Also, a patient's loved ones were more confident about acting as surrogate decision-makers when they perceived their communication with intensive care physicians to be of high quality, said senior investigator Douglas B. White, M.D., MAS., associate professor and director of the Program on Ethics and Decision-Making in Critical Illness, Department of Critical Care Medicine.
"This is the first evidence to suggest that how a doctor guides family members through the foreign territory of critical illness may influence their ability to act as a surrogate," he noted. "Teaching doctors to be better communicators may be an important step in improving end-of-life decisions for patients. The study also reinforces the value of patients, families and friends having prior conversations about the end of life so that they can feel comfortable with their decisions about medical care."
For the study, conducted at four intensive care units at the University of California San Francisco Medical Center between 2005 and 2008, the researchers surveyed 230 caregivers who were making decisions on behalf of incapacitated patients on ventilators with greater than a 50 percent chance of dying from their illnesses.
They found caregivers who hadn't had a prior conversation with patients about treatment preferences were less confident about making decisions and it took them 40 percent longer - 33 days versus 21 days - to decide to discontinue life support.
"This prolongation of the dying process may not be in the best interest of patients and it places an enormous burden on the health care system," Dr. White said. "Health care reform will provide incentives for formal advance care planning between physicians and patients, such as the completion of advance directives and living wills. Our findings indicate that informal conversations between patients and their families may be very important for both patient-centered decisions and the family's comfort with the huge responsibility of being a surrogate."
The research team included Alyssa Majesko, M.D., of UPMC, and S. Hong and Lisa Weissfeld, Ph.D., of the University of Pittsburgh Graduate School of Public Health. The project was funded by the National Institutes of Health.
Associate Professor Jacqueline Center and Professor John Eisman, from Sydney's Garvan Institute of Medical Research, based their findings on data from the long running Dubbo Osteoporosis Epidemiology Study*.
Out of a total cohort of around 2,000, a sub-group of 121 people were treated with bisphosphonates for an average of 3 years. When compared with other sub-groups taking other forms of treatment, such as Vitamin D (with or without calcium) or hormone therapy, the longer life associated with bisphosphonate treatment was marked and clear.
These findings are published in the Journal of Clinical Endocrinology and Metabolism, now online.
"While the results seemed surprisingly good, they are borne out by the data - within the limitations of any study - and appear to apply to men as well as women," said Associate Professor Center.
"When we first looked at the figures, we thought that there had to be a fallacy, that we were missing something. One of the most obvious things might be that these are people who seek medical attention, so may be healthier and live longer. So we compared the bisphosphonate group with people taking Vitamin D and calcium or women on hormone therapy."
"The comparison against these other groups of similarly health-aware people simply confirmed that our results were not skewed by that factor."
"In a group of women with osteoporotic fractures over the age of 75, you would expect 50% to die over a period of five years. Among women in that age group who took bisphosphonates, the death rate dropped to 10%."
"Similarly, in a group of younger women, where you would expect 20-25% to die over 5 years, there were no deaths."
"The data were consistent with about a 5 year survival advantage for people on bisphosphonates."
The authors are intrigued by their findings. "We speculate that it may have something to do with the fact that bone acts as a repository for toxic heavy metals such as lead and cadmium," said Professor Eisman.
"So when people get older, they lose bone. When this happens, these toxic materials are released back into the body and may adversely affect health."
"By preventing bone loss, bisphosphonates prevent some of this toxic metal release. While we know that this is the case, we don't yet have evidence that this produces the survival benefit."
Fight Osteoporosis - Order The UCLA Recommended Exercise Ball That Strengthens Bone. $29.95! - BoneFitness.com
Effects Of Osteoporosis - Learn About Osteoporosis Risks and How To Prevent Bone Fractures Here! - www.fore.org
"Osteoporosis is a big societal burden and remains a poorly understood and severely undertreated disease in Australia," said Eisman.
"Only about 30% of women and 10% of men with osteoporosis receive treatment, which is unacceptable when you consider that people could be helped, and death could be delayed by several years. There is good evidence - even without this study - that treating osteoporosis reduces fractures and reduces mortality."
"While osteoporosis is clearly under-recognised and under-treated, the findings of this study are important to better understanding the benefits of these treatments and may directly influence doctors' practice. It was unexpected and remarkable to find that not only osteoporosis but also life expectancy appear to be improved for people taking bisphosphonates," said Dr Christine Bennett, Chair of the Bupa Health Foundation Steering Committee and Bupa Australia's Chief Medical Officer.
"Bupa Health Foundation is proud to have supported this valuable research since 2005 and we see its findings as a major breakthrough that can now guide doctors' treatment decisions for these very vulnerable older people."
Like any pharmaceutical product, bisphosphonates may have unpredictable side effects in a small minority of people and should only be used for their approved purpose.
*Dubbo Osteoporosis Epidemiology Study
The Dubbo Osteoporosis Epidemiology Study is an ongoing population-based study that started in 1989 in Dubbo, a city with a population of 32,000 in regional New South Wales. The study cohort is women (1223) and men (898) over the age of 60. Approximately 60% of eligible people were recruited into the study.
Acknowledgements And Disclosure Summary
This work was supported by the National Health and Medical Research Council Australia, The Bupa Health Foundation, the Ernst Heine Foundation, and untied grants from Amgen, Merck Sharp & Dohme, Sanofi- Aventis, Servier and Novartis. There was no financial compensation paid to any of the participants in the study. The study sponsors had no role in the study design, nor the collection, analysis and interpretation of the data.
Associate Professor Center has been supported by and/or has given educational talks for Eli Lilly, Merck Sharp and Dohme, Novartis and Sanofi-Aventis. Professor Eisman has consulted for and/or received research funding from Amgen, deCode, Eli Lilly, Merck Sharp and Dohme, Novartis, Sanofi-Aventis and Servier. The other authors on the paper have nothing to disclose.
Garvan Institute of Medical Research
Bupa Health Foundation
There’s No Place Like Home—For Growing Old
We believe this site offers valuable tips and resources for keeping your loved ones in their homes.
“The stairs are getting so hard to climb.”
“Since my wife died, I just open a can of soup for dinner.”
“I’ve lived here 40 years. No other place will seem like home.”
These are common issues for older people. And, you may share the often-heard wish—“I want to stay in my own home!” The good news is that with the right help you might be able to do just that.
As part of the Federal Government’s National Institutes of Health, the National Institute on Aging (NIA) funds and conducts research related to aging, including how older people can remain independent. This NIA tip sheet introduces you to the kinds of help that you might want to consider so you can continue to live on your own. Where possible, we give you suggestions for free or low cost help and include ways to identify benefits that might be available to you. A list of groups to contact for more detailed information is included at the end of the tip sheet. You can share this tip sheet with others in your family, and you can use it to begin talking about your needs—now and in the future.
What do I do first?
Planning ahead is hard because you never know how your needs might change. But, the first step is to think about the kinds of help you might want in the near future. Maybe you live alone, so there is no one living in your home who is available to help you. Maybe you don’t need help right now, but you live with a husband or wife who does. Everyone has a different situation, but one way to begin planning is to look at any illnesses like diabetes or emphysema that you or your spouse might have. Talk to your doctor about how these health problems could make it hard for someone to get around or take care of him- or herself in the future. Help getting dressed in the morning, fixing a meal, or remembering to take medicine may be all you need to stay in your own home.
How can I help my older relatives stay independent?As they grow older, some people start having trouble doing everyday activities like shopping, cooking, and taking care of their home or themselves. Is this happening to any of your relatives—your parents or an aunt or uncle, for example? If so, talk to them about getting help. Maybe you can offer to get information for them. Think about what you and others in the family can do to help. Talk to your friends whose relatives may be facing the same kinds of problems. Ask about the solutions they found. Then let your relatives know what you have learned. You might be able to help them develop a plan.
What kinds of help can I get?
You can get almost any type of help you want in your home—often for a cost. The following list includes some common things people need. You can get more information on many of these services from your local Area Agency on Aging, local and State offices on aging or social services, tribal organization, or nearby senior center.
Personal care. Is bathing, washing your hair, or dressing getting harder to do? Maybe a relative or friend could help. Or, you could hire a trained aide for a short time each day.
Homemaking. Do you need help with chores like housecleaning, yard work, grocery shopping, or laundry? Some grocery stores and drug stores will take your order over the phone and bring the items to your home. There are cleaning services you can hire, or maybe someone you know has a housekeeper to suggest. Some housekeepers will help with laundry. Some drycleaners will pick up and deliver your clothes.
Meals. Worried that you might not be eating nutritious meals or tired of eating alone? Sometimes you could share cooking with a friend or have a potluck dinner with a group of friends. Find out if meals are served at a nearby senior center, church, or synagogue. Eating out may give you a chance to visit with others. Is it hard for you to get out? Ask someone to bring you a healthy meal a few times a week. Also, meal delivery programs bring hot meals into your home.
Money management. Do you worry about paying bills late or not at all? Are health insurance claim forms confusing? Maybe you can get help with these tasks. Ask a trusted relative to lend a hand. Volunteers, financial counselors, or geriatric care managers can also help. Just make sure you get the referral from a trustworthy source, like your local Area Agency on Aging. If you are familiar with computers, you could pay your bills online. Check with someone at your bank about this option. Some people have their regular bills, like utilities and rent or mortgage, paid automatically from their checking account.
Consider having your Federal Government benefits checks deposited directly to your bank account. It’s safer than getting your check through the mail, and you can have your money sooner. If you are interested, you can go to www.godirect.org (www.directoasucuenta.org for Spanish), call 1-800-333-1795 (toll-free), or stop by your bank, credit union, or Social Security Administration office to start the process.
You can have your Social Security or Supplemental Security Income benefit checks deposited to a prepaid debit card by using the Federal Government’s Direct Express program. Go to www.usdirectexpress.com or call 1-877-212-9991 (toll-free) to learn more.
Be careful to avoid money scams. Never give your Social Security number, credit card account numbers, or bank account numbers to someone on the phone (unless you placed the call) or in response to an email you receive on your computer. Always check all bills, including utilities, for charges you do not recognize.
Even though you might not need it now, think about giving someone you trust permission to discuss your bills with creditors or your Social Security or Medicare benefits with those agencies. You could do this by phone with each office or agency or in a letter to each one. Or, you could give overall permission to handle a variety of legal matters for you in the form of a durable power of attorney. “Durable” means the permission remains in effect if you cannot make decisions yourself, but you can change the power of attorney or cancel it at any time.
Health care. Do you forget to take your medicine? There are devices available to remind you when it is time for your next dose. Special pill boxes allow you or someone else to set out your pills for an entire week. Have you just gotten out of the hospital and still need nursing care at home for a short time? The hospital discharge planner can help you make arrangements, and Medicare might pay for a home health aide to come to your home.
If you can’t remember what the doctor told you to do, try to have someone go to your doctor visits with you. Ask them to write down everything you are supposed to do, or if you are by yourself, ask the doctor to put all recommendations in writing.
Be prepared for a medical emergency
If you were to suddenly become sick and unable to speak for yourself, you probably would want someone who knows you well to decide on your medical care. To make sure this happens, think about giving someone you trust permission to discuss your health care with your doctor and make necessary decisions. One way to do this is through a durable power of attorney for health care. A durable power of attorney for health care allows you to name a health care proxy—someone to make health care decisions for you any time you can’t. This is part of an advance directive. Another part of an advance directive, called a living will, allows you to decide in advance how much or how little care you want near the end of life.
Products to make life easier. Is it getting harder to turn a door knob or put on your socks? Devices are available to make activities you do during the day easier. The Department of Education’s website, www.abledata.com, has information on more than 30,000 assistive-technology products designed to make it easier for people to do things for themselves. If you can’t use a computer, you can call 1-800-227-0216 to learn more.
Getting around—at home and in town. Are you having trouble walking? Perhaps a walker would help. If you need more, think about getting an electric chair or scooter. These are sometimes covered by Medicare. Do you need someone to go with you to the doctor or shopping? Volunteer escort services may be available. If you no longer drive a car, check if there are free or lower-priced public transportation and taxis in your area. Maybe a relative, friend, or neighbor would take you along when they go on errands or do yours for you.
Activities and friends. Are you bored staying at home? Your local senior center offers a variety of activities. You might see friends there and meet new people too. Is it hard for you to leave your home? Maybe you would enjoy visits from someone. Volunteers, called “Friendly Visitors,” “Senior Volunteers,” or “Senior Companions,” are sometimes available to stop by or call once a week. They can just keep you company, or you can talk about any problems you are having. Call your local Area Agency on Aging to see if they are available near you.
Safety. Are you worried about crime in your neighborhood, physical abuse, or losing money as a result of a scam? Talk to the staff at your local Area Agency on Aging. Do you live alone and are you afraid of becoming sick with no one around to help? You might want to get an emergency alert system. You just push a special button that you wear, and emergency medical personnel are called. A monthly fee is charged.
Care away from home.
Do you need care but live with someone who can’t stay with you during the day? For example, maybe they work. Adult day care outside the home is sometimes available for older people who need help caring for themselves. The day care center can pick you up and bring you home. If your caretaker needs to get away overnight, there are places that will provide more extended temporary respite care.
Housing. Would a few changes make your home easier and safer to live in? Think about things like a ramp at the front door, grab bars in the tub or shower, nonskid floors, more comfortable handles on doors or faucets, and better insulation. Sound expensive? You might be able to get help paying for these changes. Check with your local or State Area Agency on Aging, State housing finance agency, welfare department, community development groups, or the Federal Government (see the resources in For More Information).
Where can I look for help?
Here are some resources to start with:
People you know. Family, friends, and neighbors are the biggest source of help for many older people. Talk with those close to you about the best way to get what you need. If you are physically able, think about trading services with a friend or neighbor. One could do the grocery shopping, and the other could cook dinner, for example.
Community and local government resources. Learn about the services found in your community. Healthcare providers and social workers may have suggestions. The local Area Agency on Aging, local and State offices on aging or social services, and your tribal organization may have lists of services. Look in the phone book under “Government.” If you belong to a religious group, talk to the clergy, or check with its local offices about any senior services they offer.
Geriatric care managers. These specially trained professionals can help find resources to make your daily life easier. They will work with you to form a long-term care plan and find the services you need. They will charge for this help, and their fees probably won’t be covered by any insurance plan. Geriatric care managers can be very helpful when family members live far apart. If asked, they will check in with you from time to time to make sure your needs haven’t changed. See the resources in For More Information.
Federal Government sources. There are many resources from the Federal Government where you can start looking for information. Some are only available with a computer. If you don’t have a computer, you might be able to use one in your local library or senior center. Perhaps your son or daughter, grandchild, niece, nephew, or a friend or neighbor could look on the internet for you.
Eldercare Locator Program
Through the Eldercare Locator, the Administration on Aging provides information on many different services for older people. The Eldercare Locator can give you the number of your local Area Agency on Aging. To use this service call 1-800-677-1116, or go to www.eldercare.gov on the internet.
You can get long-term care suggestions tailored to your own needs from the Medicare website at www.medicare.gov. Clicking on “Long-Term Care Planning” in the “Resource Locator” takes you to the “Long-Term Care Planning Tool.” Type in information about yourself (age, sex, and whether or not you are married), as well as your health problems and other needs. Very quickly it will give the kind of help you should look for and general advice on how to find it and how to pay for it. You do not have to identify yourself—not even your name or Social Security number.
The National Library of Medicine’s website, www.medlineplus.gov, has a section “Home care services” containing links to useful information.
To search the National Institute on Aging’s (NIA) online list of health and aging organizations, go to to this link on the NIA web page, or call NIA at 1-800-222-2225 (toll-free) for help finding the resource you need. The NIA list has the names, addresses, phone numbers, and websites for more than 260 government agencies, professional associations, and public and private groups that have information or help for older people.
Once you have decided on the services you need and have chosen some providers for them, you might be able to get more information about those sources from www.medicare.gov. Medicare’s Home Health Compare section there, www.medicare.gov/HHCompare/, can tell you more about some of the home healthcare providers in your State. You can also check on whether the people receiving care are satisfied. No computer? Just call 1-800-MEDICARE (1-800-633-4227/toll-free) and ask for the same information.
How much will this cost?
An important part of planning is thinking about how you are going to pay for the help you need. Some things you want may cost a lot. Others may be free. Some might be covered by Medicare, private “Medigap” policies or other private health insurance, Medicaid, or long-term care insurance. Some may not. Check with your insurance provider(s). There is a chance that paying for just a few services out of pocket could cost less in the long run than moving into an independent living, assisted living, or long-term care facility. And you will have your wish of still living on your own.
Once you have thought about which services you need, you can find out about Federal, State, and local government benefits at www.govbenefits.gov. If you can’t get to a computer, call 1-800-FED-INFO (1-800-333-4636/toll-free) for the same kind of help.
Another website to search for benefits is www.benefitscheckup.org from the National Council on Aging. By typing in general information about yourself, you can see a list of possible benefits you might qualify for. You don’t have to give your name, address, or Social Security number in order to use this service.
Are you eligible for veterans benefits from the Department of Veterans Affairs? The VA sometimes provides medical care in your home. In some areas they also offer homemaker/home health aide services, adult day health care, and hospice. You can learn more by going to www.va.gov, calling the toll-free VA Health Care Benefits number, 1-877-222-8387 (toll-free), or contacting the VA medical center nearest you.
One family’s story
The house on Maple Street has been Ellen Pinkham’s home for more than 45 years. It has changed over time—the twins’ bedroom is now Ellen’s sewing room. After Herb died, Ellen gave his mystery books to the local library. But because staying on Maple Street is so important to Ellen, her family is making changes. They call her daily to touch base. They added grab bars in the tub and by the toilet, got rid of those loose rugs in the hall, and put her doctor’s phone number on speed dial. A hot meal is delivered regularly, and Ellen’s granddaughter drives her to bingo and the grocery store. As they look to the future, Ellen’s family knows they can call the local Area Agency on Aging if they need help finding home health aides or other assistance. It looks like Ellen has a plan that is working. She may be able to stay on Maple Street.
For More Information
Administration on Aging
Washington, DC 20201
Department of Veterans Affairs
Veterans Benefits Administration
Veterans Health Administration
810 Vermont Avenue, NW
Washington, DC 20420
To speak with a healthcare benefits counselor:
Federal and State Government Benefit Information
USA.Gov for Seniors
Department of Housing and Urban Development
451 Seventh Street, SW
Washington, DC 20410
Low-Income Home Energy Assistance Program (LIHEAP)
National Energy Assistance Referral Hotline (NEAR)
National Resource Center on Supportive Housing and Home Modification
3715 McClintock Avenue
Los Angeles, CA 90089-0191
1899 L Street, NW
Washington, DC 20036
Senior Housing Associations
2519 Connecticut Avenue, NW
Washington, DC 20008-1520
National Adult Day Services Association
85 South Washington Street
Seattle, WA 98104
National Association of Professional Geriatric Care Managers
3275 West Ina Road
Tucson, AZ 85741-2198
For more information about health and aging, contact:
To order publications (in English or Spanish) or sign up for regular email alerts, go to: www.nia.nih.gov/HealthInformation.
Visit NIHSeniorHealth (www.nihseniorhealth.gov), a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health information for older adults. Special features make it simple to use. For example, you can click on a button to have the text read out loud or to make the type larger.
- CareFamily and Seniorcorp Offer New Choices for Care to Hampton Roads Seniors
- Recent Articles on Aging and Caregiving
- What is Long-Term Care Insurance?
- New "Generation Alzheimer's" Report Calls Alzheimer's Defining Disease Of The Baby Boomers
- End-Of-Life Decisions Delayed If Patient's Wishes Not Shared With Family
- An Extra 5 Years Of Life An Unexpected Benefit Of Osteoporosis Treatment
- Improvements In Memory In Older Adults Following Moderate Aerobic Exercise
- Alzheimer's Scan Might Help Spot Disease
- AHRQ News And Numbers: Approximately Five Percent Of Seniors Report One Or More Cognitive Disorders
- About Alzheimer's disease