Exhaustion in Elder Patients
Age Friendly Healthcare: Addressing Exhaustion in Elder Patients
Susanne Gilliam was picking up mail at the end of her driveway in January when she slipped and fell on a sheet of black ice. The pain rocketed through her left knee and ankle with brutal intensity. She had to use her phone to call her husband and managed to limp back to their house. The runaround started then and there, the catch-as-catch-can system that people across the country experience at America’s fragmented health system. “It’s a part-time job for me to figure out how to get everything arranged,” Ms. Gilliam said. “It just is so exhaustion in Elder Patients (Exhausting mentally and physically).”
That afternoon, Gilliam’s orthopedic surgeon, with whom she had worked through the issues with her left knee, also sees her, but he tells her “I don’t do ankles” . He manages the following day with Mr. Miracle, who refers her to an ankle specialist in Boston. The ankle specialist has Gilliam take a new set of X-rays and an MRI. She asks to have the scans done at the local hospital in Sudbury, Massachusetts, to save time. Still, the hospital doesn’t have the doctor’s order when Gilliam calls to book an appointment. After calling multiple times, she finally receives one.
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Physical therapists also treat one body part for each appointment, meaning that she requires multiple appointments per week to address both her knee and her ankle. The cost extracted from the American health care system is, in some ways, the expense of significant advancements. However, a more nuanced discrepancy between older adults’ abilities or resources and the demands and structure of the health care system reveals itself.
Thomas H. Lee, Press Ganey’s chief medical officer, a consulting firm that tracks patients’ experiences with health care, stated, “The good news is we know so much more and can do so much more “. The bad news is the system has gotten overwhelmingly complex”. The plethora of guidelines for medical conditions, clinician specialization, and financial incentives rewarding more care make it difficult. It’s a sports car when you need a family station wagon,” said Ishani Ganguli, an assistant professor at Harvard Medical School.
“This is such a boom period for beekeepers,” he says. If one has two medical problems – say diabetes and glaucoma – then the encounters with the health care system increase even more rapidly.
The author of a new study, a dissertation by Ganguli has found that Medicare patients spend about three weeks per year – that’s roughly a month or more with tests, doctors visits and treatment or procedures alone as well such emergencies and hospitalization at rehabilitation facilities. The data is from 2019, before the COVID-19 pandemic disrupted care patterns.
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Only just over 1 in 10 seniors spent significantly more of their life receiving care 50 days of services per year; Ganguli stated, “Some of this is likely to be very helpful and meaningful to patients and some of it is less so”. He then added, “We don’t think we talk enough about what we’re asking the elderly to do, and if this is appropriate.”
For many years, Victor Montori, a professor of medicine at the Mayo Clinic, has been trying to warn about the “treatment burden” for patients, which, in addition to feeling well, also includes. These include not only finding a doctor and making an appointment, but also finding a vehicle, picking up the drug at the pharmacy, talking to the insurance company, paying bills, monitoring your condition at home, and even adhering to the anemic algorithm . Four years ago, in an article called “Is My Patient Overwhelmed?” Montori and his colleagues stated that 40% of patients with chronic conditions expressed unsustainable, in their opinion, treatment burden.
Trying to lighten the load
“If it does happen, then those people don’t follow them anymore, and they begin to say that they have worse lives,” the scientists noted. High-risk categories include old patients with many physical and mental disorders, low educational levels, financial difficulties, and insufficient social support. “Although medicine has made many enormous improvements, it has also failed many patients and helped them to death,” Montori said, physicians face fewer problems in this area. “Patients have greater difficulty accessing the clinical problem-solving cooperation and question-answering teamwork that patients can involve.” This challenge is exacerbated by the increased use of digital telephony by physicians and patient websites, disturbingly disordered practice for many seniors, and time pressure on primary care doctors.
“Moreover, we infrequently inquire about their ability to accomplish the tasks we give them.” That is, “We frequently lack a thorough view of our patients’ life situations,” write several physicians in a 2022 paper on treatment burden reduction.
Picture what happened to Jean Hartnett, 53, of Omaha, Nebraska, and her eight brothers and sisters after their 88-year-old mother suffered a stroke in February 2021. At the time, their mother looked after Hartnett’s father, who retained kidney trouble and required daily help to use the shower and toilet. Over the next year, both of Hartnett’s immediate parents encountered several medical crises. Whenever a physician altered her mom’s or dad’s plan of care, the siblings had to find replacement drugs, materials, and equipment and scheduled fresh rounds of occupational, physical, and speech therapy. If one parent required medical attention, the other one cannot be left to themselves.
“It wasn’t unusual for me to be shuttling one parent to and from hospitals or clinics, only to pass an ambulance or family member ferrying the other one to emergency care en route,” Hartnett said somberly. “An incredible degree of coordination was essential amongst all parties.”
After her father’s health declined drastically, Hartnett made the difficult decision to move back in with her parents to help provide care during the final weeks of his life. Sadly, he passed away in March 2022, and her mother’s health worsened in the following months, leading to her death just four months later.
So how can elderly individuals and their caregivers alleviate some of the strain of managing medical needs?
Rogers, an assistant professor at the University of Minnesota Medical School, urges patients to be forthright with doctors if a treatment regimen seems untenable or too taxing.
“Ensure you thoroughly discuss your priorities for health as well as any tradeoffs with medical providers: What benefits might you gain from various tests or interventions, but likewise what burdens could they impose?” she advised. “Inquire which procedures are most pivotal and which might potentially be omitted or delayed.”
While medical professionals aim to tailor treatments effectively, some patients face greater challenges than others. Doctors are able to reevaluate complex plans, cease regimens proving lackluster, and schedule virtual consultations for those with technological wherewithal. However, technology often poses obstacles for elders.
Fortunately, supportive staff can smooth logistical difficulties. Don’t hesitate to inquire if a social worker or navigator may consolidate visits and exams into a single outing for your convenience. Minimizing travel proves no small benefit. These allies additionally connect clients to transportation and various community aids, helping ensure care remains accessible to all.
If you are unclear about the instructions from your doctor, it is crucial to inquire for elucidation. Wondering what will be expected of you and how much effort and resources will be involved are reasonable questions. Additionally, mention the desire for any explanatory literature that could foster comprehension.
“Were I to opt for a specific treatment pathway, I would want insight not only on how it may impact my cancer or heart condition, but also on the time expenditure necessary for care provision,” remarked Ganguli of Harvard. “If an estimate cannot be instantly supplied, a request for subsequent calculation would be in order.”
