"Let's start the powwow," a man with a brown jacket and braided ponytail said with a smile. Nineteen adults and one child filled the back conference room of the hospital. The hospital had made an industrial cylinder of coffee for the meeting, and it was almost completely drained. I hung the stethoscope around my neck, knowing I wouldn't use it as anything but a prop to signify my training and ...

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Society gives short shrift to older age. This distinct phase of life doesn’t get the same attention that’s devoted to childhood. And the special characteristics of people in their 60s, 70s, 80s and beyond are poorly understood. Medicine reflects this narrow-mindedness. In medical school, physicians learn that people in the prime of life are “normal” and scant time is spent studying aging. In practice, doctors too often fail to appreciate older ...

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A recent New York Times article described a 77-year-old retired gardener in England who had not spoken with another human being in more than six weeks. He told the reporter through tears that he felt "very lonely, and bored." Recent budget cuts prevented him from taking the bus to the grocery store. Younger people, including his own son, had left town for better jobs in larger cities. I see this loneliness ...

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If you’re sexy, fit and nimble, if you can part your thighs and bend your knees, if you can see your private parts without a mirror, ignore this. Move on. This is not for you. This is for those with flailing sex-drive and failing abilities whose sex life is a challenge, but they’d like to make their partners happy and have some fun. Maybe your parents or grandparents. This must be an ...

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Medicare wants doctors to get patients on their computers. Doctors are required to set up computer portals to communicate with patients. These portals use two-factor identification and presume substantial computer literacy from patients in their late 70s or 80s. Yet, there are limits. For many geriatric patients, a cell phone means a feature phone with gigantic numbers. If they have a computer, it ...

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This is the scenario. You (or your mother) were admitted to the hospital with pneumonia. On the third day a cheery continuing care nurse comes in and says, “You don’t have a fever, and the doctors feel you can be discharged to finish your course of antibiotics, but your nurse tells me you are still too weak to go home, so we are going to send you to rehab. Here ...

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An excerpt from How To Be A Merry Widow - Life after Death for the Older Lady. You are like an animal cut off from the herd; people are social beings and need to be with others. The very word ‘"solitary" brings fear even to the most hardened criminal. ...

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I dedicate this to each of you who have cared for or are currently caring for an ill parent or family member.  Recently, due to the stress that several of my dearest friends have been experiencing in caring for their elderly parents, I am even more appreciative and respectful of my privilege in caring for elderly patients who have attentive and loving adult children who accompany them to our ER. Although this ...

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One of the major challenges of being on medical school rotations is the necessity of changing rotations every four weeks, and how adapting to each new specialty feels like going through the first day of school all over again. I want to share my experience on other side of the coin. About a year ago, I started participating in Stanford’s Continuity of Care program, a clerkship in which I am excused from ...

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Often people (mostly residents and medical students) ask why on earth did I choose to do a geriatric fellowship? My response is because it is the medicine of the future. While we are all aging, the fastest growing age groups are those born between 1946 to 1964. The Baby Boomers. The Silver Tsunami. The Grey Hoard. Call it what you will, but estimates are that by 2060, 98 million (24 ...

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These days we are talking more about advanced directives and living wills in health care. This is progress, but as a member of the sandwich generation, I am focused on the aging process. I don’t have kids, but I have parents and have the honor of watching patients struggle with aging and helping loved ones grow old — walking the long, winding and thorny road. Patients have asked me, “Where are ...

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I recently stopped by our local grocery store after work to pick up a handful of items to bring home. With only four items in hand, I luckily found a short checkout line behind this lovely elderly couple who were almost done and ready to pay. As they smiled and made small talk with the cashier, I imagined a typical geriatric medical story about them. They appeared in good health which ...

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Caregiving is often described as a sacrifice. One individual bears a burden to care for another. There's a connotation of drainage, evocations of burned-out batteries and tired limbs. I was a premedical student. I was aggressive in pursuing an MD. I wanted to be the best doctor I could be. I did not realize that required me to become a much a better person. I left school to care for my grandmother. ...

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My 81-year-old patient came in several weeks ago and disclosed that he had stopped taking his aspirin after watching a news report on television. “They said I didn’t need it anymore,” he told me. I gently informed him that this news didn’t apply to him. He was responding to a recent study in the New England Journal of Medicine, which showed that aspirin failed to prevent ...

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Prevailing wisdom states that more is better — and it is no different when it comes to our expectation of medical treatments. With the help of the internet, patients and their families have come to expect intensive tests, treatments and therapies at every life stage. But sometimes, too much treatment can do more harm than good. This is true in all ages but is especially relevant for older adults living with ...

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It was my first day of orientation at medical school. In a hallway stood a coat rack overflowing with white garments. I set down my accumulated papers, reached for a hanger and — for the first time ever — shrugged first one arm and then the other into a white coat. It was too large, but I had no other options. The unisex coats ran from XXS to XXL, but the ...

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I like to think of myself as a relatively optimistic person.  If you have ever met me in person, you might think that I have a pretty sunny disposition on life.  And for the most part, I do.  Since I write every day, however, there are times when my posts may start going negative.  Not for an extended period, but long enough for my readers to wonder if am just a touch ...

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She had everything she needed.  Her husband had died long ago.  But the fortune he left her would suffice.  She had given up on mansions long ago.  There were no children, so who needed the space?  She was happy as can be in her little condo in the city.  The building had the most lavish pool, exercise room, and views.  She absolutely adored the doormen.  They would let ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 82-year-old woman is evaluated for a 1-week history of urinary incontinence with lower abdominal discomfort. She reports no dysuria, fever, or back pain. Medical history is significant for hypertension and allergic reaction to sulfa drugs, which cause a generalized rash. Her only medication is amlodipine. On physical examination, temperature ...

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When I finished my training, I was taught that the vast majority of dementia was Alzheimer's disease, with occasional cases of multi-infarct dementia as well as odd syndromes such as Kreutzfeld-Jacob disease and genetic, traumatic, toxic and tumor-related syndromes. Parkinson's disease, we were taught, caused a tremor and freezing up of a person's movements and only very rarely was associated with any kind of memory loss. These teachings helped us modern ...

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