As any doctor will tell you, family health history can have many implications for an individual's future health. Although some conditions, like hemophilia or Down's syndrome, are caused by genetic mutations and are thus present from birth, other diseases with possible genetic links may not develop or become evident until later in life.
Conditions like high blood pressure, high LDL ("bad") cholesterol, obesity, heart disease, Type II diabetes and even some forms of cancer, can run in families. Although not usually caused exclusively by inherited factors, genetics are almost certainly at the root of some individuals' predisposition for developing them. In addition, some diseases like Alzheimer's, Parkinson's, depressive disorders and mood disorders may have genetic links that are as-yet not well-understood.
It is critically important— especially in senior healthcare— that a treating doctor have access to reliable information about a patient's family health history.
In light of this, and since November 27th is not only Thanksgiving, but also National Family Health History Day, let's take look at how seniors can establish their own health histories and work with their children and grandchildren to establish family health histories that will help them (and future generations) have happier, healthier lives.
Every senior's electronic medical record should have a complete Cumulative Patient Profile.
A Cumulative Patient Profile (CPP) is a section of a patient's electronic medical record (EMR) that provides a doctor or other healthcare provider with a quick "snapshot" of the patient's medical history. Such a section will include information about chronic conditions a patient has been diagnosed with, major illnesses or injuries experienced in the past, and any surgical repairs or changes that person has had performed. It will also list out known allergies and any reported (by a patient or their care provider) medications.
According to a 2006 report co-sponsored by the Ontario Hospital Association, the "proper use of a CPP can save time by reducing the need to rewrite information in [doctors'] progress notes," and "help to prevent errors and duplication of documentation."
But a CPP is not complete unless it also contains a reliable social and family medical history.
Who counts as "family," from a medical standpoint?
Patients and their family members are often, understandably, confused by this. Let's take a look at a hypothetical 65-year-old patient— we'll call him "George"— who goes to his doctor with left lower back pain and blood in his urine. The doctor is concerned, based on the symptoms, that George may have a problem with his left kidney.
Is it relevant to this doctor that George's first cousin had a benign growth on her kidney removed 20 years ago? Absolutely not. For one, there was no disease— just a mild scare. But what if that growth had turned out to be renal (kidney) cancer?
In this example, no, it's still not relevant to the doctor. Why?
A first cousin shares on average only about 12.5% of the patient's genes, so the blood relationship is a bit too distant to be of concern. The same would be true if we were talking about George's great-grandparent, who would only have passed down also about 12.5% of their genes to him.
But if the person with renal cancer had been the George's mother, with whom George shares half his genes, and George's maternal grandfather had a history of kidney stones and renal failure, well then, that's probably relevant. Kidney dysfunction seems to run in his mother's family, and if there is a genetic link, it could be that George inherited those bad genes.
Have you gathered your family health history?
Here's the rub: Most of us know that family health history is an excellent medical screening tool and that it has a significant bearing on medical care. Yet the US Department of Health and Human Services reports that only about one-third of Americans make any sort of effort to collect reliable family health information. Hence, the need for National Family Health History Day.
So why recognize it in tandem with Thanksgiving? The obvious answer is that Thanksgiving is one of the few days a year on which many extended family members congregate. So it's a great opportunity, with grandparents, parents, siblings and children all in the same room, for everyone to get on the same page about medical concerns that might run in the family.
Now, we wouldn't necessarily recommend everyone have a big discussion about diseases over turkey and stuffing— that would be stressful and probably unappetizing to boot— but it might not be a bad idea at some point for everyone to report in and have a frank and open discussion, before the get-together breaks up.
Or, if you prefer, you could use a handy online tool the Office of the Surgeon General has developed.
The Surgeon General's "My Family Health Portrait" application allows Americans to record their family health histories and learn about the potential ramifications of any chronic or life-threatening disease conditions that may be prevalent in one's familial line.
This Thanksgiving/National Family Health History Day, seniors should be sure to share with their family members any known chronic health concerns from which they, or their parents and grandparents, suffered.
It's also a good time for seniors and their children to sit down and start discussing plans for future care, and to fill out Healthcare Power of Attorney and Living Will paperwork, so that if critical health care or living arrangement decisions need to be made, wishes are clear and well-known.
These discussions might seem on the surface to be a bit of a downer on the holiday. But once you've had them, you can be thankful that you're still alive and kicking, able to share time with your loved ones, and be secure in the knowledge that you will have helped yourself and your loved ones to improve your future care, as well as health care for the entire family.
