What 90-year-olds Want From Doctors

Look at older patients instead of typing notes into a computer, take more time with them and answer their questions…

Periodically I go through the “Sites and Blogs I Like” (tab above)– reading, adding and updating. The Kaiser Health News site often has relevant aging articles: “Seniors Tell Medical Students What They Need From Doctors” (9/25/15) is one. (NPR picked it up.)

Sparked by the need for many more doctors (geriatricians) to meet the special needs of an aging population, Case Western Reserve Medical School recently held its annual panel discussion, “Life Over 90,”  for their 2nd-year-medical students. The 90+-year-old panel members shared experience and advice–equally instructive for anyone whose elderly loved ones go to doctors. And isn’t that everyone?.

I remember Sr. Advisor R’s last trip to NY, three years ago at age 98– making the effort to navigate airports and flying cross country alone. She had two goals:
1. to see our new apartment and
2. to get a second opinion from our ophthalmologist.

The second was a disaster. After many tests, we went into the doctor’s office. He sat on the other side of the desk, his swivel chair in the right angle between his computer and R, who sat directly across from him. I was on R’s right. Perfect–in terms of where he sat and his ability to glance at the images on the computer then turn to talk. But he flunked the conversation by looking past R–to me–when he spoke.

My instinct was to redirect the conversation but before I could, R announced: “Dr. I pay my own bills, kindly address your remarks to me.” Granted, R didn’t achieve living independently, alone– in her home of 70+ years –by being a pussycat! She knew how to advocate for herself. But what about many elders who either never had–or have lost–that assertiveness?

Initially I faulted myself for not speaking up quickly enough. Then I decided it was much better that R advocated for herself, once again confirming she was in control. (Key Thoughts–right sidebar: Do actions empower or diminish? or Don’t do for aging parents what they can do for themselves.)

R’s experience highlights the fact that while doctors may be tops in their field, far too few have been trained to understand the special needs of older people now–and there will be even less as boomers and those younger age.

Past posts (several years back) emphasize the value of geriatricians for older people’s health care. Read Karen’s short letter re: her mother’s appointment with a geriatrician at Mt. Sinai in NYC.

Case Western Reserve and no doubt other medical schools realize that geriatrics is a relatively low-paying, underpopulated specialty. Even when medical students have interest, most incur huge debt from student loans that will need to be repaid, so they select a higher paying specialty.

Efforts are being made to encourage medical students to specialize in geriatrics–or at the least better understand the needs of older people. That said, a severe shortage of doctors, with an understanding of the special needs of those 65+ exists. It affects not only aging parents and older loved ones now, but portends pitfalls for us in the years ahead. While sobering, check out Related below.

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Related:  When do you need a geriatrician?
                American Geriatrics Society–Find Health Care Providers
                Castle Connolly Finding the Best Geriatric Doctors
                Healthgrades Geriatric Medicine-State Directory
                US News– Health: Find Geriatricians-US Doctors


Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities. respected professionals and selected publications–to help parents age well.
               

To Help Parents Age Well: US News & World Report: Best Hospitals 2014-2015

U.S. News Ranks Best Hospitals 2014-15

Again this year US News & World Report has published its Best Hospitals issue. Of the 17 hospitals to make the 2014-15 Honor Roll, top honors in Geriatrics are earned by Mayo Clinic in Rochester, followed by Mt. Sinai in New York, UCLA Medical Center in Los Angeles, Johns Hopkins in Baltimore, and Massachusetts General in Boston. Click above link for Geriatrics honor roll.

For difficult and out-of-the ordinary diagnoses and procedures the best hospitals are most likely to have the most experience, so aren’t we’re also talking about best doctors here? It makes sense to have the above list should especially worrisome health issues arise.

For more “garden-variety” health issues there are many fine regional hospitals which are recognized in the US News and World report. To find the one(s) near you or aging parents, here’s the map of the best regional hospitals. 

Also know that the several changes were made to the ranking methodology this year. They may account for some of the changes from last year’s rankings. Check out the details at: http://health.usnews.com/health-news/blogs/second-opinion/2014/01/11/us-news-hospital-rankings-to-boost-role-of-patient-safety-cut-back-reputation 

Lastly, for a quickie snapshot and information about the 17 best hospitals, take the “photo tour.”

To help parents age well–(or for all challenges it would seem)–the more good, solid information we have beforehand, the better prepared we are. And isn’t this especially true when it comes to health issues.

 

Help Aging Parents: Trying to Do it All–Help!

Reassess, Prioritize, Change Plans (Holiday Gifts for Mothers–4 postponed ’til Saturday, but read on for nursing home gift baskets and an update on a 90-year-old mother’s appointment with a Mt. Sinai hospital’s geriatrician)
Isn’t there a song– “Mamma Said There’d Be Days Like This..”

Fly home Tuesday…cross-country.  Weather delay.  Arrive home after 1am this morning. Early morning commitment for the Woman’s Club Open House.  Sleep-deprived. Volunteered to do a holiday table setting which requires going out to buy flowers for the centerpiece.

We’re having heavy downpours; high wind gusts.  My car is dead!  Won’t start. Will need a ride to the Club, but first must go outside and cut holly and other greens.  My centerpiece will have no flowers, berries win out.

The sore throat that kept me from visiting my mother-in-law at the rehab center the last two days because I was concerned about spreading something–hangs on; and being drenched by the rain as I cut the holly isn’t the medicine the doctor would order if I had time to check with him.

Nursing Home Gift Bag

Nursing Home Gift Bag

Gift for a Woman

I want to share photos of some of the Woman’s Club’s holiday gift baskets for the nursing home this December. I mentioned them in November’s “Gifts for Aging Parents in Care Facilities” (along with a gift list.) They always look great and contents cost under $12.00 total.  And Open House guests always want to buy them, but they aren’t for sale.

Gift Basket (click to enlarge)

Click to enlarge

Of course, today I wanted to finish the Holiday Gifts for Aging Mothers–4, but can’t stretch 24 hours into the 30 hours I need.  Thus, I’m saving the “Holiday Gifts…” for Saturday.
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In the meantime, a letter received today from K, whose mother’s experience with a geriatrician at Mt. Sinai was shared in September-https://helpparentsagewell.com/2010/09/13/update-on-beshospitals-geriatric-division-visit/

Susan, I took my mother to Mt. Sinai yesterday for a follow-up meeting. I can’t begin to tell you how much I like it and Dr. P in particular. My feeling is that they are all just as wonderful.

My mother was walking on air when we left. He makes her feel validated and not just “old and complaining.”

Another gift idea: an appointment with a geriatrician (especially at hospitals with highly regarded geriatrics departments). It can help parents age well, just as it’s helping Karen’s mother.  And when our mother’s feel good, don’t we feel good? Thanks for sharing, Karen.

 

Aging Parents, Best Hospitals, 16 Specialties, 5 Reasons to Consider Them

Mt. Sinai Hospital Ranked #1 in Geriatrics–2010-2011

PLEASE GO TO JULY 2013 POST FOR MOST RECENT UPDATES

Mt. Sinai Hospital’s Geriatrics Department, started by Dr. Robert Butler in 1982, (last Tuesday’s post) was ranked #1 in the August 2010  US News & World Report’s “Best Hospitals” issue, on news stands this week. An additional 49 hospitals’ geriatric departments complete the list.

Fifteen other specialty departments are also ranked. And Johns Hopkins Hospital ranks #1 as the top hospital in the country–having 15 of the 16 specialties ranking at or near the top. US News & World Report compiles this list every year (and has done so for over 20 years) “to guide patients who need an unusually high level of hospital care” (which includes high-risk patients).  Can’t this information be of enormous benefit to help aging parents?

Life takes on a more delicate balance as people age.  Making well-informed decisions ups the odds in our efforts to help parents age well.

5 reasons to consider the best hospitals’ specialties to help aging parents

1. Approximately the same time is involved, be it for procedures done in excellent hospitals or less than excellent hospitals; with excellent doctors or less excellent doctors. Only the outcomes may be different.

2. Quality of life is at risk; the more experienced the hospital and medical professionals are (the more times they’ve done your parents’ needed procedure) the better the odds to have encountered  and handled well unexpected problems.

3. Older people don’t bounce back so quickly. Patients lose independence in hospitals. It’s important they gain the confidence to feel some control. Ideally professionals working in the best hospitals’ specialties departments should have done “it” (what ever your parents’ medical situation is), worked with “it,” handled “it”–over and over and over.  Thus, they can instill confidence in you and your parents based on countless experiences with the expected and unexpected.

4. It takes hard work to recover well from certain procedures.  The skill of the professionals in the follow-up is a significant factor in hastening recovery and instilling a positive outlook. Elderly parents need to do whatever is necessary to move forward so the hospital experience doesn’t take then down a notch.

5. And yet–there are emergencies when we do what we must in a hurry. And there are times when we know the decisions we make are crucial and we may get only one chance to do it right. But even then, the professionals in the best hospitals can come to the rescue.

Have you had this experience?

Two true stories will bring the “best hospitals” theme to life in this coming Tuesday’s post. One an emergency (stroke); the other a well-thought out (after arguments and pressure) plan to treat advanced colon cancer. While not planned at the outset of the each health crisis, the best hospitals figured prominently in both. In the meantime, US News & World Report is at your newsstand now.