Adventures in Eldercare April 2014
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 and every 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 of events that can lead to serious consequences.
Medication mishaps cause a huge number of hospitalizations and in fact the majority of hospital
re-admissions. Making more time for visits with aging and complex patients is critical to avoid mishaps of 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.
1. 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.
2. 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.
3. 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, might be worth the side-effects, 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. So does it make any 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 absolutely necessary
Dr. Bruce Veltri operates 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 519-429-2644 or visit our web-site, victoriaeldercare.com for more information about our services.