Myths about older people, old age, ageing and ageism.

Lets get rid of the myths now! We are all living longer now.  The average age reached now for men is 85 years and for women 87 years.  However, I regularly see patients and relatives coming into my medical practice who are in their mid-90s. The average life expectancy of a person born today is 94 for an Australian female and 93 for an Australian male, and 50% are expected to live beyond these ages!

A healthy older person even in their 90’s -

·       Has unlimited exercise tolerance. 

·       Can walk up hills and upstairs briskly. 

·       Does not fall.

·       Does not get breathless.

·       Does not get chest pain.  

·       Does not get confused.

·      Does not slow down in movements to the point where it is affecting their day-to-day function.

These are the common myths about ageing.

Unfortunately there is an endemic, rigid, systemic, inflexible, irremovable belief in society that old age is associated with disease, disability and suffering.  I was even taught this negative perception about the elderly when I was in primary school. Childrens’ books illustrating older people greater than 65 years were showing older people as flexed over in posture with a walking stick (this may mean that they have neurological impairment with Parkinson’s disease), they had lines around their hands suggesting tremor which is a neurological disease not normal ageing, and they were painted in a pale colour to suggest anaemia which is a disease.  The message that came from these negative illustrations was that old age means disease, suffering and disability.  These perceptions unfortunately persist today.  I see this negative attitude in my daily geriatric medical practice.  Patients and their younger relatives are equally surprised when I demonstrate the normal walking pattern, speed and balance of a 90 year old which is a very brisk and steady gait. 

Patients and relatives are also surprised by the following:

• That memory and brain function do not significantly deteriorate with age to the point they cause impairments in day-to-day function.

• Falls, confusion, incontinence and chronic pain are not a normal part of growing old.

Older people should be able to function just as effectively as a younger person.

Yes older people just like younger people should be able to use common sites on the internet such as facebook, youtube, amazon, google, yahoo, instagram, twitter and ebay.

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.

Lies About Ageing and Older People.

Common myths about ageing. The greatest threat to the health and well-being of older people is blaming “old age” and ageing on illness, physical and cognitive decline.

Dr Lipski’s book represents a generational change in the way we think about “ageing” and the way we deal with older patients.

• Families love to use “old age’ as an excuse for illness, symptoms and impairment in their older relatives which is a dangerous excuse to say it’s OK to sick because you are old and so deny their older relatives a proper medical diagnosis and care!

• Families commonly watch their older relatives decline in health, becoming frail and simply waiting until they collapse in a crisis and end up in the hospital emergency department when it could have been all prevented!

• Why do we say these terrible negative things about our elderly relatives but never about our 15 year old children’s health! We don’t say for example, well you know my son is 15 years of age-so what do you expect!

• Some of the more common myths about ageing, and crazy lies that families quote about their unwell older relatives include: ·      

• Your memory worsens as you get older.

  ·       Memory loss is a normal part of ageing.

  ·       You get more confused as you get older.

  ·       Your thinking and memory slows up in old age.

  ·       Everyone gets more forgetful as they grow older.

  ·       Confusion is a normal part of getting older.

  ·       His memory is not bad for his age!

  ·       She is pretty good for her age!

  ·       He is forgetful because he is 85 years old you know!

  ·       Everyone’s memory gets worse with old age.

  ·       What do you expect for a 90 year old.

  ·       I hope that I am as good as that at 90 years.

  ·       She has had a hard life, so I expect her memory to be worse now.

  ·       She is not bad for her age.

  ·       He has slowed up a lot but he is 92 you know!

  ·       She keeps on falling but it’s just her old age.

  ·       I expect her to slow down and get more wobbly at her age. What do you expect!

  ·       Everyone gets unsteady in old age.

  ·       She is incontinent but she is 82 you know.

  ·       You eat less as you get older.

  ·       You don’t need as much food in older age.

  ·       He is pretty good for 90.

  ·       She is breathless but she is 92.

  ·       What do you expect for an 86 year old?

  ·       Aches and pains are a normal part of growing old.

  ·       He can’t manage at home alone but he is 89.

  ·       I wouldn’t expect that he can do the things he could do when he was younger.

  ·       It’s just old age.

• You’ve got to be kidding me! NO! NO! NO! NO! NO!

   For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.

How Western Medicine is Failing Older People.

• Current hospital Emergency Department (ED) practice routinely focuses on fractures or the injury sustained after a fall, while there is little systematic assessment of the underlying cause, functional consequences, and options for future care and falls prevention strategies. Frail older patients are commonly sent home without being “fully sorted”.

• Then if the Emergency Department (ED) Doctors try to admit these frail older patients under a “single organ team” when these type of patients have multiple complex medical problems that require multi-disciplinary holistic medical care, they simply do not fit into a “single tick box problem approach”.

• So these single organ teams may be reluctant to accept the patient, resulting in multiple phone calls from ED in an attempt to find someone who will accept the patient. The bottom line is that the majority of patients in public hospitals are complex, frail and old! Yet the system is still trying to palm them off to single organ Doctors who do not address their multiple complex medical and psychosocial problems.

• The lack of medical care in nursing homes commonly leads to a medical crisis such as falls, delirium, and infections that could be prevented and managed successfully in the nursing home by early intervention.

• The bottom line is that there should be much better medical care and after hours medical cover in nursing homes to deal with complex medical issues. My solution is that all Public Hospitals should be attached to local nursing homes and provide 24 hour on call rostered medical care with Junior and Senior Medical Staff doing regular rounds and providing on-site after hours medical reviews as needed.

• The worst outcome is a frail older nursing home patient lying on a trolley in ED for hours only to be sent back to the nursing home more confused. So why doesn’t a Cardiologist  or other Specialists rather than just Geriatricians visit nursing home patients?

• Better medical care in nursing homes would reduce the pressure on Public Hospital Emergency Departments and provide better outcomes for nursing home patients. This would also reduce health care costs for Governments.

• Public hospital emergency departments (ER) tend to simply “patch-up’ the patients as quick as possible and get them out! They don’t look at the “big picture”, they don’t look at the underlying multiple chronic medical problems and their impact on the older patient’s general function and quality of life instead of taking the better holistic view of the patient which results in better health outcomes, less hospital re-admissions, and reduced health care costs.

• Home visits by Doctors save health care dollars and prevent hospital admissions.

• The usual current model of “single organ” (SOD) specialised hospital care for patients, does not focus on functional impairment and early mobility.

• Prolonged bed rest of the older patient is commonly associated with significant functional decline even after the initial clinical problems have been treated.

• More than 50% of all frail older patients do not recover to their previous functional levels even after 12 months after hospital discharge, causing increased falls risk, higher risk of readmission to hospital and nursing home placement.

• Hospitals are increasingly being run by non medical, non clinical people (Managers) making decisions about the medical care of the older patients. This puts the health care of older people at risk and is just unsafe to allow unqualified people to make decisions about and manage someone’s medical treatment.

• Too much hospital bureaucracy focuses on ticking useless boxes like teaching staff how to use a fire extinguisher and washing hands rather than looking at the big picture of how to screen for delirium, falls risks, malnutrition, adverse drug reactions, drug to drug interactions, monitoring lying and standing blood pressure, actually weighing the patient, testing memory and cognition.

• It is not cost effective to put the majority of health funding for the care of the elderly into the acute hospital-based system when the greatest need is in fact in the community.

• By failing to screen and address the needs of high risk Geriatric patients in the community, hospitals are setting themselves up for a “tidal wave” of complex, frail, Geriatric patients presenting to the Emergency Department who could otherwise have been safely and cost effectively managed in the community without the need for an acute hospital presentation.

• Home visits by Geriatricians prevent hospital admissions.

• Home visits by Doctors are a dying art!

• The estimated number of hospital Emergency Department admissions prevented by home visits over 6 months by just one Geriatrician is at least 100, with a 10 day length of stay at least, the cost saving for just one hospital is at least $2 million every 6 months.

• Ambulance ramping and queuing of patients in the emergency department (ER) of hospitals could be fixed by Dr Lipski’s “White Paper” and holistic model of medical care.

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.

Single Organ Doctors (SODs) and the Medical Merry-Go Round!

• SODs are single organ Doctors.  They specialise in one area of medicine such as cardiology (heart Doctor), neurology (nervous system Doctor), respiratory (lung Doctor), renal (kidney Doctor), rheumatology (joint and bone Doctor), haematology (blood Doctor) and gastroenterology (liver and bowel Doctor).

• Most frail older patients have multiple complex medical problems affecting their daily lives, not just one single organ problem.

• Unfortunately many of the patients I see have been on what I call the “medical merry-go-round”, seeing multiple single organ Doctors including the heart Doctor, the kidney Doctor, the lung Doctor, the blood Doctor, the bone Doctor, the joint Doctor and the brain Doctor, but then are still not “sorted”.

• The “compartmentalisation” and “single organ approach” to complex elderly patients costs a lot more money, sometimes 1000% mark-up for State and Federal Governments to pay for rather than the individual, much cheaper and more successful care of a single Geriatrician in dealing with these complex elderly patients. 

• The single organ (SOD) doctor approach does not work to produce the best health outcomes for complex frail older patients, nor is it cost effective.

• No one is taking control of the “whole patient’s treatment”, just individual doctors ordering their own tests and adding in more and more medications just increasing the risk for polypharmacy (too many pills prescribed) and adverse drug reactions.

• Is it reasonable for a Doctor specialising  only in only one “organ“ for example to only look at that organ and nothing else? That organ happens to be connected to other body systems! There is a person behind the organ! So by saying to the patient “I only look at and deal with that organ” is that good medicine? No it is NOT!

• SODs should not be allowed a “cop out” and avoid doing the “hard yards” by not sorting out the patient using the lame excuse that “this is not my area of expertise”!

• One of the principles in Dr Lipski’s book is to get rid of all medical specialists (SODs)! They should all be practising general medicine!

• Even my VMO (Visiting Medical Officer) Specialist SOD colleagues agree and tell me that the best care for the complex frail older patients is with a Geriatrician.

• Yes Geriatricians are the last of the JEDI General Physicians- they are dying out and being replaced by the Empire’s SODs!

• Let’s have the debate- do we really need an Endocrinologist to manage diabetes? a Rheumatologist to manage arthritis? a Haematologist to manage anaemia? a Respiratory Physician to manage asthma? a Cardiologist to manage heart failure? when a General Physician or Geriatrician can do it all plus look and the functional outcome of the patient?

• Too much of hospital care now is driven by “tick-box”  medicine whereby protocols are followed instead of looking at the big picture, lack of thinking about the patient holistically, and losing the skills of clinical excellence.

• Young Doctors in hospitals are being taught this compartmentalised medicine to the point where medical teams now can’t manage basic general medical problems. For example, any kidney failure is referred straight to the kidney (Renal) Doctors, high serum calcium and high blood sugar are referred to Endocrine Doctors, heart failure straight to Cardiology Doctors, anaemia straight to Blood (Haematology) Doctors.

• So we are training a future generation of young Doctors who will be de-skilled and incapable of managing complex older patients and their multiple medical problems! 

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.

Massive cost savings with better health care for the elderly.

• The traditional acute geriatric medicine model of hospital care is not sustainable. There are just not enough Geriatricians to look after all the older patients.

• All Doctors should be doing comprehensive General Medicine!

• Both Governments and the public can’t recognise that the majority of inpatients in public and private hospitals are elderly.

• The problem with the public hospital system is that we haven’t changed the way we do things in the last 40 years.

• Western OECD countries are facing a massive tsunami of older people with their rapidly ageing populations.

• The cost savings per year for Governments for better health care for the elderly from Dr Lipski’s “White Paper” on a new direction for Geriatric Medical services are:

  ·       Australia $6 billion.

  ·       USA $80 billion.  

  ·       UK £9 billion.

  ·       NZ $1 billion.

  ·       Canada $9 billion.

• Since the “White Paper” was written back in 2007, the Australian government could have saved now $96 bilion or the USA $US 1.28 trillion!

• Holistic comprehensive geriatric medical care results in shorter length of hospital stay, less complications, reduced health care costs and better health outcomes.

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.

Centre of excellence in medical care of the elderly.

Brisbane Waters Private Hospital in Woy Woy on the NSW Central Coast Australia is one of the first private hospitals to follow the principles and model of care from Dr Lipski’s “White Paper” and book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition” on improving medical care for frail older patients.

• These principles, which are outlined in the latest edition of Dr Lipski’s book, were introduced to take age out of the equation when it comes to clinical care at Brisbane Waters Private Hospital.

• “By introducing a holistic approach which focuses on core pillars of care, we have been able to see our geriatric patients dramatically improve, recover and return home in greater numbers than previously experienced” says the CEO of Brisbane Waters Private Hospital.

• “Through measures to improve and address malnutrition, blood pressure, adverse drug reactions, the introduction of extensive pre-op and post-op geriatric assessments, we have seen a dramatic transformation in our older patients” says the CEO.”

• In addition to this, a project entitled HUNGER (Helping Under Nourished Get Energy to Recover) has been introduced at the hospital as part of a working group which focuses on empowering nutrition for recovery.

• The project has been done in collaboration with occupational therapists, nursing staff, dietitians, Dr Lipski and physiotherapists to improve services, including the development of a screening tool which aims to identify potential malnutrition.

• “No-one is ever too old for treatment. One of the reasons that geriatric medicine is so successful is because there is attention to detail, getting the simple things right and a holistic overview of the whole patient, not such a specific organ approach,” Dr Lipski said.

• “By applying a holistic approach which tackles a reduction in drugs and adverse drug reactions, improving nutrition and mobility, managing low blood pressure, treating organ specific disease and chronic pain, you can achieve great outcomes for older patients”.

• “By removing ageism and age from the clinical discussion and instead looking closer at patients to understand their symptoms and underlying illness, we have a greater chance of not only helping our patients but improving their overall quality of life so they recover, return home and continue to live a fulfilled and healthy life,” says the CEO.

• Patients get a medical diagnosis and management plan within 24 hours of admission. Investigations and tests are done within 24 hours. Detailed information is obtained from families and carers on day 1. All medications reviewed for adverse drug reactions and drug interactions on day 1. Safe discharge plans start on day 1. Multi-disciplinary allied health team including physiotherapy for early mobility, dietician review of nutrition, speech pathology assessment of swallowing, occupational therapy assessment of pressure area risks, activities of daily living and cognitive assessments are all done early in the admission with an early focus on improving general function and mobility for safe discharge home and reducing length of hospital stay. Referring Doctors are sent a detailed comprehensive discharge summary highlighting the key medical issues, any ongoing concerns and follow-up arrangements.

• Dr Lipski would like to see the introduction of merit awards A, B and C levels for private hospitals to reward better care by providing incentive payments to those private hospitals following holistic medicine principles from Dr Lipsk’s “White Paper”.

• The NSW Health Department in 2008 came out to review Dr Lipski’s new model of holistic geriatric medical care and were very impressed.

• The NSW Health Department in 2008 invited Dr Lipski to present his “White Paper” principles to the highest level health executives including the NSW Director General of Health who were all very impressed but nothing further was done!

• All public and private hospitals must provide holistic general geriatric medical care and complex safe discharge planning for frail older patients.

• The days are gone when hospitals rely on multiple single organ doctors (SODs) to see a complex frail older person with nobody taking control and sorting out the patient’s multiple medical problems. This approach is NOT cost effective and does NOT produce good health outcomes fof these older patients!

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.