GERONTOLOGIST versus GERIATRICIAN

‘Gerontology’ refers to the study of aging. Generally a degree in gerontology enables the holder to become an administrator of a nursing home or other age-related facility.  There is no license or certification associated with Gerontology. A ‘Gerontologist’ is a person who has studied aging and older adults. Gerontologists study physiology, social science, psychology, and public health. The field of gerontology includes studies of bodily changes from middle age through later life, multidisciplinary investigation of societal changes resulting from an aging population, and applications of this knowledge to policies and programs.

Gerontological Society of America’s mission statement is to “foster collaboration between biologists, health professionals, policymakers, behavioral and social scientists, and other age studies scholars and researchers. We believe the intersection of research from diverse areas is the best way to achieve the greatest impact and promote healthy aging.” Gerontological Society of America

Medical issues of particular interest to Geriatricians and Gerontologists are those conditions that influence the functional status of an individual as he/she gets older.

‘Geriatrics’ refers to the medical subspecialty focused on conditions or illnesses more commonly seen in older patients.  It is important to note the difference between Geriatrics, the care of aged people, and Gerontology, which is the study of the aging process itself. GERIATRICS is the medical care of older adults. Older adults have special healthcare needs that can make their medical care more complicated. More than half of adults age 65 and older have 3 or more medical problems, such as heart disease, diabetes, arthritis, Alzheimer’s disease, or high blood pressure.  Caring for older people with multiple health problems can be tricky, even for Geriatricians.The appropriate management of medications is one of the cornerstones of geriatrics. For example, prescribing medications for a patient with multiple health problems is more complex that a younger’s persons. A drug that might be useful in treating one health problem can make another problem worse, and taking multiple medications can cause problematic drug interactions and side effects.

A GERIATRICIAN is a doctor who is specially trained to evaluate and manage the unique healthcare needs and treatment preferences of older people. Geriatricians are board-certified internists or family physicians who have additional training and certification in geriatrics. Because of their special training, geriatricians typically provide care for frail older people who have the most complicated medical and social problems.

Geriatricians evaluate the older person’s medical, social, emotional, and other needs. They focus on health concerns common in older people such as incontinence, falls, memory problems, and managing multiple chronic conditions and medications.

A Geriatrician may
-Evaluate the older patient’s social supports and living situation
-Consider the person’s ability to perform daily activities such as bathing, dressing and eating
-Give special attention to patient preferences and values in care planning

A geriatrician should be consulted when an older person’s condition causes considerable impairment and frailty. These patients tend to be over the age of 75 and have a number of diseases and disabilities, including cognitive and or memory problems.

There is no set age at which patients may be under the care of a geriatrician or geriatric physician; this decision is determined by the individual patient’s needs, and the availability of a specialist.

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Continuing Care Retirement Communities

This are known as ‘CCRC’s’; much easier on the tongue! In general these have apartments beginning with active retirement living, later apartments in assisted living, and include apartments in temporary rehabilitation, and long term care in a skilled nursing unit or memory care. The advantage is that you never have to move to another place. Although you did not remain in the first apartment that is in active retirement as you move through the levels of care, you do remain in the same building.

Most CCRC’s have a substantial up front fee. In addition, there is monthly rent and sometimes other minor costs, such as having family members to dine with you. In theory, when your physical status alters and you no longer have the ability to remain in active retirement, there will be an apartment available in assisted living that you can move into when needed. This is a major advantage. Another advantage is the presence in the community of a physician and nurses, plus medical aides in the building 24 hours a day. Medical crisis do not respect holidays, evenings, or weekends, and so immediate medical attention is a huge plus.

On the down side is the question of what happens to the entry fee if, for some reason, you need to leave the community before you die. The most frequent solution is that your apartment, when you leave it, goes up for sale. When it sells, some portion of the entry fee is returned to you. Depending on the community and the floor plan you chose when you moved in, this can take months or years.

The care in a CCRC is usually excellent. I am often asked by a client if they can move into the assisted living, memory care, of skilled nursing section of a CCRC. This allows them to avoid the entry fee of moving into active retirement. The answer is usually that these areas are filled by people moving from the retirement area, and so there are no vacancies for people coming in from outside the community.

The lesson here is to consider moving from your home into a CCRC while you are healthy and active. Enjoy your retirement years, make friends in the community, and take advantage of the many activities available in the CCRC. When you have a crisis and need care, you already have a place. Think ahead!

Caregiver Bill of Rights

I have the right to:

1. Take care of myself. This helps me maintain the ability to take better care of my care-receiver.
2. Seek help from others even though my care receiver may object.
3. Recognize the limits of my endurance and strength.
4. Maintain facets of my own life that do not include the care receiver. I have the right to do some things just for myself.
5. Get angry, be depressed, and express difficult feelings occasionally.
6. Reject any attempt by the care receiver to manipulate me through guilt, anger or depression.
7. Receive consideration, affection, forgiveness, and acceptance for what I do for my care receiver.
8. Take pride in what I am accomplishing and to applaud the courage it takes to meet the needs of my care receiver.

FLU PREVENTION

We are entering the cold and Flu season. Here are some tips to keep you and your care receiver healthy.

Tamiflu (oseltamivir phosphate) does not kill the virus but prevents its spread until the virus limits itself in about 1-2 weeks, its natural cycle. H1N1, like other influenza viruses, infects only the upper respiratory tract and proliferates there. The ONLY points of entry are the nostrils and mouth/throat. It is almost impossible to avoid all contact with the virus, so follow the following basic precautions:

1. Frequent hand washing
2. Hands-off-the-face – resist the temptation to touch any part of your face unless you are eating or bathing
3. Gargle twice daily with warm salt water or Listerine. H1N1 takes 2-3 days after initial infection in the throat/nasal cavity to proliferate and show symptoms. Gargling with salt water has the same effect on a healthy person that Tamiflu has on an infected one. Don’t underestimate this inexpensive, powerful preventative method.
4. Cleanse your nostrils at least once daily with warm salt water. Blow you nose hard and swab both nostrils with Q-tips dipped in warm salt water. This is effective in keeping the viral population down.
5. Boost your natural immunity with foods that are rich in Vitamin C. If you are taking supplements, be sure that it has Zinc biflavonoids to boost absorption of Vitamin C.
6. Drink as many warm fluids as you can. Drinking warm fluids has the same effect as gargling but in the reverse direction. They wash proliferating viruses form the throat into the stomach where they cannot survive, proliferate, or do any harm.

Caregiving Guidelines

1. When providing care for a loved one, remember not to assume responsibility for meeting those needs  that they are able to meet without your assistance. Do not do for them what they can do for themselves. This is demeaning and keeps them dependent on you.

2. Wise caregivers know that they are not responsible for their care receiver’s feelings. When they are happy, it is not due to some action on your part; when they are sad, it is not your fault.  Caregivers recognize that their behavior affects their care receiver, but they know it is their reaction to the caregiver’s behavior that produces their feelings; therefore, they do not assume responsibility for the care receivers emotions.

3. A good caregiver makes no demands on the behavior of the care receiver. When their behavior is less than optimal, they do not get upset. They know that the care receiver’s behavior is up to them.

4. Caregivers do not manipulate their care receivers into doing things as they advise. When things go well, they recognize that it is not always due to the efforts of the caregivers; and when things go badly, it is not the fault of the caregiver.  The care receiver has the freedom to make their own mistakes and the caregiver is not to take the blame for their mistakes.

5. Excellent caregivers do not focus so much on the needs of their care receivers that their own needs are neglected. Caregivers need to stay aware of their own needs and try to get them met in order to have more time, energy, and patience for my care receiver.

6. Caregivers do not see their care receivers as extension of themselves. By maintaining the boundaries between them, they are able to see their care receiver as they really are.

Cant’ We Talk about Something more PLEASANT??

I encouraged my readers to attend the recent Dallas Area Gerontological Society’s forum on ‘Having “the” Conversation’. My October Caregiver eLetter is about the book Being Mortal by Dr. Atul Gawande. I imagine that people are beginning to think I am focused on death and dying.

Last summer one of my clients introduced me to a book called “Can’t We talk about something more Pleasant?” by the New York Times cartoonist Roz Chast. It is about exactly that; surely we can discuss something else…? I recommend this book for caregivers who are dealing with care receivers who have every imaginable excuse for not having directives for health care. The book is a series of cartoons, some of which are quite funny. The book goes deeper than promoting directives. It pokes fun at excuses for not going to the doctor, at the craziness of living with a person with dementia, hiring home assistance, and searching for assisted living.

Humor is often the best medicine. Laughter is healthy and therapeutic, and laughing about a stressful subject such as caregiving, makes it a little less threatening. This is a book to read and share with others. I hope it lightens your burden and gives you many smiles.

Reminiscing

Remembering ‘the good ole days’ can be pleasant for everyone. It can be a useful tool for caregivers and their care receivers.  A famous psychologist, Eric Erikson, postulated that the task of later life is integrating our various former personas, jobs, and roles into a satisfying whole. If this task is not successfully accomplished, the alternative can be despair. If the person in later life looks back and sees failures and unfilled goals, and now has no time to repair damages, it is very depressing. With positive reminiscing, that same person can look back and focus on the small successes and achievements, and come to feel that life has been well spent and satisfying.

Remembering the things we have done that were successful, the things that made us feel good about ourselves, reminds us of what we have achieved. The caregiver can help make this possible by asking for youthful memories, and emphasizing the positives. Photographs, family albums, diaries, and memorabilia can be useful in bringing back memories. Magazine pictures can help trigger  memories, as can sounds and smells. Have a whiff of fir or cedar, peppermint, chocolate, popcorn, rain, alfalfa, or cut grass – and notice how the smells bring back memories. Some of these are hard to bottle, like rain, but many others can be found on your pantry shelf. Music is especially likely to elicit memories; try big band dancing music, hymns, the Beatles, lullabies, music from musicals to name just a few.

These journeys down memory lane can be fun and satisfying for both caregiver and care receiver. Indulge!