Four decades ago, I finished my training in internal medicine. My first real life “job” was working at On Lok in San Francisco Chinatown. On Lok focuses on providing healthcare to frail older patients. There is an emphasis on home and community-based services. Daycare services and medical transport are included. On Lok was the original site of the Program of All-Inclusive Care for the Elderly (PACE). The above picture was taken at On Lok. I’m sitting with a 100-year-old patient. She would always walk up to me, show me her watch, and ask me what […]
Almost half of the people born in 1940 are still alive today. They are over 80 years old. For people who were born in 1950 or later, more than 70% are expected to live past the age of 80. What will life be like for these people? Is 80 the new 70? Or will living longer mean an extended period of weakness and frailty? It is true that frailty can be delayed. However, it is more controversial whether this has happened. Some people will live with extended periods of frailty. Why do some people become […]
“I recently went to my 50th reunion. A bunch of old people showed up. They looked like the grandparents of the people I knew in high school. It was freaky. The school athletes are now anything but athletes. They looked overweight and out of shape. Some even had problems walking.” Have you ever been to a high school reunion? Everyone is roughly the same age, but some people seem to “age” sooner and more rapidly than others. As the years go by, some of these classmates will become frail while others will not. Will we […]
The last several posts have been about fall prevention strategies. However, there are seniors who continue to fall frequently despite interventions. Some individuals are unstable as soon as they stand up and start walking. Other “frequent fallers” have dementia, poor judgement, and impaired impulse control. An accident can happen as soon as you’re not watching. Frequent falls can result in the decision to put a person into a nursing home. But nursing homes have limited success in reducing falls. Nursing home strategies include health assessments, medication review, exercise programs, and environmental improvements. However, falls continue […]
Kate is an 84-year-old widow with mild Alzheimer’s Disease. She lives alone and in the past year she has lost 10 pounds. She has also fallen multiple times. This is serious. The last time she fell she was on the floor for at least 8 hours. Her daughter called and then came by when Kate didn’t answer the phone. She was hospitalized for a condition called rhabdomyolysis. Afterwards, she was in a skilled nursing facility before returning home. She regained weight and received physical therapy. The daughter has “decluttered” the apartment to decrease the risk […]
My Dad has lived with us for two years ever since Mom died. He’s 87 now and has become more and more disabled due to recurrent strokes. Is there a better way to control his hypertension? He’s on 3 medicines and his blood pressure is still over 160. His doctor is suggesting another medicine. I’m very worried because he needs help walking. His pressure drops below 95 when he stands up. He gets dizzy and he falls a lot. I think it’s because of his meds. What is the best blood pressure for this person? […]
My Mom is 86 years old and “frail”. She has been in and out of the hospital for heart problems. I’ve been checking her oxygen levels, her blood pressure, and her heart rate. Her heart rate is usually around 55. Sometimes it dips as low as 48 then goes back up. That seems slow to me. Her PCP says that her slow heart rate is due to her medicines. Is her heart rate too slow? Is it making her weaker? Is she getting enough oxygen to her brain? In the above scenario, the patient’s heart […]
In a previous post, my friend Shannon talked about gracefully and thankfully accepting a caregiver at a certain stage in life. Today’s post is Part 2 of our discussion. Shannon talks about the relationship “rules” that both the caregiver and the client need to keep in mind to make the relationship a strong one.
In my last post I talked about a patient who had some bleeding in her brain. That was the obvious diagnosis. However, I'm frustrated because an important diagnosis was missed. It was immediately obvious that she was severely underweight. I looked through her chart carefully. Her weight had gone from 89 pounds to 74 pounds in a little bit over a year. No one had mentioned this.
Last week I was busy taking care of some patients. I reviewed the chart on a patient who recently had some falls and bleeding in the brain. She had a “subdural hematoma”. What is a Subdural Hematoma? Subdural hematoma is a medical term for bleeding between the brain and the skull. The bleeding can be a small or large amount and is easily seen on CT scan of the brain. The bleeding is due to bursting of veins on the surface of the brain. This is usually related to an injury to the head although […]