I gave this lecture during a Geriatrics Grand Rounds to Family Medicine Residents when I was still in Academia. I miss teaching. However, there is no reason this should remain locked on my USB power-point. Could I try to submit it to JAMA or NEJM? Certainly! But it’s just so much easier to post it on a blog. Enjoy! Mind you, it’s way better in person and live with me, naturally. Also, it’s meant for physician learners, in particular internal med and family med (primary care). Still there is probably something for everyone in these Haikus regarding the care of our Elderly.
It's Geriatrics The real art of medicine. Have to use your brain. No rules for aging, Protocols are rough guidelines. Sherlock Homes-ing it. Physiology Of aging needs understood. A lot common sense. Kidney and liver Normal decreased functioning Can't handle as much. Muscle mass goes down Lipophilic things linger Changes kinetics. Genetics start it, Add lifetime of divergence. Not predictable. Don't live forever. Must counsel on prognosis, Cut back futile care. System is broken Medicare incentives wrong Creates more problems. Want Geriatrics? Pay for time instead of pokes! It's quite simple math. Falls are so common. Many are preventable. Don't rush your old folks. Falls cause M and M. Leading cause of death in old. Script Responsibly! Prevention can help. Small exercises better Than zero motion. Polypharmacy Beers is theoretical Use the STOPP/START tool. Pharmaceuticals Pharmakos Greek for Poison. More is not better. The memory loss. Alzheimer's is dementia. Need to educate. Care for Dementia Is not based on prescriptions. Treat the Caregivers. We've staved off death from Heart, kidney, cancer disease. Can't replace the brain though. Frailty's many signs Do not ignore them up front Your patients suffer Unwanted weight loss Multifactorial Gait Disorders are rough Incontinence is A rampant problem for all. Depends are your friend. Delirium yikes! Can stop it before it starts In certain cases. If medical cause Treat that first and pray for best. Antipsychotics? Haldol is no cure. Often complicates things more. Only for danger. Exercise is good No matter how old you are. Even if in chair. What's the fracture risk? It's Osteoporosis! Find it and treat it. No movement also Leads to more pressure ulcers. Good luck with those wounds. Loneliness and the Isolation that causes Poor quality of life. Individuals Need community to thrive Or else depression. I'm in my thrities Retirement community Sounds like my heaven. Hypertension kills Do does hypotension peeps Brain needs perfusion. Systolic one-ten? Consolidate and cut back BP medicines. Low blood sugars are More danger than the high ones In elderly folks If A1c low Sugars are going hypo You just ain't seeing. Metformin still great Sliding scales are bad news bears Basals are more safe. Don't undertreat pain Quality of Life matters Tylenol safest If need something more Narcotics low dosages Stool softener too. NSAIDS are no good For very elderly folks Bye bye to kidneys. Geriatric peeps Not the cause of opioid Epidemic here. What is DNR? Everyone seems quite confused. AND more clear. Advanced Directives Not around when needed Most. Document these talks. Maybe one fine day All states will adopt the MOST Make our jobs better. Parkinson's disease Does not require neuro doc PCP's can treat. If you are worries Read up for your patients' sake. Don't delay Levo. That's one example Where we rely far too much On specialty care. You are doctors too Diagnosing and treating Not just referring. Too many cooks in A much fragmented kitchen Leads to huge grease fires. That's our EMRs That don't communicate or Produce quality. Bad system ok For relatively simple Not for old and frail. As so it happens No replacement for judgment And good physicians.