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Mature Focus: Aug. 7

Sandwiched at work

As the population ages, more and more American workers are providing care for elderly parents, which is increasingly creating needs for support from their employers.

In addition to their full-time jobs, about a quarter of American adults now care for an elderly family member on an unpaid basis, according to the U.S. Census Bureau. This number is only expected to rise as more people live into their 80s and beyond, and many seniors choose to “age in place” in their homes rather than entering nursing homes or other care facilities.

Many of those informal caregivers experience significant work disruptions as a result. However, they often don’t receive support from their employers, either because it is not offered or because they are hesitant to use it, according to a recent study.

Researchers from Baylor University, Louisiana State University and the University of Iowa analyzed data from about 650 people who described themselves as informal caregivers. Nearly three-fourths of those interviewed said they experience some degree of work interruption due to their caregiving responsibilities, ranging from mild disruptions such as adjusting work hours to more severe ones, such as needing to move from full-time to part-time status or taking a leave of absence. 

More than half of those serving as caregivers for 10 or more hours weekly reported more severe disruptions at work.

“So-called sandwiched caregivers, typically middle-aged, are caring for ailing parents while trying to work full-time and raise their own children,” said the study’s lead author Matthew A. Andersson, Ph.D., an assistant professor of sociology at Baylor.

“But what’s particularly troubling … is that employees who are experiencing work interruption are much more likely to say they have unmet need for workplace support than those who manage to keep working at the same pace,” Andersson said. “This tells us that employers may not be stepping up to connect informal caregivers with workplace supports they need. That makes informal caregiving an even tougher role.”

Andersson cited employer-sponsored programs such as eldercare referral or financial counseling, along with workplace environments and training programs structured to accommodate and support family needs, as areas of opportunity for employers. 

“We know that informal caregiving is becoming more common and more complicated due to the multiple health conditions of care recipients and the all-too-familiar work-family conflict … we need to get employers more involved in the reality of this pressing situation,” he added. 

Pinpointing surgery risks

The American College of Surgeons recently identified four specific health factors impacting elderly patients’ lifestyles and ability to return home after surgery.

Seniors who undergo surgery are often more vulnerable than younger adults to complications that delay their recovery. As part of its Geriatric Surgery Pilot Project, the American College of Surgeons recently identified four specific risk factors associated with older patients’ inability to return home for at least a month after surgery. 

A research team looked at about 4,000 patients who had inpatient procedures between 2015 and 2017. Eighteen percent of them were still living in a care facility 30 days after surgical treatment. These patients commonly had one or more of four health events: 1. a history of a fall within the past year, 2. preoperative malnutrition as defined by more than 10% of unintentional weight loss, 3. postoperative delirium, and 4. a new or worsening pressure ulcer after surgery.

This information can help surgeons advise patients beforehand about the possible effects of a surgical procedure on their clinical outcomes and future lifestyles, the group stated. It also may guide hospital quality improvement programs to address these conditions.

“When surgeons speak with older patients about the decision to operate, we discuss complication rates and the risk of mortality. We don’t usually talk about whether they will have the independence they had beforehand,” said study co-author Ronnie Rosenthal, M.D., F.A.C.S. “This information should help us make better preoperative decisions with our patients by allowing us to tell them about the impact a surgical procedure will have on their way of life.” 

Money management-dementia connection 

Problems with simple money math, such as making change or figuring tips, are extremely common with aging. But trouble managing money can also be a symptom of dementia, and may correlate with the amount of protein deposits called amyloid plaques built up in the brain, according to new Duke University research. 

“There has been a misperception that financial difficulty may occur only in the late stages of dementia, but this can happen early and the changes can be subtle,” said P. Murali Doraiswamy, MBBS, a professor of psychiatry and geriatrics at Duke and the study’s senior author. 

The study included 243 adults between 55 and 90 participating in the Alzheimer’s Disease Neuroimaging Initiative, which included tests of financial skills along with brain scans to look for protein buildup. The testing showed that more extensive amyloid plaques were directly related to a deteriorating ability to understand basic financial concepts and complete tasks, such as calculating account balances. These declines were similar in men and women.

“Older adults hold a disproportionate share of wealth in most countries and an estimated $18 trillion in the U.S. alone,” Doraiswamy said. “Given the rise in dementia cases [expected] over the coming decades and their vulnerability to financial scams, this is an area of high priority for research.”

Most testing for early dementia and Alzheimer’s disease now focuses on memory skills, the researchers pointed out. A financial capacity assessment could be another valuable tool for doctors to track subtle changes in a person’s cognitive function over time, and could also help older adults protect their finances, they added.

The study was published in The Journal of Prevention of Alzheimer’s Disease.

MoBap receives ACEP geriatric accreditation
The Missouri Baptist Medical Center emergency department recently earned a Level 3 Accreditation for geriatric care from the American College of Emergency Physicians [ACEP]. MoBap is the first St. Louis area hospital to achieve this accreditation, and one of only three hospitals in the state.
ACEP launched the nationwide program in 2014, to recognize emergency departments that provide excellent care for older adults as the U.S. population ages. Guidelines range from adding geriatric-friendly equipment and specialized staff to providing routine screening for delirium, dementia and fall risk. 
For MoBap, the accreditation follows a three-year effort to improve care for older patients both during and after their emergency department visits. An analysis of its patient population had initially found that 37% of emergency visits were by people older than 65, with falls often listed as the cause of their injuries. 
This analysis led to a multi-disciplinary effort to improve care, with an emphasis on reducing patients’ long-term fall risk. It includes home health visits immediately after discharge for patients determined to be at high risk for falls, as well as providing seniors with mobility devices such as canes or walkers to improve their safety and working with their primary care physicians on long-term plans to reduce fall risk.
In addition to the fall prevention program, MoBap is nearing completion of a two-year, $1.3 million capital improvement project to refresh the ED environment, focusing on safety for the geriatric population.
“The GEDA accreditation validates all of the hard work by those involved in developing our fall program and in updating our facilities,” said Emergency Medicine Associate Chief Joseph Galkowski, D.O. “And we will continue to look for best practices and other ways to enhance the care we provide to all those in need, particularly our geriatric patients.”

On the calendar

A Total Control Course is offered on Mondays and Wednesdays, Aug. 12 through Sept. 30, from 1:30-2:45 p.m. at the St. Luke’s Desloge Outpatient Center, 121 St. Luke’s Center Drive in Chesterfield, in Building B. This course integrates specific core training exercises and educational discussions to help women improve their pelvic health. Topics include nutrition selection, pharmaceuticals, behavior modifications and lifestyle information. The course fee is $99. Register online at stlukes-stl.com; call (314) 205-6881 with questions.

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Missouri Baptist Medical Center presents a free monthly caregiver class, Supporting the Caregiver, on Tuesday, Aug. 13 from 1-2:30 p.m. in Auditorium 1 of the hospital, 3015 N. Ballas Road. This class is for those caring for a loved one; BJC employees will provide personal and professional insight on resources to assist caregivers. Light refreshments will be served. Register online at https://classes-events.bjc.org.

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St. Louis Oasis presents a free information session, Opiates: What You Need to Know, on Wednesday, Aug. 14 from 10 a.m.-noon at Missouri Baptist Medical Center, 3015 N. Ballas Road, in Room 420 of the Clinical Learning Center. To register, call (314) 996-5433.

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BJC Missouri Baptist Medical Center sponsors a Today’s Grandparents class on Thursday, Aug. 15 from 6:30-9 p.m. in Building D, Suite 400 of the hospital, 3023 N. Ballas Road. This two-hour class serves as an update for grandparents-to-be, and focuses on current trends in infant care as well as tips on both local and distant grandparenting. Discussion is encouraged; a tour of the OB division is included. The cost is $20 per person. Register each grandparent online at https://classes-events.bjc.org.

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St. Luke’s Hospital presents Heart Failure, Now What?, on Tuesday, Aug. 20 from 1-2:30 p.m. at the Desloge Outpatient Center, 121 S. Luke’s Center Drive in Chesterfield, in Building A. The word “failure” can be a wake-up call for those diagnosed with heart failure; it can also provide motivation to do something about it and be successful at taking care of your heart. Join a multi-disciplinary team of health professionals to discuss proven strategies to help you take control of your heart health and minimize your risk of complications. The program is free. Register online at stlukes-stl.com; call (314) 542-4848 with questions.

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Choice: Healthy Living for Seniors sponsors a Beginning Meditation course on Friday, Aug. 23 from 10-11 a.m. at the Samuel Sachs Library, 16400 Burkhardt Place in Chesterfield. Participants will learn simple meditation techniques, presented by Sahaja Meditation Group, to achieve mental silence, inner peace, and a stress-free life. Class sizes are limited. To register, call 314-994-3300 or visit agingahead.org. Following class, participants may stay for lunch from St. Louis Bread Company; the suggested donation for lunch is $5 for those over age 60 and $10 for those under 60. Choice events are sponsored through a partnership between the St. Louis County Library and Aging Ahead. 

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An AARP Smart Driver Course is offered on Wednesday, Sept. 18 from 9 a.m.-1 p.m. at the Ellisville Parks and Recreation building, 225 Kiefer Creek Road in Ellisville. This program will help tune up your driving skills, update your knowledge of the rules of the road, learn about normal age-related physical changes and ways to adjust for these changes. The cost is $15 for AARP members and $20 for non-members. To register, call (314) 780-8465.

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