Older Patients, Wiser Care
Improving an Elder's Health in 2010: 7 Things to Check
Last updated: Dec 31, 2009
It's that time of year again: New Year's, when many of us take stock of our lives and think about how we might make things better. As a doctor, I'm always glad to see that health-improving resolutions remain among the most popular: quit smoking, lose weight, exercise more, stress less. These are great things for people of all ages to do. Even frail older people can benefit by not smoking, maintaining a healthy weight, taking a short walk every day, and spending quality time with friends and family in a familiar environment.
Now as a geriatrician, let me offer a few additional things that caregivers who want to improve the health and well-being of an elderly loved one can do in 2010. The following seven actions are simple, but too often overlooked:
1. Check your loved one for signs of functional impairment, both mental and physical. This means checking to make sure he or she hasn't lost any ability to do the basic activities needed for self care. For instance, is your loved one still able to walk, get dressed, control the bladder and bowels, use the bathroom, and manage personal hygiene? Has there been any difficulty with managing medications, finances, driving/transportation, meal preparation, and light housework? Changes in these abilities can be subtle, and are often not picked up at the doctor's office unless a family member speaks up. But these kinds of changes are often signs of physical or mental problems, so it's important to bring them to the attention of a medical professional.
2. Have your loved one assessed for pain. Studies have repeatedly shown that pain (enough to often bother a person) is common in older adults "“ but that it's also under-recognized and under-treated. This can really negatively affect an older person's health, from decreasing the motivation to take that daily walk to increasing the risk of depression. The good news is that with treatment it's often possible to reduce pain, which can improve function and quality of life. Could your loved one benefit from better pain management? Start by watching your loved one for signs of pain, and bring potential problems to the attention of a doctor.
3. Have your loved one assessed for depression. Depression is another problem that's all-too-common in late life, and often goes undiagnosed and untreated. Fortunately, a simple two-question quiz has been shown to be reasonably effective as a screening tool: 1) "Over the past two weeks have you felt down, depressed, or hopeless?" and 2) "Over the past two weeks have you felt little interest or pleasure in doing things?" Anyone who answers "yes" to one or both questions should get a more in-depth assessment. If your loved one answers "no" but you still have concerns, be sure to mention it to the doctor; your gut instinct may be even more valid than a screening quiz.
4. Check on when your loved one last had vision, hearing, and dental check-ups. There's no medical consensus as to exactly how often older people should be screened for these issues, but we do know that often quality of life really improves when common problems such as cataracts, hearing loss, and painful teeth have been diagnosed and treated. To evaluate vision and teeth, you'll probably need to see an eye doctor and a dentist. Assessing hearing usually starts in a regular doctor's office, by asking the patient and family if they've noticed problems with hearing. If you suspect problems or hear complaints, or the person can't begin to remember when he or she was last screened, just make an appointment, to be safe.
5. Consider calcium and vitamin D supplements. Calcium and vitamin D are involved in maintaining stronger bones, which can reduce the chance of breaking a bone if an older person falls. Unfortunately, many, if not most, older people have low vitamin D levels, especially if they spend a lot of time indoors. More and more experts are now recommending that older people take at least 800 IUs of vitamin D daily, along with 1200mg of elemental calcium. (But be sure to check first with a doctor if there have been concerns about kidney disease or kidney stones.) Whether or not older people should regularly have their vitamin D level checked is more controversial; high-dose vitamin D can be used for four to eight weeks in people who have very low levels, but using regular doses will also eventually bring up the vitamin D level.
Start by checking your loved one's medications to see what's in them. If there's not any calcium or vitamin D, plan to bring the question up to the doctor. You can also ask the related question, which is whether your loved one should be checked for osteoporosis. (Women over age 65 are supposed to be regularly checked; older men should be assessed for risk factors.)
6. Bring all the medications in for an annual review, and ask the doctor to explain what each is for and why it's helping your loved one. Although medications are meant to improve a person's health and well-being, every year thousands of people suffer from side effects or drug interactions. The elderly, who take more medicines and sometimes need different dosing, are especially at risk of harm from their pills. For this reason, it's a good idea to regularly review all medicines with a doctor, to confirm that each is still needed and is at the correct dosage. Don't forget to bring in any over-the-counter medications or herbal supplements used, as these can also cause side-effects or affect the body's response to prescription drugs.
7. Find out if your loved one has had the "one-time only" senior vaccinations. These are the pneumoccoal vaccine (one dose after age 65), which helps protect older adults from life-threatening pneumonia, as well as the zoster vaccine (one dose after age 60), which reduces the risk of getting shingles. Both vaccines are recommended by the Centers for Disease Control and other expert panels, but studies have shown that many older adults never get them, even though both pneumonia and shingles are common problems as we age.
Addressing all seven items may not be possible in a single medical visit, especially if your loved one has other acute (i.e. newly worse) or chronic medical conditions you want to ask about. If you don't feel that everything you're concerned about has been covered, don't hesitate to ask for a follow-up appointment (ideally within a few weeks) to wrap up the health maintenance.
Best wishes for 2010!
Did you find this information helpful? Why or why not? Dr. Kernisan wants to know, so she can keep improving this blog and better serve this community of caregivers. Your comments and e-mails to her will be very much appreciated.