Here at AgingOptions we’ve long believed that the traditional health care system in the U.S. is not particularly kind to seniors. Now this article just published on the website Kaiser Health News gives us more reason to believe that older Americans are not always well served by traditional medicine. The article describes how seniors who go to hospital emergency rooms suddenly find themselves and their families caught up in a harsh, crisis-driven medical environment for which they are often unprepared. And because there are more and more seniors among the population who are using the ER, the problem is getting worse.
Some hospitals are beginning to address the issue. As the Kaiser article says, an influx of elderly patients is forcing emergency rooms to practice palliative care, or “comfort care,” and to pay more attention to the particular psychological needs of their senior patients and their families. But that change is slow to come and faces many medical and cultural obstacles.
We’ve all heard that the percentage of the U.S. population in the 65-plus age group is on the rise. According to UN statistics reported by Pew Global, in 1975 seniors 65 and older made up about 10.5 percent of the American population. By the year 2000 that percentage had grown a bit – but not by much – to about 12.4 percent. But propelled by aging boomers, the percent of the population 65 and older is rising more and more rapidly, projected to top 16 percent by 2020 and 21 percent by 2045. You can read more on those statistics here.
Says the Kaiser article, “As the nation’s elderly population swells, more older Americans are visiting the emergency room, which can be an overcrowded, disorienting and even traumatic place.” In 2013 adults 65 and older made a total of almost 21 million visits to emergency rooms, up from about 16 million visits in 2000, according to the Centers for Disease Control and Prevention. Already seniors account for one of every six ER visits, and that number is rising fast. But it turns out that about half of these visits take place in the final month of a patient’s life, which means the typical ER protocol involving the rapid and often impersonal application of life-saving care may not be the appropriate way to meet an older patient’s needs. Because of the procedures in the ER, a large number of older patients who would rather pass away at home instead end up dying in the impersonal environment of a hospital room.
“The influx (of older patients) is prompting more clinicians to rethink what happens in the fast-paced emergency room, where the default is to do everything possible to extend life,” says the Kaiser article. To remedy this situation, many hospitals are starting to bring palliative care, which focuses on improving quality of life for patients with advanced illness, into the emergency room. But changing the culture of the ER is a hard process, and efforts to institute a new approach to senior care face significant pushback from ER personnel who complain of a lack of time, staffing and expertise. Reports Kaiser, “ER doctors questioned how they could handle delicate end-of-life conversations for patients they barely knew. Others argued the ER, with its ‘cold simple rooms’ and drunken patients screaming, is not an appropriate place to provide palliative care, which tends to (involve) physical, psychological and spiritual needs.”
One doctor quoted in the article said that dialing 9-1-1 is the default emergency choice for many elderly patients, especially those living on their own with impaired strength, mobility and vision. “They can barely see,” he said. “They can barely get out of the house.” They may not be willing to wait for a ride service or transportation from a friend. “So what do they do?” this doctor said. “They call 9-1-1.” Once at the ER, these patients are at the mercy of a “pedal to the metal” system that treats acute symptoms but not underlying needs and preferences. “In more severe cases,” says the Kaiser article, “when the patient can’t talk and doesn’t have an advanced directive or a medical decision-maker available, doctors default to the most aggressive care possible to keep them alive — CPR, intravenous fluids, breathing tubes.” Then “when doctors learn after the fact that the patient would not have wanted that, the emergency rescue puts the family in the difficult position of deciding whether to remove life support.”
There’s no simple answer to this nationwide situation, but we at AgingOptions do have a few recommendations. First, make sure you have a geriatric physician, or geriatrician, in charge of your health care. With the professional help of a trained geriatrician who understands the physical and emotional needs of seniors, you’ll not only stay healthier longer but you’ll also be better prepared if a medical emergency should occur. We can refer you to a geriatrician in your area. Second, plan now to attend an AgingOptions LifePlanning Seminar. Having a LifePlan in place ensures that you and your loved ones will be able to face the future with clarity and confidence. Not only will your finances be protected, but your medical needs will have been addressed, your housing options explored, and your legal protection firmly established. A LifePlan is your best guarantee that your desires will be honored as you age, and that you’ll be able to avoid burdening your loved ones or having them forced into making difficult medical decisions on your behalf without knowing your wishes.
We have a full schedule of free LifePlanning Seminars coming up, so why not plan now to attend the one most convenient for you? Click here for details and online registration, or contact us during the week. You don’t have to face the future with fear and insecurity. An AgingOptions LifePlan is the answer you’ve been looking for.
(originally reported at www.khn.org)