What Does Good Geriatric Care Look Like?

 Good geriatric care looks fundamentally different from standard adult medicine.  It's a philosophy focused on function, quality of life, and the whole person, not just diseases.  Care decisions are shaped around the patients goals, whether that's staying independent, avoiding hospitalization, traveling or minimizing medications.

Good geriatric care looks at the whole person, not organ by organ.  Physical, cognitive, mood, mobility, hearing and vision, etc. are all assessed.  Medication restraint is also the hallmark of good geriatric care.  Regular medication reviews, stopping drugs that no longer help, using the lowest effective doses.  The goal is to improve your life, not complicate it.

Longer office visits and fewer rushed decisions, proactive prevention of common geriatric problems like falls and social isolation can prevent a crisis from happening.  Clear, honest communication between doctor and patient is key.  The doctor MUST make sure the patient understands medications and procedures to follow.

Good geriatric care exists, but it is hard to find.  Geriatric doctors are not in large supply, because good care of seniors requires more time be spent with each patient.  Hospitals and insurance companies don't like that, so geriatric care is more expensive, and may not be available to all.  It's sometimes hard to do this, but make sure that you understand everything before leaving the doctor's office.  They may try to rush you, but try not to let them.  Ask questions.  Bring a list of concerns with you to the office, and make sure everything you want has been addressed.  That's probably the best we can do for now.

Healthcare: Are You Satisfied?

 I've been thinking about the healthcare system lately, and to sum it up in a word, I feel it is inadequate.  Not because we don't have highly trained doctors, most of whom care about their patients, but because of the system.  Patients experience long wait times to even get in to see a doctor, short office visits (10-12 minutes is what they schedule), and often time much of that time is not with the doctor, but a nurse or technician.  Our system prioritizes efficiency, not care.  There is a heavy reliance on checklists and protocols.  

Most healthcare in the U.S. is for profit.  This means that the goal is to make money.  Most doctors are great at ordering tests and medications, yet lack the required time, continuity and personalization needed to help many patients.  

Here's an example from my life.  I have significant arthritis in my lower back, causing me extreme pain.  I had this six years ago, was treated with 2 epidural injections, and felt great for many years.  Now, the pain is back and worse than ever.  In order to get the epidural injections, I must first have several weeks of P.T., when that doesn't help, have an MRI, then I can see the doctor.  All that takes weeks, weeks that I am suffering!  I finally see the doctor and miraculously I only have to wait a few days for the injection.  Then, I wait two weeks to see results.  If the results aren't good, you schedule another shot, which is just what I did.  Luckily, the results have been better.

After each injection, I had a Zoom follow up with my doctor.  She asked how I was feeling, and told me that if the next injection didn't work, I should consider surgery.  The Zoom appointment was less than 5 minutes.  No other alternatives, or lifestyle changes were suggested.  

Aging patients are often the most harmed by the weaknesses of modern healthcare, not because their needs are extreme, but because the system is poorly designed for complex, slow-moving, interconnected problems.

Seniors usually have more than one problem at a time, which means going to multiple specialists, often getting conflicting information.  Seniors may take numerous medications, and reviewing them can take time, time the doctor does not have.  Doctors often minimize the complaints of seniors, saying things like "Let's just watch it,"  or  "That's normal for your age.

There are numerous other factors that affect the healthcare that seniors receive.  Our system is designed to treat disease, manage emergencies and follow protocols.  Aging patients need systems that manage complexity, preserve function, protect dignity and prioritize quality of life.  That mismatch is why care so often feels inadequate.

The Impact of Stress on Your Life

 Chronic stress severely impacts health by causing long-term, systemic wear and tear on the body.  It damages cardiovascular health, weakens the immune system, causes musculoskeletal tension, and triggers mental health issues like anxiety and depression.

I have often thought that stress impacts our overall health dramatically, and now studies at the Mayo Clinic and Cleveland Clinic, among others, confirm this.  Stress is a natural human reaction that happens to everyone, and it's not all bad.  It can keep you alert, motivated and ready to avoid danger.  But stress becomes a problem when stressors continue without relief or periods of relaxation.

The key impacts of chronic stress are  on heart and cardiovascular systems, immune system suppression, mental health and brain function, and digestive and metabolic issues.  Constant stress keeps blood pressure high and heart rates elevated, increasing the risk of hypertension, heart attacks and stroke.  Chronic stress also reduces the body's ability to fight off infections, leading to more frequent illnesses and slower wound healing.  Prolonged stress can lead to depression, anxiety, memory impairment and burnout.  Finally, stress can cause stomach pain, diarrhea and nausea.  It can put you at higher risk for type 2 diabetes.

So, what can we do?  We live in a stressful world, so we must try our best to manage stress.  Some easy ways include techniques like exercise, proper nutrition, relaxation and socialization.  They are all critical to preventing long-term damage.

Nothing does more for me than a good walk with a buddy.  I have been walking regularly for 22 years with my good friend Fran.  We walk and talk and enjoy the beauty of our surroundings, and after an hour, we've done our 10,000 steps, caught up on gossip, and solved the world's problems.  I always feel better after our Saturday walks.  Find what works for you.  You'll be surprised at how good you will feel.

Is It Safe To Travel Abroad?

 I have been traveling a great deal in the past few years, and many people ask me the same question.  "Is it safe?"  The short answer is yes, and the long answer is also yes.

Statistically, an American is far more likely to be murdered while living in the U.S. than while traveling abroad, even in places that seem dangerous.

Here are some statistics for some places you might consider visiting.  Mexico:  60-75 American citizens per year are murdered in Mexico, out of 28-30 million visitors.  Risk per trip 0.2-0.3 murders per 100,000 American visitors.  Guatemala:  0-2 American homicide victims per year, out of 1million American travelers.  United Kingdom:  0 American tourists murdered, out of 4-5 million American tourists per year.  France:  0-1 American homicide victims per year out of 3-4 million American visitors.

Odds of being murdered in the United States:  6-7 murders per 100,000 people per year. With 330 million people, that equals about 20,00-30,000 murders annually.

These statistics show Americans are far more likely to be murdered here in America, than any place they might travel.  I did not include many "high risk" areas, but the rate of homicide is still far less than staying home.  In Israel, 0-2 American citizens are murdered each year (excluding times of war or terrorist attacks),  Likewise, the number of American tourists murdered in China is 0.

So, for those of you still not traveling and say it's because of safety, think again.  You may have many other reasons not to travel, but safety should be crossed off your list.  Yes, it's tiring, flights are overbooked and delayed, and lots of other obstacles may upset your trip.  But, many unexpected surprises may come from these disruptions.  I think of the play, Come From Away, and know that the passengers that landed in Iceland, where they stayed for several days, will never be the same.