As I enter the exam room, I hear, “Don’t get old honey!”
As a physician caring for a large population of geriatric patients in Florida, I hear this approximately five times a day. To this statement, I always reply, “There’s no alternative, though!” I also try not to get offended by repeatedly being called “honey.” Although I am waiting to someday state; “it’s Doctor Honey.” Usually, my level is offense is …
Why I love caring for geriatric patients
The chances that you or someone you love will be diagnosed with dementia are shockingly high. By age 65, your chances are already at 9 percent. Make it to age 85, and the chances go up to 33 percent. Of course, if you’re diagnosed with dementia, it will be a struggle for you to think clearly about your diagnosis. So, today, while all of your faculties are still intact, I’d …
Dementia is worse when coupled with inadequate preparation
First, you have to call up your daughter to pick you up and take you to the lab. It’s hard for the nurse to find your vein. The pain from his fishing around in your arm is not nearly as bad as the pain you always have in your hip, and back, and shoulders, but it’s the straw that breaks the camel’s back, and you cry a little bit. The …
A quick CT scan for the frail and elderly
Sometimes what makes truly great catchphrases, mission statements, and movie titles so powerful is that they are true, always necessary, and sometimes sufficient. I was reminded of this a few months back when a patient called into our telephonic urgent care triage line worried about a drug overdose. I was in my office typing or talking away, as I am prone to do, when the registered nurse who took the …
Treat the whole patient and do the right thing
The holidays bring friends and family together for celebrations and the chance to reconnect with people we may not see regularly during the rest of the year. But for people who are the caregivers for a parent, spouse, partner, or other family member who is living with Alzheimer’s disease or other forms of dementia, the holidays can be more complicated.
Beyond the stress of continuing to provide care during an especially …
Navigating the holidays when you’re a caregiver for a loved one living with dementia
The afternoon that I went for a walk with Linda* for the first time was one of the moments I’ve been proudest of as a hospice volunteer, odd though that may seem.
I’d first met Linda a few months prior to that, when the late fall and winter light made her and her husband Joseph’s small and cluttered apartment dark in the early afternoons. I was there mainly to visit Joseph, …
Easing a burden, one step at a time
My brother and I are both physicians. He is a pediatrician; I am a geriatrician and palliative medicine doctor. We are both getting older.
My brother has been a practicing pediatrician for almost 50 years. He had a remarkably successful solo practice in the city where he lived. He recently retired but continued to work at a free clinic several days a month. When it became time for him to renew …
Aging out of being a physician
Five months ago, “little kids” started visiting my father-in-law, stealing things. The hallucinations and dementia progressed, and we were forced to move him to a memory care unit.
Memory care unit is the polite term for a lockup unit for people with dementia. Walking through the locked doors for the first time triggered in me an intense urge to run away.
First, you encounter the “dementia parking lot” with the “inmates” parked …
How to make compassion your personal pain reliever
Dean Ernest had been living in a nursing home about a year when his son, John, got a call last winter asking if his father was experiencing back pain and would like a free orthotic brace.
The caller said he was with Medicare. John Ernest didn’t believe him, said “no” to the brace and hung up. He didn’t give out his father’s Medicare number.
And yet, not just one, but 13 braces …
How the latest Medicare fraud schemes involve telemedicine
On October 1, 2019, Nevada began allowing individuals to avoid living in late-stage dementia. The new statute recognizes the legitimacy of an advance directive that instructs health care providers to stop hand feeding food and fluid by mouth. Individuals have already been completing such directives in New York and Washington. The Nevada law is the first that explicitly authorizes such instructions.
Growing …
Avoiding late-stage dementia with advance directives for stopping eating and drinking
At first, Dr. Robert Zorowitz thought his 83-year-old mother was confused. She couldn’t remember passwords to accounts on her computer. She would call and say programs had stopped working.
But over time, Zorowitz realized his mother — a highly intelligent woman who was comfortable with technology ― was showing early signs of dementia.
Increasingly, families will encounter similar concerns as older adults become reliant on computers, cellphones, and tablets: With cognitive impairment, …
Taking away a senior’s smartphone is a complicated issue
A month ago, during a visit to her doctor’s office in Sequim, Wash., Sue Christensen fell to her knees in the bathroom when her legs suddenly gave out.
The 74-year-old was in an accessible stall with her walker, an older model that doesn’t have brakes. On her left side was a grab bar; there was nothing to hold onto on the right.
Christensen tried to pull herself up but couldn’t. With difficulty, …
Health care facilities are difficult to navigate for older adults
Ageism in health care abounds. Older adults are often overtreated or undertreated for various conditions. The presence of things like fatigue, chronic pain, arthritis, and even cognitive impairment are often accepted as “normal” parts of aging — by physicians and patients alike — despite the fact that many are preventable.
According to a recent opinion piece by NBC News, “We medicalize the natural process of …
Can entrepreneurial geriatrics fight ageism in health care?
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Recently I visited a lady at her home who was a palliative care patient. She was seated on the couch in the living room with a turban on her head and a look of anxiety and depression. Her husband was quiet during the entire visit. He was seated in a chair next to the couch and just looked at his wife and did not participate in the conversation. Her son …
Simple suggestions can make such a positive impact
It’s often said that pediatricians and veterinarians have the hardest jobs in medicine because their patients can’t tell them where it hurts. But the same is often true for the health care professionals treating older patients who can’t communicate well or don’t fully understand what’s being explained to them.
So, whose job is it to advocate for these patients? The answer is that everyone on the medical team must play a …
Who should advocate for older patients in the hospital?
During my training to become a primary care physician, the importance of preventive cancer screening was ingrained in me. The idea of catching cancer at an early stage so we can better treat it made intuitive sense. But as I’ve learned over the years, the simplicity of this concept can obscure its limitations and make it difficult …
Convincing patients to stop cancer screening isn’t always easy
Everyone knows someone today who’s dealing with dementia. And as a geriatrician — that means a lot of questions come my way. Questions about parents who recently had cognitive testing, about the role of assisted living, about prevention — you name it. Dementia is out there in a way it never was before. People have questions, and they need answers.
Dementia is not a normal part of aging
This is where I …
Arm yourself with new dementia information
The decision seemed straightforward. Bob McHenry’s heart was failing, and doctors recommended two high-risk surgeries to restore blood flow. Without the procedures, McHenry, 82, would die.
The surgeon at a Boston teaching hospital ticked off the possible complications. Karen McHenry, the patient’s daughter, remembers feeling there was no choice but to say “go ahead.”
It’s a scene she’s replayed in her mind hundreds of times since, with regret.
On the operating table, Bob …
The questions surgeons need to ask their seniors before surgery
Literature surrounding the effects of social isolation and loneliness for older adults is no longer lacking. Studies and articles outlining the dreadful consequences of these epidemics have even pierced large media outlets like Time magazine, where they emphasize how one in three older adults are lonely.
While any attention brought to the fact that the age group containing people age of 85 and up is …
The suffocation of social isolation
Cognitive decline in older adults has been accepted as a normal part of aging. Recall, episodic memories, processing speed, and divided attention are all expected to decrease with time, but the implications of this decay are rarely discussed. Elderly scholars, or individuals who have sought to learn about the world or facets of the world through books, articles or newspapers, often are devastated by this cognitive decay. But, what if …
The uphill battle for scholars in elderly care
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