Now, we’re going to focus
on a different special population,
and I mean really special because I get a lot
of satisfaction out of taking care of older adults.
So, let’s talk about best
practices among older adults.
So, we have a 75-year-old woman.
She lives alone.
Her son brings her in and she's –
and he is worried that she is losing
weight despite not trying to lose weight.
So, what should be the first
thing that you should do?
Is it A, perform a thorough dietary history;
B, check the patient's weight
over time based on clinic records;
C, evaluate the patient for neglect;
or D, perform a screening
exam for cognitive function?
What do you think?
These are all – could be correct answers.
So, this is really more of my bias,
but I want a little objective
data as to what's going on.
So, I would check B.
It's kind of like the newborn,
when you’re worried about
failure to thrive or the infant –
you know, the first thing you do is
go to record and actually see,
‘Well, is this a real result,
let's retest the baby's weight.’
Here, let's see if the patient is actually
losing weight because when I hear that issue,
'Oh, doc, I'm losing weight,'
a lot of times, I’ll go back
and six months ago they
had the exact same weight
or sometimes they’ve actually
gained some weight in the interim.
Of course, A, C, D
are good options too.
And once you demonstrate their –
oh, gee, there has been a weight loss,
you’re going to follow-through
on all of those things.
And we’ll talk about unintentional weight
loss among older adults in a minute.
But just as broadly concerning
the assessment of older adults
and some of the key facets to understand,
the heart failure,
the chronic kidney disease are still there.
So, we have to make sure that we’re
managing those chronic conditions.
Then we’re addressing new conditions –
pains in hips and pains in chest,
and feeling dizzy, all those
things need to be addressed.
And function becomes even more important,
and so we start thinking
about activities of daily living.
And what the patient actually does day-to-day
and where they’re limited
in terms of their abilities
and what can they still do you even to
the extent they did 30 or 40 years ago.
That functional assessment is big.
And lot of times,
that's related to cognition.
Watching for cognitive declines,
evidence of problems with memory,
executive function among older
adults as part of their care.
And understanding that's also
intertwined with their mental health.
Depression is very common among older
adults and presents in a different way too.
So, just being mindful of that.
Then, finally, the social environment.
What kind of social network do they have?
Within their families,
within their friends,
with other groups,
those who may be able to support them,
finding the right support group
for our seniors is important.
And so, part of that support
group is the healthcare team itself.
Again, with the patient at the center,
but includes a physician,
nutritionists are very helpful,
social workers – so, some great programs for
older adults they can get involved with,
often needing a physical therapist
(inaudible) mobility and safety
and occupational therapist to help
them with those activities of daily living.
That's a nice start for a team there,
but also consider a mental
health professional in that list too.