living your best to the end

Infections in the elderly how to best treat: Are antibiotics always the answer

‘If you don’t give her antibiotics, she’ll go toxic and die.” Although my 96 year old aunt (pictured at left, between me and my cousin – her daughter) had no symptoms of a bladder infection, a urine test resulting from cloudy pee revealed she indeed had a Urinary Tract Infection (UTI. My aunt hadn’t complained about pain or discomfort, my cousin – her ‘power of attorney’ – authorized treatment with antibiotics. Many would agree. However, when I shared this with Dr. Jocelyn Charles, Chief of the Department of Family & Community. Medicine and Medical Director of the Veterans Centre at Sunnybrook Health Center, she shook her head. “Treating the test results and not the patient.” The (assuredly well-meaning) healthcare professional who made that pronouncement was talking about ‘sepsis’: when the bloodstream – and therefore the whole body – has become one big infection it becomes ‘toxic.’ In a younger person, antibiotics – standard protocol – would be a no-brainer. Rarely it seems, is taken into account the repercussions of ‘standard protocal’ in the elderly. Functionality and age should have an impact on treatment decisions From the blog, Geripal – devoted to optimal treatment of the elderly: Survival from severe sepsis: yes the infection is cured but not all is well – the point is made that, in the elderly – unlike those younger, whose bodies have more resources – treatment does not equal ‘back to how she was before’. Instead, treatment that sounds so necessary and logical can lead to increased confusion, worsening dementia, and a more vulnerable immune system. In my aunt’s case, several courses of antibiotics failed....

A new medical decision PATH for the frail elderly

Palliative and Therapeutic Harmonization: PATH In plain language PATH means an assessment and treatment recommendation that takes into account what’s going on with us as a whole person, rather than our specific parts.  A worthy goal for all of us, but with particular importance for those both elderly and frail, and who may have a dollop or more of confusion. Dr Laurie Mallery Dr Paige Moorhouse Dr. Laurie Mallery, head of the Division of Geriatric Medicine at Dalhousie University and Director of the Centre for Health Care of the Elderly at the QEII Health Sciences Centre in Halifax, Nova Scotia. and DrPaige Moorhouse with her Masters in Public Health, also practicing at the QEII, are like-minded in their concerns for care of the frail elderly. Together,  these two good doctors took the initiative to research and develop a  framework for medical decisions related to the frail elderly. The result is PATH: Palliative and Therapeutic Harmonization. Says Mallery: “We spent many years, looking at all factors related to the frail elderly.  Drs Mallery and Moorhouse  practice and teach at the PATH CLINIC . The approach has three parts: 1. Understanding “The frail elderly are often in and out and in and out of healthcare with many crises, assessed by many people – each of whom brings their own lens. There’s no  organizational plan to take this info and use it collectively and understand the significance, for example: is this person near end of life, and should we take that into account in discussing a medical procedure. Sometimes the patient seems frail but they really have a hearing impairment. 2. Clarity of Language “For those...

Bringing Creativity into Clinical Practice with Older Adults.

It was a day of music, arts and drama, of passion and compassion, entitled, Bringing Creativity into Clinical Practice with older adults. Bringing creativity into a Clinic Day brought relief and hope to many working with Dementia and Alzheimer’s patients. The presentation was refreshingly unlike most clinical education and on breaks, we were greeted by a Drum Circle, lead by Terri Segal, Expressive Arts Therapist, Not just a demonstration, we were encouraged to pick up a percussion tool and join in. A combination exercise and mental health break. Another presenter – a psychiatrist –  showed photography assignments from nursing home residents, whose average age was 87, entitled: “A View of the World though the eyes of the Elderly: I’m 90 going on middle Age.” One of the photos – a self-portrait assignment – won first prize at an art show: it had been submitted anonymously and the winner surprised everyone when she wheeled over to accept. Robin Glazer, Director of the Creative Center: Arts in healthcare, in NYC was quick to point out that her ‘arts’ are not the same as Art Therapy. “There is no agenda here. It’s de-stressing and fun. We have excellent artists who are flexible and design their approach to the audience. For example, in a group of Japanese elders, our artist started with simple Japanese brush strokes: something they’d be familiar with.” She told of her own experience – which she attributes to honing her observational skills through art appreciation: “I was invited to Grand Rounds at a hospital that one of our artists is at. I saw a young man with an unexplained...

Dr Paula Rochon: Medications and the Elderly

Dr Paula Rochon, Geriatrician,Vice-President Research–Women’s College Research Institute; Adjunct Scientist Kunin-Lunenfeld Applied Research Unit I heard Dr Paula Rochon speak to a small but extremely attentive group of senior seniors. The topic: Medications and the elderly. Rochon is a Geriatrician by training, and her research focus and passion is medication. My take-away: don’t underestimate the impact of medications – the time and effort and challenges required to take ‘em, and the potential effect on other functions. I spoke with Dr. Rochon afterwards, and she clued me in to specific issues related to medications and aging, and a message to pass along to fellow females: Women have to be particularly diligent because so much medication research is done with men. Here’s what I learned: Even if your parent’s been taking the same medication(s) forever, it’s still a good idea to get them reviewed every 4 -6 months. Why? Because aging bodies may not need as much of any one medication. Ask if all medications are necessary, or if any medications can be eliminated If new medication is prescribed, find out what it’s for, if it’s replacing something else, and how it’ll interact with other medications food and drink. Much as weight plays a huge role in how much medication infants are given, as an aging body shrinks, they may not need as much medication. Know your parents weight and height Many medications, or combination of medications can cause confusion, which can lead to a mess o problems: confusion, losing balance and falling, misplacing glasses, dentures, and often –are you ready for this: misdiagnosis of dementia or early Alzheimers. Many pills...

Cardiopulmonary resuscitation (CPR) in elderly: low survival

Study of In-Hospital Cardiopulmonary Resuscitation (CPR) in the Elderly : Cardiopulmonary resuscitation (CPR) evolved from a specific intervention applied in limited clinical situations to the default response to cardiac arrest in or out of the hospital, an evolution accompanied by a dramatic decline in survival rates after CPR.1-3 The largest study to date, which included 14,720 CPR events from the National Registry of CardioPulmonary Resuscitation, showed that 17% of patients survived to discharge.9 Associations between age and survival after CPR remain unclear, with conflicting results from previous studies.6,10,11 Black race may be associated with lower survival after in-hospital or out-of-hospital CPR and may be associated with delayed defibrillation.12-14 Subsequently, innovations allowing rapid out-of-hospital CPR resulted in improved outcomes in the out-of-hospital setting.4,5 However, it is unclear whether advances in CPR or in care after cardiac arrest have improved outcomes after in-hospital arrest. Full article New England Journal of...