Slowing down Medical Decisions
Adventures in Eldercare November 2017
Slowing down the Medical Process saves Lives
Ageing seniors are often faced with more health conditions that need to be treated on a regular basis. It is important to be aware that more use of medicines and normal body changes caused by ageing can increase the chance of unwanted or maybe even harmful drug interactions.
As you get older, body changes can affect the way medicines are absorbed and used. For example, changes in the digestive system can affect how fast medicines enter the bloodstream. Changes in body weight can influence the amount of medicine you need to take and how long it stays in your body. The circulatory system may slow down, which can affect how fast drugs get to the liver and kidneys. The liver and kidneys also may work more slowly, affecting the way a drug breaks down and is removed from the body.
The business of medicine, for most doctors in Ontario, is fee-for-service and unfortunately this means that a physician’s income is directly dependent on the number of patients that he sees move through his clinic each day. This means short visits, a lot of information exchanged quickly and an emphasis on the patient being able to handle it all. In the elderly population this can be a very bad combination.
Medication mishaps cause a huge number of hospitalizations and most hospital re-admissions. Making more time for visits with ageing and complex patients is critical to avoid poor communication and rushed decisions. Slowing down the process is essential to help avoid possible life-threatening mistakes. There are three simple rules that all elderly patients and their caregivers can follow that will help to slow down the process.
Never alone. Elderly patients should be encouraged to bring a trusted person to all medical visits, and this should not be, if possible, their equally elderly spouse. This advocate in the room can act as a second set of ears, write down vital information and ask questions that might seem intimidating for the older senior to ask the doctor.
Pace medical decisions. Allow more time for reflection and the generation of questions, time for talks with family and friends, time for research on-line helps all of us to better understand our situations. Medical interventions in the elderly can have very serious consequences on quality of life; these decisions cannot be made in a 5-minute scrum. Take the information home, consult family and think about the consequences of having or not having the intervention. Consider all possible outcomes, good or bad, before making the decision.
Re-assess medications. The value of medications can change over time. What was wise and useful to take when younger in hopes for a healthier future can diminish in value as one ages. There are many examples of this, the most obvious being the trend to prescribe cholesterol lowering medications. These medications may have some benefit if prescribed to younger people and possibly help prevent heart disease down the road. Fine if you’re forty, but to prescribe the same medication to a 90-year-old because a blood test result indicates higher than normal cholesterol is cookie cutter medicine that has no proven outcome. These medications are known to cause dizziness in some people. Falls in the elderly are the number one reason for hospitalization. Does it make sense to prescribe these medications to the elderly when the risk of falling is increased and the benefits to heart health in a 90-year-old man are extremely limited if there are any at all. As an elderly patient or the caregiver of an elderly patient make it your goal to constantly re-assess medication and be very wary of adding any new medication unless proven necessary.
Dr. Bruce Veltri is the founder of Victoria Eldercare, a non-medical home care agency matching exceptional care-givers with elderly seniors, to help them maintain independence and remain safely in their own home. Victoria Eldercare is conveniently located in the Roulston’s Wellness Centre on Donly Drive in Simcoe. Call 519-429-2944, visit our web-site, victoriaeldercare.com or our Facebook page for more information about our services.