The best new information about the care of older adults can be found at the annual Spring meeting of the American Geriatrics Society (AGS), held every year in May. You’ll find bright upcoming students, graduates in fellowship training, community practitioners in the trenches, academic educators and researchers creating new knowledge, and legendary experts in the field, all there mixing elbow-to-elbow and drawing inspiration from one another. We actually know that our patients are really the ones who can choose what is best for them—after all, they’ve been very successful at it for years, or they wouldn’t have made it to a ripe old age! But given my responsibility to share the latest, most accurate information to support my patient’s decisions, I always search for new information about 1) staying healthy and functional as long as possible, 2) ways to treat health conditions which are different than the way we care for “regular” adults, and 3) new ways to share information. This year, three presentations really drew my attention:
- Finding trustworthy personal access to medical knowledge;
- The most dangerous threat in the care of diabetes in older adults; and
- A new website that PREPARE-s older adults and caregivers themselves to understand and take care of their advance directives.
Trustworthy Access to Medical Information, or Yes, There’s an App for That
Smart phones seem to be everywhere, yet there is a definitely a generation gap. According to the Pew Research Center annual survey of smartphone use released in April 2015, only 27% of those ages 65 and older own cell phones. This is compared to 54% of those ages 50-64 years and 64% of young adults. Overall, 62% of smartphone users say they have used their phone in the past year to look up information about a health condition. Yet where does this leave older adults, whose generational cohort does not have the natural electronic health literacy of today’s generation? Many are anxious about “breaking” a device they depend on for emergency communication, are unfamiliar with navigating data plans, and uncertain whether the information accessed is actually trustworthy. For my part, how do I know where to direct my patients for advice they can use which is accurate?
At this year’s meeting, a presentation called “Yes, There’s an App for That” demonstrated how to find ratings and recommendations for reliable, up-to-date health care phone apps, which apps had medical information especially useful for clinical care, how to use health care apps to teach geriatrics to trainees, and how to access free internet resources for innovative educational strategies. For a list of resources from this presentation, Eric Widera, MD (known for the GeriPal blog) has posted information available to anyone at http://www.geripal.org/2015/05/yes-there-is-a-medical-app-for-that.html.
The Most Dangerous Threat to Older Adults from Diabetes
Did you know that in 2014 there were more hospital admissions related to blood sugar levels that were too low rather than too high? Bill Hall, MD, has been a giant in the field of geriatrics for 30 years, and for many of those years has provided an overview of the most important advances in geriatrics at the AGS meeting. For his last-ever official talk this year, he included information from a key research article by Lipska and others published in the March 2015 issue of JAMA Internal Medicine regarding potential overtreatment of diabetes mellitus in older adults. By examining data from the National Health and Nutritional Examination Survey collected over the course of 10 years, the authors found that the “tight” control of blood sugars currently recommended for all adults by the American Diabetes Association was associated with excessively low blood sugars in adults over age 65 if they had 3 or more chronic conditions (e.g. arthritis, heart disease, chronic kidney problems, etc.) or 2 or more impairments in their instrumental activities of daily living (difficulty driving, using medications, managing money, etc.) It was found to be very likely that this tight control may actually have worsened their health outcomes rather than improving their health. This is in line with a 2013 “Choosing Wisely” recommendation by AGS, which states that older adults should have a somewhat more generous target permitting more variability in blood sugar levels. “Tight” control is considered a lab test outcome of a hemoglobin A1C (HgA1C) level less than 7.0, which reflects a blood sugar level range from 123-185 over a 90-day period. The standard advocated by the AGS is for a blood sugar range from 147-217, or a HgA1C less than or equal to 8.0 for most older adults. This could apply to almost every nursing home patient, and to many older adults living in the community as well. For more information about the AGS Choosing Wisely recommendation, see http://www.choosingwisely.org/clinician-lists/american-geriatrics-society-medication-to-control-type-2-diabetes/
PREPARE-ing Older Adults and Caregivers
The last word goes to Rebecca Sudore, MD for her presentation of the Outstanding Scientific Achievement for Clinical Investigation Award talk. Dr. Sudore has worked for a decade on her concerns working with older adults who may have difficulty understanding the complex legal documents required in most states to actually carry out one’s wishes near the end of life. These might include directions on whether or not to perform cardiopulmonary resuscitation (CPR), receive artificial feedings, or be sustained by a ventilator. Although many older adults have fairly well-formed opinions, it is often hard to communicate those wishes to your family or health care providers, particularly when unwell, and even harder to put them in writing that everyone can understand. Dr. Sudore’s solution over the years, as formed by her experiences with her patients and her own grandfather, was to first change the paperwork documents to large print, plain language explanations in both English and Spanish. The next step was to convert these documents into an interactive, video format which guides the patient and their chosen caregivers to think about various options and make personal choices at their own speed. There’s even a video tutorial about how to use a computer to work through the website. To try it out for yourself in Spanish or English, go to www.prepareforyourcare.org
Stay tuned for more of the latest and greatest from AGS and the Institute for Successful Longevity. We’ll be back!