What is Geriatric Care?
PPC is devoted to geriatric medicine, and we have spent most of our careers caring for geriatric patients. We love watching a ninety-year-old patient strut or roll into the office, share stories with us about her family, and then walk out with a smile on her face and a feeling of empowerment and control over her own health. We love visiting a patient in his assisted living room and help him understand his medicines and diagnoses, explaining that it’s more important to focus on happiness and function than numbers and illness.
At PPC, we adhere to a geriatric model of care for our patients who are over the age of 70. It doesn’t matter if they are running and still working, or if they are having a hard time walking and riddled with chronic illness. Regardless, an older body is a temple that must be respected, one that has stood up to the test of time and that in a large part takes care of itself without all our meddling. It doesn’t follow the same rules as a younger body. What is normal for an old person may viewed as abnormal by standard convention and lead to dangerous treatments and procedures. Older people don’t do well with medicines, and they do best with fewer tests and more attention paid to symptoms than numbers.
The guiding philosophy of PPC is that there is no single right approach that is appropriate for every patient. As a PPC patient we discuss all aspects of your health with you and we give you multiple options for your medical care. Just because it's broken doesn't mean we have to fix it. That's up to you.
Our goal is to keep our elderly patients active and independent, and the personalized approach helps achieve that objective. But that does not mean we do not intervene medically when necessary. Sometimes physical therapy, home health, holistic treatments, and even hospital-level care will be required. Exercise is a crucial element of care, no matter what a patient's physical state is, and we will pursue a rigorous physical regimen with all of our patients. We will work with families when necessary to help their parents/relatives stay healthy. We will confront memory loss and physical disability sensibly, with every reasonable means we have at our disposal. We will treat illness quickly before it becomes severe and potentially life threatening. We will discuss with patients and their families their wishes for resuscitation and life support, hospitalization, testing, and screening tests and providing them with a reliable risk/benefit assessment. Most of all, we will come to know our older patients well, so when a change in health does occur, we can always act in their interest.
There are several caveats of geriatric care to which we adhere at PPC.
Most medical studies are done on younger people and intentionally exclude those over 70 and who have chronic illness or are on too many medicines. Thus, the results of these studies are not valid, leaving us forced to use common sense, clinical judgment, our decades of experience, and a patient’s own symptoms as a guide to care. How novel is that approach!
Fixing numbers in older people is self-destructive. Many elders need higher sugars and blood pressure; in fact, their bodies push up pressure intentionally to get blood through blockages. High cholesterol is beneficial in elders, as often is higher weight. Other numbers like kidney function are invalid in elders because they have less muscle mass. To base a diagnosis on numbers can lead us down a very dangerous road. Recently my dad came to the hospital severely dehydrated, but a random lab test told the doctors he had too much fluid. Rather than look at and speak with the patient, they based treatment on the number. The results were horrific. We see this all the time. Number chasing with a gaze away from the patient is terrible geriatric care. As Osler says, if you want to know what’s going on, ask the patient.
No medicine or intervention is likely to keep an elderly person alive longer. Under some circumstances, we need to surgically fix a problem or treat a medical condition with medicines. But we must be cautious, weighing risks and benefits of every interventions, and knowing that drugs and surgeries don’t act the same in elders as in young people.
Polypharmacy—or the use of too many drugs—is the drug epidemic among our elderly population. Because elders have so many chronic illness and aberrant numbers, doctors often flood them with medicines. Copious studies show that polypharmacy—even taking just 5 pills—leads to worse outcomes, physical and mental decline, and rarely any benefit than if the drugs are not used. Again, we want to take care of people, not their numbers as they age.
The goal of geriatric care is to maintain function and well-being. We want to keep the brain sharp, the legs strong, and the heart happy. We want our patients to have energy and vitality. This not only helps them feel better, but they usually live longer and avoid catastrophic injuries or complications if they do less. The mantra of geriatric care is that less is more. Again, the focus is on diet, exercise, and stress reduction, not on chasing the fountain of youth or believing promises that this drug or that procedure will solve our problems. Usually they cause more.
We see you as a whole person, not a series of measurements, and we want you to be as independent, vibrant, and happy as you can be. Let’s not be fooled by a medical system that thrives on fixing things by scaring you to death, diagnosing you with endless conditions, and finding reasons to flood you with one intervention and pill after another. That’s not geriatric care. That’s bad care. And at PPC, we want to take care of you as a person, which is what geriatric care is all about. Watch our Video to learn more!