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.
A call came about noon a few years ago that a patient I’ll call Stella was being admitted once again. She had come into the ER from her nursing home to receive transfusions. These were now needed every two weeks to keep her alive. The problem was that every time Stella was moved she decompensated. Her Alzheimer’s was severe. She no longer recognized her family. She was now 83 and slowly …
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When “do no harm” is no longer textbook
Our practice will no longer see nursing home patients in our office. If a nursing home patient is already established with us, then we will see him; but, we have decided not to accept new patients.
Of course, we believe that these individuals — like the rest of us — deserve medical care. This demographic not only deserves care, but has the greatest need for medical services. Our practice will see …
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Why this physician will no longer see nursing home patients
I’ve known Pat McCann (identifying information changed) for many years. He carries a diagnosis of COPD and has a preventative and a rescue inhaler, but he has never really had any serious flare-ups.
He fell and broke his hip. Then he went to skilled rehab, one of a half dozen near Cityside Hospital. His stay turned longer than expected because he fell, luckily didn’t break anything, but had to go back …
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A diagnosis of pneumonia in a rehab facility: We can do better
I left a full-time academic position five years ago because I was literally, “check-all-the-boxes,” burned out. In looking back during that time prior to my decision to leave, I recall months of feeling overwhelmed, emotionally exhausted, depressed, and in a sense grieved for the loss of what I envisioned my career path to be until retirement. It was not until one of my favorite patients, Mr. Young, who knew me …
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How a patient saved this physician from losing her passion for medicine
“Let’s start the powwow,” a man with a brown jacket and braided ponytail said with a smile. Nineteen adults and one child filled the back conference room of the hospital. The hospital had made an industrial cylinder of coffee for the meeting, and it was almost completely drained. I hung the stethoscope around my neck, knowing I wouldn’t use it as anything but a prop to signify my training and …
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A family meeting in Navajo Nation
Society gives short shrift to older age. This distinct phase of life doesn’t get the same attention that’s devoted to childhood. And the special characteristics of people in their 60s, 70s, 80s and beyond are poorly understood.
Medicine reflects this narrow-mindedness. In medical school, physicians learn that people in the prime of life are “normal” and scant time is spent studying aging. In practice, doctors too often fail to appreciate older …
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Ageism in medicine is real. How can it be stopped?
A recent New York Times article described a 77-year-old retired gardener in England who had not spoken with another human being in more than six weeks. He told the reporter through tears that he felt “very lonely, and bored.” Recent budget cuts prevented him from taking the bus to the grocery store. Younger people, including his own son, had left town for better jobs in larger cities.
I see this loneliness …
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Older adults and the epidemic of loneliness
If you’re sexy, fit and nimble, if you can part your thighs and bend your knees, if you can see your private parts without a mirror, ignore this. Move on. This is not for you.
This is for those with flailing sex-drive and failing abilities whose sex life is a challenge, but they’d like to make their partners happy and have some fun. Maybe your parents or grandparents. This must be an …
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Sex in the elderly is not a need. It’s a privilege.
Medicare wants doctors to get patients on their computers. Doctors are required to set up computer portals to communicate with patients. These portals use two-factor identification and presume substantial computer literacy from patients in their late 70s or 80s.
Yet, there are limits. For many geriatric patients, a cell phone means a feature phone with gigantic numbers. If they have a computer, it …
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It’s time to teach the elderly about computer safety
This is the scenario. You (or your mother) were admitted to the hospital with pneumonia. On the third day a cheery continuing care nurse comes in and says, “You don’t have a fever, and the doctors feel you can be discharged to finish your course of antibiotics, but your nurse tells me you are still too weak to go home, so we are going to send you to rehab. Here …
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How to choose the right rehab option after a hospital stay
I dedicate this to each of you who have cared for or are currently caring for an ill parent or family member.
Recently, due to the stress that several of my dearest friends have been experiencing in caring for their elderly parents, I am even more appreciative and respectful of my privilege in caring for elderly patients who have attentive and loving adult children who accompany them to our ER.
Although this …
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Appreciative and respectful of my privilege in caring for elderly patients
One of the major challenges of being on medical school rotations is the necessity of changing rotations every four weeks, and how adapting to each new specialty feels like going through the first day of school all over again.
I want to share my experience on other side of the coin. About a year ago, I started participating in Stanford’s Continuity of Care program, a clerkship in which I am excused from …
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Why medical students need more continuity of care training
Often people (mostly residents and medical students) ask why on earth did I choose to do a geriatric fellowship? My response is because it is the medicine of the future. While we are all aging, the fastest growing age groups are those born between 1946 to 1964. The Baby Boomers. The Silver Tsunami. The Grey Hoard. Call it what you will, but estimates are that by 2060, 98 million (24 …
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Geriatric medicine is a calling
These days we are talking more about advanced directives and living wills in health care. This is progress, but as a member of the sandwich generation, I am focused on the aging process. I don’t have kids, but I have parents and have the honor of watching patients struggle with aging and helping loved ones grow old — walking the long, winding and thorny road.
Patients have asked me, “Where are …
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Getting old ain’t for sissies
I recently stopped by our local grocery store after work to pick up a handful of items to bring home. With only four items in hand, I luckily found a short checkout line behind this lovely elderly couple who were almost done and ready to pay. As they smiled and made small talk with the cashier, I imagined a typical geriatric medical story about them.
They appeared in good health which …
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The elderly couple who bought vitamins at the grocery store
Caregiving is often described as a sacrifice. One individual bears a burden to care for another. There’s a connotation of drainage, evocations of burned-out batteries and tired limbs.
I was a premedical student. I was aggressive in pursuing an MD. I wanted to be the best doctor I could be. I did not realize that required me to become a much a better person.
I left school to care for my grandmother. …
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Here’s what caregiving taught me
Prevailing wisdom states that more is better — and it is no different when it comes to our expectation of medical treatments. With the help of the internet, patients and their families have come to expect intensive tests, treatments and therapies at every life stage.
But sometimes, too much treatment can do more harm than good. This is true in all ages but is especially relevant for older adults living with …
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Too much of a good thing when it comes to medicine for older adults
