Anticipatory Guidance From Primary Care Physicians Could Prevent Falls Among Seniors

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We hear about stories like this all time. An elderly person falls and breaks something…a hip, a wrist or an arm. Soon, what once was a healthy, independent senior begins an inexorable down hill slide. Such is the case of my 89-year old mother who fell recently and broke her wrist.

Turns out that 30% of people >65 years fall each year. Predictably seniors with the following risk factors are more prone to falls:

  • Using Sedatives
  • Cognitive Impairment
  • Problems Walking
  • Urinary Tract Infection
  • Eye Problems
  • Balance Issues

 

Similarly, when a person does fall, a cascading series of predictable clinical events occurs. It even has a name “post fall syndrome.” This syndrome is characterized by things like fear of falling again, increased immobility, loss of muscle and control, lack of sleep, nutritional deficits, and so on. Seniors susceptible to falls also have higher rates of hospitalization and institutionalization.

What strikes me about falls among the elderly is that they are seemingly predictable events. And once a fall does occur, the consequences seem pretty predictable as well, e.g., post fall syndrome. So if falls and their consequences are so predictable, why aren’t primary care physicians more proactive it terms of:

  1. Preventing falls
  2. Treating post fall syndrome patients

 

In the case of my mother, her primary care physician and orthopedist were both very diligent at treating her episodic needs, i.e., her pain and broken bones.  But little attention if any was given to assessing her her long term needs, i.e., nutrition, inability to do anything with her left hand (she’s left-handed), sensitivity to new medications (she never took drugs because they make her loopy), gait analysis, or depression counseling.

I know, I know, doctors can not be expected to do everything in the confines of a 7-15 minute office visit. Yes I know that doctors aren’t paid what they deserve.  I am also aware that many physicians just don’t like treating geriatric patients.  But hey… this is my mother!

Pediatrics coined a term awhile back called “anticipatory care.” It refers to the act of helping children and parents anticipate and deal with predictable developmental and health issues associated with childhood.

It seems to me that primary care physicians and insurance companies need to get together with respect to providing anticipatory guidance for aging as well. Not only would it improve seniors’ quality of life, it would also prevent unnecessary hospitalizations and institutionalizations.

Besides…wouldn’t you want that for your mother or father?

6 Comments

  1. Falls among the elderly are absolutely a major contributors to early death and an increased decline in overall health status. Some solutions are related to improved medical care and better medication management but initial prevention can start with simple good old safety in the home.
    A search using “Fall Prevention” will link the individual and family to a number of site including but not limited to http://www.cdc.gov/ncipc/duip/spotlite/falltips.htm

  2. Cathy Ojalvo says:

    You are so right.My mother, who is 75, had quadruple bypass surgery 6 weeks ago.She was in the cardiac ICU for 5 days and developed something the nurse called ICU delirium.They told us once she got out of the hospital she would be fine in a few days.She was in the hospital for 18 days, and was confused and delirius during most of it.They adjusting her medication and finally let her go home on a friday morning with a drugs she should be taking.I packed a bag to stay with my Dad after she got home.Over the weekend , her condition continued to deteriorate.She would not eat and would scream at us if we tried to feed here.She could not walk 3 ft. without assistance.After talking to numerous doctors, we had an ambulance take her to a different hospital for a psychiatric evalution.She was admitted for medical reasone because she had fluid on her lungs.They did do a Cat scan, an EEg and an MRI of her head and all were normal but she was not.We were finally referred to a geriactric psychiatrist.She is trying to adjust her meds., but she is still very confused and wobbly when she walks.After research, I found out that 30 to 60% of patients who have traumatic surgery after the age of 70 develope cognitive problems.They call it “Sundowner’s Syndrome ” because it is worse at night.She didnt sleep for 3 days and fell and hit her head , but it was ok.We are living with this on a day-to-day basis and have seen very little improvement.

  3. pcp says:

    “assessing her her long term needs, i.e., nutrition, inability to do anything with her left hand (she’s left-handed), sensitivity to new medications (she never took drugs because they make her loopy), gait analysis, or depression counseling.”

    Spend an hour doing that (which is what it takes if done thoroughly) and Medicare pays the doctor a grand total of zero dollars and zero cents.

    If you want things done differently, you must change the payment system first. Continually telling primary care docs that they need to do more work for free is a non-starter.

  4. midwest woman says:

    “assessing her her long term needs, i.e., nutrition, inability to do anything with her left hand (she’s left-handed), sensitivity to new medications (she never took drugs because they make her loopy), gait analysis, or depression counseling.”

    Why so much burden on the docs? Nutrition is not brain science….that could be taken care of by the family..meals on wheels, stocking her fridge with her food preferences etc? Depression screening? Gait analysis? Advocate for your mother and take her to get one. This is like laying all the burdens of high school misbehavuir on the schools letting the parents of the hook. She’s YOUR mother….take care of her.
    Seriously as a nurse working with the geriatric patient, families do not want to take any responsibility or use common sense when it comes to their elderly parent.

  5. Dear Midwest Woman,

    Thanks for your comments. I am not sure physicians need to be defended so much as reminded that people look to them to anticipate and prevent health issues in addition to treating them. Senior like my Mom grew up in an age where physicians did assume more responsibility for patients. Unfortunately that rug has been pulled out from underneath them and no one told them that they can no longer “trust” that their physician (and nurse?) is looking out for their best interest.

    Fear not…my Mom is being well cared for.

  6. Regina says:

    Deterioration and aging do not have to go hand-in-hand. One approach is to encourage older adults to keep moving and not tell them to “slow down.” The power of suggestion is strong and warning older adults “be careful, don’t fall” can plant a seed of fear and start a cycle of moving less and can actually cause loss of strength and balance through deconditioning. Moving is medicine!

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