Geriatricians, physicians, and family caregivers writing on KevinMD about growing old: dementia and Alzheimer's disease and the biomarkers and drugs argued over since 2010, caring for aging parents, nursing homes and long-term care, polypharmacy and when to stop screening, falls and delirium in the hospital, the shortage of geriatricians, and longevity medicine. One maintained record draws on this archive: Aging and dementia: what physicians say, in their own words.
When a patient asks where to go for a knee replacement, a colonoscopy, or their mother's rehab stay, they have usually already looked. Not at the federal record. At the stars. Here is what the stars do not show. Our…
When a patient asks where to go for a knee replacement, a colonoscopy, or their mother’s rehab stay, they have usually already looked. Not at the federal record. At the stars.
Here is what the stars do not show. Our analysis of Centers for Medicare & Medicaid Services records found that 46 percent of U.S. nursing homes carry at least one federal civil money penalty on the current enforcement record, and …
My phone lit up in the dormitory: "Can you come back after camp? Mom needs you to help persuade Grandma." I was at a summer program in Seattle. I booked the earliest flight I could, already marshaling arguments in my…
My phone lit up in the dormitory: “Can you come back after camp? Mom needs you to help persuade Grandma.”
I was at a summer program in Seattle. I booked the earliest flight I could, already marshaling arguments in my head: statistics on cognitive decline, studies about social engagement, the kind of evidence-based reasoning I had absorbed from years of watching people around me in Silicon Valley try to optimize everything, …
There are plenty of things we tend to accept as part of getting older: turning the television up, struggling to follow conversations in restaurants, or asking people to repeat themselves because everyone seems to mumble these days. Other signs are…
There are plenty of things we tend to accept as part of getting older: turning the television up, struggling to follow conversations in restaurants, or asking people to repeat themselves because everyone seems to mumble these days.
Other signs are easier to overlook. You stop noticing the microwave beep or refrigerator alert. You miss phone notifications. While none of these seem significant on their own, they capture one of the biggest …
On the 13th floor of the Jen Chi station-front building in Taipei, a school bell rings. The room does not feel like a hospital. Older adults move through simple exercise, cognitive activities, music, conversation, and the small rituals that make…
On the 13th floor of the Jen Chi station-front building in Taipei, a school bell rings. The room does not feel like a hospital.
Older adults move through simple exercise, cognitive activities, music, conversation, and the small rituals that make a day feel like a day. Some need prompting. Some repeat a question. Some are stronger than their families expected. Nearby, caregivers finally have a little room to breathe.
I recently revisited the story of Ramona Pierson, a woman who survived a devastating accident, spent 18 months in a coma, and eventually rebuilt her life with the help of an unexpected community of older adults. It is an inspiring…
I recently revisited the story of Ramona Pierson, a woman who survived a devastating accident, spent 18 months in a coma, and eventually rebuilt her life with the help of an unexpected community of older adults.
It is an inspiring story. It is also one that raises an important question for those of us who have worked in long-term care: What kind of facility was this?
There was a point, not very long ago, when I thought I understood the staffing crisis in America's nursing homes. Like most people, I had heard the statistics. We don't have enough nurses. Too few certified nursing assistants are entering…
There was a point, not very long ago, when I thought I understood the staffing crisis in America’s nursing homes.
Like most people, I had heard the statistics. We don’t have enough nurses. Too few certified nursing assistants are entering the profession. Caregivers are overworked, underpaid, and burning out. An aging population needs more care than the workforce can provide.
It all made sense.
When another story surfaced about a resident suffering a …
The day after a man completed a physical fitness assessment for people with disabilities, he came back. He did not return because we had forgotten a test. He was not asking for another consultation. He did not need a prescription.…
The day after a man completed a physical fitness assessment for people with disabilities, he came back. He did not return because we had forgotten a test. He was not asking for another consultation. He did not need a prescription. He came back carrying a box of pineapple cakes.
In Taiwan, that gesture means more than bringing dessert. The Taiwanese pronunciation of pineapple is associated with wang-lai, a phrase that sounds …
When a family finds a loved one with a severe bedsore in a nursing home, they often sue. But these cases are rarely decided by the wound itself. They are decided by what the medical record shows. Tracy Liberatore is…
When a family finds a loved one with a severe bedsore in a nursing home, they often sue. But these cases are rarely decided by the wound itself. They are decided by what the medical record shows. Tracy Liberatore is an attorney and former physician assistant who does expert witness work …
During my first week as a clinic operations volunteer at Lawndale Christian Health Center, I expected to learn about medicine. Instead, I learned about a scooter. This scooter belonged to a certain Mr. Simmons (or so I will call him).…
During my first week as a clinic operations volunteer at Lawndale Christian Health Center, I expected to learn about medicine. Instead, I learned about a scooter.
This scooter belonged to a certain Mr. Simmons (or so I will call him). Mr. Simmons was a man experiencing homelessness who was beloved by the Lawndale Mobile Care Team (the group which provides health care to Chicago’s homeless shelters) because of his unwavering optimism …
Health care systems do not function on institutional design alone; they function on the invisible labor of the people moving through them. There's a kind of education you don't choose. It begins, in my case, when my son is eight…
Health care systems do not function on institutional design alone; they function on the invisible labor of the people moving through them.
There’s a kind of education you don’t choose. It begins, in my case, when my son is eight months old and continues for nearly two decades. At some point, it stops feeling like managing medical care and starts feeling like learning a second language, except the language is institutional, …
We are exquisitely good at managing the aging emergency and strikingly bad at preventing it. That is a system design choice, not a clinical inevitability. Every physician who cares for older adults knows the pattern. A patient we have seen…
We are exquisitely good at managing the aging emergency and strikingly bad at preventing it. That is a system design choice, not a clinical inevitability.
Every physician who cares for older adults knows the pattern. A patient we have seen for years, stable, independent, managing, arrives one day transformed by a single event: a fall, a hospitalization, a stroke, an acute delirium. And in the seventy-two hours that follow, a family …
Everyone celebrates a successful hospital discharge. The patient is medically stable. The paperwork is complete. The prescriptions have been sent. Transportation has been arranged. Another bed becomes available for the next patient who needs care. On paper, the system worked.…
Everyone celebrates a successful hospital discharge. The patient is medically stable. The paperwork is complete. The prescriptions have been sent. Transportation has been arranged. Another bed becomes available for the next patient who needs care. On paper, the system worked.
Yet discharge is not the finish line. It is a transition point. For hospitals, discharge often marks the successful completion of an episode of care. For patients and families, it marks …
I am the first physician in my family. Serving others as a physician and physician researcher is not just my profession, it is my calling. But with that calling comes an unseen responsibility: the weight of caring for those closest…
I am the first physician in my family. Serving others as a physician and physician researcher is not just my profession, it is my calling. But with that calling comes an unseen responsibility: the weight of caring for those closest to me, including aging relatives.
When my grandmother was dying, I found myself stepping into the role of physician at moments when all I wanted was the space to grieve as …
A school bell rings inside the Jen Chi station-front building, a historic health and social welfare hub in Taipei. For a visitor, it may sound ordinary. For staff, it marks the end of another class, another session, another carefully planned…
A school bell rings inside the Jen Chi station-front building, a historic health and social welfare hub in Taipei.
For a visitor, it may sound ordinary. For staff, it marks the end of another class, another session, another carefully planned activity for older adults. For family caregivers, it may mean a short moment of relief. For a person living with dementia, the sound may not become a lasting memory, but …
Frederick Smith is in his 70s, has advanced Alzheimer's disease, and lives in a nursing home just south of Boston. He has not had a meal in three days because his roommate is stealing his food and no one has…
Frederick Smith is in his 70s, has advanced Alzheimer’s disease, and lives in a nursing home just south of Boston. He has not had a meal in three days because his roommate is stealing his food and no one has stopped it, either because staff have not noticed or do not have the time or training to intervene.
Tens of thousands of older adults spend their final days in nursing homes …
In medicine, we are trained to notice decline. We track blood pressure, glucose, gait speed, medication lists, cognitive scores, fall risk, frailty, and health care utilization. These measures matter; they save lives and guide care. But we risk reducing aging…
In medicine, we are trained to notice decline. We track blood pressure, glucose, gait speed, medication lists, cognitive scores, fall risk, frailty, and health care utilization. These measures matter; they save lives and guide care. But we risk reducing aging to a checklist of deficits.
I was recently reminded that aging care requires something much harder to measure: the ability to let an older person remain whole.
There's a moment that happens in almost every family caring for an aging parent. It usually begins the same way. Someone leans in, frustrated, exhausted, sometimes whispering, sometimes shouting, and says, "My family is crazy." As a geriatric psychiatrist, I…
There’s a moment that happens in almost every family caring for an aging parent. It usually begins the same way. Someone leans in, frustrated, exhausted, sometimes whispering, sometimes shouting, and says, “My family is crazy.”
As a geriatric psychiatrist, I hear this often. What’s interesting is that everyone says it. Every sibling group thinks the others are unreasonable. Every adult child believes they’re the only one who sees things clearly. Every …
A dry cough can be one of the most misleading symptoms in medicine. At home, it can dominate the emotional climate of an entire household. It interrupts sleep, breaks conversations, unsettles meals, and keeps caregivers in a state of low-grade…
A dry cough can be one of the most misleading symptoms in medicine. At home, it can dominate the emotional climate of an entire household. It interrupts sleep, breaks conversations, unsettles meals, and keeps caregivers in a state of low-grade vigilance. It appears in cold air, at the beginning of a speech, during the first few sentences of a phone call, or in the quiet moment when everyone is finally …
Families often ask me what "healthy aging" really means. They expect actionable answers: target lab values, a 30-minute exercise prescription, or a strict dietary plan. In modern health care, we deliver these metrics with precision, yet our patients continue to…
Families often ask me what “healthy aging” really means. They expect actionable answers: target lab values, a 30-minute exercise prescription, or a strict dietary plan. In modern health care, we deliver these metrics with precision, yet our patients continue to struggle. That gap is not a failure of compliance. It is a failure of imagination. Recently, I found myself contemplating a different kind of prescription while attending a piano recital …
Every year on March 14, mathematicians celebrate Pi Day. The constant π (approximately 3.14) describes the ratio between a circle's circumference and its diameter. It represents perfection in geometry. But in clinical life, health rarely looks like a perfect circle.…
Every year on March 14, mathematicians celebrate Pi Day. The constant π (approximately 3.14) describes the ratio between a circle’s circumference and its diameter. It represents perfection in geometry. But in clinical life, health rarely looks like a perfect circle. I was reminded of this while speaking with Mrs. Chen at a community health program. She was 78 years old. By most medical standards, she was doing well. Her blood …
