DiversityNursing Blog

GENEVIEVE SHAW BROWN

abc news 

What happens when you bring preschoolers and the elderly together to share the simple things in life? This story and video are very touching. We think it’s a terrific idea to spread across the country.

It's being done at a preschool in Seattle, where child care takes place throughout a campus which is also home to more than 400 older adults.

Called the Intergenerational Learning Center, the preschool is located within Providence Mount St. Vincent, a senior care center in West Seattle. Five days a week, the children and residents come together in a variety of planned activities such as music, dancing, art, lunch, storytelling or just visiting.

And now this incredible place is about to have its own film. Called "Present Perfect," it was shot over the course of the 2012-2013 school year by filmmaker Evan Briggs, who is also an adjunct professor at Seattle University. Funded completely out of her own pocket and shot by her alone, Briggs has now launched a Kickstarter to fund the editing of the movie. She has more than $45,000 of her $50,000 goal with 15 days to go.

Residents of "the Mount," Briggs said, did a "complete transformation in the presence of the children. Moments before the kids came in, sometimes the people seemed half alive, sometimes asleep. It was a depressing scene. As soon as the kids walked in for art or music or making sandwiches for the homeless or whatever the project that day was, the residents came alive."

The kids, she said, took everything in stride. She talked of a moment at the beginning of the film trailer when a young boy, Max, is meeting an elderly man named John. John has to repeatedly ask Max his name, calling him Mack, Matt and Match. "That scene actually went on far longer that what you see in the trailer. But Max was just so patient, he just kept repeating his name over and over."

Interestingly, the parents of the students don't send their kids to the Intergenerational Learning Center primarily for the experience with the seniors. "It's got a great reputation and great teachers," said Briggs. But parents of kids who were in the class that she embedded herself in for the school year now tell her they see the benefit of the model. "One father told me that he especially sees it now that his own parents are aging."

She named the film "Present Perfect" she said, as a reference to the fact that these two groups of people — the preschoolers, who have almost no past and so much future and the elderly who such rich past but very little future — really only have a few years of overlap in their lives.

"It's also about being in the present moment," Briggs said, "something so many adults struggle with."

Briggs said the moments between the kids and the residents "sweet, some awkward, some funny — all of them poignant and heartbreakingly real."

Briggs hopes her film will open a conversation about aging in America. She writes on her Kickstarter, "Shooting this film and embedding myself in the nursing home environment also allowed me to see with new eyes just how generationally segregated we’ve become as a society. And getting to know so many of the amazing residents of the Mount really highlighted the tremendous loss this is for us all."

She called the preschool a "genius" idea that is "well within our reach" on a larger scale and hopes the idea expands to other schools around the country. "It's a great example of how we integrate the elderly into society."

By Barbara Diamond

www.littlethings.com 

Now tell us: Is this a viral-worthy video or what?!

Everyone loves it when seniors prove that you’re never too old to have fun. The video below is brand new on YouTube, but I have no doubt it will soon be seen by millions of people.

I couldn’t stop smiling as I watched this clip, which features the residents of Belvedere of Westlake’s Assisted Living Facility fighting for their right to party. With a hilarious parody of The Beastie Boys’ classic song, “(You Gotta) Fight For Your Right (To Party)” — an anthem in both the rap and rock worlds — the Cleveland, OH nursing home residents are here to prove that age is but a number, and they certainly still know how to rock. From slingin’ back bottles of booze and gambling, to rocking out on the guitar and stripping down to their skivvies, these seniors are certainly doing it their way. LOL!

Not only do they still have a great sense of humor and tons of energy, but it’s clear that these folks are truly young at heart. My favorite part is at the 1:53 mark. I won’t give it away, but I will say this… You go, Granny!

If this video made you smile, please SHARE it with your friends on Facebook!

  PAULA SPAN

What she wanted, the patient told the geriatricians evaluating her, was to be able to return to her condominium in Boston. She had long lived there on her own, lifting weights to keep fit and doing her own grocery shopping, until a heart condition worsened and she could barely manage the stairs.

So at 94, she consented to valve replacement surgery at a Boston medical center. “She never wanted to go to a nursing home,” said Dr. Perla Macip, one of the patient’s geriatricians. “That was her worst fear.”

Dr. Macip presented the case on Saturday to a meeting of the American Academy of Hospice and Palliative Medicine. The presentation’s dispiriting title: “The 30-Day Mortality Rule in Surgery: Does This Number Prolong Unnecessary Suffering in Vulnerable Elderly Patients?”

Like Dr. Macip, a growing number of physicians and researchers have grown critical of 30-day mortality as a measure of surgical success. That seemingly innocuous metric, they argue, may actually undermine appropriate care, especially for older adults.

The experience of Dr. Macip’s patient — whom she calls Ms. S. — shows why.

Ms. S. sustained cardiopulmonary arrest during the operation and needed resuscitation. A series of complications followed: irregular heartbeat, fluid in her lungs, kidney damage, pneumonia. She had a stroke and moved in and out of the intensive care unit, off and on a ventilator.

After two weeks, “she was depressed and stopped eating,” Dr. Macip said. The geriatricians recommended a “goals of care” discussion to clarify whether Ms. S., who remained mentally clear, wanted to continue such aggressive treatment.

But “the surgeons were optimistic that she would recover” and declined, Dr. Macip said.

So a discussion of palliative care options was deferred until Day 30 after her operation, by which time Ms. S. had developed sepsis and multiple-organ failure. She died on Day 31, after life support was discontinued.

The key number here, surgeons and other medical professionals will recognize, is 30.

Thirty-day mortality serves as a traditional yardstick for surgical quality. Several states, including Massachusetts, require public reporting of 30-day mortality after cardiac procedures. Medicare has also begun to use certain risk-adjusted 30-day mortality measures, like deaths after pneumonia and heart attacks, to penalize hospitals with poor performance and reward those with better outcomes.

However laudable the intent, reliance on 30-day mortality as a surgical report card has also generated growing controversy. Some experts believe pressures for superior 30-day statistics can cause unacknowledged harm, discouraging surgery for patients who could benefit and sentencing others to long stays in I.C.U.s and nursing homes.

“Thirty days is a game-able number,” said Dr. Gretchen Schwarze, a vascular surgeon at the University of Wisconsin-Madison and co-author of an editorial on the metric in JAMA Surgery. Last fall, she led a session about the ethics of 30-day mortality reporting at an American College of Surgeons conference.

“Surgeons in the audience stood up and said, ‘I can’t operate on some people because it’s going to hurt our 30-day mortality statistics,’” she recalled. The debate is particularly urgent for older adults, who are more likely to undergo surgery and to have complications.

Those questioning the 30-day metric point to potential dilemmas at both ends of the surgical spectrum. Surgeons may decline to operate on high-risk patients, even those who understand and accept the trade-offs, because of fears (conscious or not) that deaths could hurt their 30-day results.

At a hospital in Pennsylvania, for instance, a cardiothoracic surgeon declined to operate on a man who urgently needed a mitral valve replacement. He wasn’t elderly, at 53, but he was an alcoholic whose liver damage increased his risk of dying.

Dr. Douglas White, the director of ethics and decision-making in critical illness at the University of Pittsburgh School of Medicine, was asked to consult. According to Dr. White, the surgeon explained that “we have been told that our publicly reported numbers are bad, and we have to take fewer high-risk patients.”

Other surgeons at the hospital, under similar pressure, also refused. A helicopter flew the patient to another hospital for surgery.

An outlier case? A study in JAMA in 2012 compared three states that require public reporting of coronary stenting results to seven nearby states that didn’t report. Older-adult patients having acute heart attacks had substantially lower rates of the stenting in the reporting states. Doctors’ concerns about disclosure of poor outcomes might have led them to perform fewer procedures, the authors speculated; they might also have weeded out poorer candidates for surgery.

Perhaps as important for older people, when things go wrong, surgical teams concerned about their 30-day metrics may delay important conversations about palliative care or hospice, or even override advance directives.

“There are no good published studies on this, but it’s something we see,” Dr. White said. “Surgeons are reluctant to withdraw life support before 30 days, and less reluctant after 30 days.”

That may have been what happened to Ms. S. Or perhaps her aggressive treatment resulted from a surgical ethos that has little to do with mortality reports.

“We want to cure patients and help them live, and we consider it a failure if they don’t,” said Dr. Anne Mosenthal, who heads the American College of Surgeons committee on surgical palliative care.

With surgeons already prone to optimism and disinclined to withdraw life support, the effect of reporting failures, if there is one, is subtle. Surgeons tell themselves, “Maybe if we wait a little longer, he’ll improve; there’s always a chance,” Dr. Mosenthal said.

But many older patients, and their families, have different ideas about what makes life worth sustaining and might welcome a frank discussion before a month passes.

“The 30-day mortality statistic creates a conflict of interests,” said Dr. Lisa Lehmann, an associate professor of medical ethics at Harvard Medical School. “It can lead to the violation of a physician’s duty to put patients’ interests first.”

Leaders at the nonprofit National Quality Forum, which just endorsed 30-day mortality as a measure for coronary bypass surgery, find such fears overblown. The forum evaluates quality measures for Medicare and other insurers, and went ahead with its endorsement despite some physicians’ objections.

“There is some concern,” said Dr. Helen Burstin, the chief scientific officer of the forum, but “certainly no evidence” that the metric is unduly influencing patient care.

“Is it better not to measure and compare, just because we can’t get it perfect?” added Dr. Lee Fleisher, a co-chairman of the forum’s surgery standing committee.

But critics think other quality measures might serve better. Perhaps the benchmark should be 60- or 90-day mortality. Perhaps patients having palliative surgery to relieve symptoms should be tracked separately, because comfort is their goal, not survival.

Maybe quality should include days spent in an I.C.U. or on a ventilator, Dr. Schwarze said.

“Medicine isn’t just about keeping people alive,” she said. “Some of it is about relieving suffering. Some of it is about helping people die.”

Source: www.nytimes.com