Category Archives: Links

The Importance of Primary Care

This New Yorker article by Atul Gowande emphasizes how important it is — and how life-extending — to have a strong and lasting relationship with your primary care physician. Incremental care at the primary level can do more to promote health and well-being than heroic surgeries and other interventions by specialists after a problem has been neglected.

Unfortunately, the incentives in our health care system work against primary care. Surgeons and specialists earn twice as much as primary care physicians, discouraging medical students from pursuing primary care or elder care careers. Meanwhile,  deductibles and co-pays can discourage people from making regular doctor visits. Looming changes to the Affordable Care Act and Medicare may make the situation worse.

As usual with Gowande, the article is extremely well written, and chock full of interesting medical anecdotes.


High Tech Help for Aging in Place

If you are caring for a senior senior, or worried about how you’ll manage when you become one, you’ll be interested in this story from Marketplace.  It’s about a company based in Baltimore, Sentinel Care, that works nationwide with alarm companies, such as ADT, to put sensors around the home that can alert up to ten caregivers to problems. It all works through a cell phone app.

Has the loved one gotten out of bed this morning? Has the medicine cabinet been opened? How many times was the bathroom used last night? (Frequent visits could indicate a health issue.)  Is the kitchen being used at mealtimes? More basically, is there motion within the apartment, indicating that the loved one is at home and moving around?

Sounds intrusive, but many of us know of instances in which a senior has fallen and lain for hours unattended. Even if they have a panic button, they may have left it somewhere or not wanted to push it for fear of causing a fuss. We also know of folks who have wandered off outside due to dementia.

Here’s the website of Sentinel Care, also known as Concordia Systems. (Be careful when browsing. There seem to be a number of companies called Sentinel Care.)

This sort of high tech system may well make it possible for seniors, even those living alone, to remain at home into advanced age.

On Electroshock Therapy and Being Really Old

The January 1 New York Times had a couple of articles of interest to seniors.

One was about electroshock therapy to relieve depression. According to the article, electroshock  today is nothing like what you remember from One Flew Over the Cuckoo’s Nest, and in fact can be very helpful for the depressed. Kitty and Michael Dukakis (aged 80 and 83) are advocates because of all the treatment has done for her. The late Carrie Fisher reported positive experiences with the treatment, as has Dick Cavett.

The Times also published the latest in its series on how several of the “oldest old” in New York City are faring. Every day is a blessing, we often hear, and certainly these nonagenarians are still leading lives full of meaning and joy. But great age, the series underscores, brings great challenges.

Useful Links

The Washington Post does a good job of reporting on issues of interest to seniors. One recent article reported that rates of dementia seem to be declining and speculated on the reasons. It’s nice to have some good news!

This article on atrial fibrillation is also interesting. Since I had my episode on July 4, I’ve learned in talking with others that this problem is quite common — and difficult to learn to live with. My only problem with the article is that it makes no mention of helpful medications. Beta blockers and calcium channel blockers can restore and maintain a normal heart rhythm for many sufferers. They are working for me, so far.


Link: “Polypharmacy” and Its Risks for Seniors

Are seniors taking too many pills? Some are, according to the New
York Times, as a result of what it calls “polypharmacy.”

We seniors visit our various specialists, and each one prescribes something for one of the problems they deal with — high blood pressure, acid reflux, thyroid, rosacea, or whatever. Then we hear about some supplement that’s in fashion and start taking it too — fish oil, perhaps, or Vitamin D, or zinc. After a while, our weekly pill boxes can get chock full, forcing us to buy a larger model to accommodate all our meds.

“Pretty soon, you have an 82-year-old man who’s on 14 medications,” according to one of the physicians interviewed by the Times.

Some interactions among common medications can be dangerous, the Times reports. Taking a statin for cholesterol with amlodipine for high blood pressure can lead to muscle spasms and weakness. I used to take both of these together — guess I was lucky.

I thought about Sally down in Florida as I read this article. The kindly neighbor who rescued Sally after her fall commented, “There were pills everywhere.”

The solution is to be upfront with all the medical practitioners you consult. Let them know about everything you are taking — the non-prescription medications and supplements as well as the prescription drugs. But that’s not enough. After all, my physicians knew I was taking a statin with amlodipine, but none of them said anything about it.

A further worthwhile safety measure is reading the enclosures that come with prescriptions alerting you to side effects and interactions. Keep an eye out for articles like this one in the Times. And, don’t hesitate to ask your physicians about why they are prescribing drugs and what you need to know about side effects. Some may not credit you with the intelligence to handle the information, but more likely they are under the pressure of time.

Be your own advocate.


Link: Eat Fish To Avoid Alzheimer’s

My canned fish collection

My canned fish collection

Here’s an article with a straightforward title: “To Reduce the Risk of Alzheimer’s, Eat Fish.”  Turns out there’s a catch: fish only help if you happen to carry a gene associated with the disease. Still, if we don’t know whether we have that gene, eating fish sounds like a good idea.

I’ve been a believer in fish, particularly fatty fish, for quite a while — but because they are rich in Omega 3s, which help with cholesterol. Take a look at the fish collection in my cupboard. And now, for an anchovy sandwich.

Link: Not Fair To Say “Never Put Me In A Nursing Home”

Thanks to the Washington Post for “Promise You’ll Never Put Me In A Nursing Home.” It’s not fair to ask a spouse or other loved one to make this promise. The fact is, any of us may need skilled nursing care one day.  We shouldn’t make our loved ones agonize over the decision, when the time comes.  A better course is to look around for the kind of place we might like to be, if necessary, and to let our loved ones know.

Link: Geriatricians In Short Supply

Physicians specializing in geriatric care are an endangered species, according this article in the New York Times. They are scarce in the area where I’m living, though we do have a couple of internal medicine practitioners who list geriatric medicine as a second specialty.

A geriatrician discussed in the article treated one patient on the day of the interview for pressure ulcers, a poorly dressed wound, dehydration, and depression. These were all problems that afflicted Sally down in Florida. The poorly dressed wound was a particular problem. I wish she could have seen a geriatrician.

Seniors are increasing in numbers all around the country. We should find ways of increasing the numbers of physicians trained to treat them.