced Directive, a POLST is intended for the short-term, e.g. options during a hospital stay, it’s more general and offers fewer options, and it may change more frequently. It’s also more likely to be created with a physician’s assistance.

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Elder’s Family Learning Initiative: Create an Advance Directive

By Lesley Sacks and Sarah Wheeler, Social Services Co-Directors

Robison Jewish Health Center frontAdvance Directive is a general term for documents providing a person’s instructions about future medical care and appointing a person to implement those instructions in case of their inability to do so. 

In the most extensive form of advance directives, which was formerly known as a living will, individuals go into some detail about their wishes for medical treatment at the end of life should they be unable to communicate. The advance directive guides family and physicians in choosing treatment protocols.

Compared with Physician’s Order for Life Sustaining Treatment (POLST), Advance Directives are intended for long-term future planning, they’re more specific and complex, and they change less over time.

The issues to be addressed by individuals and families when deciding what the Advance Directive will state are dictated by family values and culture related to end-of-life issues. Some individuals and families are determined to sustain life at all costs and direct physicians to provide life-sustaining treatment which replaces or supports essential bodily functions. Other individuals and families are determined to limit the interventions and direct physicians to provide palliative care to relieve suffering, control pain and symptoms and maximize function even if these efforts hasten death.

It’s important for every individual, particularly elderly, to have an advance directive. The advance directive provides you with the ability to indicate who should make medical decisions for you if you cannot. It can be very emotional for family members to make such medical decisions in the moment of crisis. While it is impossible to foresee all of the possibilities for individuals at the end of life, it is easiest to make decisions well before events make them urgent. The emotional stressors at the time of illness and medical crises can make it difficult to consider values, culture, past experiences, and attitudes. The advance directive, therefore, provides a service to family members by making your wishes known. While it’s challenging to think about your own advance directive or to discuss it with family members, it’s much less stressful than having to deal with the decisions an advance directive covers in crisis.

You can create an advance directive on your own, but a physician may help you with medical details you may omit to consider. In any case, witnesses are required for the advance directive to be valid. If you need further information about the legal implications of creating or having an advance directive, you may wish to speak to a lawyer.

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Elder’s Family Learning Initiative: Learn to Recognize Stroke Symptoms

Robison Jewish Health Center frontA recent article in The Oregonian told a story of a woman whose quick reflexes and knowledge of stroke symptoms saved her husband’s life as she got him to the hospital in time for treatment. As the story indicates, being able to recognize the stroke warning signs and knowing what to do in case of witnessing a stroke can be more than beneficial because a stroke can happen to anyone at any time.

What is a Stroke?

According to the National Stroke Association, a stroke occurs when

a blood clot blocks an artery (a blood vessel that carries blood from the heart to the body) or a blood vessel (a tube through which the blood moves through the body) breaks, interrupting blood flow to an area of the brain.  When either of these things happen, brain cells begin to die and brain damage occurs.

When brain cells die during a stroke, abilities controlled by that area of the brain are lost.  These abilities include speech, movement and memory.  How a stroke patient is affected depends on where the stroke occurs in the brain and how much the brain is damaged.

Stroke Warning Signs

The American Heart Association lists the following symptoms that may signal a stroke in progress:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause

If you see someone exhibit these symptoms they may be experiencing a stroke.

The National Stroke Association provides a helpful acronym to help identify stroke signs:
Use FAST to remember the warning signs:

  • Face: Ask the person to smile. Does one side of the face droop?
  • Arms: Ask the person to raise both arms. Does one arm drift downward?
  • Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
  • Time: If you observe any of these signs, call 9-1-1 immediately.

Learn more about strokes in the National Stroke Association’s Fact Sheet.

Support our effort to help people prepare for their involvement in the long-term care system–donate online now. Thank you for your generosity!

Elder’s Family Learning Initiative: Educate Yourself About Incontinence

By Kimberly Fuson, Chief Program Officer and member of the Elder’s Family Learning Initiative project team

Robison Jewish Health Center frontAddressing incontinence issues requires a holistic and sensitive approach, particularly when it comes to reversible causes of incontinence.

Social workers can help individual elders identify underlying causes of incontinence, educate them about the possibility of their incontinence being reversible, and encourage them self-advocate with their physician to comprehensively assess and treat the issue. The social worker may also facilitate the conversation between the elder, family and physician, depending on the elder’s situation.

Most importantly, social workers can help elders reduce the suffering that the indignities of incontinence cause by advocating for comprehensive assessment. Social workers must play an active role in such an assessment by building relationships with elder clients that promote trust and the ability to engage in sensitive discussions around incontinence. They should also educate clients and families about the causes of incontinence, demystifying the idea that incontinence is always a part of aging.

In fact, some of the causes of incontinence are reversible. They include:

  • D – Delirium/dementia
  • I – Infections, especially of the urinary tract and reproductive organs
  • A – Atrophic vaginitis
  • P – Psychological, especially depression
  • P – Pharmaceutics
  • E – Endocrine conditions such as diabetes
  • R – Restricted mobility
  • S – Stool impaction

References

  • Florence Safford, “Helping the Incontinent: A Biopsychological Challenge”, in: Safford and Krell, eds., Gerontology for Health Professionals, 1997
  • A.P. Klausner and J.M. Vapnek, “Urinary incontinence in the geriatric population”, Mt Sinai Journal of Medicine, Vol. 70, No. 1, 2003, pp. 54-61
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Elder’s Family Learning Initiative: Be Aware of Barriers to Exercise for Older Women

By Kimberly Fuson, Chief Program Officer and member of the Elder’s Family Learning Initiative project team

Robison Jewish Health Center frontHow might older women’s psychological perceptions and attitudes about exercise decrease their motivation to be active?

Older women’s psychological perceptions and attitudes regarding exercise are multi-faceted and arise from:

  • conflicting and contradictory information throughout the course of their lives based on gender expectations, e.g. “women and girls don’t rock climb”;
  • medical research, e.g. “women need to safeguard their reproductive organs”;
  • culture; and
  • social context.

In late life older women’s motivation to exercise may be decreased by both real and perceived issues, such as:

  • fear of injury;
  • exacerbation of chronic condition(s);
  • inexperience; or
  • fear of looking foolish.

The most poignant reason, however, may be the fact that many older women realize they may have not been looking after themselves according to new standards and that they see themselves being scrutinized by a society that has suddenly changed the health rules. For some older women, this may add an additional layer of feeling inadequate that could translate into lack of motivation to be active.

References

Sandra O’Brien Cousins, “‘My Heart Couldn’t Take It’: Older Women’s Beliefs About Exercise Benefits and Risks”, Journal of Gerontology, Vol. 55B, No. 5, 2000, pp. 283–294

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Elder’s Family Learning Initiative: Know the Social Worker’s Role

By Kimberly Fuson, Chief Program Officer and member of the Elder’s Family Learning Initiative project team

Robison Jewish Health Center frontSocial workers play an important role in primary care settings. We believe social work should be a key element in all primary care settings because social work provided to patients as a basic element of primary care builds relationship and trust that the primary care physician cannot provide due to pace or skill set.

The social worker bridges the gap between patient and physician by informing the physician regarding who their patient is as a person, allowing the physician to focus on medical issues and the patient to feel a sense of being listened to, heard, and honored as an individual. The social worker may also offer behavior-based strategies that the physician can use with her patients to promote better health care choices and outcomes. Additionally, social work in the primary care setting contributes to better diagnostic results for the patient.

Social Workers in the Primary Care Setting

What’s the role of social workers in the primary care setting?

  • Become an integral and trusted colleague of the doctors understanding their roles as social workers in the context of a medical practice; helping the physician craft appropriate referral questions; assist the physician with their own frustrations regarding their patients; teaching physicians different techniques to better understand their patients’ needs
  • Be a trusted professional to the patient, allowing better medical assessment through collaboration with physician regarding psycho-social issues before medical appointment (person-centered primary care).
  • Be quick, definitive, and relevant in communicating their social work assessment to physicians, addressing the physician’s initial reason for referral.
  • Be knowledgeable regarding psychopharmacology and pathophysiology in order to be a resource to both the patient and physician, respecting that the physician has the ultimate prescribing responsibility.
  • Be willing to support the use of the least invasive interventions first.
  • Trust, respect, and honor their own expertise and skill set.
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