Priorities For End-Of-Life Care Revealed By Europe-Wide Survey

Main Category: Palliative Care / Hospice Care
Also Included In: Cancer / Oncology;  Caregivers / Homecare
Article Date: 24 Mar 2011 - 3:00 PDT
A survey of over 9,000 people in seven different countries across Europe has shown that the majority would want to improve the quality of life in the time they had left, rather than extend it. The survey reveals attitudes across Europe for dealing with serious illnesses such ascancer, and issues raised when caring for a close friend of relative in the last few months of life. The research was carried out as part of an EU-funded project led by researchers from King's College London.

The telephone survey of 9,339 people was carried out to explore attitudes to end of life care in seven European countries: Germany, England, the Netherlands, Belgium (Flanders), Portugal, Spain and Italy. The survey showed that 71% of people said they would want to improve quality of life for the time they had left; 4% would like to extend life; and 25% said both quality and extending life was equally important. Across all countries in the survey, 'being in pain' was the symptom or problem that was of most concern, followed by 'being a burden to others'

The results of the survey will be discussed by policy makers, research funders and experts in palliative care on Thursday in Brussels at a symposium held by PRISMA - a consortium of experts from nine European and African countries, led by King's College London. The PRISMA group says greater attention must be paid to quality of life alongside potentially life-prolonging treatments, as the survey shows quality of life is important to people, often more so than extending it.

A group of leading researchers and clinicians, led by Professor Irene Higginson OBE at King's College London, will call for delivery of end-of-life care across Europe to be reviewed in the light of the results, and investment in research increased, in order to meet people's needs more effectively at the end of their lives.

Professor Irene Higginson OBE, scientific lead of PRISMA and Professor of Palliative Care and Policy at King's College London, said: 'There needs to be a fundamental shift in the approach to delivering end-of-life care across Europe. Although individuals' priorities and needs will differ, it is absolutely clear that people value highly the quality of the time they have left.

'What we need to see is a step-change in the way policy-makers and clinicians across Europe look at end-of-life care, and ensure that people's priorities and needs inform planning and delivery of these services. Together with an increased investment in scientific research into end-of-life care, this will really make a difference to the quality of people's lives as they face their last weeks and days.'

The PRISMA group is calling for a change in the way all health care professionals working with patients with advanced diseases measure things which are important to patients and their families. Currently, the focus is on physical tests such as x-rays, scans and monitoring bloods. But PRISMA warns that, although important, these routine tests may miss the effects of the illness on the person and their family. A move towards assessment of symptoms, psychological, social and spiritual needs is urgently required in order to ensure an adequate response to patient and family priorities.

PRISMA compared the survey results with the views of nearly 800 clinicians working in end-of-life care and recommended a five-pronged approach to tackle: symptom control; emotional well-being; family support; choice for where to be cared for; and information needs.

Professor Stein Kaasa, a member of PRISMA, Professor of Palliative Medicine and an oncologist at the Norwegian University of Science and Technology said: 'It is now the responsibility of all clinicians working with patients with life-threatening diseases such as advanced cancer, to measure and lead others to measure the outcomes of their work against what matters to patients, so they know they are on the right track to providing quality care.'

Source:
Katherine Barnes
King's College London

http://www.medicalnewstoday.com/articles/220052.php

"Learn About Senior In Home Health Care in Columbus, Ohio Senior Helpers Provides Many services in the Columbus, Ohio area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check. If you need Home Care services in Amlin, Clintonville, Columbus, Delaware, Dublin, Galena, Hilliard, Lewis Center, New Albany, Powell, Sunbury, Upper Arlington, Westerville, Worthington, and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Columbus Home Health Care Company. "

2010 Tax Tips for Family Caregivers

If you are supporting an elderly parent, you may qualify for some tax benefits from the government that rewards you for your caregiving efforts. These tax benefits may include claiming your parent as a dependant on your tax return or deducting the contributions you made towards their medical expenses and medical care. In order to qualify for these tax breaks, you must first be aware of the tax benefits available and then determine whether or not you qualify. "It is important for all family caregivers to verify their eligibility and take advantage of these tax credits," said Allen Hager, chairman and CEO of Right at Home, Inc, an international in-home care franchise.
Tip #1: Determine if You are Able to Claim Your Elderly Parent as a Dependent
If you support your elderly parent, you will want to claim them as a dependant on your tax return to receive the maximum amount of tax savings. You can then take an exemption for the 2010 tax year which will equate to a reduction of your taxable income by $3,650. In order to determine if you qualify to claim your elderly parent as a dependent, you will need to pass the following four tests.

1. Not a qualifying child test
2. Member of household or relationship test
3. Gross income test
4. Support test

Not a Qualifying Child Test
Obviously, a qualifying child is another type of a dependent; however, the IRS wants to ensure a qualifying child dependent status (which has its own set of requirements, such as under age 24 and a full-time student) is not claimed using these four tests. This test is a non-issue for caregivers.
Member of Household or Relationship Test
If you are a son or daughter who is caring for a parent, you qualify since you meet the relationship test. You and your parent do not need to live with one another in order to qualify. In the case where a parent lives on their own or in assisted living, your parent may still qualify as a dependant as long as they pass the other tests.
Gross Income Test
In order to meet the requirements of this test and qualify as a dependant, your parent's gross income for the year must be less than $3,650. This amount does not include income from non-social securityor disability payments. However, income received from other sources, such as withdrawals from retirement plans, pension benefits, rental income, or interest and dividends from investments would go towards a parent's income total, which could disqualify them as a dependant if they exceed the income limit.
Support Test
The final test to complete is the support test. This test can be the most complicated to determine. In order to meet the requirements of this test, you must pay for over half of your parent's expenses. There are many factors involved in coming to this conclusion including food, housing, clothing, medical care and transportation expenses.

Tip #2: File a "Multiple Support Declaration" if Multiple Siblings are Providing Support
Another possible deduction comes into play when there are multiple siblings giving support for a parent. In this case, as long as a sibling provides at least 10 percent of the support and the combined support of all siblings makes up half of their parent's annual expenses, the parent could be claimed as a dependent. However, only one sibling can take the exemption for the parent. An agreement needs to be reached each year as to which sibling will take the exemption on their return. The sibling taking the exemption will need to file Form 2120, Multiple Support Declaration, and have all of the other siblings sign the form claiming that they will not take the exemption on their own return.
Tip #3: Determine if You are Eligible for a Dependent-Care Credit
As a family caregiver, you may be eligible for the Child and Dependent Care Credit if you paid someone else to care for your elderly parent so you were allowed the opportunity to work or look for work. If eligible, you would be allowed a credit of up to 35 percent of the expenses paid for dependent care with the maximum amount of expenses being $3,000. This means the tax credit can be worth up to $1,050. To be eligible, the care recipient must be unable to physically or mentally care for him or herself. Care recipients must also be claimed as a dependent (or could claim as a dependent expect that the person had a gross income of $3,650) on the caregiver's tax return, according to the qualifications listed on IRS Form 2441.
Tip #4: Deduct Your Parent's Medical Costs
If you were not able to claim your elderly parent as a dependant because his or her gross income was more than $3,650, there still may be a chance to receive tax savings this tax year. Medical expenses may be deducted on your tax return, along with your own expenses, for dependants and for individuals that would have been a dependant, except for the income guidelines. The IRS allows caregivers to deduct costs incurred from a parent's health care, such as hospitalization,prescription drugs, dental care and even long-term care services. The deduction is limited to medical expenses that are in excess of 7.5 percent of the caregiver's adjusted gross income (AGI). So in the case where a caregiver makes $50,000 in 2010, they would not be able to receive any deductions until they had paid medical bills accumulating to $3,750.

http://www.agingcare.com/Featured-Stories/145339/claiming-elderly-parents-as-dependents-2010-taxes.htm

"Learn About Senior In Home Health Care in Columbus, Ohio Senior Helpers Provides Many services in the Columbus, Ohio area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check. If you need Home Care services in Amlin, Clintonville, Columbus, Delaware, Dublin, Galena, Hilliard, Lewis Center, New Albany, Powell, Sunbury, Upper Arlington, Westerville, Worthington, and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Columbus Home Health Care Company. "

New Devices Help Seniors Stay Longer in Their Own Homes

Sensors, GPS and more are being used to track aging parents' movements

By Dennis Thompson
HealthDay Reporter
TUESDAY, Jan. 18 (HealthDay News) -- Seniors who want to remain in their homes despite illness and infirmity can get a high-tech assist these days.
So can their children who might worry about an elderly parent living alone, often far from family members.
The 1980s-era medical alert pendants made famous by their television advertising ("I've fallen, and I can't get up!") are now among a wide array of devices that can help keep an eye on aging parents and get them help when they need it.
Available technologies include:

• Sensors in the home to track an older person's movement, from the front door to the medicine cabinet to the refrigerator to the stove. The sensors are linked with computers that can issue alerts when people deviate from their routine.
• Global positioning system devices, using the GPS technology that's become so common in cars, that can help locate someone with dementia who's wandered from home.
• Computerized pillboxes that track whether medication is being taken on time.

"The notion behind these technologies is that people stay in their homes with some peace of mind on both their and their families' part," said Elinor Ginzler, AARP's senior vice president for livable communities. "In many cases, sensors are actually placed in various places throughout the older person's home. They are continuously tracking data. More or less all of them are looking for changes in that typical pattern and can note that change and alert responsible parties."
Ginzler gave the example of a "sensor checking to see if the front door is opened to pick up the newspaper every day by a certain time, because that's what Dad does." If he usually gets the paper by 7:30 a.m. and it's now 8:30 a.m., an alert might be sent to his son or daughter letting them know about the deviation in his schedule. They then have the option of calling to check in on him.
It might seem that older parents would reject the loss of privacy that can come with so much electronic eavesdropping, but that's an incorrect assumption, Ginzler said.
Nearly nine in 10 seniors in an AARP survey said they would be willing to give up some privacy if it allowed them to remain in their own homes longer. When asked about specific home safety technologies, seniors often said they would be willing to use them even if they weren't previously aware of the devices.
"Resoundingly, people said, 'Yeah, I'll learn new things,'" Ginzler said. "There's a resounding motivation for learning new things when your independence is on the line."
Though such devices aren't in wide use yet, a significant number of people seem to be taking advantage of them.
Harry Wang, director of health and mobile product research for Parks Associates, a Dallas-based market research firm that tracks digital technology trends, said that with "the senior safety tracking and monitoring that helps seniors remain in the home longer, we've seen a little bit better traction over the last several years."
About one in 10 caregivers of senior citizens use tracking sensors that can remotely detect a potential safety hazard in the home, according to an AARP survey of caregivers. About 16 percent of caregivers said they had used some type of emergency response system.
Parks Associates has projected that by 2012 more than 3.4 million senior citizens in the United States will be using networked sensor applications to monitor their movements and improve their health.
"There are more and more products out there, more and more technologies available," Wang said. "It's an emerging field. I don't think we're done with all those brilliant ideas yet."
However, Wang and Ginzler cited three things that must happen for such technologies to succeed:

• The design must be simple, elegant and enticing so that seniors can easily learn how to use the device -- and perhaps even enjoy it. "You have to make sure the solutions are well-designed, in the sense that it's exciting," Wang said. "It's not reminding seniors that they are old and fragile in the home, but reminding them that they are still young and able to enjoy life and remain in the home."
• The devices must come down in price. "The No. 1 barrier is the cost of the system," Wang said. "They must be affordable to seniors."
• Companies and families must market the devices properly. "A lot of this has to do with the way the technology is presented, and the family conversation about this," Ginzler said. "The message needs to be, 'We want to make sure you can stay in your house and be independent the way you want to be, and we can respond if you get in trouble.' When that family conversation goes well, it results in peace of mind both for that person and their family members."

http://consumer.healthday.com/Article.asp?AID=643459

"Learn About Senior In Home Health Care in Columbus, Ohio Senior Helpers Provides Many services in the Columbus, Ohio area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check. If you need Home Care services in Amlin, Clintonville, Columbus, Delaware, Dublin, Galena, Hilliard, Lewis Center, New Albany, Powell, Sunbury, Upper Arlington, Westerville, Worthington, and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Columbus Home Health Care Company. "

6 Estate Planning Questions Your Parents Should Answer

The essential issues your parents will address through estate planning

By Barbara Kate Repa, Caring.com Author

In deciding whether they need to do any estate planning, the key questions your parents should answer are whether there is any property they would like a particular person or charity to receive after their deaths and whether they have strong opinions about their medical care and final arrangements. If so, it's usually wise for them to get some simple documentation in writing to provide legal assurance that those wishes will be enforced.

Specifically, when considering whether to take any steps toward estate planning, your parents should ask themselves:

1. What are my assets and what is their approximate value?
2. What people or organizations do I want to have these assets -- and do I wish to give them up during my lifetime or after my death?
3. Who should manage these assets during my lifetime if I become unable to do so, or after my death if management is needed?

4. Who should be responsible for taking care of any minor or dependent children if I become unable to do so?
5. Who should make decisions about my medical care and finances if I     cannot make them?
6. After I die, do I want my remains to be donated, cremated, scattered, or buried?

http://www.caring.com/checklists/estate-planning-questions

"Learn About Senior In Home Health Care in Columbus, Ohio Senior Helpers Provides Many services in the Columbus, Ohio area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check. If you need Home Care services in Amlin, Clintonville, Columbus, Delaware, Dublin, Galena, Hilliard, Lewis Center, New Albany, Powell, Sunbury, Upper Arlington, Westerville, Worthington, and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Columbus Home Health Care Company. "

Aged care market will drive franchise growth; Paul Wheeler

• MEREDITH BOOTH

• From:AdelaideNow

• February 02, 2011

BABY Boomers are the target for a new Australasian franchise headed by former Cartridge World chiefs Paul Wheeler and Mike Fuller.
The duo has announced its first master franchise deal with US group Senior Helpers since launching their consultancy business Group Seven last year.
The deal comes three years after Mr Wheeler and co-founder Bryan Stokes sold down their share of the successful global Cartridge World business for a reported $70 million.
Group Seven aims to build a $150 million business in the next seven years as it opens 75 and 100 outlets across Australia and New Zealand to offer non-medical help to the elderly in their homes.
Mr Fuller said Australia was "crying out for an organised alternative" to services which help the elderly live in their own homes.
Demand for "companion and personal services" for the elderly is expected to grow as Australians aged over 65 double to 6 million by 2031, the group said.
"People want to stay in their homes. They want to be as independent as they can. It's not always possible for families to provide the full extent of that support and Senior Helpers is a fabulous business ...," Mr Wheeler said.
Senior Helpers founders Peter Ross and Tony Bonacuse, in Adelaide this week, operate the fastest growing home care company in the world, building to a 300-franchise business in just 10 years.
Mr Ross said he had been aware of the Cartridge World brand in the US before teaming with Group Seven and was confident the group would meet its Australasian ambitions, particularly with a more competitive US home care market than in Australia and similar demographics.
Senior Helpers deal with Group Seven is its first foray outside North America, spearheading international expansion plans which will target 16 countries.
The franchise will include a training component for aged care workers expected to be based at Group Seven's Norwood headquarters.

http://www.adelaidenow.com.au/business/aged-care-market-will-drive-franchise-growth-paul-wheeler/story-e6fredj3-1225998666516

"Learn About Senior In Home Health Care in Columbus, Ohio Senior Helpers Provides Many services in the Columbus, Ohio area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check. If you need Home Care services in Amlin, Clintonville, Columbus, Delaware, Dublin, Galena, Hilliard, Lewis Center, New Albany, Powell, Sunbury, Upper Arlington, Westerville, Worthington, and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Columbus Home Health Care Company. "

Letting Mom and Dad Live on Their Own Terms

Author: Janice Van Dyck

Millions of us went home for the holidays. Well, not "home" exactly. In reality, millions of us left home, and went back for the holidays. Back to who we used to be, back to where we came from, and in some cases, back in time. Like salmon up the river, we inexplicably navigated back to the people of our birth. Our parents.
Have you ever made the trip thinking, what if this is the last time? Parents age, especially when we're not looking, and most especially when we live far away from them. Periodic visits sharpen our senses. All of a sudden, we may be witnessing our parents in steep decline, heading toward the exit ramp, and it raises all kinds of questions.
When will it be time for assisted living? Should Mom still be driving? Are they taking their pills? Is Dad's memory actually shot?
These realizations can be tough, especially if your parents have been role models of determination and resourcefulness. Dealing with normal age-related decline can cause dissention amongst siblings, too, because each has a different relationship with Mom and Dad. For example, in my family, my sister lives closest to our father, and has regular visits with him. My brother and I live in different corners of the country and our main contact with Dad is by e-mail and telephone. Who is in the best position to judge how he's doing? As he approaches the 80-year mark, who has got the best perspective on his health?
This same conversation came up a few days ago in my book club, and again with friends at dinner last night. It seems that everyone of a certain age with living parents has the same questions. There are no easy answers. But I offer these three issues at the root of the debate:
Whose life is it anyway? We live our lives free to make our own mistakes, to put ourselves at risk and determine our own destinies. Why should this change just because we're old?
In our culture, roles often reverse: At some point adult children seem to think they need to parent their parents. This is fine if a parent asks for help, but often elderly parents are resentful because their middle-aged kids keep bossing them around. Their final years are full of conflict and humiliation because of well-meaning -- but strong-willed -- children, intent on removing the "risks" of living. So what if Dad's floors are dirty or your parents don't take their medicine and are going to get sick? If it's their choice, then perhaps you need to reconcile yourself to the fact they're not living their lives your way. And that's ok. After all, since anywhere from your teen years forward, they had to adjust that you weren't living your life their way.
Are your parents capable of clear thinking and reasonable risk assessment? Again, remember that at one time (or perhaps several times), they doubted your ability to make decisions. The point here is whether or not there's an actual, treatable medical/psychological impairment that would prevent your parent from rational thinking and action. And unless you're a doctor, you really can't make this determination on your own.
Consider getting an expert opinion before you take your parents' checkbook away. When they want to blow money at the casino or turn the heat down too low or mow the lawn themselves, just remember that even though it isn't what you want for them, that doesn't mean they shouldn't be allowed to do it. That being said, a parent who is unable to fend for him or herself because of a disability obviously needs help. But when it comes to your parent's livelihood, be careful to distinguish between fact and opinion.
Are your parents putting other people at risk? This again, is a matter of degree. Take driving, for example: We all put others at risk each time we get behind the wheel of a car. Senior citizens represent about 15 percent of all drivers, and they tend to get in more accidents due to age-related skill decline. But driving is risky anyway, and younger people can be even worse drivers than someone's 82-year old father driving 40 mph on the freeway.
So when calculating the risk factor, be realistic. If you worry about your parent causing a fire, it is obviously more dangerous if they live in multi-unit complex than a single home.
If you're struggling with how much autonomy and freedom your parents should have as they age, remember that someday, someone will be making the same decisions for you. Show your kids how you want to be handled in your old age by setting an example with your own parents. I don't know about you, but as long as I'm not hurting other people or actually incapable of making my own decisions, I want to be able to live with the consequences of my own actions, regardless of how old I am.
And you know what? Maybe that's a concept we're losing in our society, the idea of consequences. We can't protect our kids from getting hurt in life by putting a bicycle helmet on them in the stroller (which I actually saw the other day). Nor can we protect our parents from dying by taking away their dignity, freedom and choice. When we're born, the only guarantee is that someday we're going to die. That's the risk of living.
Since losing our parents is inevitable, why not let them do it on their own terms? I know of a man, now 94, who bought into a senior living community in his 80's. He hated it and moved out despite the protests of his family. I applaud his courage! What's the worst thing that could happen? He might die alone, on his own terms, looking around at his own belongings, satisfied that his life was well lived.
His only regret might be that his children didn't understand.

http://www.huffingtonpost.com/janice-van-dyck/how-storytelling-can-exte_b_805502.html

"Learn About Senior In Home Health Care in Columbus, Ohio Senior Helpers Provides Many services in the Columbus, Ohio area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check. If you need Home Care services in Amlin, Clintonville, Columbus, Delaware, Dublin, Galena, Hilliard, Lewis Center, New Albany, Powell, Sunbury, Upper Arlington, Westerville, Worthington, and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Columbus Home Health Care Company. "

Who Thrives After Surgery?

By PAULA SPAN
Martin A. Makary, a surgeon and public health researcher at Johns Hopkins Hospital in Baltimore, had a long talk with a patient last week. The man had a tumor in his pancreas that was probably benign but might not be. Should Dr. Makary remove it? Or should the man have regular scans to see whether it grew?
"If you're 25, the decision is easy — get rid of that risk," Dr. Makary told me afterward. But this patient was 89.
Let's pause for a moment to consider the changing surgical landscape. When Dr. Makary was in training, he recalled, surgeons were just starting to offer elective procedures to patients in their 70s. Now, with better techniques, safer anesthesia and, of course, more old people — half of all operations in the United States are performed on those over age 65.
"It's become acceptable to do major procedures on very old patients," he said. "We routinely do elective surgery on people in their 80s and 90s."
That doesn't mean it's always a good idea, or that it's easy to calculate the costs and benefits. How very old patients respond to surgery has proved unpredictable. "There are some people you worry won't do well, and then they fly," Dr. Makary said. "And some people you are confident will do well have a cascade of symptoms that lead to their demise or permanent disability — and everybody is shocked."
Surgeons eyeball their patients all the time to try to evaluate whether they can recover well from the stress of an operation, but it's an inexact science. "You can be thrown off by hair or teeth or wrinkles, things that don't have much to do with physiologic reserve," Dr. Makary said.
The usual tests surgeons use to try to predict how older patients will fare are crude, Dr. Makary added, mostly based on cardiovascular strength. And standard estimates of mortality and length of hospitalization for specific operations are all but useless for patients who might be 30 or 40 years older than the norm.
But thanks to a rather elegant piece of research by a Johns Hopkins team, recently published in The Journal of the American College of Surgeons, surgeons can give more informative answers when elderly patients in this situation, or their families, wonder what to do.
For years, the geriatrician and gerontologist Linda P. Fried, now dean of the Mailman School of Public Health at Columbia University, has been talking and writing about frailty. We laypeople tend to use the word imprecisely to allude to fragility or vulnerability in old people, but for physicians and researchers, frailty is a specific medical syndrome with measurable criteria.
They look for a series of declines that include weight loss (specifically, an unintentional loss of 10 pounds or more in the past year), a weaker grip, exhaustion and lack of physical activity, and a slower gait. The assessment takes perhaps 15 minutes to conduct in an office. Then the doctors assign a score: 0 to 1 for those who aren't frail, 2 to 3 for the intermediately frail.
Patients who score 4 to 5 are frail. "They tend to have much less reserve, a decreased ability to bounce back" from physiological stress, said Dr. Fried, who previously taught at Johns Hopkins.
Might frailty scores be better at predicting how patients fare after surgery than the existing methods? For a year, Dr. Makary, Dr. Fried and their colleagues at Johns Hopkins tracked nearly 600 patients over age 65 who had elective surgery in that hospital – from minor gallbladder removal to joint replacement and major abdominal surgery. All lived independently.
The researchers assessed patients' frailty before their operations: slightly more than 10 percent were adjudged frail (average age 76.3), and more than 58 percent weren't frail at all (average age 71.3). The remainder were classified as intermediately frail.
"The data are quite persuasive," Dr. Fried said. "People who are frail before surgery are at higher risk for poor outcomes afterwards." This is the way careful researchers talk; they say results are "persuasive."
A layperson like, say, me would say: Yow. The frailty index did a superior job of predicting how seniors will do after surgery, and just look at the extent of the differences.
Those who were intermediately frail faced twice the odds of complications after surgery, compared to patients who were not frail, according to the study; frail patients had more than two and a half times the complication rate. Hospital stays were 44 percent to 53 percent longer for those intermediately frail, and 65 percent to 89 percent longer for the frail.
And after operation, the odds of a patient being discharged to a nursing home or to assisted living, instead of her own home, rose in proportion to her frailty. The intermediately frail were more than three times as likely to have to enter such a facility, compared with those who were not frail. The frail were 20 times (not a typo) as likely to go to a nursing home or assisted living — from which they may or may not have emerged.
"If the risks are likely to be higher, it changes the equation as to whether the surgery has benefit," Dr. Fried said.
That 89-year-old patient, for example, turned out to be intermediately frail when Dr. Makary evaluated him using the frailty index. "I thought he was stronger," he acknowledged. After considerable discussion, doctor and patient agreed not to remove the tumor, but to track it with annual scans.
Surgeons at Johns Hopkins have widely adopted the index to help make such pre-op decisions, and Dr. Makary says he has heard from surgeons at about a dozen other major medical centers who are also using it. In some cases, patients may decline surgery. In many, they and their families will have a more realistic idea of how long recovery may take and how much help they will need.
This is a question, Dr. Makary suggested, that older patients and their families ought to routinely ask their surgeons in fairly blunt terms: You want to operate on my father? You think he's too old for surgery? What's his frailty score?

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http://newoldage.blogs.nytimes.com/2010/12/28/who-thrives-after-surgery/?partner=rss&emc=rss

"Learn About Senior In Home Health Care in Columbus, Ohio Senior Helpers Provides Many services in the Columbus, Ohio area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check. If you need Home Care services in Amlin, Clintonville, Columbus, Delaware, Dublin, Galena, Hilliard, Lewis Center, New Albany, Powell, Sunbury, Upper Arlington, Westerville, Worthington, and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Columbus Home Health Care Company. "