Tuesday, November 26, 2013

Health Literacy: The Aging Process, Dementia, and Loving Your Loved One

Part of being fully health literate is understanding the aging process. Whether you are in your 80's and leading your family through the end of your life, in your 60's and learning about retirement, in your 50's and stuck in the sandwich generation, or in your 20's and watching your parents and grandparents try to navigate the aging process, this is a process that is often fraught with heavy disagreements, guilt,and independence vs safety issues. Yet there is also a very clear process.

Depending on how one has taken care of themselves earlier in life, somewhere between 60 and 70, aging begins to take it's toll. Vision and response times slow, hearing begins to deteriorate, muscles lose mass faster than the best weightlifters can add it back. Slowly but surely, seniors begin to need a little help with small things. Chronic health problems, multiple medications, and long standing family discord can make the entire journey even more unpleasant. Add dementia in any of it's forms to the mix and the result can be absolute chaos.

So how does someone deal with all of this? By trying to remember that everyone is doing their best. By opening lines of communication as early as possible. By showing respect while keeping safety the ultimate priority.

So let's take a quick look at some questions you will eventually need to answer when dealing with a loved one who has been diagnosed with dementia.
1. How do the children really judge the daily safety of a parent who has dementia and still lives alone or with their spouse.
~~Are they taking their medication correctly?
~~Are they likely to forget something on the stove and risk causing a fire?
~~Can they really safely drive? (How many fender benders are allowed before one takes away their driving privileges?)
2. At what point in your family does safety for others and your loved one top the need for independence? Every family has different values in this area (think child rearing), but at some point in the dementia process, safety must top independence.
~~When do you look at home care support or a great out of home day program (with locked doors for wandering protection)?
~~How do you keep your loved one safe when you are away from home?
3. When is it time to move the loved one out of their house? And to where?The dementia diagnosis of any form will keep your loved one out of most senior housing options, as they are not equipped to deal safely and securely with the sudden changes that can occur.
~~Child's or grandchild's house?
~~A memory care center? A high security nursing facility?

4. And then maybe the toughest questions of all.
~~Do you ask them to sign a DNR when they are still competent enough to do so. (It's not legal once a certain level of dementia is noted in the medical files, a level that varies from state to state.)
~~Do you treat medical conditions like cancer or mental health conditions like bipolar disorder when the treatments can make the dementia worse?

These are tough decisions. Every family is going to answer them different. But if you can talk the questions out early in the journey, you can simply rely on the fact that you already decided what to do in the calm, when the storms of life make the answers necessary. As a country, we are aging. More and more families are facing these tough decisions every day. And ignoring the problems now, do not make them better later. This I know from personal experience. My mom has dementia. We have had to move her into my home, and then slowly lock it down and make it safer for her. Some days she is so weak, she needs a walker to balance. Some days, she wanders away. Someone in my house is always on Grandma duty. But my family isn't fighting with each other over her care. We know what our family lines are that make it unsafe for her to live with us and we have already been looking at options.  Because we love her, dementia and all.

Thursday, August 22, 2013

Health Literacy- Self Medicating, Medications, and Life

       As Americans, we often think we know what's best for us. We read an article in a magazine, talk to a neighbor about her experiences, or see an ad on TV for a new drug and decide that we know our body and that drug/herb/supplement will work perfect for us. For prescription medications, we are often annoyed that we need to go through the hassle of seeing our doctor to get something we want. We are irate when it turns out our insurance company requires that medication to have be approved ahead of time, or heaven forbid, they refuse to pay for it all together. But what is really dangerous about our medical system isn't how hard it is to get a drug that has laboratory proof that it works and is safe. The real danger lies in how easy it is for us to self medicate with unproven chemicals.

       Now let me be perfectly clear. I have no objections to trying an holistic approach. I love that our country allows alternative medical practitioners to encourage people to take herbs over pharmaceuticals, or to try yoga instead of blood pressure medications. As long as your blood pressure is in the normal ranges, who cares how you get it there. And there is certainly strong evidence that says exercise, healthy eating, and plenty of water can keep blood pressure in the healthy ranges for lots of people.The risk in using only holistic approaches occurs when you don't know that you have a problem because holistic providers cannot do they same tests as medical providers. But this isn't a blog about holistic options.

       My concern today is for people who choose self-medicating behaviors with no guidance at all. This includes the soccer mom who treats her migraine with too many over the counter pain killers, the young man who chooses alcohol to reduce social anxiety disorder, and the cancer patient who must hide their medical marijuana use from their doctor. As Americans, we need to stop thinking because we can buy it, it's safe. Because we feel a tiny bit better after we take it, it's working well. And most importantly, because we can, means we should!

     Anything you put in or on your body to change the way you feel, relieve a symptom, or help you live healthier (other than food), should be evaluated for safety and effectiveness. (Food could go in that category too, as more and more people develop food allergies!)  You would be up in arms if your doctor prescribed a medication that created harmful side effects with other medications you were on, and rightly so. But when you "prescribed" yourself something, are you checking to make sure it is safe and effective for you? That there isn't a cheaper, healthier option? That you aren't treating a symptom when you should be looking for an underlying disease?

     How do you stop the process of self-medicating? By talking to your provider (medical or holistic) about how you self-treat when you are not feeling well. If you drink, smoke, or use recreational drugs, share with your doctor why you find the need to take them. So often there is a medical condition underlying mild to moderate drug use. The man who needs a drink every night to relax after a stressful day, might really be struggling with anxiety or depression that can be more easily and safely relieved with an herb, a lifestyle change, some therapy or a safer prescribed medication.

     If you find yourself standing in front of the vitamin aisle wondering if the claims that something "naturally lowers blood sugar levels" (or whatever the claim might be) will work for you, try asking your doctor. And make sure anything you use regularly is in your Electronic Medical Record. This will ensure that your pharmacist and other doctors treating you know what you take. Food allergies should be listed along with medication allergies in your records, some medications are created from peanut oil or use shellfish as an ingredient.  It's time to start behaving responsibly with everything we use! That's really living a healthy life!


Monday, May 27, 2013

Health Literacy - Communication in an Emergency Room

Health Literacy consists of the skills needed to live a healthy life, navigate the healthcare system in sickness and in health, and respond appropriately in a public health crisis. In order to do any of those things well, you must be able to communicate well. Communicating with your medical provider is a key skill to both living a health life and navigating the healthcare system in sickness. There are several moments in an Emeergency Room or Urgent Care Center where good patient communication leads to better care and, ultimately, better health for you.

As you enter the Emergency Room or Urgent Care Center, being able to calmly and concisely state what is wrong, helps the triage desk evaluate your condition. Using the same words for pain that doctors use (throbs, aches, dull, sharp, constant) and being very specific about where you hurt (my kneecap, along the outside of my leg, behind my knee) helps speed the diagnosis process along. "My knee hurts" is just not enough information.

During the visit, you will probably get snippets of info as the medical team works to discover what is wrong with you. Be calm about not having good information as they search for what is wrong. Doctors do not like to speak until they know for sure what is going on with your body. Patiently explaining everything over and over to each new team member gives you the best chance to get the right diagnosis. Good doctors understand and value the opinions of the rest of their staff. Each time you explain thoroughly what is wrong to a new staff person, you and your doctor get the benefit of their expertise and training. It can be frustrating to keep repeating the same information over and over when you are sick or in pain, but the answer may reside in the knowledge of a tech, nurse, or lab assistant who has experience with your problem. So take a deep breath and keep talking.

Finally, you will have a diagnosis. Whether the problem was minor or major, the doctor will give you advice on getting better and on keeping yourself healthy in the future. You must understand this information completely in order to get well and stay that way! There are some proven ways to ensure you understand everything you are being told.

First, try to bring someone with you. You are in pain or sick. You just cannot be focused on every detail. A friend, relative, neighbor, or health advocate can remind you later what the doctor said. They can ask for clarification when they don't understand. But only if they are in the exam room with you. They are useless in the waiting room.

Second, make notes. Write down questions you have during the testing phase and ask the doctor the questions before you leave. Write down your diagnosis and the things you need to do in the next few days. Yes, you will get all the info on a discharge form, but most people learn better when they write it down.

Third, ask questions. Actually, ask one question- "Have I gotten everything right?" Ok, it's actually a bit more complicated than that.  You know you are going to go home and someone (loved one, noisy neighbor) will ask you what happened. Say to the doctor "When I get home, my {loved one} will want to know what you said. If I tell {him/her} this_____________________, have I gotten everything right?" In that big blank space, tell the doctor everything you have learned from him/her. Then give the doctor a chance to correct anything you have wrong, add something s/he forgot to tell you, or compliment you on totally getting it right.

Need other ideas on how to improve communication with your doctor? Check out my website http://your-health-advocate.com/ to see when classes are happening or how to arrange a class at your job, your fitness center, or your doctor's office.


Tuesday, April 23, 2013

Health Literacy and Preventive Care

In my last blog, I mentioned that health literacy includes the skills and knowledge necessary to navigate the health care system. Today, let's take a look at the part of the health care system that helps to keep us healthy-preventative care.

Prevention is the key is to excellent medical care in most of the world. The US traditionally has thought of prevention as unnecessary. This attitude is reflected in the fact that our original health insurances were hospitalization only plans. Nowadays, people often have health insurance out of a fear of big hospital bills, but they don't use the preventative care that insurers will cover. This is a costly mistake.

Preventative services include seeing your primary care doctor once a year when you are healthy. Parents are pretty good about doing this for their kids, but often skip it for themselves. When you see your doctor, he (no disrespect meant, I'm going to refer to your provider as he)  should be asking about your lifestyle:not just do you smoke or use drugs, but your job, your driving habits, what you usually eat and how much you work out. He will run you through a series of quick tests to see how your body is functioning- blood pressure, urine tests, blood tests, vision and hearing will all be screened. He is looking for the earliest warning signs that your body is not handling life well. If all is fine, he should be suggesting small changes you can make to continue to live as healthy as possible. If there are signs that small things are going wrong, he is going to make suggestions on how to improve your health and explain what medical interventions may need to happen if you cannot improve your health on your own.

There are other screening tools that the doctor may order based on your age, lifestyle choices, sex, and family history. Mammograms, EEGs (heart tests), prostrate exams, neurological exams, HIV testing may all be suggested. It's important that you understand the health risks involved in both participating in these exams and in refusing these tests. There are very few good reasons to refuse a screening exam. These are critical ways the doctor has to help you stay healthy. Fear of the outcome should never stop you from taking the test. The earlier the doctor finds something wrong, the easier it is to treat. In my family, my cousin died of skin cancer because he refused to allow the spot on his face to be examined, even when it grew rapidly. Instead of listening to his doctor that he needed to have it checked by a dermatologist when it was small, he stopped going to the doctor. When he finally sought medical attention, it was too late to save his life; the cancer had spread through his body.

Speaking of a dermatologist (skin doctor), prevention may mean seeing a specialist. There are 13,000 known conditions that can affect the human body and no doctor is proficient in all of them. Most are really great at treating about 2000 of them. The other 11,000 diseases will require a trip to a different doctor.  It's not a sign that you are seriously ill, it's a sign that your primary doctor doesn't treat that set of symptoms enough. Frequently people see the specialist and then discover the problem is  something easily treatable. You want the doctor with the most experience looking at your symptoms and your body.

Preventative care also includes vaccinations. Vaccinations are most often created for viruses that affect our bodies. Viruses do not respond to antibiotics of any kind and are, in general, untreatable. Like the common cold, when you get one of these viruses, you are simply sick until you get better. Many of the viruses for which there are vaccinations create illnesses that kill or seriously maim the infected person. One of the huge fallacies in the world right now is that these viruses are no longer a threat to us. This leads parents to often skip vaccinating their children. The viruses are still out there though. The only virus for which we have a vaccination that does not occur anywhere in the world is small pox; and we no longer vaccinate for that illness. This was a unique virus that only infected humans. Most viruses pass between humans and animals,  and so they become impossible to fully eradicate. As more people refuse vaccinations, we will see a spike in diseases that the average American thought were gone. This could leave us vulnerable to an US outbreak of disease that rivals the bird flus coming out of the China and other eastern countries.

In summary, it's important that we all visit the doctor and use the preventative services provided. There may be some legitimate reasons why a particular screening or vaccine is not appropriate for you, but these reasons should not be based on a broad fear of a reaction or the results. If you have concerns about a particular preventative service, talk it over with your doctor. If you are concerned with the cost, mention that to your doctor too. There are lots of free and low cost programs out there to help you with the financial aspects of staying healthy. The programs are there to help keep you healthy.

So then let me ask you, when was the last time you saw your doctor for a well visit? Did your doctor suggest a preventative measure? Did you do it or did you put it off? Why? What are you doing instead of the doctor's suggestion to keep yourself healthy? Is it working? And finally, what can you do today to make sure you are taking good care of yourself? How about scheduling that appointment you have been putting off? It's all for your healthy future!

Thursday, April 4, 2013

Health What?

Welcome to my new blog! So for those of you who know me, you have a vague idea of what health literacy is. For those of you who are still struggling to figure out what Health Literacy, this blog is for you! Upcoming blogs will focus on how to improve your health literacy and hopefully get you thinking about how to improve your health as well.

In the meantime, Health What???

Health Literacy is a set of skills and knowledge that people need to navigate the health care system, make healthy choices, and respond appropriately in a public health crisis. If you have ever tried to decide between two different medical treatments, forgotten to take your medications, wished you understood what your doctor was saying, or tried to live healthier but got confused by the research out there, your health literacy skills need improvement. Don't be insulted though, our federal government estimates only 12% of English speaking Americans are fully health literate. Factor in the 20% of Americans who do not speak English at home, and the fact that skills related to public health emergencies were not included in this estimate, we are really taking about only 3-4% of Americans being fully health literate. This is a real crisis in our health care system!

So if our government knows how bad it is, what's being done to improve health literacy skills in Americans? Sadly,very little. Our medical system has known that people aren't as health literate as they should be since the 1980s when AIDS and Breast Cancer patients both began demanding more information about treatments and their care. The medical system has slowly responded to the lack of health literacy skills, by providing information in easier to read formats, speaking slowly, encouraging patients to ask questions, and using techniques like the teach back method to ensure the patient understands what is going on. None of these things however, teach the patients the health literacy skills they need to be successful. It's like saying Johnny Can't Read, so dumb down the curriculum instead of teaching Johnny to read!

As a public health educator, with a history of special education and designing training programs, it didn't take me long to identify the need to teach people these skills. So, after months of research on what the skills are that the medical field feels is lacking, I designed a comprehensive program called "Health Literacy and You" to teach patients how to be fully health literate, as well as to teach providers how to be better communicators. As word has spread through the Capital District, I am finding more and more people who are anxious to learn these skills and as a result live a healthier life.

So now that you have an idea what Health Literacy means, where are you struggling with these skills? What topics do you wish you understood better, in order to live a healthier life? Share your thoughts and I can generate blogs to answer those questions, because if you have them so do other people. In the meantime, choose to do something healthy today!