I just finished reading Being Mortal: Medicine and What Matters in the End by Atul Gawande, MD, MPH. In his book, Dr. Gawande, a nationally known surgeon, writer, and public health researcher, discusses end-of-life care, the many issues with traditional nursing home care in this country and the ways in which long-term care should be re-imagined.
More than 70% of health care dollars in this country are spent on chronic conditions. Two out of three older Americans have multiple chronic conditions, and 95% of health care spending for older adults is attributed to chronic disease. As Baby Boomers live longer than the generations that came before them, research into conditions that are common in old age – like osteoporosis, fractures, falls, dementia, and delirium – is becoming more and more critical.
Osteoporosis is a disease in which the bones become weak and are more likely to break. People with osteoporosis most often break bones in the hip, spine, and wrist. According to the National Osteoporosis Foundation, 54 million Americans have osteoporosis or low bone mass, putting them at risk for broken bones. Therefore, researchers are continuing to work towards finding strategies to improve bone health and decrease osteoporosis risk.
We often associate the term “frail” with older adults, particularly the “oldest old,” defined as individuals 85 and older. Frailty has become a particularly important geriatric topic as the ranks of seniors continue to grow at an unprecedented rate. As someone who has devoted a career to aging research, I have focused a significant amount of my work on understanding frailty— how we define and treat it.
Life is a continual balancing act. When we’re young, it may seem as though we’re able to take on everyday activities with ease. But, as we grow older, our senses and ability to efficiently perform multiple tasks at the same time start to slowly deteriorate. Even the simplest of simultaneous activities, such as walking and talking, can disrupt our balance and put us at risk for a serious fall-related injury.
I have devoted my research career to advancing the understanding of a serious condition called delirium and the impact it has on clinical outcomes. As a medical resident, I observed symptoms of confusion and disorientation in many of the seniors I cared for during my hospital rotations. These symptoms were generally shrugged off as just something that sometimes happens to older patients. Little, if anything was done to prevent or treat it despite its devastating effects.
Imagine this scenario: your 75-year-old mother falls and can no longer walk independently. You take her to the hospital emergency room. Although she doesn’t need hospitalization, she does need rehabilitation in a skilled nursing facility to regain her ability to walk.
The catch--she must be admitted to the hospital for three nights in order for Medicare to pay for rehabilitation. Without that stay, you or she must either pay for her care in a nursing facility or nursing home (about $300-$430 per day) or hire caregivers to support her at home ($20-$30 per hour).
Delirium in the elderly is a serious, under-recognized and often fatal condition that affects between 25-60 percent of older hospital patients. Although scientists have made progress toward predicting, treating and preventing delirium, there is still a great deal of work to be done.
For nursing home residents with advanced dementia, managed care may mean equal or better outcomes
If a loved one of yours is a nursing home resident with advanced dementia, there’s a good chance that keeping him or her comfortable is your main goal--that’s the preference of more than 90% of family members in this situation. Yet many of these residents commonly experience stressful, aggressive interventions, like hospital transfers or tube-feeding, which don’t improve their quality of life or help them live longer.
Dr. Susan Mitchell is a senior scientist at Hebrew SeniorLife whose pioneering research focuses on decision-making, health outcomes and resource utilization for older people near the end of life, particularly those with dementia. I recently had the opportunity to speak with Dr. Mitchell about the motivation and vision behind her work.
Of the many medical specialties available, why did you become a geriatrician?