Geriatrics Overview in Haiku

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.

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.

Beers is theoretical
Use the STOPP/START tool.

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.

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.

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.


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