Geriatrics

Lewy body dementia and a farewell to a physician’s father

Conditions
November 20, 2018

When I finished my training, I was taught that the vast majority of dementia was Alzheimer’s disease, with occasional cases of multi-infarct dementia as well as odd syndromes such as Kreutzfeld-Jacob disease and genetic, traumatic, toxic and tumor-related syndromes. Parkinson’s disease, we were taught, caused a tremor and freezing up of a person’s movements and only very rarely was associated with any kind of memory loss.

These teachings helped us modern …

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The influence of a physician’s father

Physician
September 25, 2018

Because of my father

When you lose a parent during childhood, it effects just about everything you become.  Decisions about life naturally stem from enduring this trauma.  Some try to form families early and replace that which they feel has been lost.  Others spurn close connections and create a wall so firm that no one else can encroach.  An attempt to protect against pain.  Because of my father I …

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The existential benefits of ginger ale

Conditions
September 14, 2018

On a curiously warm morning last February, the minister arrived at my childhood home to guide my father to the other side. When he approached the bedside where all of us were gathered around with the Eagles Pandora radio humming in the background, my dad emerged from a semi-conscious state and sat up as best as he could. “Listen. I am not dying,” he declared. As an early-career researcher focused …

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The Medicare merry-go-round in geriatric psychiatry

Physician
May 28, 2018

Martha (not her real name) was not an overly complex case in my field of geriatric psychology. But the case was complex enough to require multiple approaches and reliable follow up. And in rural Mississippi, follow up can be elusive. Soon it occurred to me that Martha’s case is emblematic of how caring for this vulnerable population often runs up against a huge problem — the Medicare merry-go-round.

A 78-eight-year-old with …

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We are all aging every day. But mostly we ignore, do not recognize, or deny it.

Conditions
February 26, 2018

Part of a series.

We are all aging every day, but mostly we ignore, do not recognize or deny it. Then all of a sudden, we look in the mirror and realize that older age has found us. Even then each person deals with aging differently. There is Dr. Seuss’ “Cat in the Hat” who sees nothing but adversity in aging. There are others who accept aging but …

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Technology is not friendly to the elderly

Tech
November 2, 2017

In about 1990 we got our first computer. I say “we” because my husband and I shared a desktop which I used infrequently. I mostly used it for word processing, and the Internet was very young. At the turn of the millennium, my children were using computers, and they were limited to 1 hour of computer time a day, which was on a shared desktop. By 2001, I was communicating …

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The problem with prescribing sleeping pills for older patients

Conditions
October 11, 2017

It seems that everyone has advice about sleep these days, and we have become immune to it. “Avoid naps, caffeine and alcohol close to bedtime. Get exercise. Get out of bed if you can’t sleep. Turn off the TV and any electronic devices hours before bedtime. Enjoy a relaxing ritual. Keep to a routine.”

Please do all of these, because they actually work! Shifting your bedtime later to achieve sleep consolidation …

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5 ways to make dealing with death easier

Physician
July 19, 2017

My husband, the anesthesiologist, came home one evening, he was solemn, affected, not himself. His patient died in the recovery room. It was sudden and unexpected for my husband. Despite the team’s swift efforts and perfectly executed code, the patient died anyway. It’s relevant to note that his patient was an almost 90-year-old man with significant congestive heart failure, probably chronic kidney disease, and complete occlusion of one of his …

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How do we fix the apathy in nursing home staffs?

Conditions
June 22, 2017

My grandmother’s room is silent, save for the plucks of sitar strings and Pixar movie soundtracks I try to stimulate her with. Instead of books, we fill the shelves around her bed with mouth swabs, drab hospital gowns and vials of baby powder. My grandmother — who walked an hour every day, who thrashed me in gin rummy, who rose before sunrise every morning to read — now lies bedridden …

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The elderly need hired professionals to administer their medications

Meds
May 9, 2017

One of the most challenging and difficult parts of my professional day is trying to determine if my patients are actually taking their as prescribed.

I ask my patients to bring their medications to each visit in the original pill bottles, and we count pills. I ask them to bring their medication lists as well, and we go through the time-consuming practice of reviewing each medication against the prescribing date and …

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Normal aging: A steady loss of organ and process function

Conditions
April 20, 2017

Part of a series.

The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent, and now it’s about fourteen and six percent. By 2030 it will be substantially more again.

There are many …

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Let older people talk about sex

Conditions
March 30, 2017

He was referred to me by a colleague with a large geriatric practice for evaluation and treatment for HIV. He was 76 years old and lived in an assisted living facility. He was, however, very independent and only required limited assistance. When asked what he expected from the visit he responded that he had been sent to me by his PCP. Review of his records suggested that in addition to …

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How a board of optometry is restricting eye care to homebound adults

Physician
September 2, 2016

This spring, the California Board of Optometry shut down the only optometrist providing services to homebound patients in the San Francisco Bay Area. I learned about this because affected patients included several referred from our UC San Francisco Housecalls program, one of a few non-profit, non-concierge home-based practices in the state providing geriatrics care to homebound adults.

With over 1 million adults homebound in California, why would any board deliberately limit …

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The story of a man who did not feel well

Physician
June 9, 2016

Once upon a time, not that long ago, there was man who lived an uncomplicated life. One morning he awoke and did not feel well. He could not really describe his malaise, but he definitely was not his usual self. Nothing particularly noteworthy had happened to him except that his dog had recently died of old age. William, a scruffy little terrier, was 17 years old, and the man knew …

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A physician’s open letter to Medicare patients

Physician
November 1, 2015

Dear patients,

This is a hard letter to write, but it is important that you know about a major change that is coming for both of us in 2017, just a short year away.

As you recall, last year I left a large hospital group practice and opened my own office, and I want to thank you for your faithfulness in following me to my new location.  With the newfound freedom of …

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A patient turns down hypertension treatment. What happens next is tragic.

Physician
October 8, 2015

I have previously written about a patient on this site: “How elderly patients can be stubborn to their own detriment.” In that post, I discussed how the patient repeatedly turned down appropriate therapy for her hypertension, saying she didn’t need the help.  Now I’m writing an update.

Due to the patient’s refusal to accept treatment for her hypertension, despite counseling on the part of her cardiologist and primary care …

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Doctors aren’t allowed to cry. But maybe they should be.

Physician
August 7, 2015

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“There’s no crying in baseball!”

Over the years, my fellow surgery residents and I heard these words shouted countless times by Dr. Norris, a cantankerous elderly surgeon with whom we had the dubious pleasure of working.

Dr. Norris was a former Navy ship surgeon. He didn’t operate much anymore, but he fondly remembered the “good old days” when trainees spent days on end in …

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The problem with home health care communication

Physician
January 6, 2015

Home health care is in many ways a fantastic service, especially for those Medicare beneficiaries who are essentially homebound due to frailty or illness.

But it often feels surprisingly hard to synergize with home health care.

The main problem, as I see it, is that home health care agencies have set themselves up to provide only administratively required communication with the ordering doc. (There are rules governing home health care, you know!)

Now, …

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DNR/DNI: More code than status

Physician
August 25, 2014

“If a tree falls in a forest and no one is around to hear it, does it make a sound?”

Chances are that many of you have duked this out with your college roommates back in the day, but how about this one? “If a doctor and a patient make an advance care plan, but when an emergency happens, nobody can find a copy of it, the proxy doesn’t know what’s …

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