Health Treatment for the Elderly
As we review the professional research literature, we are struck with the evidence of undertreatment of elderly patients by the medical profession and/or the overmedication of the elderly. A good example of this is found in an article in the Journal of the American Medical Association (JAMA, July 28, 1999) which implied that about half of the elderly patients who have heart attacks were not getting adequate care. The NY Times (July 28, 1999) quotes one of the main researchers of this study, Dr. Nathan R. Every, a professor of medicine at the University of Washington, as saying "More attention needs to be paid to treating eligible elderly Americans with these life saving devices (referring to clot-dissolving drugs and angioplasty)."
Heart attacks are the leading cause of death in older Americans. Dr. Sidney E. Smith, past president of the American Heart Association, indicates that use of clot-dissolving drugs and/or angioplasty may reduce death rate by half. (For those readers unfamiliar with angioplasty, it involves the insertion of a flexible tube with a tiny balloon at the tip into the artery to clear the blockage.)
The study in JAMA of 80,356 heart-attack patients over 65 years of age found that 59,673 individuals did not receive either clot reducing drugs or angioplasty within six hours of arrival at the hospital. Those that received angioplasty had a 19 percent higher survival rate after one year compared to those that received clot-dissolving drugs.
Heart attacks occur when the blood flow to a part of the heart is blocked, often by a blood clot. Blood vessel problems develop over time and usually involve a buildup of cells, fat and cholesterol, commonly called plaque, leading to stroke or heart attack.
Symptoms of a heart attack include, but are not limited to, uncomfortable heavy feeling, pressure, pain or squeezing in the center of your chest that lasts more than a few minutes.
The American Heart Association recommends a number of key steps that can taken to prevent heart attacks:
At the same time, hospitals must be prepared to take the steps to increase the chances of survival following heart attacks. There is no question that angioplasty and drugs that dissolve clots have their risk factors especially in the elderly. Doctors should proceed cautiously, but when evidentiary medicine strongly suggests robust ways of saving lives, the medical profession needs to mobilize itself into action.
Another critical situation in the elderly is related to dementia and the existence of comorbid disorders. Dementia, as reflected in Alzheimer’s disease, involves a progressive cognitive loss. Many of these individuals have chronic diseases associated with the aging process (i. e. hypertension, diabetes mellitus, high low density lipid cholesterol (LDL), and atrial fibrillation), the classical risk factors for vascular disease. Postmenopausal osteoporosis is a not an uncommon disorder in elderly women who may also suffer Alzheimer’s disease. The professional literature indicates that it is important to aggressively treat these diseases/conditions to limit their negative consequences on cognition. But what about the adverse effects of the medication treatment and the ability of mild to moderate demented individuals to report these side effects, or to adhere to the treatment regimen? Are they fully capable of understanding basic questions about the medication benefits and burdens?
Take a drug such as Alendronate, which is considered effective in the treatment of postmenopausal osteoporosis. The Physician Desk Reference (PDR) indicates that it can cause chemical esophagitis with severe ulceration in some patients. The risk of developing this condition is greatly reduced by taking the medication in a certain way: take more than 180 mL of water while standing up and do not lie down after ingesting this medication. If you begin to feel any of the following side effects that suggest esophagitis, you should report it to the treating physician: heart burn, chest discomfort and ulceration. For an elderly individual suffering mild to moderate Alzheimer’s disease, this may prove impossible to follow unless this person is closely supervised. Yet, in closely supervised settings, such as nursing homes, this procedure is not always followed because of the frailty of the patient and the work demands placed on treating personnel. The patient then develops difficulty in eating and a whole series of events then can occur that could prove highly detrimental to the patient’s health. Caregivers need to be alert to behavioral changes such as decreased appetite, increased restlessness or decreased activity and report these changes to the proper medical authority.
For references related to the content of this article see the following:
This site will attempt to cite peer reviewed professional research articles that indicate appropriate treatment for older Americans, so that longevity can be improved and quality of life enhanced. We hope this information will help in the collaborative treatment between physician and patient. Nothing excuses the medical profession from providing the highest quality of care to the elderly. We are also aware of the fact that the medical profession and others often cite the cost factor when discussing treatment for the elderly. The issue of "quality of life" is another factor that is often mentioned when discussing the care and treatment of the elderly. These are items that are weighed but the quality of care to the elderly should be of the highest level available to the medical profession.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting a Nursing Home"
Harold Rubin, MS, CRC, ABD, Guest Lecturer
July 2, 2000
http://www.therubins.com
To e-mail: RehabStrat@aol.com or rubin@brainlink.com