Many older patients fall in the hospital and these falls often lead to injury. Hospitals are under a lot of pressure to reduce falls. Generally, these falls happen when patients transfer such as when an older person tries to get out of bed or get up from a chair. While hospitalized, many patients are weak, dizzy, or confused, and they can be at risk of falling when ambulating ...
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Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to do more harm than good. Also, persons who have limited life expectancy may want to plan, discuss their values, and consider palliative care approaches of care in addition to care focused on living as long as possible.
But can one actually predict life expectancy accurately in an individual patient? ...
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Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators.
The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve ...
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I sometimes wonder if we spend too much time talking about professionalism.
It is not that I don't think we should promote professionalism. Of course we should. But many discussions of professionalism descend into overly academic and scholarly treatises that end up obscuring rather than clarifying the values such discussions hope to promote. It may be a mistake to overly ...
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Generally, Alzheimer’s disease is diagnosed only after patients have progressed to major levels of cognitive impairment that results in substantial problems in daily functioning. But the brain changes that result in cognitive impairment start years, if not decades, before patients become symptomatic. So, wouldn’t it make sense to try to diagnose Alzheimer’s Disease in patients who have the brain changes, before they have clinical symptoms?
The answer would be yes if ...
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There is a lot of focus on what elders with dementia can't do. But what about more discussion of what they can do?
When you see a patient with dementia, how do you help family members maintain meaningful interactions with their loved ones? I am sad to admit that I don't do this nearly as well as I should. After all, this is not the type of thing we are taught ...
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In 1927, Francis Peabody remarked that, "The secret of the care of the patient is in caring for the patient."
Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring that concerned Peabody have been lost. Of course, there are many health professionals that still embody this caring ethic. And in today's era, perhaps the group that best personifies this central ...
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Long term care is a hot topic. When people talk about long term care, they are generally talking about nursing homes. Policy makers put a lot of attention on nursing homes because they cost so much money. About half of nursing home care is paid out of public dollars. In California, in the setting of our state budget fiasco, the high cost of nursing home care to the state has ...
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-Eric Topol, MD, author of The Creative Destruction of Medicine
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