Eight things every elderly patient wants you to know before you treat him
Dr SS Agarwal, Dr K K Aggarwal 1. All doctors should be educated in the basics of Geriatric Care: With the explosion of the aging population it is impossible to train enough geriatricians. To ensure that elderly patients receive good care there need to be 10 times as many geriatrics savvy internal medicine physicians as certified geriatricians. 2. Focus on maintaining patients mobility than the disease: Most older adults spend the majority of their days in the hospital in bed, even when they are able to walk independently. This is a major risk factor for functional decline. One should ambulate three times a day with nursing supervision. 3. Follow the ten Choosing Wisely Guidelines Set Forth by the American Geriatrics Society: Taking care when prescribing medications for the elderly, guarding against the dangers of polypharmacy, and avoiding restraints in cases of delirium 4. Follow an interdisciplinary team based approach to cover patient's and family's needs and individual goals for care. 5. Guard Against Delirium: Do not frequently wake patients multiple times per night, it can add to delirium. Dementia patients are at an "especially high risk for delirium and must be observed more closely. 6. Beware of polypharmacy and of at risk drugs. Polypharmacy is a major contributor to delirium. Ensure the right drug in the right dose is ordered for the right patient at the right time. 7. Follow syndrome approach rather than independent cause approach. For example in a patient with post-operative delirium, incontinence, or an increased risk for falls look for multiple contributing factors rather than a unique cause. 8. Focus care on the patient as a whole, and on individual goals for treatment. Treat the patient and not the disease. Do not treat high blood pressure aggressively if the drugs make a patient dizzy to the point of falling.
Dr SS Agarwal, Dr K K Aggarwal 1. All doctors should be educated in the basics of Geriatric Care: With the explosion of the aging population it is impossible to train enough geriatricians. To ensure that elderly patients receive good care there need to be 10 times as many geriatrics savvy internal medicine physicians as certified geriatricians. 2. Focus on maintaining patients mobility than the disease: Most older adults spend the majority of their days in the hospital in bed, even when they are able to walk independently. This is a major risk factor for functional decline. One should ambulate three times a day with nursing supervision. 3. Follow the ten Choosing Wisely Guidelines Set Forth by the American Geriatrics Society: Taking care when prescribing medications for the elderly, guarding against the dangers of polypharmacy, and avoiding restraints in cases of delirium 4. Follow an interdisciplinary team based approach to cover patient's and family's needs and individual goals for care. 5. Guard Against Delirium: Do not frequently wake patients multiple times per night, it can add to delirium. Dementia patients are at an "especially high risk for delirium and must be observed more closely. 6. Beware of polypharmacy and of at risk drugs. Polypharmacy is a major contributor to delirium. Ensure the right drug in the right dose is ordered for the right patient at the right time. 7. Follow syndrome approach rather than independent cause approach. For example in a patient with post-operative delirium, incontinence, or an increased risk for falls look for multiple contributing factors rather than a unique cause. 8. Focus care on the patient as a whole, and on individual goals for treatment. Treat the patient and not the disease. Do not treat high blood pressure aggressively if the drugs make a patient dizzy to the point of falling.
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