My first volunteer work was feeding elderly patients in a local nursing home when I was 13. Although I was nervous at first, I came to love being with these elderly patients and especially hearing their stories.
After I graduated from nursing school in 1969, I took care of many elderly patients in ICU, oncology, kidney dialysis and home health/hospice as well as my own relatives and friends. I learned a lot from all these people about the special needs of older patients and have written about them in my blogs.
In 2018, I wrote a blog titled “Don’t Write Off the Elderly” about “Melissa” (not her real name), my friend who is also the mother of one of my best friends and who died recently at the age of 99 years, 9 months and 5 days.
Melissa had wonderful care from her family, caregivers and spiritual support but she also had some difficult situations with the healthcare system. Thankfully, these situations were resolved and Melissa died peacefully and comfortably in her own home, as she had hoped.
So I was delighted to see this wonderful article at ‘Medical Methuselahs’: Treating the Growing Population of Centenarians (medscape.com) from the website Medscape for healthcare professionals that can help not only doctors and nurses but also older people and their friends and families.
Although this article is mainly about people who reach 100, it has observations and tips that can help other older people over 65. And as an older person myself, I really appreciate the positive outlook in this article.
Although the article is longer than most other Medscape articles, it is well worth reading for anyone who is older or who has elderly friends and/or relatives.
Here are some excerpts and all emphasis is mine:
1.“Priya Goel, MD is a New York doctor who works for a national home healthcare company that primarily serves people older than 65. Dr. Goel has observed that although some of the ultra-aged live
in nursing homes, many continue to live independently. They require both routine and acute medical care.
Dr. Goel urges her colleagues not to stereotype patients on the basis of age, saying that:
“You have to consider their functional and cognitive abilities, their ability to understand disease processes and make decisions for themselves… Age is just one factor in the grand scheme of things.” Dr. Goel visits her patients aged 65 and up in their homes to provide herself with insights into how well they’re doing, including the safety of their environments and the depth of their social networks.
2. Geriatrician Thomas Perls, MD says “”People can age so very differently from one another” and agrees that “that healthcare providers and the lay public should not make assumptions on the basis of age alone as to how a person is doing. People can age so very differently from one another,” he said and that:
“Up to about age 90, the vast majority of those differences are determined by our health behaviors, such as smoking, alcohol use, exercise, sleep, the effect of our diets on weight, and access to good healthcare, including regular screening for problems such as high blood pressure, diabetes, and cancer. “People who are able to do everything right generally add healthy years to their lives, while those who do not have shorter life expectancies and longer periods of chronic diseases,” Perls said.
“Paying diligent attention to these behaviors over the long run can have a huge payoff” and
“Centenarians are the antithesis of the misguided belief that the older you get, the sicker you get. Quite the opposite occurs. For Perls, “the older you get, the healthier you’ve been.“
3. “We have to be very cognizant of what we call a typical presentation of disease or illness and that a very subtle change in an older adult can signal a serious infection or illness,” Baker said. “If your patient has a high fever, that is a potential problem.”
The average temperature of an older adult is lower than the accepted 98.6° F, and their body’s response to an infection is slow to exhibit an increase in temperature, Baker said. “When treating centenarians, clinicians must be cognizant of other subtle signs of infection, such as decreased appetite or change in mentation,” she cautioned.
A decline in appetite or insomnia may be a subtle sign that these patients need to be evaluated, she added.”
4. Environmental changes, such as moving a patient to a new room in a hospital setting, can trigger an acute mental status change, such as delirium, she added. Helping older patients feel in control as much as possible is important.
“You want to make sure you’re orienting them to the time of day. Make sure they get up at the same time, go to bed at the same time, have clocks and calendars present ― just making sure that they feel like they’re still in control of their body and their day,” she said.”
6. And, in a very important observation:
“Dr. Flomenbaum, a pioneer in geriatric emergency medicine, says physicians need to be aware that centenarians and other very old patients don’t present the same way as younger adults.
He began to notice more than 20 years ago that every night, patients would turn up in his ED who were in their late 90s into their 100s. Some would come in with what their children identified as sudden-onset dementia ― they didn’t know their own names and couldn’t identify their kids. They didn’t know the time or day. Flomenbaum said the children often asked whether their parents should enter a nursing home.
“And I’d say, ‘Not so fast. Well, let’s take a look at this.’ You don’t develop that kind of dementia overnight. It usually takes a while,” he said.”
Dr. Flomenbaum also said:
“The decline in hearing and vision can lead to a misdiagnosis of cognitive impairment because the patients are not able to hear what you’re asking them. “It’s really important that the person can hear you ― whether you use an amplifying device or they have hearing aids, that’s critical,” he said. “You just have to be a good doctor.”
Often the physical toll of aging exacerbates social difficulties. Poor hearing, for example, can accelerate cognitive impairment and cause people to interact less often, and less meaningfully, with their environment. For some, wearing hearing aids seems demeaning ― until they hear what they’ve been missing.
I get them to wear their hearing aids and, lo and behold, they’re a whole new person because they’re now able to take in their environment and interact with others,” Perls said.”
Dr. Flomenbaum said alcohol abuse and drug reactions can cause delirium, which, unlike dementia, is potentially reversible. Yet many physicians cannot reliably differentiate between dementia and delirium, he added.”
7. The geriatric specialists talk about the lessons they’ve learned and the gratification they get from caring for centenarians.
“I have come to realize the importance of family, of having a close circle, whether that’s through friends or neighbors,” Goel said. “This work is very rewarding because, if it wasn’t for homebound organizations, how would these people get care or get access to care?”
For Baker, a joy of the job is hearing centenarians share their life stories.”
In helping to care for many elderly people over many decades, I can attest to the wisdom and hope of these experts.
Aging itself is not a terminal disease and it can be a wonderful to spend more time with loved ones and reflect on how much we have learned and can still enjoy in every stage of life!