Geriatrics

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.

Doctors should ask about financial safety

Susan M. Reverby, PhD

Patient

January 26, 2014

In most states, doctors are mandated to ask their patients if they feel physically “safe at home.” With an aging population, perhaps another question should be added: are you financially safe?

Two examples suggest the problem.

“Trudy” had always managed her financial matters, even complex transactions. Aging, however, had made her short-term memory a bit more problematic and her focus diminished by TIAs. Even though her daughter shared responsibility on some of …

When should you use antibiotics in hospice care?

Alex Smith, MD

Physician

January 23, 2014

Case 1: You have a 94-year-old woman with multiple medical problems in hospice who develops a fever (subjectively hot to the touch), shortness of breath, and a cough producing yellow sputum. Her daughter asks if she can be treated with antibiotics “to make her feel better.” The patient is not well enough to make decisions, but in earlier conversations had stated a goal of remaining comfortable at home, while also …

What I’m looking for in a personal health record system

Leslie Kernisan, MD, MPH

Health Technology

January 15, 2014

When it comes to the health care of a frail older person, families really need a good personal health record (PHR) system. So I am once again preparing to take a look at what’s available, in hopes of finding something that I can more confidently recommend to the families I work with. (To see what medical info I urge families to track, see this Geriatrics for Caregivers post.)

I have …

Inside a home visit: Seeing her as she really was

Jordan Grumet, MD

Physician

January 9, 2014

I guess it shouldn’t have been a surprise.

Her house was exactly as I expected it to be. The door couldn’t have been more fitting; red wood with a green holiday wreath attached perfectly in the center. The carpet was so white that I almost took off my shoes on the front porch before entering through the threshold. The room was warm. The ambient temperature was accentuated by a plethora of …

3 ways Medicare can reduce overtreatment

Jim Sabin, MD

Physician

December 16, 2013

If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications.

Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), and that the Medicare Part A trust fund is projected to have insufficient funds to cover …

Are we prepared as the Boomer generation downsizes?

Jim deMaine, MD

Physician

December 9, 2013

John and Eva had ongoing conversations about their home which was now far too big for their needs and lots of trouble and expense to repair and keep up. John said, “It’s the yard, the leaves, the painting, and general repair and replacement problems. What’s next to go? The refrigerator or me?” Eva was tired of shopping and cooking. Her arthritis was slowing her down. She told John, “Ok, you …

I spend more time checking boxes than talking to patients

Regina Harrell, MD

Physician

November 26, 2013

I am a primary care doctor who makes house calls in and around Tuscaloosa, Alabama. Most of my visits are in neighborhoods, but today my rounds start at a house located down a dirt road a few miles outside of town.

Gingerly, I cross the front walk; Mrs. Edgars told me that she killed a rattlesnake in her flowerbed last year.

She is at the door, expecting my visit. Mr. Edgars sits …

Why electronic medical records are dangerous to older adults

Michael Wasserman, MD

Health Technology

October 20, 2013

A recent experience with my father-in-law reminded me of something that has concerned me for some time. While EMRs have some benefits for older adults, on balance I believe that they portend more dangers. There are multiple reasons, but the biggest is that health care providers tend to believe everything they read in an EMR. Even if what they read is wrong!

A wise computer programmer once told me that “computer’s …

We need more innovations in caring, not curing

Leslie Kernisan, MD, MPH

Health Technology

October 17, 2013

I assume by now that you’ve heard the news: Google wants to tackle aging. Specifically, they announced the launch of Calico, “a new company that will focus on health and well-being, in particular the challenge of aging and associated diseases.”

Because, says Larry Page, with some “moonshot thinking around healthcare and biotechnology, I believe we can improve millions of lives.”

“Can Google Solve DEATH?” shrieks a TIME cover.

Google’s goal, it seems …

Had I met her anywhere but the hospital, I would have helped her

Ilana Yurkiewicz

Medical Education

October 16, 2013

Had I met her anywhere but the hospital, I would have gone to her side. I would have asked her what was wrong. I would have offered to help.

She was 99-years-old and about to undergo surgery. Pre-operative holding is generally a busy place. Patients lie in gurneys, spending some last moments with loved ones and fielding questions from various players of the surgical team as they come to the bedside. No, …

Communication about prognosis and goals of care is still lacking

Alex Smith, MD

Conditions and Diseases

October 14, 2013

Advanced dementia is a terminal illness needing palliative care. Unfortunately, there is a great divide between this statement of the world as it should be, and the current reality of the world as it is. Rates of pain and shortness of breath are high for patients with advance dementia. Patients with advanced dementia often reside in nursing homes, and few nursing homes offer specialized palliative care services.

And, as we can see from an …

Being the kind of doctor that I would want to care for my loved ones

Jordan Grumet, MD

Physician

October 11, 2013

I was spiking a fever.

It was as if someone flipped a light switch inside my body. I could feel the sensation rise through the chest, and trample the dazed contents of my skull. Light, however, was a poor, lazy metaphor. There was no heat, only stimulation.

My belly ached from the repetitive heaving that preceded the fever. I envisioned the sandwich I had eaten that afternoon. I pictured small bacteria crowding …

The gaps in our current care of critically ill patients

Albert Fuchs, MD

Conditions and Diseases

October 10, 2013

A sudden life-threatening illness is every family’s nightmare. A loved-one suddenly develops an overwhelming infection or is in a terrible accident. She is rushed to the intensive care unit (ICU) and is put on a ventilator (breathing machine). Many medications are started or she is rushed to surgery for her traumatic injuries.

To the family, the first day or two is a blur of life-saving treatments, painfully waiting for the next …

What do we do with the extreme elderly?

Janice Boughton, MD

Physician

October 10, 2013

A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …

Read more…

What do we do with the extreme elderly?

Stop cancer screening in patients with dementia

Ken Covinsky, MD

Conditions and Diseases

September 13, 2013

Cancer screening is of little benefit in persons with dementia but can cause very serious harms. Older persons with dementia have limited life expectancies which makes any benefit from cancer screening very unlikely. This is because cancer screening works by identifying a cancer many years (generally at least 5-10 years) before it would threaten health.

But cancer screening tests cause lots of burdens when given to persons with dementia. The …

The future of geriatrics: Questions to consider

Leslie Kernisan, MD, MPH

Physician

September 13, 2013

Recently, the New York Times featured a post about me and my practice. Titled “Walking Away from Medicare,” it describes my decision to opt-out of Medicare and create a different kind of geriatric practice.

It has generated quite a lot of comments. Most of them judge me pretty harshly. It seems that many people feel that I’m doing this for the money. And that I don’t care …

Is there any single secret for aging well?

Suzanne Koven, MD

Physician

September 11, 2013

The word “doctor” derives from the Latin verb docere: to teach and, as a doctor, I do often offer instruction. But when a woman in her eighties comes in for her annual physical and tells me she’s still dancing, mowing her own lawn, and helping out her older neighbors, I have no illusions about which of the two of us should be doing the teaching.

Particularly since reading this lovely feature story about Ethel …

The difficult transition between the hospital and nursing home

Ken Covinsky, MD

Physician

September 5, 2013

nursing_home_abuse

Huge numbers of older persons transition from hospitals to the nursing home. Often, an older hospitalized patient needs skilled nursing care before they are ready to return home. In other cases, a nursing home patient who needed hospitalization is returning to the nursing home. Older patients and their families certainly hope that great communication between the hospital and nursing home would assure …

Can technology help individualized medical decision making?

Leslie Kernisan, MD, MPH

Physician

September 1, 2013

Shouldn’t everyone get an individualized assessment of likely benefits, burdens, and risks before making a big medical decision?

I was asked this question recently, during an interview for an Internet radio show on aging.

Per my host’s request, I’d been explaining the practice of geriatrics, and talking about the geriatric approach to addressing the medical needs of older adults. Since I’d mentioned that aging often brings on greater risk of side-effects or …