Good Medical Care for the Elderly and How to Get It

Health Vault - online medical records

Is this what we've been waiting for? Continuity of care is enhanced when consumers' medical team has access to a broad health record of patients. Microsoft announced on October 4, 2007 a free online service where folks can store their personal health records. Called HealthVault, this is an online project based upon two years of collaboration with partners Johnson & Johnson, the American Heart Association, the Mayo Clinic, and numerous hospitals. Of course, privacy is a huge issue. According to the New York Times, each individual putting his or her health information online will do so in secure, encrypted files. The individual is in charge of setting the privacy controls and can decide what information goes into the files and who can have access to it. Take a look and judge for yourself. Microsoft HealthVault can be accessed at www.healthvault.com

Read the New York Times article, Microsoft Offers System to Track Health Records.

Take a look and judge for yourself. Microsoft HealthVault can be accessed at www.healthvault.com

Read the New York Times article, Microsoft Offers System to Track Health Records.

Technorati tags:health vault, online medical records

Heart attacks | No. 1 killer

Victims of heart attacks often make crucial mistakes that can critically affect their survival and their recovery. One of the most frequent mistakes is not calling 911 and arranging transportation by ambulance to the hospital. Another is not adhering to medication regimens prescribed by a doctor to decrease the potential for heart attacks. Some people refuse medications. Other people start to feel better and stop taking medications that their doctors have prescribed.

Doctors are able, if a heart attack victim arrives quickly at a hospital, to use treatments and techniques that will open clogged arteries, preserve heart muscle, minimize the amount of heart damage caused by the heart attack, and prescribe medications that reduce the risk of a future heart attack by treating conditions such as high cholesterol that put people at risk.

Watch the New York Times online video” Heart Disease No. 1 Killer” in which a doctor and heart attack victim discuss the dos and don’ts for those who suffer a heart attack. A one-time registration may be required.

Read, in addition, a New York Times article, "Lessons of Heart Disease, Learned and Ignored"
By Gina Kolata,published on April 8, 2007. A one-time registration may be required.

Critical facts about heart attack treatment and prevention

Victims of heart attacks often make crucial mistakes that can critically affect their survival and their recovery. One of the most frequent mistakes is not calling 911 and arranging transportation by ambulance to the hospital. Another is not adhering to medication regimens prescribed by a doctor to decrease the potential for heart attacks. Some people refuse medications. Other people start to feel better and stop taking medications that their doctors have prescribed.

Doctors are able, if a heart attack victim arrives quickly at a hospital, to use treatments and techniques that will open clogged arteries, preserve heart muscle, minimize the amount of heart damage caused by the heart attack, and prescribe medications that reduce the risk of a future heart attack by treating conditions such as high cholesterol that put people at risk.

Watch the New York Times online video "Heart Disease No. 1 Killer" in which a doctor and heart attack victim discuss the dos and don’ts for those who suffer a heart attack. A one-time registration may be required.

Read: "Lessons of Heart Disease, Learned and Ignored" by Gina Kolata, published on April 8, 2007 in the New York Times. A one-time registration may be required.

What you should know about strokes

You can access an online video at the New York Times website that discusses the risk factors for stroke and the importance of recognizing symptoms of stroke and getting promptly to the hospital. TPA administered within 3 hours of the onset of an ischemic stroke can vastly increase a person’s chances for a good recovery. This is part of the New York Times’ Health sections archives of valuable health materials. A one-time registration may be required.

Crucial Facts About Stroke | One of the Nation’s Top Killers

Stroke: The importance of getting to an ER quickly

A report prepared by the Morbidity and Mortality Weekly Report (MMWR) Series for the Centers for Disease Control and Prevention (CDC) states that less than one half of the victims of stroke (of the patients for whom data about the time of the onset of stroke was collected) presented to an emergency room in time to obtain optimal treatment.

To avoid potential for death and significant disability, ischemic stroke patients should receive the most effective treatment—intravenous t-PA therapy, as soon as possible after diagnosis and determination of eligibility. This therapy must be given within 3 hours of the onset of symptoms. The report indicated that fewer than half of the patients arrived at the emergency room within 2 hours of symptom onset. Of those patients arriving within 2 hours of onset, only 2/3 received brain imaging within 1 hour of their arrival.

Arrival at the ER by ambulance was tied to a significantly shorter wait time for brain imaging—i.e., to quicker diagnosis and ordering of the life-saving treatment. According to the report, however, approximately half of the patients in the registry population arrived by ambulance.

Why it's difficult to attract doctors to geriatrics

According to the New York Times on February 6, 2007, Veterinarians who care for the animals that provide the United States with food are in increasingly short supply. The answer? The pay is better if the patients are dogs and cats; the hours are better. Thus it’s difficult to attract veterinarians to large animal practice.

In A New Problem for Farmers: Few Veterinarians, a recent survey by the American Veterinary Medical Association found the median starting salary of large-animal veterinarians to be $60,500/year, $11,000 less than that of small-animal veterinarians. The gap was even wider for veterinarians practicing 25 years: $98,500 for large-animal practitioners, $122, 500 for small animal practitioners.

One veterinarian told why she shifted from caring for farms animals to caring for family pets: She’d get paid $50 to do a C-section on a cow. But for the family pet, she’d earn $300. “It’s the money. I hate to say that.”

What does this have to do with Aging in Place? First, what the Times calls a “seismic shifts in farming, veterinary medicine, the economy and American culture” is much the same kind of problem America is seeing in its failure to attract medical students to the practice of geriatrics. This is a critical problem given the coming of age of the Baby Boomers. See the Alliance for Aging Research 2002 report: Medical Never-Never Land: 10 reasons why America is not ready for the coming age boom, 2002. Last accessed March 1, 2006 at http://www.agingresearch.org/advocacy/geriatrics/02016_aar_geriatrics_text.pdf

More on delirium: A "red flag" signaling a medical emergency

In August 2005, Dr. Margaret Rathier and her colleague Dr. J McElhaney, published a review study on delirium, its causes, the fact that it should be managed as a medical emergency, and how important early detection and treatment of the underlying causes of delirium will improve both short-and long-term outcomes. Rathier, Margaret O, McElhaney, J. Delirium in Elderly Patients: How You Can Help. Applied Neurology. August 2005. Last accessed February 1, 2007. http://appneurology.com/showArticle.jhtml?articleId=170100541

Dr. Rathier wrote that because delirium represents one of the nonspecific presentations of illness in elderly patients, the disorder can be easily overlooked or misdiagnosed. She states that misdiagnosis may occur in up to 80% of cases, but it is less likely with an interdisciplinary approach that includes input from physicians, nurses, and family members. Successful prevention of delirium requires systematic evaluation of hospitalized elderly patients. In this article, Dr. Rathier identified key risk factors to be alert for in the evaluation. She also outlined a multidisciplinary approach to diagnosis and management.

[Note: Misdiagnosis rates of 80% are too high. Misdiagnosis rates of 95%, as in the study I cited in my earlier Aging in Place article, are too high. Dr. Rathier relied upon different studies, most by Dr. SK Inouye. Dr. Inouye’s studies dated from 1990 to 1996.]

Getting an Accurate Diagnosis

It is essential to the good health and well-being of our seniors if they and their caregivers detect emerging problems early and get an accurate diagnosis. That's why Taking Charge tells readers what to look for and when to advocate for medical intervention.

How often does misdiagnosis occur? Frequently. As I write in Chapter Two, delirium is misdiagnosed 95% of the time by doctors. This results in a serious problem for the elderly because the underlying disease or condition causing the delirium then goes untreated. Research shows that 26% of patients whose delirium is undiagnosed or misdiagnosed die within a year and that usually the cause of death is the underlying disease or condition that caused the delirium. This means that delirium is a huge red flag that can be a tremendous asset to the elderly and their caregivers if they recognize that the sudden onset of confusion is a fire alarm to get medical doctors involved in diagnosis and treatment.

On February 22, 2006, the New York Times published an article by David Leonhardt wrote titled "Why Doctors So Often Get It Wrong." It illustrates the importance of advocating for a correct diagnosis.

"[W]e still could be doing a lot better. Under the current medical system, doctors, nurses, lab technicians and hospital executives are not actually paid to come up with the right diagnosis. They are paid to perform tests and to do surgery and to dispense drugs.

There is no bonus for curing someone and no penalty for failing, except when the mistakes rise to the level of malpractice. So even though doctors can have the best intentions, they have little economic incentive to spend time double-checking their instincts, and hospitals have little incentive to give them the tools to do so.

'You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality.'

here are some bits of good news here. Dr. McClellan has set up small pay-for-performance programs in Medicare, and a few insurers are also experimenting. But it isn't nearly a big enough push. We just are not using the power of incentives to save lives. For a politician looking to make the often-bloodless debate over health care come alive, this is a huge opportunity."

You can read the entire article here.

Shortage of Doctors Trained in Geriatrics

Taking Charge makes clear that a major reason why it's so hard for the elderly to get a correct diagnosis and the right medication is the fact that there is a tremendous shortage of doctors and nurses trained in geriatrics. The major point of Taking Charge is that the family caregiver is the one person in contact with the elderly patient who can provide the continuity of care and quality of objective observations -- the one person able to tell the medical team what is normal for the patient -- so that changes in status are red flags that medical intervention needs to occur.

A report published in 2002 by the Alliance for Aging Research revealed:

Only 9,000 of the 650,000 licensed physicians are certified in geriatrics – that’s fewer than two percent. Worse, this number is shrinking as older physicians retire or choose not to be re-certified.

This report also makes clear that most doctors and nurses lack any training at all in geriatrics.

At the time Taking Charge was researched, only 3 of the nation’s 144 medical schools had a department of geriatrics. Today, there is an increase -- 145 medical schools, 9 of which have a department in geriatrics.

In 2002, only 14 medical schools required a course in geriatrics; 86 medical schools offered electives in geriatrics, but only 3 percent of medical students choose to register for these courses.

Worse, only 720 of the nearly 200,000 pharmacists in the U.S. have geriatric certifications. And we all know that the elderly take most of the prescription medications.

It’s difficult to attract new doctors to geratrics because of the low reimbursements by Medicare and Medicaid.

Jane Gross told a compelling story about how this affects the nation's elderly in her article published on October 18, 2006 in the New York Times. "Geriatrics lags in age of high-tech medicine."

Reading this news article makes one realize how important the observations of a family caregiver can be when doctors try to diagnose medical problems in the elderly.

Getting an Accurate Diagnosis

It is essential to the good health and well-being of our seniors if they and their caregivers detect emerging problems early and get an accurate diagnosis. That's why Taking Charge tells readers what to look for and when to advocate for medical intervention.

How often does misdiagnosis occur? Frequently. As I write in Chapter Two, delirium is misdiagnosed 95% of the time by doctors. This results in a serious problem for the elderly because the underlying disease or condition causing the delirium then goes untreated. Research shows that 26% of patients whose delirium is undiagnosed or misdiagnosed die within a year and that usually the cause of death is the underlying disease or condition that caused the delirium. This means that delirium is a huge red flag that can be a tremendous asset to the elderly and their caregivers if they recognize that the sudden onset of confusion is a fire alarm to get medical doctors involved in diagnosis and treatment.

On February 22, 2006, the New York Times published an article by David Leonhardt wrote titled "Why Doctors So Often Get It Wrong." It illustrates the importance of advocating for a correct diagnosis.

"[W]e still could be doing a lot better. Under the current medical system, doctors, nurses, lab technicians and hospital executives are not actually paid to come up with the right diagnosis. They are paid to perform tests and to do surgery and to dispense drugs.

There is no bonus for curing someone and no penalty for failing, except when the mistakes rise to the level of malpractice. So even though doctors can have the best intentions, they have little economic incentive to spend time double-checking their instincts, and hospitals have little incentive to give them the tools to do so.

'You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality.'

There are some bits of good news here. Dr. McClellan has set up small pay-for-performance programs in Medicare, and a few insurers are also experimenting. But it isn't nearly a big enough push. We just are not using the power of incentives to save lives. For a politician looking to make the often-bloodless debate over health care come alive, this is a huge opportunity."

You can read the entire article here.