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San-Diego-Geriatric-Care-Management-300x225San Diego Geriatric Care Management is being taken to new levels with the advent of telemedicine and new care models fueled by health information technology. With healthcare reform driven legislation and maturing technologies, personal health information is coming back home.

There is a nationwide osmotic shift of health information from the hospitals and larger health centers out through electronic health records (EHR’s), health information exchanges (HIE’s), and personal health records (PHR’s), so that “patient centered medical homes” can become a reality. Patients and families also will have more access to and control of their own vital health information. That is no small change in particular for the elder population facing multiple chronic illnesses.

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chronic-care-300x217According to a recent report out of John Hopkins University, “people with chronic conditions account for 88 percent of all prescriptions filled, 72 percent of all physician visits, and 76 percent of all inpatient stays.”

Chronic conditions are those which last longer than a year, limit activities of daily living and may require ongoing medical care. The report cites the usual offenders: “hypertension (26 percent of non-institutionalized people with chronic diseases), chronic mental conditions (22 percent), respiratory disease (18 percent), arthritis (13 percent), heart disease (12 percent), eye disorders (10 percent), asthma (10 percent), cholesterol disorders (9 percent), and diabetes (9 percent).”

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daughter-visiting-her-senior-motherSAN DIEGO ‑ I was at the corner coffee shop yesterday when I ran into a man who I have seen over the last few years at a certain nursing home down the hill. I’d never really talked to him, though he’d been a constant presence at dinner time, helping his wife when as I sat and fed other patients in the same dining room.

As he got into his car, I asked how his wife was.

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DSCF2624According to the Journal of American Geriatric Society, “A full 30% of hospital admissions in elderly patients may be related to drug related problems or toxic drug effects.” Potentially inappropriate medication (“PIM”) is widespread with the elderly in both acute and community-based settings.

One of the benefits of hiring a Geriatric Care Manager is that they can monitor medication use and side effects.Anticholinergics are one family of medications that are on the usual offender list. This family of drugs blocks the neurotransmitter acetylcholine and includes such common drugs as Paxil, Detrol, Demerol and Elavil. Common sleep aides such as Tylenol PM, Excedrin PM both contain Benadryl which is an anticholinergic as well. Geriatric Care Management’s role in patient advocacy is to protect their clients from not only polypharmacy but from “PIM” as well.

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elder-talking-on-the-phoneGeriatric Care Managers know how to start these critical conversations and more importantly, they know how to listen to the answers. The following article gives adult children the encouragement they may need to begin these critical conversations with their parents.

“Remember when your parents were lecturing you on the rules for taking the car for a spin? Dad would put his face in front of yours and say, “Are you listening?” Of course you would say “sure” even though your mind was miles away on the adventure to come.

Today, as adults, the children who received the counsel and wisdom of their parents are facing a reverse situation in their lives. They are finding themselves concerned about their aging parents and what their needs will be as their health and mental abilities fail them. In some cases the children must take the role as parent in securing the safety and well being of an elderly family member.

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