AGING IN PLACEProject ECHO

University of Hawaii John A. Burns School of Medicine Department of Geriatric Medicine

May 10, 2017

THE STORY OF WAYNE AND LAVERNE

➤Once upon a time, there was a handsome young man named Wayne. He met a lovely young woman named Laverne on the bus.

➤Pretty soon, they fell in love and got married. Wayne started a small grocery shop in Kalihi, and grew his small business with the help of Laverne.

➤With hard work, they bought their own little apartment in Chinatown.

➤They had one daughter, Jamie. Their hard way to law school. Jamie became very successful and moved to New York where she practices law and teaches in NYU.

➤Jamie would visit them once a year. Wayne and Laverne missed Jamie but were very happy and proud about her success.

WAYNE AND LAVERNE

➤Years went by… The couple retired and sold their shop to the son of one of their friends. They felt they had enough money for retirement.

➤Wayne developed dementia, cardiac problems and began to lose weight. He could not manage his own meds, needed supervision with his ADLs and had very poor judgment.

➤Laverne was his caregiver, but despite not having many illnesses, she too, developed mild cognitive impairment.

➤The two would stay at home, get on each others nerves and constantly argue because neither understood the condition of the other.

WAYNE AND LAVERNE

➤Their PCP became concerned because Laverne had missed appointments, but the PCP but could never get a good picture of what was happening at home. Laverne would tell her that everything was going great, but the PCP didn’t think so.

➤It took the PCP some time to convince Laverne to accept services from Meals on Wheels.

➤It took another few months for him to convince Laverne to hire a caregiver who came 2 times a week to do their shopping and light chores.

➤The PCP also finally convinced Laverne to allow a referral to a Public Health Nurse to do a home visit for the couple, but something happened before that happened…

WAYNE AND LAVERNE

➤Laverne slipped in the kitchen and fell in the kitchen as she prepared lunch. She asked Wayne to pick her up but Wayne was too frail. They both got frustrated and ended up arguing.

➤Laverne:“Fine, then leave me here then! You’re so useless!”

➤Wayne: “No I am not useless! You’re useless!”

➤Laverne: “Whatever, I’ll just sleep here on the floor tonight since you can’t do anything right.”

➤Wayne: “Okay then!”

➤And Wayne went to bed and forgotall about Laverne…

WAYNE AND LAVERNE

➤Laverne stayed down on the ground overnight until the next morning, when Ben from Meals and Wheels came to bring their food.

➤Wayne happily answered the door, even if he had no clue who Ben was.

➤Ben heard a very faint “Help! Help!” and asked when what was going on.

➤Wayne said “I don’t know. What is that sound? Hmm…” Wayne let Ben in, who found Laverne on the floor. Ben called 911.

WAYNE AND LAVERNE

➤At the hospital, Laverne was diagnosed with a hip fracture, a Stage 3 sacral ulcer and acute renal failure from rhabdomyolysis.

➤She received IV fluids and hip surgery was done. She also received debridement of the sacral ulcer.

➤Laverne needed long term care for PT/OT and a WoundVac.

➤In the meantime, APS was called to check on Wayne. Wayne was emergently placed in the first care home that could accept him.

WAYNE AND LAVERNE

➤It took Jamie a week to fly back to Honolulu. There was a delay in contacting her because no one had her number. All this time she had no clue that her parents were in so much trouble.

➤Wayne developed new behavioral problems over being placed. He didn’t understand why he was in a new home and couldn’t understand why Laverne “abandoned” him. He would yell at the caregivers and repeatedly tried to elope.

➤Laverne was admitted to SNF for PT/OT, Wound Vac and Foley care. She was later moved to ICF as she never regained her premorbid function. She continues to be very depressed because of this.

WAYNE AND LAVERNE

➤Jamie says, “I wish I knew they were in so much trouble! If I did, maybe I could have done something to prevent all this from happening. I feel like I have failed my parents.”

WHAT IS SUCCESSFUL AGING?

Living to 100?

…OR IS IT ABOUT WHAT YOU CAN DO?

➤ 4 – Not peeing in your pants

➤ 12 – Having friends

➤ 16 – Having a driver’s license

➤ 20 – Having sex

➤ 30 – Having money

… OR NOT DO?

➤ 50 – Having money

➤ 60 – Having sex

➤ 70 – Having a driver’s license

➤ 80 – Having friends

➤ 90 – Not peeing in your pants

Courtesy Dr. Joseph Ouslander, Emory University

SUCCESSFUL AGING

Rowe & Kahn (1998)

SUCCESSFUL AGING IS MOSTLY DETERMINED BY LIFESTYLE

IMPORTANT GOALS

BUT WHAT IF ….

THE GAME OF L I F E

HOSPITAL

FALLS

LONG TERM CARE

DEMENTIA

THE GAME OF

THE GAME OF THE GAME OF LL

L I

I I

F

FF

E

EE

…JUST HOPE FOR THE BEST?

PLANNING HELPS….

SO HOW DO WE START THE CONVERSATION?

…and what do we talk about?

PLANYOURLIFESPAN.ORG

➤ Released publically Sept 15th, 2015➤ Free to Use➤ Nationally available with links to local resources

PLANYOURLIFESPAN.ORG

Developed by Dr. Lee Lindquist, Northwestern University, funded by PCORI

HOSPITALIZATION

Diagram Courtesy of Rosanne Leipzig,MD, Dept of Geriatric Medicine, Mount Sinai School of Medicine

Hospitals are Hazardous Places

HOSPITALIZATIONS

HOSPITALIZATIONS

GETTING HELP AT HOME: POST-HOSPITALIZATION

HOSPITALIZATIONS

FALLS

FALLS

FALLS

FALLS

FALLS

OTHER RESOURCES:

DEMENTIA

ALZHEIMER’S DISEASE IS VERY COMMON

www.alz.org/facts

➤Estimated 5.2 million Americans living with Alzheimer’s Dementia

➤AD is 6th leading cause of death across all ages

➤1 in 3 seniors dies with some type of dementia

EARLY DETECTION OF DEMENTIA

➤ Screening and early detection allows for:

➤ Opportunity to address safety issues (prevent a crisis!)➤ More time for planning ahead (healthcare, finances,

housing, caregiving, etc)➤ Education and support for caregivers

DEMENTIA

DEMENTIA: MEDICATION

DEMENTIA: BILLS

DEMENTIA: ADLS - DRIVING

DEMENTIA: ADLS

DEMENTIA: ASSISTANCE WITH ADLS

DEMENTIA: LONG TERM GOALS

DEMENTIA: HOUSING OPTIONS

ENCOURAGE EVERYONE TO HAVE THIS CONVERSATION…

IN ADDITION: DON’T FORGET TO TALK ABOUT HEALTHCARE GOALS!

➤ Health Care Proxy➤ Advanced Care Planning➤ Provider’s Orders for Life Sustaining Treatments (POLST)

University of Hawaii Elder Law Program www.Hawaii.edu.uhelp

Kokua Mau Hawaii Hospice & Palliative Care Organization www.kokuamau.org

SOMETIMES CONVERSATIONS ARE MORE CHALLENGING…

➤ The Mediation Center of the Pacific, Inc.245 N Kukui Street, suite 206

Phone: 521-6767 www.mediatehawaii.org

IN SUMMARY

STAYING AT HOME REQUIRES PLANNING

…PLANNING FOR SUCCESSFUL AGING IN PLACE IS PLANNING FOR QUALITY OF LIFE

Start the Conversations…

You will make a difference!

Take action!