Category Archives: Geriatrics and Gerontology

Using advance directives as tools

Guest Post by Dan Morhaim

The tools are here. We just need to use them.

These tools offer something rare and important in our modern medical system: an opportunity to exert influence. I am talking about advance directives, the powerful instruments that allow each of us to manage the final chapter of life in a dignified manner and according to our own wishes and values.

As an emergency medicine physician, I’ve seen scenarios like this one all too often: An ambulance brings to the hospital a frail, elderly patient with shortness of breath, irregular heartbeat, and plunging blood pressure. The wasted limbs indicate years of incapacitation, and the medical record reveals a long history of dementia. As we work to restore stability, probing paper-thin skin for a vein, the patient suddenly goes into cardiac arrest.

The patient does not have an advance directive or a Do Not Resuscitate (DNR) order, so the ER team goes into full CPR mode, cracking brittle ribs with every chest compression. If the team’s efforts are “successful,” the patient will endure suffering that may last for the rest of his or her life.

We know that too much of this “care” is futile, hurtful, and wasteful. While some will opt to “do everything” no matter how painful the treatment or how unlikely the chance for recovery, most people do not want to die in this manner.

There comes a time when most of us would choose to allow a natural death rather than use medical technology to prolong life for what is usually only a few extra hours, days, or weeks. But when that moment comes, we are often not in a position to speak for ourselves. That’s why we need advance directives, which are free, straightforward, easily available forms that are legal in every state.

Americans cherish the right to make their own medical decisions. In light of our ardent individualism, it’s puzzling that so few of us exercise this right when it comes to something most of us will face: medical care at the end of our lives. (A study from the Johns Hopkins Bloomberg School of Public Health showed that only about one-third of us have completed advance directives.)

Care at the end of life involves making some deeply personal choices. Who should make them? Doctors? Government? Insurance companies? Hospitals? Ethics committees? Religious institutions? As both a physician and a state legislator, I believe that the operative values should be the patient’s. When patients haven’t expressed their wishes or designated someone who can act for them if they’re incapacitated, controversy and painful family upheaval can ensue.

While cost is not the primary reason to have an advance directive, saving money is one of its consequences. Medicare estimates that 25-30 percent of its spending goes for care during the last six months of life. The costs to Medicaid programs and private insurance are equally staggering.

As the baby boom generation reaches its senior years, new lifesaving medical treatments are devised, and our health care system confronts a crisis of affordability, we, all of us, need to take time to record our end-of-life decisions.

I hope that, one day, completing advance directives will become as routine as renewing your driver’s license. If advance directives were to become the norm—if, say, 80 percent of adult Americans had them—we could offer more personalized and humane care for far less money. Respecting individual rights is the right way to reduce health care costs.

Remember: only you can complete your advance directive. No one can do it for you. Get the forms, fill them out, share with family, friends, and physicians as appropriate and then encourage everyone you know to do the same. This is not a tool just for “old people,” either. It’s a tool for everyone, to specify the kind of care you want as you approach the end of life, whenever that occurs.

The tools are here. We just need to use them.

And what better way to get started than on April 16, National Health Care Decisions Day?

Dan Morhaim and Brent Pawlecki, M.D., Medical Director Goodyear Tire Company  have written a column  for Health Affairs on the role employers can play in promoting advance directives.

morhaimDan Morhaim, M.D., is an adjunct professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, Deputy Majority Leader of the Maryland House of Delegates, and the author of The Better End: Surviving (and Dying) on Your Own Terms in Today’s Modern Medical World. He is board certified in emergency medicine and internal medicine.

http://healthaffairs.org/blog/

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Filed under For Everyone, Geriatrics and Gerontology, Health and Medicine, Public Health

The 36-Hour Day Podcast: Getting Help

Today is the fifth and final in a series of brief podcast excerpts from The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss. This bestselling title by Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H., is in its fifth edition and is now available in an audio edition.

Podcast #5: Excerpt from Chapter 10: Getting Help

In this excerpt from Chapter 10, Dr. Rabins focuses on the need for caregivers to have outside help and have time away from the responsibilities of caregiving. He describes how to find good information on available services, how to seek and accept help from friends and neighbors,  and how to address problems you may encounter.

You can find this podcast and the rest of the series of podcasts here.

mace

These podcasts are excerpted from a Johns Hopkins University Press audio book of The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss, fifth edition, by Nancy L. Mace and Dr. Peter V. Rabins.

The definitive guide for people caring for someone who has dementia, The 36-Hour Day features chapters on the causes of dementia, managing the early stages of dementia, the prevention of dementia, and finding appropriate living arrangements for the person who has dementia when home care is no longer an option.

The complete book is available on 11 CDs or in a print edition. You can also download the audio edition from Audible.com.

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Filed under Consumer Health, Dementia and Memory Loss, Geriatrics and Gerontology, Health and Medicine, Mental Health, Public Health

The 36-Hour Day Podcast: suggestions for caregivers

Today is the fourth in a series of brief podcast excerpts from The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss. This bestselling title by Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H., is in its fifth edition and is now available in an audio edition.

In this excerpt from Chapter 3, Dr. Rabins offers practical advice and addresses some common frustrations for caregivers, such as solving one problem at a time to avoid feeling overwhelmed, relying on common sense and creativity, and sticking to a predictable schedule. Dr. Rabins emphasizes the importance of getting enough rest and “caring for the caregiver.” Dr. Rabins explains the latest medical understanding of dementia. He describes the types of dementia, when and how the condition progresses, and how diagnosis determines treatment options.

You can find this podcast and the rest of the series of podcasts here.

mace

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The 36-Hour Day Podcast: Why People Who Have Dementia Do the Things They Do

Today is the third in a series of brief podcast excerpts from The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss. This bestselling title by Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H., is in its fifth edition and is now available in an audio edition.

In this excerpt from Chapter 3, Dr. Rabins offers insights into why people who have dementia do the things they do. He explains how our brains do thousands of tasks, many of which we are unaware, and how the illness that causes dementia interferes with the complex sequence of steps required for even relatively simple tasks.

You can find this podcast and the rest of the series of podcasts here.

mace

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March events feature Shakespeare, Lindsay, Einstein, and more

March roars in with a variety of events suitable for lionizing, and JHU Press authors, editors, and staff will keep busy all month. Stephen H. Grant loved the idea that the official publication date for Collecting Shakespeare would be the Ides of March, and several events around that date welcome his book. At Hunter College, Joseph P. Viteritti and a group of very distinguished panelists will discuss the legacy of New York Mayor John Lindsay to launch the publication of Summer in the City: John Lindsay, New York, and the American Dream. And Michael C. C. Adams will discuss and sign Living Hell: The Dark Side of the Civil War in the latest Virtual Book Signing™  hosted by Chicago’s Abraham Lincoln Book Shop. A Virtual Book Signing™ is a live and online book talk and signing event webcast from the bookstore and streamed round the world. Customers both in the store and online can listen to the presentation, ask questions, and then buy books and see them signed by the author. Please spread the word about JHUP’s March line-up!


weaver-zercher rev comp.indd6 March 2014, 11:30 a.m.

Book Talk & Signing
– Valerie Weaver-Zercher
Thrill of the Chaste: The Allure
of Amish Romance Novels

Common Hour, Mayser Gymnasium
Franklin & Marshall College
Admission: Free and open to the public; information here.


 grant.collecting11 March 2014, 12:30 p.m.
Hopkins Club Lunch & Lecture – Stephen H. Grant
Collecting Shakespeare:
The Story of Henry and Emily Folger

JHU’s Homewood Campus
Baltimore, MD
Admission: $20; members call the Club to make reservations; non-members contact Jack Holmes at 410-516-6928 to attend as a guest of the Press.


mace512 March 2014, 7:30–9:00 pm
Book Talk & Signing Peter V. Rabins, M.D., M.P.H.
The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss
The Kaleidoscope Program
Roland Park Country School
Baltimore, MD
The author’s JHUP’s best-selling book discusses “The Ethical Issues of Alzheimer Disease and Memory Loss” in the popular RPCS speaker series.

Admission: $30; call 410-323-5500 to register.


gimbel13 March 2014, 6:30–8:30 pm
Book Talk & Signing – Steven Gimbel
Einstein’s Jewish Science
The Johns Hopkins Odyssey Program
JHU’s Homewood Campus
Baltimore, MD
Admission: $28; call 410 -516 -8516 or register online here.


14 March 2014, 7:00 p.m.
Book Talk & Signing
– Stephen H. Grant
Collecting Shakespeare: The Story of Henry and Emily Folger
One More Page Books
2200 N. Westmoreland St.
Arlington, VA
Admission: Free; call 703-300-9746 or visit www.onemorepagebooks.com.


adams.hell15 March 2014, 12:00–1:30 p.m.
Virtual Book Signing™
– Michael C. C. Adams
Living Hell: The Dark Side of the Civil War
The Abraham Lincoln Book Shop
Chicago, IL
Admission: Free and open to the public; participate at the book shop or online; more information here.


osteen19 March 2014, 6:00–8:00 p.m.
Book Talk & Signing
– Mark Osteen
Nightmare Alley: Film Noir and the American Dream
Loyola University Maryland, Knott Hall
Baltimore, MD
This program is sponsored by the Phi Beta Kappa Alumni Association of Greater Baltimore.
Admission: Free with RSVP to baltopbkalum@yahoo.com.


kelly20 March 2014, 6:30–8:30 pm
Book Talk & Signing – Cindy Kelly
Outdoor Sculpture in Baltimore: A Historical Guide to Public Art in the Monumental City
The Johns Hopkins Odyssey Program
JHU’s Homewood Campus
Baltimore, MD JHU Press author Cindy Kelly will present “A Close Look at Baltimore’s Battle Monument.”
Admission: $28; call 410-516 -8516 or register online here.


vitteriti20 March 2014, 5:00 p.m.
Book Talk & Signing
– Joseph P. Viteritti
Summer in the City:
John Lindsay, New York, and the American Dream

Hunter College, The Kaye Playhouse
New York, NY
Roosevelt House Public Policy Institute at Hunter College hosts a launch event for Summer in the City featuring Joseph P. Viteritti, Sam Roberts, Lilliam Barrios-Paoli, Vincent Cannato, Lizabeth Cohen, and Richard Ravitch.
Admission: Free, reservation required; call 212-396-7931.


20 March 2014, 6:00–8:00 p.m.
Book Talk & Signing
Stephen H. Grant
Collecting Shakespeare: The Story of Henry and Emily Folger
Drama Book Shop
250 W. 40th St.
New York, NY
Admission: Free; call 212-944-0595 or email info@dramabookshop.com.


kilcup26 March 2014, 7:00 p.m.
Book Talk & Signing
– Angela Sorby
Over the River and Through the Wood:
An Anthology of Nineteenth-Century
American Children’s Poetry

Boswell Book Company
Milwaukee, WI
Admission: Free; 414-332-1181 or visit online.


28 March 2014, 6:30 p.m.
Book Talk & Signing
– Stephen H. Grant
Collecting Shakespeare:
The Story of Henry and Emily Folger

Folger Shakespeare Library
Washington, D.C.
Admission: Members only; for information, call 202-675-0302.

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Filed under American History, American Studies, Amish, Baltimore, Biography, Book talks, Dementia and Memory Loss, General Science, Geriatrics and Gerontology, Kids, Literature, Mental Health, Physics, Poetry, Politics, Urban Studies

The 36-Hour Day Podcast: What is Dementia?

Today is the second in a series of brief podcast excerpts from The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss. This bestselling title by Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H., is in its fifth edition and is now available in an audio edition.

In this excerpt from Chapter 1, Dr. Rabins explains the latest medical understanding of dementia. He describes the types of dementia, when and how the condition progresses, and how diagnosis determines treatment options.

You can find this podcast and the rest of the series of podcasts here.

mace

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Introducing The 36-Hour Day: A Podcast

Today begins the first in a series of brief podcast excerpts from The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss. This bestselling title by Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H., is in its fifth edition and is now available in an audio edition.

We begin the series of podcasts with an excerpt from the book’s Introduction and Preface. In it Dr. Rabins describes recent advances in understanding the needs of people with dementia, along with the importance of supporting the families and friends of patients afflicted with Alzheimer dementia. He also offers an overview of all the topics covered in The 36-Hour Day.

You can find the first podcast and the rest of the series of podcasts here.

mace

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Filed under Consumer Health, Dementia and Memory Loss, Geriatrics and Gerontology, Health and Medicine, Mental Health, Public Health