Sunday, December 7, 2008

Elderspeak and Baby Talk: Same language?


All too often, in an attempt to be friendly or as a way of showing an elderly person they care, health care providers, retail clerks, hair dressers and restaurant servers, just to name a few, start talking in “elder speak.” People use this form of language when they assume that the older person they are talking to isn’t “all there” and probably can’t hear very well, either. In no time at all, they start dumbing down the conversation to a point where it almost sounds like “baby talk.”

If you’re wondering what elderspeak sounds like, here are some examples offered up by respondents on the “New Old Age” blog of the New York Times:

When asking someone their age, they ask “How many years young are you?”

Salutations often begin with “Hi sweetie, cutie, or honey.”

Actions, as simple as taking a pill, are evaluated like a grade school child with “Good job! Or good girl or good boy.”

A woman clearly in her seventies and older is referred to as “young lady.”

The nurse or doctor who asks her patient, “How are we feeling?”

Rather than asking about a career or current interests, an older person is asked, “Who were you or what did you used to be?

Greeting older people by their first name, as they would a teenager.


The overall tone of elderspeak is usually patronizing, over bearing and spoken slowly in a loud voice using simple words. The speech sends the subliminal message that the older person is incompetent. And here’s the thing: people pick up on it – even those with Alzheimer’s disease – and they don’t like it. They see it as insulting and a form of bullying.

New research shows that elderspeak, no matter how well intentioned by the speaker, is a lot more than an annoyance for those on the receiving end. Dr. Kristine Williams, an associate professor at the University of Kansas School of Nursing, analyzed hundreds of video tapped interactions between staff and residents who suffered from mild to moderate dementia. They identified if the staff used elderspeak, spoke normally or said nothing at all while they helped a resident with bathing, dressing, or grooming and then rated how residents reacted to the exchange. What the researchers found was sobering: when nurse aides used elderspeak, the residents resisted by physically pulling back, saying no, grimacing, grabbing the person or clenching their teeth. The more the residents became uncooperative, the more the staff resorted to talking to them like misbehaving children.

Dr. Mary Mittleman, Director of Psychosocial Research at the Silberstein Institute on Aging explains it this way: “It is a mistake to assume that a diagnosis of dementia means that a person becomes more like a baby. They may still have a lot of memories from far-distant times…they have a history which babies don’t.” She goes onto advise that ‘speaking to a person as an adult is probably going to get a whole lot more cooperation.”

It’s not just older people with dementia that are negatively affected by elderspeak. Anyone over sixty can be worn down by all the negative messages and images of aging conveyed in our culture, let alone as to how people talk to them. One major study showed that older people, who buy into these harmful perceptions and stereotypes, live 7.5 years LESS than those who ignore them and keep a positive attitude about growing older.

YOUR TURN

Share your elderspeak story. What's your pet peeve?

Thursday, November 6, 2008

Dogs Making Hospital Rounds


Question: My mom is going into the hospital for a lengthy stay and hates the thought of not being able to see her dog. She begged me to ask her doctor if I could bring the dog in to see her in her hospital room. I’m afraid to ask. Is that even possible?

Answer: Believe it or not, your mom’s furry friend has a pretty good chance of being able to make a get well visit at the hospital. In fact, dogs are fast becoming new members of the medical team at hospitals in the region and throughout the country.

Over the years, plenty of research has shown the benefits of “pet therapy” for nursing home residents and children suffering from chronic and life threatening illnesses. As a result, it’s not uncommon to visit a senior care facility today and be greeted by the center’s dog, an aquarium in the lobby and a cat snoozing on the lap of a resident.

Studies show that blood pressure rates among humans are reduced when a friendly dog or cat enters the room and it goes even lower when people stroke or cuddle the pet. Researchers at UCLA Medical Center, Los Angeles, report that a short bedside visit with a therapy animal can ease anxiety levels by 24 percent in heart patients compared to a 10 percent drop when visited by a human volunteer.

People tend to smile and feel less stress and tense when “man’s best friend” enters the scene: And where best to reduce stress and anxiety but in an emergency room? That’s where you’ll find therapy dogs through Hershey Medical Center’s Pet Program coordinated by Cindy Wilson. “We’ve found the dogs offer a positive distraction in the emergency room, but you’ll also find them visiting patients in the ICU unit and throughout the entire hospital.” It’s not unusual for physicians to give her a call to “prescribe” a visit to a patient from one of the program’s therapy dogs. The program has become so popular among doctors that two of them actually volunteer with their own dogs.

Many hospitals throughout the country use therapy pets to promote the recuperation of their patients. It is more common for licensed therapy dogs to make patient visits with their owners who have attended training programs than having the patient’s pet come to visit.

But arrangements can be made for personal pet visits and, in your mother’s case, approach her physician and ask him or her to prescribe a recuperative in-room visit with her pet. The hospital will likely require that her dog is well groomed and verification from a veterinarian that the dog is up to date with vaccinations and healthy.

Besides the benefit of touch and positive emotional feelings that, in turn, strengthen the immune system; animal-assisted therapy can also make great gains in physical rehabilitation. One of Cindy Wilson’s favorite stories is watching a stroke patient being given a brush to groom a dog as a way for her to perform her physical therapy. She was much more motivated to reach and brush the dog rather than reach for a ball. It distracted her from the pain. “It’s so joyful to see how pets can touch a patient’s life,” exudes Wilson, “it’s not about me…I’m just at the other end of the leash.”

YOUR TURN TO SPREAD THE JOY

So for those of you who have a good natured pet and would like to spread the joy as a therapy pet volunteer visiting local hospitals, nursing homes, hospices and adult day centers here are some resources for you:

Contact Therapy Dogs International and they will identify a local dog evaluator for you and your pet to meet so they can determine whether or not your dog is ready for assisted pet therapy and what training is required.

Want to see a Youtube video on pet therapy?

Delta Society promoting the "Human-Animal Health Connection" is another great resource to find training in your area for you and your dog to become a volunteer

Also call your local hospital and ask for their Public Affairs Department to find out if they have a pet therapy volunteer program that you can join.

Credits: The photo is presented by Cape Fear Dog Training Club featuring one of their therapy dog hospital visits at Womack Hospital.

YOUR STORY

Please share your story as to how a pet helped you or a loved one recover from an illness. Send a photo, too! Or tell us about your volunteer story.

Tuesday, August 26, 2008

Physician Office Mistakes: Beat the Odds


The odds are mounting that you will be on the receiving end of a medical mistake resulting from your doctor’s office visit. If you want to weigh the odds, consider this: For every eight people that are admitted to the hospital, nearly 30 times that number visit a physician’s office. The average family physician sees 100 patients every week spending about seven minutes to listen, examine, diagnose and treat you. Two out of every three office visits result in giving patients pills and four out of ten order some type of diagnostic test (prescription mistakes and testing slip-ups are the leading causes of medical errors in doctor’s offices).

It’s not just the likelihood that you’ll be visiting a doctor’s office that places you at risk: there are not enough primary care physicians, appointments are getting shorter, and patients are seeing more and more doctors that specialize in body parts with no one coordinating their care. Most of the new safety practices and technology to prevent medical errors have zeroed in on the hospital setting not the doctor’s office.

Just a few weeks ago, a new report sponsored by the U.S. Agency for Healthcare Research and Quality along with the American Academy of Family Physicians uncovered just high how the odds are for medical errors at the doctor’s office. Here is what they found from 243 clinicians who reported close to 1,000 errors in a 32-week period: nearly one out of every five mistakes caused some type of physical or emotional harm to the patient of which half caused pain and suffering. The vast majority of cases (80 percent) lead to extra time and expense but did not adversely affect the patient’s health. Most mistakes were made in the process of ordering, performing and reporting test results. For example, the wrong tests were ordered, misfiled, lost, misinterpreted, not done properly or no one told the physician and/or patient the results.

So, if you want to reduce your odds, take these steps:

1. When your doctor orders a test (e.g. blood, x-ray, EKG) always ask what is
the name of the test, what is it for and when will you receive the results
and how?
2. Never accept, “If you don’t hear from us, then assume everything is okay” from
your doctor or nurse. Tell them you want to know the results whether it is normal
or abnormal.
3. If you have not heard from your doctor’s office on the test results when he or
she said they should be done, call and ask for the results.
4. Always bring a current list of your medications or better yet, bring the pill
bottles of all the current medications you are taking to the doctor’s office to
prevent prescription errors.
5. Ask for a copy of your test results and check them against what the doctor told
you he ordered.
6. Don’t be afraid to ask your doctor about the results and if you are making major
decisions on cancer treatment or surgery based on test results, ask your doctor
about having another pathologist or radiologist look at your tests for a second
opinion.

Medical care these days is more complex and overburdened. Despite all of this, most of the time your doctor is treating you mistake-free but it doesn’t hurt to become a safety-check partner, so you both can beat the odds.

YOUR TURN

Do you have a doctor's office mistake you want to share? Or a tip on how to prevent one? Click on the Post a Comment link below.

Want to know more? Check out the following articles and reports:
"Testing Process Errors and their Harms and Consequences Reported from Family Medicine Practices" by J. Hackner et al, Quality and Safety in Health Care 2008; 17:194-200.

"Test-Related Errors Uncovered in Family Practice Clinics," John Gever, Med Page Today, August 14, 2008.

"Danger at Your Doctor's Office" by Lorie A. Parch at Health.com

"Patient Safety in the Physician Office Setting" by Nancy C. Elder, MD, MPH