Your Life, Your Choice

September 15, 2014 by Leave a Comment

Always be prepared. It’s something we’re taught from the time we’re old enough to enter the Scouts and continues throughout life. Be earthquake ready; have car insurance; build a hefty emergency fund; bring a sweater. All these ideas are so commonly repeated, but what about being prepared for the last major event in life? Few people like to talk about it, but it’s important that we do. Having the “end-of-life” discussion with your loved ones is a necessity.conversation

Although it may be uncomfortable or even a bit scary, it is better to address end-of-life issues while you are alive and well. When you have everything in place, there will be no confusion on what you would have wanted and your family may grieve in peace, rather than handling messy paperwork. Over the next few weeks, we will discuss and simplify the options you have in expressing your wishes for when the time comes.

Two birds, one stone.
The Advance Health Care Directive is now the legally recognized format for living wills and has also replaced the Durable Power of Attorney for Health Care (DPAHC). You can now include either or both of these in one document.

Whereas the traditional living will states your desire not to receive life-sustaining treatment only if you are terminally ill or permanently unconscious and DPAHC appoints an individual to make health care decisions on your behalf; an Advance Health Care Directive allows you to do a number of things:

  • You may appoint another person to be your health care “agent” to make health care decisions for you once you are unable to do so yourself.
  • Identify your primary physician.
  • Specify your preferences about accepting or refusing life-sustaining treatment such as CPR, feeding tubes or breathing machines.
  • Leave instructions on receiving or declining pain medications
  • Make decisions on organ and tissue donations.
  • Otherwise formally express your health care wishes, values and beliefs.

*If you have a valid DPAHC, you may want to review it to make sure it still accurately reflects your wishes. If your DPAHC has expired, you will need to replace it with an Advance Health Care Directive.

Unstoppable: Advance Directive + POLST
POLST (Physician Orders for Life-Sustaining Treatment) has been legally recognized in California stock-footage-hospital-bed-handssince 2009. POLST is meant to complement an Advance Health Care Directive, particularly for those who are seriously ill or have been diagnosed as terminal. With POLST in place, your end-of-life health care wishes have been translated into actionable physician orders, meaning your wishes are implemented and followed without delay.

Who can complete an Advance Health Care Directive?
Any California resident who is at least 18 years old (or is an emancipated minor), of sound mind, and acting of his or her own free will can complete a valid Advance Health Care Directive. You do not need a lawyer to assist you. The only exception applies to individuals who have been involuntarily committed to a mental health facility who wish to appoint their conservator as their agent.

Start the process today by looking over the forms for Advance Health Care Directive and POLST with your loved ones:
http://ag.ca.gov/consumers/pdf/ProbateCodeAdvancedHealthCareDirectiveForm-fillable.pdf
http://capolst.org/wp-content/uploads/2014/01/CAPOLSTform2011.pdfPOLST

Look out for our upcoming discussion on Power of Attorney and Conservatorship.

 

 

 

Sources

http://www.mayoclinic.org/healthy-living/consumer-health/in-depth/living-wills/art-20046303

http://www.cmanet.org/about/patient-resources/end-of-life-issues/advance-directives

 

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A New Prescription: Giving Thanks

September 11, 2014 by Leave a Comment

Recently, we discussed current efforts to eliminate stigma against mental health, including the potential effects of the Affordable Care Act on mental healthcare in the United States. This week, we will see how gratitude, a deeply humanistic emotion, can improve your mental and physical health.

gratefulheartOn March 3, 2008, my father experienced a minor heart attack. My family rushed to the ICU and crowded around his bed. We feared that he would sustain lasting damage to his heart. Surprisingly, he was in great spirits, and thanked us for coming to visit him! As soon as he left the hospital, my dad started to perform daily ‘gratitude meditations,’ in which he reflected upon the things in his life for which he was grateful. This simple act helped to relieve him of the stress associated with recovery.

Physiological Effects of Gratitude
My father’s story illustrates that feeling grateful can influence not only our psychology, but also our physiology. In fact, just 2 minutes of intensive gratitude meditation can reduce heart rate and negate stress. Higher gratitude levels can also lead to:

  • Increased quality of life, even in patients with debilitating neuromuscular diseases
  • Improved immune function
  • Higher energy levels
  • Better quality and duration of sleep
  • Higher levels of happiness and optimism, which in turn have powerful effects on the chemical regulation of our brains. Happiness and optimism have been linked with a lower lifetime burden of disease and improved familial relationships.

Our emotions can pass on to our children
Increased gratitude levels may even carry over to our children. Recent research has focused on how epigenetic modification of DNA resulting from long term depression may be inherited. In essence, our emotions and grat checkexperiences, if strong enough, may be passed down to the next generation in the form of DNA modification. This offers a powerful explanation for why depression seems to run in some families, but happiness in others. Taken as a whole, these studies demonstrate the holistic effect of positive thinking on the human body and bring a new meaning to Descartes’ famous conclusion, “I think; therefore, I am.”

It is difficult to imagine how one can feel grateful in the face of adversity. However, as Dr. Robert Emmons, a positive psychology researcher at the UC Davis explains, “in the face of demoralization, gratitude has the power to energize. In the face of brokenness, gratitude has the power to heal. In the face of despair, gratitude has the power to bring hope.” Though it may not be easy to feel grateful during trying circumstances, focusing on the positive aspects of one’s life can help us through the worst of situations. See our Weekly Gratitude Activities Checklist for ideas on how to bring gratitude into your lifestyle.

Expressing one’s gratitude has been enumerated by the world’s major religions for thousands of years. Not only does it improve interpersonal relationships and bring out the best in others, it also provides us with numerous health benefits. There is never a better time than now to start reaping the benefits of thanking those who are important in our lives.

So, in the spirit of gratitude, the staff at Aarris Homecare thanks you for choosing our services!

Works Cited
Dunavold, P. “Happiness, Hope, and Optimism.” CSU Northridge, 1997 (http://www.csun.edu/~vcpsy00h/students/happy.html)

Emmons, R. “How Gratitude Can Help You Through Hard Times.” Greater Good: The Science of a Meaningful Life, UC Berkeley, 2013 (http://greatergood.berkeley.edu/article/item/how_gratitude_can_help_you_through_hard_times)

Emmons, R & McCullough, ME. “Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-Being in Daily Life.” Journal of Personality and Social Psychology, 2003, Vol. 84, No. 2, 377–389

Emmons, R & Stern, R. “Gratitude as a Psychotherapeutic Intervention.” J. Clin. Psychol: In Session, 2013 Vol. 69, pg. 846–855

Braunstein, D. “Pass the Gratitude: Recipe for a Happy Thanksgiving.” Huffington Post (http://www.huffingtonpost.com/glenn-d-braunstein-md/gratitude-health_b_2131450.html)

Levinson, DF & Nichols, WE. “Major Depression and Genetics.” Stanford School of Medicine 2014 (http://depressiongenetics.stanford.edu/mddandgenes.html)

Nestler, EJ. “Epigenetic Inheritance: Fact or Fiction?” Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 2013

(https://www.dana.org/Publications/ReportOnProgress/Epigenetic_Inheritance_Fact_or_Fiction/)
Rimer, S & Drexler, M. “Happiness & Health.” Harvard School of Public Health, Winter 2011

(http://www.hsph.harvard.edu/news/magazine/happiness-stress-heart-disease/)

Scott, E. “Family Connection and Happiness—Fostering A Closer Relationship With Your Family.” Stress.about.com, 2007 (http://stress.about.com/od/familystress/qt/family.htm)

Heartmath Institute: http://www.heartmath.org/templates/ihm/e-newsletter/publication/2013/spring/appreciation-is-good-for-you.php
WebMD: http://www.webmd.com/women/features/gratitute-health-boost

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Silencing the Stigma

August 22, 2014 by Leave a Comment

Last month, we discussed the social, institutional, and self-stigmatization of mental illness in the elderly and their ramifications. This week, we will discuss current efforts to eradicate mental health stigma and improve access to care.

How can we influence the media’s depiction seniors with mental illnesses?

notebook2004While the media promulgates inaccurate and damaging stereotypes about mental illness, it can also be a source of positive change in the battle against social stigma. For example, the movie The Notebook (2004) provides a genuine portrayal of strain and heart-ache accompanied by dementia. The vast majority of mass media, however, reinforce social stigma through stereotypical presentations of mental illness.

Organizations such as the Center for Mental Health and Media and Mental Health Reporting have launched their own campaigns to counter prevailing stereotypes by educating the public. They have also posted tips for reporters and screen writers to avoid promoting stigmas. Writers should:

  • Ask, “Is mental illness relevant to the story?”
  • Verify statements that mental illness is a factor in a violent crime. A past history of mental illness is not necessarily a reliable indicator.massmedia
  • Avoid using language that implies people with mental illness are violent.
  • Double-check specific symptoms of diagnoses with valid mental health resources, as necessary.

Ultimately, these organizations hope to inform writers that meaningful stories do not need to peddle incorrect and damaging stereotypes about the mentally ill. They have also initiated their own media campaigns to bring awareness to mental health stigmas.

The biggest advances in combatting stigma against mental illness have come through public policy

The passages of the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA), also known as Obamacare, have profoundly improved access to resources for the mentally ill.

mhpThe MHPAEA (2008) ensures that financial requirements (ex. Co-pays, deductibles) and treatment limitations (time of stay in hospital) for mental health or substance abuse disorder benefits are no more restrictive than corresponding surgical or medical benefits.

The ACA (2013) builds upon the principles of the MHPAEA and expands access to mental health services for geriatric patients in a number of ways:

  1. Employer-based insurance for seniors no longer can deny coverage based on preexisting psychiatric acaconditions.
  2. The ACA contains provisions that will increase quality of care in nursing homes.
  3. Healthcare institutions that are categorized as “Health Homes” or “Medical Homes” will receive increased federal funding, which will make mental health treatment more accessible for the disabled and elderly.
  4. All states will be required to have some level of mental healthcare coverage, though specific services are decided on a state-by-state basis.
  5. Medicaid has been expanded in 27 states. Medicaid’s broad range of mental health and community support resources mean that millions more people will be able to obtain treatment for psychiatric disorders.

Collectively, this means that mental health services will be more accessible than ever before to the majority of Americans, including geriatric patients. Though these policies are an important step forward, it is important to remember that social and self-stigmas are powerful factors in care quality and access, especially for seniors. Furthermore, the ACA only mildly addresses the most pressing issue facing seniors—the lack of geriatrics-specialized physicians and healthcare workers.

Fortunately, numerous colleges offer stipends and scholarships to encourage medical and graduate students to pursue specialty training in geriatric care. The American Association for Geriatric Psychiatry (AAGP) and the Geriatric Mental Health Foundation (GMHF) also support yearly scholarships for students who hope to obtain training in geriatric-focused medical care. As the Baby Boomer generation ages, these scholarships and programs will likely become more common in the nation’s medical colleges and healthcare training institutions.

Next week, we will discuss how practicing gratefulness in your daily life can improve your mental health.

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Products of Prejudice

July 21, 2014 by Leave a Comment

Last week we examined the causes of commonly-held stigmas against geriatric mental illness, including self-stigma, social stigma, and institutional stigma.

How do these stigmas affect the ability of elders to seek care for mental illnesses?

1. Fewer doctors train in geriatric healthcare, which makes it difficult for seniors to find specialized medical doctorattention. Seniors must travel further distances to see doctors with a detailed understanding of mental illness in the elderly.

a. Many doctors believe that they can have a more meaningful impact as pediatric psychiatrists, rather than as geriatric psychiatrists because they can change a child’s future as opposed to alleviating just a few years of suffering in mentally ill seniors.While pediatric psychiatrists provide immeasurable services to mentally ill youths, this mindset devalues the mind of the senior with respect to other age groups.

b. Historically, major healthcare plans have not provided enough incentive for hospital to provide mental health services. This is changing as a result of the Affordable Care Act, which we will discuss more in detail next week.

2. Doctors without training in geriatric care often misdiagnose or directly discriminate and stigmatize patients with mental illnesses. This can have a profoundly negative effect on patients by reducing treatment efficacy. Discrimination from healthcare workers can even worsen treatment outcomes. While many doctors are not directly prejudiced against the elderly, they are just as susceptible to prevailing stereotypes as the next person.

3. Because of social and self-stigmas, patients may distrust the medical establishment’s ability to treat their illness or fear institutionalization in a psychiatric ward. As a result, patients would be less likely to seek treatment for psychiatric disorders.

Education is the best strategy to overcoming stigma

Education and Empowerment of the Mentally Ill
ageismIn order to effect long-lasting change of public sentiment, people afflicted by psychiatric diseases must dispel their own stereotypes against mental illness. These include the incorrect assumptions that:
• Mental illness is incurable
• Mental illness is a normal part of aging
• Elders with mental illnesses are not worth being treated

 

Education and Empowerment of the Public

The public must also be educated about mental health and aging. Today’s mass media often disseminates misleading and derogatory images concerning mental health and the aging process. Seniors are often portrayed as out of touch with reality, childish, and useless. Few films depict old age in a positive light, and many films focus on the dangerous aspects of mental illness, though only a small percentage of mentally ill patients are violent.

bedsideEducation of the next generation of doctors and medical professionals must be a priority for the future. A study conducted at the University of Calgary, Canada, showed that basic psychiatry education in a group of medical students helped to reduce common stigmas and misconceptions about mentally ill patients and improved student confidence when working with patients with psychiatric diseases. Geriatric healthcare must also become an integral part of medical education as America’s senior population (65+) is projected to double by the year 2030. Many of these efforts are currently underway.

Tune in next week to learn about current efforts to eliminate mental illness stigmas.

References

  • CDC.gov. “Depression is Not a Normal Part of Growing Older.” http://www.cdc.gov/aging/mentalhealth/depression.html
  • Mentally Healthy Aging: A Report on Overcoming Stigma for Older Americans. DHHS Pub. No. (SMA) 05-3988. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005.
  • Neelgard, L. “Report: Too little mental health care for seniors.” Associated Press. http://usatoday30.usatoday.com/news/health/story/2012-07-10/aging-mental-health/56132426/1
  • Papish et al. “Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial.” BMC Medical Education 2013, 13:141
  • Persky, T. “Overlooked and Underserved: Elders in Need of Mental Health Care.” http://www.mhaging.org/info/olus.html
  • Thornicroft, G et al. “Discrimination against people with mental illness: what can psychiatrists do?” Advances in Psychiatric Treatment, 2010, 16: 53-59

 

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Beating the Burnout

July 10, 2014 by Leave a Comment

“I’m taking care of them all by myself.” “I don’t want to burden anyone else with this.” “I’m not getting any rest” “I need help, but who can I turn to?”

balance

If this sounds like you, you’re not alone. About 30% of adults age provide some type of formal or informal care to a family member or friend.This means these caregivers are spending over 20 hours per week, on average, with the arduous task of giving care, while still juggling other responsibilities like children, job, spouse, and managing a household.

As a family caregiver, you may have found yourself faced with several unfamiliar or even intimidating tasks, along with feelings of being overwhelmed. These feelings that come with the role of being a caregiver can place you at high risk for depression, fatigue, anxiety, neglect of your own needs, and ultimately, caregiver burnout. This is the state of mental, physical, and emotional exhaustion that comes from unrelieved stress.

elder_care_stress

Because it is so vital that both you and you elderly or ill loved one stay in the best possible health, here are 3 key points to help you manage and prevent caregiver burnout.

• Reach Out For Help
This is where we can help. At Aarris, we believe in providing your family with quality homecare to help you provide for your loved ones. Through handpicked and personalized caregivers based on expertise and your needs, we’ll be able to help you in the areas you need most; Care for them, peace of mind for you.

Computer-2 • Learn As Much as You Can about your loved one’s illness or condition(s) as well as their needs, especially on a day to day basis from both a family as well as a caregiver perspective. The more you know, the less anxiety you’ll feel about the new role in your loved one’s life and the more effective you can be when communicating with caregivers, other family members, and physicians.

• Take Care of Your Health
In order to provide the best care for your loved one, it’s important to give your best care to yourself and your own health. Try to get some physical activity for at least 20-30 minutes, two or three times per week. A balanced diet coupled with consistent and adequate sleep will help you, your loved one or patient, and caregiver work together to provide the best care and experience for your entire family.

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