Eldercare Q & A Helping the Deaf and Hard of Hearing

By admin|2017-01-11T16:16:22+00:00January 11th, 2017|

Q:What’s the difference between hard of hearing and deaf?

A: Hard of hearing (HOH) refers to people who still have some useful hearing, and can understand spoken language in some situations, with or without amplification. Most HOH people can use the phone and use hearing aids. Deaf people, on the other hand, have little or no hearing. They may use sign language of speech reading, and a hearing aid may help make speech understandable. People who use spoken English to communicate are called “oral deaf.” Most deaf people lost their hearing before they learned spoken language, and they see hearing loss not as a medical condition that needs to be corrected, but as a cultural distinction.

People who are “late-deafened” are those who lost all or most of their hearing during or after their teen years. Most need sign language or speech reading to understand conversation, and cannot use the telephone. In many cases doctors can’t determine what causes deafness later in life, but some common causes include: exposure to loud noise, aging, meningitis, accidents/trauma, virus, Meniere’s disease, and tumors of the acoustic nerve. If you experience a sudden drop in hearing, unexpected dizziness, drainage from your ear, or significant pain in your ear or head—contact your doctor.

Acquired deafness is a traumatic loss, especially for people who lose their hearing suddenly. People who are born deaf never feel this overwhelming sense of loss, because they never experienced hearing. But for adults who become deaf, the sense of loss can be devastating. They may go through a grieving process that lasts months or even years. This loss also strikes people who gradually experience hearing loss.

Newly-deafened people often report a feeling of isolation and loneliness. But deafness does not mean that your recreational or social life has to stop. You can still do many of the same things you used to do, just do them differently.

There are some special concerns for the elderly. The incidence of hearing loss increases dramatically with age. One third of all people over the age of 60 and 50% of people over 80 have some form of hearing loss. Hearing impairment in the elderly can seriously affect their safety, quality of life, and ability to live independently. Some seniors are not comfortable with new technologies like assistive listening devices or close captioned TV. The small controls on hearing aids may be hard to use. Seniors may be anxious about being able to remain living at home, and may be unaware of safety alerting devices and other assistive technology.

The Massachusetts Commission for the Deaf and Hard of Hearing can be used as a central point of contact for seniors and their caregivers. Their website is www.mass.gov/mcdhh. Much of the information in this column is taken from The Commission’s publication, The Savvy  Consumer’s Guide To Hearing Loss. This publication lists organizations that offer support services, medical help, financial assistance and benefits programs, communications options, assistive technologies, and real life coping skills. Call 1-800-882-1155, or 617-740-1700 (TTY) to get a copy of this book.

This former journalist helps caregivers get to know who their patients once were, before dementia took hold

By admin|2016-12-16T19:12:17+00:00December 16th, 2016|

This former journalist helps caregivers get to know who their patients once were, before dementia took hold https://www.washingtonpost.com/news/inspired-life/wp/2016/12/15/this-former-journalist-is-helping-caregivers-get-to-know-who-their-patients-once-were-before-dementia/?postshare=3201481836351187&tid=ss_tw&utm_term=.aa37489c6002

The Alzheimer’s Laboratory

By admin|2016-11-28T17:26:54+00:00November 28th, 2016|

An extended family in Colombia with a genetic mutation causing Alzheimer’s may help scientists prevent the disease someday. Lesley Stahl reports on the groundbreaking study.

http://www.cbsnews.com/news/60-minutes-alzheimers-disease-medellin-colombia-lesley-stahl/

Eldercare Q&A December, 2016 Drug Abuse & The Elderly

By admin|2016-10-27T13:35:49+00:00October 27th, 2016|

Q: Is drug abuse an issue with older people?

A: Yes.  Little attention has been paid to the issue of substance abuse—both legal and illegal drugs–among the elderly. But recent data demonstrates that drug abuse is increasing among elders, and is a larger proportion of all substance abuse among this population.

One study in 2011 reported that 6.3% of those age 50 to 59 reported they had used illicit drugs in the past month, more than twice the rate recorded in 2002. Baby boomers (born between 1946 and 1964) haved a lifetime rate of illicit drug use higher than those of people older than them. The number of older adults needing treatment for substance abuse is estmated to increase from 1.7 million in 2000 to 4.4 million by 2020.

Nonmedical use of prescription drugs among people 50 years and older is predicted to increase to 2.7 million American by 2020, and one recent study of elderly men in hospital emergency rooms showed that 11.6%  involved opioid use—a rate nearly 5 times higher than marijuana, and 6 times higher than cocaine.

One large study of emergency department admissions in 2008 for illicit substance abuse among adults over age 50 years noted that nearly 60% were aged 50 to 54 years, while only 1.5% were over age 75 years. Substance abusers were 70%  male. The substances most commonly abused include cocaine (50%–60% of cases), heroin( 25%), and marijuana ( 20%).

Researchers define “early onset users” as  individuals with a long history of substance abuse, who continue to abuse as they age. “Late-onset” substance abuse is a less common pattern, accounting for less than 10% of substance abuse among the elderly. Some elders who start abusing drugs do so because of medical factors, like higher rates of painful medical conditions that push the elder toward self-medication, and the development of psychiatric conditions like  depression or dementia. Older adults also suffer from higher rates of many of the same risk factors found in younger adults—like bereavement, social isolation, financial difficulties, or poor support systems

Some studies suggest that in recent years prescription opioids have replaced heroin as the opioid of choice, including among the elderly. But among people who were early users of illicit drugs,  heroin has been a drug of choice for so long that changing trends are not immediately reflected among elderly users.

The most common addiction among the elderly is with legal substances, like nicotine and alcohol. Psychoactive prescription drugs come in third, and illegal drugs, like marijuana, cocaine, or narcotics, come in fourth. One study of alcohol use in assisted living  found that 60% of residents drank alcochol, 34% drank daily, 19% had health impacts from drinking, and 12% had physical or psychosocial harm from alcohol. Alcohol abuse is a risk factor for a psychiatric illness: older adults are 3 times as likely to develop as mental disorder if they have a lifetime diagnosis of alcohol abuse.

Some studies recommend that every 60 year old should be screened for alcohol and prescription drug use/abuse as part of their routine  physical exam. But diagnosis of elder drug abuse is a challenge for primary care doctors. Older patients may feel compelled to hide their abuse. Doctors  may become absorbed with other medical concerns and neglect to explore the possibility of substance abuse. Bringing more attention to elderly drug abuse will hopefully encourage physicians to become more comfortable learning about treating older substance abusers.

Eldercare Q&A Medicare & Your Maintenance Care

By admin|2016-09-30T12:50:25+00:00September 30th, 2016|

Eldercare Q&A                     November, 2016

 Medicare & Your Maintenance Care

Q: Do I have to “improve” to keep getting home health care?

A: No. One of the biggest mistakes that nursing homes, rehabilitation centers, and home health agencies make is telling people on Medicare that they can’t get skilled nursing, home health care, or physical therapy because they’ve “reached a plateau,” or “failed to improve.” The courts have ruled that “improvement” is not a requirement for Medicare therapy or home health benefits. A federal judge recently ordered Medicare to do a better job of informing health care providers that the so-called “improvement standard” was no longer in effect.

Older patients with chronic and progressive diseases like Alzheimers, Parkinson’s, or congestive heart failure are unlikely to “improve” over time, but they can still get physical therapy or home health care. Rehabilitation therapy helps prevent declines in walking, eating, speaking, dressing and bathing.  Denying someone access to these treatments can worsening their disability, threaten their independence and result in more expensive health care needs.

People on Medicare might get confused reading their Medicare & You booklet, which describes on page 50 that home health is “part-time or intermittent.” That does not mean it has to be short-term. It is true that a doctor must approve your care, and you must be “homebound,” which is defined as having trouble leaving your home without help, and that leaving your home is a major effort. But you cannot be denied care because you are not “improving.”

In a 2013 court decision in Vermont, Medicare was ordered to pay for home health services to prevent a deterioration in a patient’s condition. The “stability presumption” was found to be unlawful. The Judge wrote: “A patient’s chronic or stable condition does not provide a basis for automatically denying coverage for skilled services. The determination of whether a patient needs skilled nursing care should be based solely upon the patient’s unique condition and individual needs, without regard to whether the illness or injury is acute, chronic, terminal, or expected to extend over a long period of time. In addition, skilled care may, depending on the unique condition of the patient, continue to be necessary for patients whose condition is stable.”

The fact that skilled care in a nursing home or at home has stabilized a person’s health does not render that level of care unnecessary. An elderly person need not risk a deterioration of her fragile health to validate the continuing requirement for skilled care. Your “failure to improve” cannot be used as a reason to deny you Medicare therapies or home health care. Your care cannot be cut off because you “exhibit a decline in functional status.”

If you are on traditional Medicare or Medicare Advantage, and receiving services from a nursing facility, rehab facility or home health agency, and you think your covered services are ending too soon, you can ask for a fast appeal, referred to as an “expedited determination.” Your provider will give you a notice before your services end that will tell you how to appeal. For more assistance, call 1-800323-3205 and ask for the Medicare Advocacy Project.