Part of a series. Beginning at about age 40, our bodies begin a process of organ and functional decay of about 1 percent per year. Bone mineral density decline leads eventually to osteoporosis and fracture risk, cognition decline leads to memory and thinking impairments, and muscle decline leads to loss of strength while increasing the fracture risk of a fall. According to the Centers for Disease Control, almost ...

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Part of a series. The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent, and now it’s about fourteen and six percent. By 2030 it will be substantially more again. There are many ...

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Part of a series. For most of recorded human history, lifespans did not change. Life expectancy doubled in the twentieth century. At the time of Lincoln the average life span was 38 years; today it is about 78 to 80 years. But whenever it ends it is like a waterfall. Most people begin to die near to the expected point; the drop off in percentage still living declines precipitously. Fortunately, ...

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Part of a series. Those of you who have read some of my past posts are aware that I wrote mostly about various aspects of primary care and our dysfunctional healthcare delivery system overall. About 18 months ago I wrote a post for KevinMD on moving to a retirement community. More recently I became focused on the primary care needs of older individuals and from there got ...

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Part of a series. Here is a model for the delivery of primary care which offers certain rights balanced by responsibilities for patient, provider and insurer alike. First the rights of each party. As a patient, you deserve a high level of care in a satisfying manner without frustrations. The insurer and your employer want to see the total cost of health care come down. The physician wants the satisfaction ...

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Part of a series. I have advocated in this series of posts on direct primary care in one form or another (i.e., membership, retainer-based, concierge and various other incarnations and conceptions) because it works well for both patients and primary care practitioners. Direct primary care allows the doctor the opportunity to give the type of outstanding care that each of us needs, whether currently healthy or beset with multiple ...

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Part of a series. Primary care needs to change. That change will need the concerted efforts of patients, doctors, and other constituents. Many are cynical and believe that no worthwhile change can ever occur; others are simply resigned. But optimism can be realistic with intense advocacy and simply taking the initiative to make change. This may surprise you, but change will only happen when patients along with doctors become ...

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Part of a series. Among Medicare recipients, those discharged from the hospital incur about a 20 percent risk of an unplanned readmission within 30 days. The number is higher for some conditions such as heart failure. This is the result of a terribly dysfunctional health care delivery system. Of course some patients will need readmission; the number can never be pushed down to zero, but 20 percent is appalling. Why ...

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Part of a series. You know the serenity prayer, written by Reinhold Niebuhr in about 1940:

God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference.
I saw an elderly woman in the hallway recently with the prayer framed and done in needlepoint by her daughter. It was very beautiful, and it got me to thinking ...

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Part of a series. We tend to think of the primary care physician (PCP) as the one who does the simple stuff, a doctor who is a mile wide and an inch deep in knowledge and experience. That is a false impression. By education and experience, the PCP is actually a chronic disease specialist. That is, provided the PCP has the time to care for his or her patients with ...

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