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:
- Preventing falls
- 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?