SENIOR LIVING: Can The Medical Profession Make Aging Any Easier</tit= le> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"place"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"State"/>  <style>  </style>  </head> <body lang=3DEN-US link=3Dblue vlink=3Dpurple style=3D'tab-interval:.5in'> <div class=3DSection1> SENIOR LIVING= : Can The Medical Profession Make Aging Any Easier? Part Two<o:p></o:p> By FRANK KENN= EY Director, Grant County Senior Services <o:p> </o:p> This week’s column is the second of two articles based on an piece wri= tten by Dr. Atul Gawande, of the Harvard School of Public Health. Dr. Gawande questions MedicineR= 17;s ability to effectively treat our elders as they approach and enter the frai= lty phase of aging. He says that “medicine has been slow to confront the very change that it has been responsible for—despite a rapidly growing elderly population, the num= ber of certified geriatricians fell by a 33% between 1998 and 2004.” He adds, “ and partly whethe= r we admit it or not, most doctors don’t like taking care of the elderly.” Even if they = were paid more money. Dr Gawande n= otes that “most elderly folks don’t have just one chief ailment, most will have a range of medical problems.&nbs= p; A medical professional is not going to cure something a patient has = had for 20 years. They may have h= ad high blood pressure, and diabetes and arthritis…There’s nothing glamorous about taking care of any of those things.” <o:p> </o:p> There is, however, a skill to it, a developed body of professional expertise, skills geriatricians have been taught to administer= . “Little of what geriatricans= do is high-tech medicine: they don’t do lung biopsies or back surgery or PET scans. Instead, they simplify medications. They see that arthritis is controlled. They= make sure toenails are trimmed and meals are square. They look for worrisome signs of isolation and have a social worker check that the patient’s home is safe,” says Dr. Gawande. <o:p> </o:p> For Felix Silverstone, understanding human aging has b= een the work of a lifetime. He wa= s a national leader in geriatrics for five decades. But he is now himself eighty-seven= years old. “He can feel= his own mind and body wearing down, and much of what he spent his career studyi= ng is no longer abstract to him,” according to Dr. Gawande. <o:p> </o:p> Felix was able to continue working until he was eighty= two, when his wife of sixty years became almost completely blind. Felix no longer felt safe leaving = her home alone and gave up his practice. They moved to a retirement community. Felix commented that “(he) didn’t think he would survive the change.” He’d observed in many patien= ts how difficult aging transitions could be. But as he was examining his last patient and packing up his home, he felt that he was about to die. “I was taking apart my life as well as the house,” he recalled. “It was terrible.” <o:p> </o:p> Unlike Felix, the median income of people eighty and o= lder is only about fifteen thousand dollars.&nb= sp; More than half of the elderly who live in long-term-care facilities = go through their entire savings and have to go on Medicaid—welfare—= ;in order to afford it. And, ultimately, the average American spends a year or more of his old age disab= led and living in a nursing home, which is a destination Felix desperately hope= s to avoid. <o:p> </o:p> He tries to note the changes he’s experiencing objectively, like a good geriatrician.&nbs= p; He notices that his skin has dried out. His sense of smell has diminished. His night vision = has become poor. He tires easily.= He has begun to lose teeth. He takes measures to mitigate the physical losses he experiences, with exercise, diet, protection from heat, etc.. But, he is most concern= ed about the changes in his brain. “I can’t think as clearly as I used to,” he said.<= span style=3D'mso-spacerun:yes'> “I used to be able to read t= he Times in half an hour. Now it takes me a hour and a half.” Even then, he= 217;s not sure that he has understood as much as he did before, and his memory gi= ves him trouble. He makes use of methods that he once taught his patients.&= nbsp; “I try to deliberately focus on what I’m doing rather th= an do it automatically. I haven’t lost the automaticity of action, but I can’t rely on it= the way I used to. For example I can’t think about something else and get dressed and be sure I’= ve gotten all the way dressed.” Felix’s knowledge as a geriatrician has forced him to recognize his own decline, but that hasn’t made it easier to accept. <o:p> </o:p> “I get blue occasionally,” he said. “I think I have recurring ep= isodes of depression. They are not e= nough to disable me, but they are…uncomfortable.” <o:p> </o:p> What buoys him, despite his limitations, is having a purpose. It’s the same purpose, he says, that sustained him in medicine: to be of service, in some way, to = those around him. He helped steer a committee to improve the health-care services at the home. He tried to form a journal-reading= club for retired physicians. He ev= en guided a young geriatrician through her first independent-research study.</= p> <o:p> </o:p> More important is the responsibility that he feels for= his family, most of all, for his wife, Bella.&= nbsp; Her blindness and recent memory troubles have made her deeply dependent. Without him, she w= ould probably be in a nursing home. </spa= n>He helps her dress. He administers her medicines. He makes her breakfast and lunch.<= span style=3D'mso-spacerun:yes'> He takes her on walks and to doctor’s appointments. “She is my purpose now,” he said. <o:p> </o:p> Felix does not feel this responsibility to be a burden= . With the narrowing of his own life= , his ability to look after Bella has become his main source of self-worth. “I am exclusively her caregiver,” he said. &#= 8220;I am glad to be.” And thi= s role has heightened his sense that he must be attentive to the changes in his own capabilities; he is no good t= o her if he isn’t honest with himself about what he can and can’t do.= <o:p> </o:p> Felix Silverstone is, without question, up against the debilities of his years. Once, it would have been remarkable simply to have lived to see eigh= ty-seven. Now what’s remarkable is tha= t he has the control over his life that he does. Even today, most people his age ca= nnot live as he does. <o:p> </o:p> Partly he has been lucky. His memory, for example, has= not deteriorated significantly. B= ut he has also managed his old age well. His goal has been modest: to have as decent a life as medical knowle= dge and the limits of his body will allow.&nbs= p; So he saved and did not retire early, and therefore is not in financ= ial straits. He kept his social contacts, and avoided isolation. </s= pan>He monitored his bones and teeth and weight.&= nbsp; And he has made sure to find a doctor who had the geriatric skills to help him hold on to an independent life. <o:p> </o:p> Dr. Gawande asked Chad Boult, a geriatrics professor at Johns Hopkins, what can be done to insure that there are enough geriatricia= ns for our country’s surging elderly population. “Nothing,” he said.<sp= an style=3D'mso-spacerun:yes'> “It’s too late.”= Creating geriatricians takes years= , and we already have far too few. = This year, just three hundred doctors will complete geriatrics training, not nea= rly enough to replace the geriatricians going into retirement, let alone meet t= he needs of the next decade. <o:p> </o:p> Yet Boult believes that we still have time for another strategy: he would direct geriatricians toward training all primary-care doctors in caring for the very old, instead of providing the care themselves. Dr. Gawande state= s that “even this is a tall order—ninety-seven per cent of medical students take no course in geriatrics, and the strategy requires that the nation pay geriatricians to teach rather than to provide patient care.” But if the will = is there, Boult estimates that it would be possible to establish courses in ev= ery medical school and internal-medicine training program within a decade. “We’ve got to do somet= hing,” he said. “Life for older people can be better than it is today.” <o:p> </o:p> Boult and his colleagues have yet another strategy, ju= st in case—a strategy that they have called Guided Care, and that doesnR= 17;t depend on doctors at all. They’re recruiting local nurses for a highly compressed, three-week course in how to recognize specific problems in the elderly, suc= h as depression, malnutrition, isolation, and danger of falling; how to formulat= e a plan to remedy those problems; and how to work with patients, families, and doctors to follow through on the plan.&nbs= p; Dr Gawande comments that “It is a meager solution for a huge problem, but it is cheap, which insurers demand, and, if it provides even a fraction of the benefit geriatricians have, it could nudge medical care in = the right direction.” <o:p> </o:p> This author invites members of our local medical commu= nity here in southwest <st1:place w:st=3D"on"><st1:State w:st=3D"on">New Mexico<= /st1:State></st1:place> to comment on Dr. Gawande’s article and the perceived imbalances in o= ur medical profession, especially in the area of geriatrics. In fact we encourage guest columni= sts to share their senior stories with the community. <o:p> </o:p> For more information on this article or any topic rela= ted to aging, or how to become a guest columnist contact this writer at 505-388-25= 23 or <a href=3D"mailto:rsvpgrant@zianet.com">rsvpgrant@zianet.com</a>. </div> </body> </html>

MIME-Version: 1.0 Content-Location: file:///C:/664AD969/KenneyArticle6-5-07MedicineandAgingPartII.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" SENIOR LIVING: Can The Medical Profession Make Aging Any Easier</tit= le> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"place"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"State"/>  <style>  </style>  </head> <body lang=3DEN-US link=3Dblue vlink=3Dpurple style=3D'tab-interval:.5in'> <div class=3DSection1> SENIOR LIVING= : Can The Medical Profession Make Aging Any Easier? Part Two<o:p></o:p> By FRANK KENN= EY Director, Grant County Senior Services <o:p> </o:p> This week’s column is the second of two articles based on an piece wri= tten by Dr. Atul Gawande, of the Harvard School of Public Health. Dr. Gawande questions MedicineR= 17;s ability to effectively treat our elders as they approach and enter the frai= lty phase of aging. He says that “medicine has been slow to confront the very change that it has been responsible for—despite a rapidly growing elderly population, the num= ber of certified geriatricians fell by a 33% between 1998 and 2004.” He adds, “ and partly whethe= r we admit it or not, most doctors don’t like taking care of the elderly.” Even if they = were paid more money. Dr Gawande n= otes that “most elderly folks don’t have just one chief ailment, most will have a range of medical problems.&nbs= p; A medical professional is not going to cure something a patient has = had for 20 years. They may have h= ad high blood pressure, and diabetes and arthritis…There’s nothing glamorous about taking care of any of those things.” <o:p> </o:p> There is, however, a skill to it, a developed body of professional expertise, skills geriatricians have been taught to administer= . “Little of what geriatricans= do is high-tech medicine: they don’t do lung biopsies or back surgery or PET scans. Instead, they simplify medications. They see that arthritis is controlled. They= make sure toenails are trimmed and meals are square. They look for worrisome signs of isolation and have a social worker check that the patient’s home is safe,” says Dr. Gawande. <o:p> </o:p> For Felix Silverstone, understanding human aging has b= een the work of a lifetime. He wa= s a national leader in geriatrics for five decades. But he is now himself eighty-seven= years old. “He can feel= his own mind and body wearing down, and much of what he spent his career studyi= ng is no longer abstract to him,” according to Dr. Gawande. <o:p> </o:p> Felix was able to continue working until he was eighty= two, when his wife of sixty years became almost completely blind. Felix no longer felt safe leaving = her home alone and gave up his practice. They moved to a retirement community. Felix commented that “(he) didn’t think he would survive the change.” He’d observed in many patien= ts how difficult aging transitions could be. But as he was examining his last patient and packing up his home, he felt that he was about to die. “I was taking apart my life as well as the house,” he recalled. “It was terrible.” <o:p> </o:p> Unlike Felix, the median income of people eighty and o= lder is only about fifteen thousand dollars.&nb= sp; More than half of the elderly who live in long-term-care facilities = go through their entire savings and have to go on Medicaid—welfare—= ;in order to afford it. And, ultimately, the average American spends a year or more of his old age disab= led and living in a nursing home, which is a destination Felix desperately hope= s to avoid. <o:p> </o:p> He tries to note the changes he’s experiencing objectively, like a good geriatrician.&nbs= p; He notices that his skin has dried out. His sense of smell has diminished. His night vision = has become poor. He tires easily.= He has begun to lose teeth. He takes measures to mitigate the physical losses he experiences, with exercise, diet, protection from heat, etc.. But, he is most concern= ed about the changes in his brain. “I can’t think as clearly as I used to,” he said.<= span style=3D'mso-spacerun:yes'> “I used to be able to read t= he Times in half an hour. Now it takes me a hour and a half.” Even then, he= 217;s not sure that he has understood as much as he did before, and his memory gi= ves him trouble. He makes use of methods that he once taught his patients.&= nbsp; “I try to deliberately focus on what I’m doing rather th= an do it automatically. I haven’t lost the automaticity of action, but I can’t rely on it= the way I used to. For example I can’t think about something else and get dressed and be sure I’= ve gotten all the way dressed.” Felix’s knowledge as a geriatrician has forced him to recognize his own decline, but that hasn’t made it easier to accept. <o:p> </o:p> “I get blue occasionally,” he said. “I think I have recurring ep= isodes of depression. They are not e= nough to disable me, but they are…uncomfortable.” <o:p> </o:p> What buoys him, despite his limitations, is having a purpose. It’s the same purpose, he says, that sustained him in medicine: to be of service, in some way, to = those around him. He helped steer a committee to improve the health-care services at the home. He tried to form a journal-reading= club for retired physicians. He ev= en guided a young geriatrician through her first independent-research study.</= p> <o:p> </o:p> More important is the responsibility that he feels for= his family, most of all, for his wife, Bella.&= nbsp; Her blindness and recent memory troubles have made her deeply dependent. Without him, she w= ould probably be in a nursing home. </spa= n>He helps her dress. He administers her medicines. He makes her breakfast and lunch.<= span style=3D'mso-spacerun:yes'> He takes her on walks and to doctor’s appointments. “She is my purpose now,” he said. <o:p> </o:p> Felix does not feel this responsibility to be a burden= . With the narrowing of his own life= , his ability to look after Bella has become his main source of self-worth. “I am exclusively her caregiver,” he said. &#= 8220;I am glad to be.” And thi= s role has heightened his sense that he must be attentive to the changes in his own capabilities; he is no good t= o her if he isn’t honest with himself about what he can and can’t do.= <o:p> </o:p> Felix Silverstone is, without question, up against the debilities of his years. Once, it would have been remarkable simply to have lived to see eigh= ty-seven. Now what’s remarkable is tha= t he has the control over his life that he does. Even today, most people his age ca= nnot live as he does. <o:p> </o:p> Partly he has been lucky. His memory, for example, has= not deteriorated significantly. B= ut he has also managed his old age well. His goal has been modest: to have as decent a life as medical knowle= dge and the limits of his body will allow.&nbs= p; So he saved and did not retire early, and therefore is not in financ= ial straits. He kept his social contacts, and avoided isolation. </s= pan>He monitored his bones and teeth and weight.&= nbsp; And he has made sure to find a doctor who had the geriatric skills to help him hold on to an independent life. <o:p> </o:p> Dr. Gawande asked Chad Boult, a geriatrics professor at Johns Hopkins, what can be done to insure that there are enough geriatricia= ns for our country’s surging elderly population. “Nothing,” he said.<sp= an style=3D'mso-spacerun:yes'> “It’s too late.”= Creating geriatricians takes years= , and we already have far too few. = This year, just three hundred doctors will complete geriatrics training, not nea= rly enough to replace the geriatricians going into retirement, let alone meet t= he needs of the next decade. <o:p> </o:p> Yet Boult believes that we still have time for another strategy: he would direct geriatricians toward training all primary-care doctors in caring for the very old, instead of providing the care themselves. Dr. Gawande state= s that “even this is a tall order—ninety-seven per cent of medical students take no course in geriatrics, and the strategy requires that the nation pay geriatricians to teach rather than to provide patient care.” But if the will = is there, Boult estimates that it would be possible to establish courses in ev= ery medical school and internal-medicine training program within a decade. “We’ve got to do somet= hing,” he said. “Life for older people can be better than it is today.” <o:p> </o:p> Boult and his colleagues have yet another strategy, ju= st in case—a strategy that they have called Guided Care, and that doesnR= 17;t depend on doctors at all. They’re recruiting local nurses for a highly compressed, three-week course in how to recognize specific problems in the elderly, suc= h as depression, malnutrition, isolation, and danger of falling; how to formulat= e a plan to remedy those problems; and how to work with patients, families, and doctors to follow through on the plan.&nbs= p; Dr Gawande comments that “It is a meager solution for a huge problem, but it is cheap, which insurers demand, and, if it provides even a fraction of the benefit geriatricians have, it could nudge medical care in = the right direction.” <o:p> </o:p> This author invites members of our local medical commu= nity here in southwest <st1:place w:st=3D"on"><st1:State w:st=3D"on">New Mexico<= /st1:State></st1:place> to comment on Dr. Gawande’s article and the perceived imbalances in o= ur medical profession, especially in the area of geriatrics. In fact we encourage guest columni= sts to share their senior stories with the community. <o:p> </o:p> For more information on this article or any topic rela= ted to aging, or how to become a guest columnist contact this writer at 505-388-25= 23 or <a href=3D"mailto:rsvpgrant@zianet.com">rsvpgrant@zianet.com</a>. </div> </body> </html>