Tuesday, July 19, 2011

How do you stop the elderly from falling? Diet and exercise

If you are over 65 years old, one of the most dangerous things that can happen in your world is a fall. Thousands of people die every year in North America from the repercussions of falling. Worse than death sometimes, falls can lead to significant reduction in quality of life. Elderly people who were independent and living on their own can be bed bound and completely dependent on assistance to do everything from shopping and cooking to eating and toileting.

The actual act of falling is rarely fatal for seniors. Obviously, if a person falls from the roof of their house, they could break their neck and die, but very few seniors are running around on roof tops. Death from a fall is usually secondary to the comorbidities caused by the fall. For example, an all too common way for an elderly person to die is to fall and break their hip. Their hip may be surgically repaired, but post-operatively their mobility has been decreased and they lie in bed all day. Lying in bed causes parts of their lung to collapse on themselves and become an incubator for bacteria. Then they develop a pneumonia that they cannot fight off and their weakened body succumbs to this series of insults hurled against it.

There are a number of ways to protect elderly people who fall, including hip protectors which cushion the hip from the force of the fall. Unfortunately, these are not the most stylish, comfortable, or even effective methods to protect seniors. The best protection is prevention. An article in the globe and mail discusses how a good diet and adequate exercise are fall prevention and protection methods.

I know that doctors and health media always push improved diet and exercise as the solution to every problems, but it really makes sense here. Seniors who exercise will have an increased range of motion, stronger stabilizing muscles, thicker bones, and better balance (I think the better balance is primarily due to the strong stabilizing muscles). This means that they will be less likely to fall. If they do fall, they will be more flexible and have stronger bones, which means they will be able to escape the fall with fewer torn muscles and broken bones.

Diet is also important because seniors are no longer as effective at getting or keeping nutrients from their food. Calcium and vitamin D are particularly important because they are essential nutrients in the building, strengthening, and repair of bones. Again, a healthy diet leads to a healthy body and that can better prevent falls and injury.

The Globe and Mail will be discussing fall prevention and protection in further detail. I suggest having a read through this series because stopping the falls and the injuries they can cause will significantly increase both the quantity and quality of the lives of any elderly family you have.

Sunday, July 17, 2011

Technology: Information technology and the informed patient

As technology continues to advance many facets of our lives, patients will become more knowledgable about and have better access to their health information. This is already very evident in multiple patient interactions I have every day.

Often when I meet with a patient, particularly a computer literate patient, they have already googled their symptoms and they have their own provisional diagnosis. I have even been told which lab tests I should order. There are obviously both benefits and drawbacks to improved patient access to health information.

First and foremost, I love having informed patients. Caring enough to look up symptoms on the internet is correlated with patients being motivated to actually get better. The apathetic, deflated patients who aren't interested in taking an active role in improving their own health are notoriously difficult to treat because even if I develop an amazing therapeutic plan for them, they often do not care to follow it. These patients need two treatment plans. The therapeutic plan for the disease and the motivational plan to get them interested in following through with the therapeutic plan.

Second, patients who have researched their illness have often learned about the physiology surrounding their disease and treatment. Obviously, it is easier to teach someone about their disease if they have done their homework.

Third, these patients have often studied the different available treatment options and reflected on their illness giving them a better idea about what kind of treatment they want and what they are willing to sacrifice to get better.

However, patient access to health information over the internet is not always positive. For instance, patients can come to their own diagnoses for their symptoms because they read something from "Dr. Google". I had a patient who knew she had endometrial cancer because she had uterine bleeding after menopause. Now, endometrial cancer is certainly something that needs to be ruled out when a patient has postmenopausal uterine bleeding; however, there are many more common, benign diseases that cause postmenopausal uterine bleeding that should be considered too. These patients are often fixed in their belief that they have a serious disease and it can be very difficult to prove to them that they have a more benign illness.

Patients may also decide they know which test needs to be ordered because they read an internet post about a person who claims that their disease was misdiagnosed until some doctor ran the correct (but rarely indicated) test. For example, I had a patient who was suffering from jaundice, abnormal liver enzymes, and abdominal pain who admitted to heavy drinking. Unfortunately, he would not accept a diagnosis of alcoholic liver disease. Instead, he insisted that he first get tested for alpha-1 antitrypsin deficiency with a liver biopsy because he read about a patient online who had similar symptoms and was misdiagnosed with other diseases, including alcoholic liver disease, until one doctor ordered a liver biopsy. This patient would not accept that we can look at alpha-1 antitrypsin levels in his blood to screen for the disease, he wanted the gold standard test, which is the biopsy. Any surgical procedure has associated risks that only make them worthwhile when they are the best option and for a patient who has new onset hepatitis and a known history of alcoholism... a liver biopsy is notthe best or safest first option.

Of course, overall I think it is better to have informed patients than ignorant patients. The benefits of the internet educating people about their health far outweigh the problems. However, I would prefer if patient used their internet research to question and challenge doctors and not assume physician incompetence when your doctor presents a differing view than John Doe does in his blog.