The Case For Geriatric Care
Last updated: Sep 11, 2008
When it comes to caring for older adults, signs of overall health and well-being often come in unexpected places. Here's a clue: Have you checked out your parent's toes lately?
It seems the little things matter big time for seniors. That's the premise of an eloquent article by Atul Gawande, The Way We Age Now, in the New Yorker last year, which showcased the systematic and thoughtful practices of physicians who specialise in caring for the aging and ailing. The piece has done more to advance the cause of geriatric physicians, one geriatrician told me, than any medical association could ever do (with all due respect to the American Geriatrics Society).
In the story we meet geriatrician Juergen Bludau, who spends a good deal of time carefully examining 85-year-old Jean Gavrilles' feet -- the soles, the toes, the web spaces -- though she presented with a myriad of ailments, including back pain, arthritis, high blood pressure, glaucoma, incontinence...oh, and a lung nodule.
Bludau's assessment? The woman's biggest danger wasn't cancer -- it was her risk of falling . Jean Gavrilles had two of the three risk factors for falls: poor balance (an awkward gait when she walked in gave that away), taking more than four prescription medications (she takes five, together they can cause dizziness), and muscle weakness (she was strong enough, but not getting adequate nutrition to preserve her muscle strength). And, he observed, her feet were swollen, the toenails unclipped, there were sores between her toes, and the balls of her feet had thick, rounded calluses. Gavrilles risk for taking a life-changing tumble was very, very high.
Enter Bludau to the rescue. He referred Gavrilles to a podiatrist for monthly foot checks. He couldn't find a med he could cut, but did switch her diuretic to a blood-pressure drug that wouldn't cause dehydration. And he recommended ways she could maintain muscle strength through better eating. He followed up three months later and all was well. A check nine months later revealed she had not had a single fall and was still living independently. Strike one for the geriatricians.
Senior specialists aim to protect the frail elderly as much as possible from the ravages of disease and preserve function, but, just as importantly, they seek to support quality of life.
Here's a case where we can learn from others. New York Times reporter Jane Gross draws on professional and personal experience writing about the challenge of caring for older adults in her nascent blog The New Old Age. In a post titled What I Wish I'd Done Differently , she says "my single biggest mistake was not finding a doctor with expertise in geriatrics to quarterback my mother's care and attend to the quality of her life, not merely it's length."
Say no more. How do you find a physician with this type of training and experience? There's a serious shortage of geriatricians around the country so locating one may take a little legwork.
- Try a visit to the Physician Referral Service of the American Geriatrics Society’s Foundation for Healthy Aging or call 1-800-563-4916.
- Search for a board-certified geriatrician on the American Board of Family Medicine or the American Medical Association web sites.
- Ask for referrals or recommendations from your parent's primary physician, specialists, or other health professionals, friends who have aging parents, or the nearest university or medical center.
Your parents, and their feet, will thank you.
Image by Flickr user Martin Kingsley used under the Creative Commons attribution license.
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