Forty years ago Army Staff Sgt. Walt Myers was exposed to the herbicide Agent Orange in Vietnam. Now he suffers profound muscle weakness in his legs. He was facing the possibility of spending the rest of his life in a wheelchair. But thanks to a special knee brace developed at Mayo Clinic, Myers is walking tall.
Learn more about the new Mayo Clinic W. Hall Wendel Jr. Musculoskeletal Center by clicking here: http://www.mayoclinic.org/musculoskeletal-center-rst/
Many Americans die in facilities such as hospitals or nursing homes receiving care that is not consistent with their wishes. To make sure that doesn’t happen, older people need to know what their end-of-life care options are and state their preferences to their caregivers in advance. For example, if an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes this known to healthcare providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments.
Caregivers have several factors to consider when choosing end-of-life care, including the older person’s desire to pursue life-extending or curative treatments, how long he or she has left to live, and the preferred setting for care.
Doctors can provide treatment to seriously ill patients in the hopes of a cure for as long as possible. These patients may also receive medical care for their symptoms, or palliative care, along with curative treatment.
A palliative care consultation team is a multidisciplinary team that works with the patient, family, and the patient’s other doctors to provide medical, social, emotional, and practical support. The team is made of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains.
Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics and certain other specialized clinics, or at home. Medicare, Medicaid, and insurance policies may cover palliative care. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance might pay for some services. Health insurance providers can answer questions about what they will cover. Check to see if insurance will cover your particular situation.
In palliative care, you do not have to give up treatment that might cure a serious illness. Palliative care can be provided along with curative treatment and may begin at the time of diagnosis. Over time, if the doctor or the palliative care team believes ongoing treatment is no longer helping, there are two possibilities. Palliative care could transition to hospice care if the doctor believes the person is likely to die within 6 months (see What does the hospice 6-month requirement mean?). Or, the palliative care team could continue to help with increasing emphasis on comfort care.
At some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. Hospice is designed for this situation. The patient beginning hospice care understands that his or her illness is not responding to medical attempts to cure it or to slow the disease’s progress.
Like palliative care, hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person’s illness are stopped. Hospice is provided for a person with a terminal illness whose doctor believes he or she has 6 months or less to live if the illness runs its natural course.
Hospice is an approach to care, so it is not tied to a specific place. It can be offered in two types of settings—at home or in a facility such as a nursing home, hospital, or even in a separate hospice center.
Hospice care brings together a team of people with special skills—among them nurses, doctors, social workers, spiritual advisors, and trained volunteers. Everyone works together with the person who is dying, the caregiver, and/or the family to provide the medical, emotional, and spiritual support needed.
A member of the hospice team visits regularly, and someone is always available by phone—24 hours a day, 7 days a week. Hospice may be covered by Medicare and other insurance companies; check to see if insurance will cover your particular situation.
It is important to remember that stopping treatment aimed at curing an illness does not mean discontinuing all treatment. A good example is an older person with cancer. If the doctor determines that the cancer is not responding to chemotherapy and the patient chooses to enter into hospice care, then the chemotherapy will stop. Other medical care may continue as long as it is helpful. For example, if the person has high blood pressure, he or she will still get medicine for that.
Some Differences Between Palliative Care and Hospice
Who can be treated?
Anyone with a serious illness
Anyone with a serious illness whom doctors think has only a short time to live, often less than 6 months
Will my symptoms be relieved?
Yes, as much as possible
Yes, as much as possible
Can I continue to receive treatments to cure my illness?
Yes, if you wish
No, only symptom relief will be provided
Will Medicare pay?
It depends on your benefits and treatment plan
Yes, it pays all hospice charges
Does private insurance pay?
It depends on the plan
It depends on the plan
How long will I be cared for?
This depends on what care you need and your insurance plan
As long as you meet the hospice’s criteria of an illness with a life expectancy of months, not years
Although hospice provides a lot of support, the day-to-day care of a person dying at home is provided by family and friends. The hospice team coaches family members on how to care for the dying person and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks.
Families of people who received care through a hospice program are more satisfied with end-of-life care than are those of people who did not have hospice services. Also, hospice recipients are more likely to have their pain controlled and less likely to undergo tests or be given medicines they don’t need, compared with people who don’t use hospice care.
For More Information About Hospice and Palliative Care
Human beings are social creatures. Feeling like we’re part of a community helps us thrive. But we sometimes have a hard time making and keeping the relationships that sustain us. Many Americans report feeling lonely for long periods of time. Connections with others are important for your health.
Social isolation and loneliness can both cause problems. “Isolation is about whether other people are physically there or not. Being lonely is about not feeling connected to others. You can feel lonely in a room full of people,” explains Dr. Steve Cole, an NIH-funded researcher at the University of California, Los Angeles, who studies loneliness.
Loneliness not only feels bad, it may also be harmful to your health. People who feel lonely are at higher risk of many diseases. These include heart disease, high blood pressure, and Alzheimer’s disease. Loneliness may also increase the risk of death for older adults.
Some of the increased risk of disease may come from changes in behavior. People who feel isolated may not have friends or family encouraging them to eat right, exercise, or see a doctor. New research suggests that loneliness can also directly harm our health.
“Lonely people have differences in their biology that make them more vulnerable to disease,” Cole explains. He and colleagues have studied how loneliness affects the immune system, your body’s disease fighting system. They found that loneliness may alter the tendency of cells in the immune system to promote inflammationHeat, swelling, and redness caused by the body’s protective response to injury or infection.. Inflammation is necessary to help our bodies heal from injury. But when it goes on too long, it may raise the risk of chronic diseases.
People who feel lonely may also have weakened immune cells that have trouble fighting off viruses. “So that leaves lonely people more vulnerable to a variety of infectious diseases,” Cole adds.
People often associate loneliness with getting older. But you can feel lonely at any age. A recent survey found that young Americans are more likely to feel lonely than older adults. Some research suggests that social media tools and resources are preventing younger people from connecting in real life, Cole says. However, more studies are needed to know whether this is true.
It can be hard for people to talk about loneliness, Cole explains. They may feel like something is wrong with them, even though feeling lonely happens to almost everyone at some point.
NIH-funded researchers are looking into ways to help people break the cycle of loneliness. Studies have shown that feelings of loneliness can be reduced by helping others, Cole says. Caregiving and volunteering to help others may therefore help people to feel less lonely.
Having a sense of purpose in life may be another way to fight the effects of loneliness. Research has found that having a strong sense of mission in life is linked to healthier immune cells. “And when you start to pursue a goal that’s important to you, you almost always have to cooperate with others to do that,” Cole says. “That helps bring people together.”
Don’t have time for intensive skin care? You can still pamper yourself by acing the basics. Good skin care and healthy lifestyle choices can help delay natural aging and prevent various skin problems. Get started with these five no-nonsense tips.
One of the most important ways to take care of your skin is to protect it from the sun. A lifetime of sun exposure can cause wrinkles, age spots and other skin problems — as well as increase the risk of skin cancer.
For the most complete sun protection:
Use sunscreen. Use a broad-spectrum sunscreen with an SPF of at least 15. Apply sunscreen generously, and reapply every two hours — or more often if you’re swimming or perspiring.
Seek shade. Avoid the sun between 10 a.m. and 4 p.m., when the sun’s rays are strongest.
Wear protective clothing. Cover your skin with tightly woven long-sleeved shirts, long pants and wide-brimmed hats. Also consider laundry additives, which give clothing an additional layer of ultraviolet protection for a certain number of washings, or special sun-protective clothing — which is specifically designed to block ultraviolet rays.
Smoking makes your skin look older and contributes to wrinkles. Smoking narrows the tiny blood vessels in the outermost layers of skin, which decreases blood flow and makes skin paler. This also depletes the skin of oxygen and nutrients that are important to skin health.
Smoking also damages collagen and elastin — the fibers that give your skin strength and elasticity. In addition, the repetitive facial expressions you make when smoking — such as pursing your lips when inhaling and squinting your eyes to keep out smoke — can contribute to wrinkles.
In addition, smoking increases your risk of squamous cell skin cancer. If you smoke, the best way to protect your skin is to quit. Ask your doctor for tips or treatments to help you stop smoking.
Daily cleansing and shaving can take a toll on your skin. To keep it gentle:
Limit bath time. Hot water and long showers or baths remove oils from your skin. Limit your bath or shower time, and use warm — rather than hot — water.
Avoid strong soaps. Strong soaps and detergents can strip oil from your skin. Instead, choose mild cleansers.
Shave carefully. To protect and lubricate your skin, apply shaving cream, lotion or gel before shaving. For the closest shave, use a clean, sharp razor. Shave in the direction the hair grows, not against it.
Pat dry. After washing or bathing, gently pat or blot your skin dry with a towel so that some moisture remains on your skin.
Moisturize dry skin. If your skin is dry, use a moisturizer that fits your skin type. For daily use, consider a moisturizer that contains SPF.
A healthy diet can help you look and feel your best. Eat plenty of fruits, vegetables, whole grains and lean proteins. The association between diet and acne isn’t clear — but some research suggests that a diet rich in fish oil or fish oil supplements and low in unhealthy fats and processed or refined carbohydrates might promote younger looking skin. Drinking plenty of water helps keep your skin hydrated.
Uncontrolled stress can make your skin more sensitive and trigger acne breakouts and other skin problems. To encourage healthy skin — and a healthy state of mind — take steps to manage your stress. Get enough sleep, set reasonable limits, scale back your to-do list and make time to do the things you enjoy. The results might be more dramatic than you expect.
Skin care. American Osteopathic College of Dermatology. http://www.aocd.org/?page=SkinCare. Accessed Oct. 12, 2017.
Prevention guidelines. Skin Cancer Foundation. http://www.skincancer.org/prevention/sun-protection/prevention-guidelines. Accessed Oct. 12, 2017.
Clothing: Our first line of defense. Skin Cancer Foundation. http://www.skincancer.org/prevention/sun-protection/clothing/clothing-our-first-line-of-defense. Accessed Oct. 12, 2017.
Brinker TJ, et al. A dermatologist’s ammunition in the war against smoking: A photoaging app. Journal of Medical Internet Research. 2017;19:1. https://www.jmir.org/2017/9/e326/. Accessed Oct. 12, 2017.
Dusingize JC, et al. Cigarette smoking and the risks of basal cell carcinoma and squamous cell carcinoma. Journal of Investigative Dermatology. 2017;137:1700.
Dry skin: Overview. American Academy of Dermatology. https://www.aad.org/public/diseases/dry-sweaty-skin/dry-skin. Accessed Oct. 12, 2017.
How to create an anti-aging skin care plan. https://www.aad.org/public/skin-hair-nails/younger-skin/creating-anti-aging-plan. Accessed Oct. 12, 2017.
Melnik BC. Linking diet to acne metabolomics, inflammation, and comedogenesis: An update. Clinical, Cosmetic and Investigational Dermatology. 2015;8:371.
Palma L, et al. Dietary water affects human skin hydration and biomechanics. Clinical, Cosmetic and Investigational Dermatology. 2015:8;413.
Hunter HJA, et al. The impact of psychosocial stress on healthy skin. Clinical and Experimental Dermatology. 2015;40:540.
Improving healthcare is the mission of HealthLynked. HealthLynked focuses on improving healthcare services for patients as well as physicians. Our technology shortens wait time with online scheduling of appointments, Real-time appointments by local providers and provides easy access to yours as well as your family’s updated medical records.
Appointments can be comfortably made online and providing your healthcare provider access to your medical files. The website also makes it possible to link together family members and provide access to critical information in case of an emergency