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On Senior Health Care

Pneumonia

A few observations and ideas regarding health care for aging parents and elders:

1.  What is it about the medical assistants and nurses in the doctor’s office who do not tell you what your vital sign numbers are?  Must we ask for such basic information?

2.  Cholesterol and statin (Lipitor and generics) medication.   After retiring last year, I switched to the VA for my medications.  That also means a couple of appointments per year with a primary care physician (PCP), free immunizations, and free lab work.

I have been taking statins to keep my cholesterol under control for a number of years.  My VA PCP looked at my numbers and took me off Lovastatin, the drug I have been on for most of the time.  Well, OK, let’s see what the numbers look like in six months.  They were back over 220, which isn’t alarming, but too high.  The physician didn’t order statins again.  I was surprised, but saved my lab report.

Along with many other people this year, I came down with a sinus infection about six weeks ago that didn’t clear up.  Off to my old PCP, not VA, for antibiotics.  The PA that saw me looked at the VA lab report and had me see my PCP.  She prescribed a statin again.  We talked about the issue of using one doctor against another, but as I have promised Carol I will try to stay alive for a while, I am going with the statin and paying for the prescription.

3.  Pneumonia in elders.  Pneumonia is a leading cause of death in elderly patients.  Often the cause is aspirating food into the lungs.  The foreign material is a breeding ground for the bacteria that cause pneumonia.  Many elders, especially when they are frail or have some dementia, have some difficulty swallowing and food gets aspirated.

Pneumonia means a trip to the hospital for a few days, oxygen and antibiotics.   It also generally weakens the patient and can cause enough lung damage to bring about COPD and congestive heart failure.  The odds of a repeat occurrence increase after each bout.

I observed a patient who had no support system who ended up with a tracheotomy, a feeding tube, a urinary catheter, a fecal tube, and a constant IV drip, all against his wishes.  Frank had several bouts of pneumonia, after each time he was a bit worse.  He died with congestive heart failure and COPD, both the aftermath of pneumonia.

Here is the dilemma: at what point in this succession of decline from pneumonia hospitalizations to you say, “Enough!”
My personal opinion is no feeding tubes, especially if general weakness and dementia are fairly well advanced.  One
of Frank’s greatest pleasures in his last few months was chocolate ice cream.  I would not have wanted to deny any pleasure he was capable of enjoying.

All this emphasizes the need for individual and family planning for end of life issues.  Living Will, Durable Power of Attorney, DNR Instructions, a MOLST form, all are important when an elder is nearing the end of life.

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