MVP Newsletter – February 2018 - Vol 2
Our first article of two in these newsletters will discuss a topic of interest in Life Care Planning, the second about current medical conditions, treatment, and recommendations. This month we will discuss Life Care Planning with the elderly.
Life Care Planners need to be cautious about including costs of care in a Life Care Plan for conditions that existed pre-injury. In the United States, those over 65 years old in 2009 comprised 12.8% of the population. By the time we are 65 we may have co-existing conditions i.e. diabetes, atrial fibrillation, gastro-esophageal reflux disease, cancer, etc. Only 5% of this 12.8% population live in institutions i.e. skilled nursing facilities. Therefore, 95% of those over 65 live independently. Of the ‘old-old’ over 85 year-old population, half of women and two-thirds of men live independently, not requiring assistance.
We here at MVP have prepared Life Care Plans for the elderly for litigation resulting from falls, motor vehicle accidents, medical negligence, among other reasons. While physicians with the specialty of Physical Medicine & Rehabilitation (PM&R), also known as physiatrists, are ideal as attending physicians for individuals with spinal cord injury, geriatric specialists are best for the elderly. A Life Care Planner who is also a Registered Nurse is in a unique position to provide the best Plan to establish nursing diagnoses and treatment for those conditions.
Ideally, when preparing a Life Care Plan for an individual who has sustained an acquired brain injury, it would be most helpful (but almost never is the case) for a neuropsychological evaluation to have been conducted pre-injury to establish a baseline. In the same vein, a geriatric assessment (as seen at ocw.tufts.edu/data/42/499797.pdf) would be incredibly helpful as a baseline before an elderly person sustains an injury. However, I have never seen such baseline information, and medical records from attending physicians seldom present a complete pre-injury picture. Therefore, the nurse life care planner must obtain the most comprehensive nursing assessment possible. Discussion with the geriatrician, if there is one, is part of hoped-for teamwork for a Life Care Planner.
AANLCP Journal of Life Care Planning, Summer 2010, Vol. X, No. 2
Let us turn our attention to men's health in discussing the prostate gland. The first surgery to enlarge the urethra because of a large prostate occurred in 1575 by Ambrose Pare, and amazingly continues to be the basis for endoscopic surgery today. Without such surgery, hollow-core rigid catheters were liberally used to relieve urinary retention caused by the enlarged prostate. Because life expectancy only recently has increased sufficiently for the prostate to enlarge to a problematic degree, much is not written about the gland and its treatment until the eighteenth century. World average life expectancy at birth (LEB) in 1900 was only 31 years; in 1950 it increased to 48, and in 2014 to 71.5 years. Several surgical procedures were tried, including surgical castration which helped many men but many men were not helped by this drastic surgery which ceased about 1904.
One of the things I love about medicine is progress. There has been a revolution in treatment of enlarged prostate glands. The surgical procedure used when I worked in acute care hospitals was the transurethral resection of the prostate (TURP) to relieve urinary obstruction caused by the enlarged prostate. Side effects included retrograde ejaculation and erectile dysfunction (ED). Recurrence of the enlarged prostate would also occur in about 15% of men for five to ten years after surgery.
There are now a variety of treatment options to shrink or remove the prostate: TUNA (transurethral needle ablation), TUMT ((transurethral microwavethermotherapy), TULIP (transurethral ultrasound-guided laser-induced prostatectomy), TUIP (transurethral incision of the prostate), TUVP (transurethral electrovaporization of the prostate), TUEP (transurethral evaporation of the prostate), HoLEP (holmium laser enucleation of the prostate), CALRP (computer-assisted transurethral laser resection of the prostate), and VLAP (visual laser ablation of the prostate). According to John Wrenn, MD, about half of all men will develop Lower Urinary Tract Symptoms (LUTS) as they age. In this modern age while discoveries continue, we can be grateful to the many physicians and surgeons over the centuries who have built upon previous discoveries to improve the treatment we have today.
Conferences Michele will be attending:
March, 2018 – Florida
American Association of Nurse Life Care Planners (AANLCP)
April, 2018 – Salt Lake City
American Board of Vocational Experts (ABVE)
April, 2018 – Mexico
Life Care Planning