AgingHuman InterestWellness

PRIORITIES IN GERIATRIC CARE

In spite of statistics that show the average life expectancy of Americans has been declining over the past 5-10 years, the number of people over age 65 is increasing. It is not the elderly who shortened life expectancy, but rather it’s the deaths of young adults from drug overdoses, suicide, and accidents. The elderly are receiving the best health care in the world and are living longer and longer. The reference for this article states by 2060 there will be 95 million people over age 65. These folks face the problem of multi-morbidity which means as they age, there are more and more things that can go wrong that will influence their quality of life. 

In response to this concern, geriatricians from Parkland Hospital in Dallas have identified what they call Geriatric 5M’s, five aspects of the care of senior citizens identified as improving longevity, quality of life, and permitting aging to occur with fewer incidents. Focusing on these aspects of care has been shown to improve outcomes and quality of life for older adults and are cost-effective.

The five categories are:

           Mind

           Mobility

           Medications

           Multi-complexity

           Matters Most (What)

MIND: Mentation, Dementia, Delirium, Depression

     Dementia, delirium, and depression are often interlinked. Older adults with depression are twice as likely to develop cognitive impairment. Lack of communication, social isolation, and the loss of a loved one contribute to depression. Depression leads to despair and withdrawal which often lead to declining health. Recognizing and treating depression is integral to the success of the 5M strategy. Treating depression won’t prevent dementia, but it certainly won’t make it worse. 

MOBILITY: Gait, balance, falls

     Falls are the beginning of the end for many elderly folks. Hip fractures are the biggest risk related to falling. Assessing fall risk, which includes evaluating gait and balance, is very important for preventing the downward spiral a fractured hip can cause. Physical activity, including walking and other exercise, improve strength and balance and reduce fall risk. Mobility does what the name implies—it keeps people moving and gives them confidence in their physical ability.

MEDICATIONS: Managing polypharmacy

     Older adults are prescribed multiple drugs which don’t always interact well with one another. They also have adverse effects that contribute to issues with mobility and mentation. The physician must be aware of the drugs he, and other physicians, prescribe for older patients. “At least do no harm.” Be alert to harmful side effects and interactions and adjust dosing accordingly.

MULTICOMPLEXITY: Managing multiple chronic conditions

     Multiple co-morbidities lead to polypharmacy that leads to mobility and mentation problems. Navigating multiple complex diseases is the direct responsibility of the attending physician, and over-treatment must be avoided. The elderly don’t need to be on a drug for every problem they have. Recognizing when a comorbidity is causing problems is very important and should be dealt with appropriately. 

What MATTERS MOST: Person-centered care

     An elderly patient’s desires and concerns must be taken into consideration for stabilizing mental and physical health. The patient and physician must work together and establish a “holistic” health care environment. Shared decision-making allows the older adult to decide if the care plan is appropriate to their station in life. Meddlesome procedures are discussed, avoided, and not done without just reason. Remember, older adults have years of life experience, know if their life goals have been fulfilled, and should be heard when decisions are being made. What “matters most” to them is the path to be followed.

The last years of our lives are the most difficult, medically. Problems mount as our organ systems decline, or fail altogether. Our vision and hearing fail, we can’t remember things, we are weak, short of breath, can’t walk without falling, or even walk at all. It is a tough time with multiple problems that interfere with “living.” The Geriatric 5M’s have been devised to improve the state of our last years, and when applied actively will make “living” a bit safer and more tolerable. 

Reference: Jamshed N, Gangavati A. Prioritizing the 5M’s in Geriatric Care: A Holistic Approach to Care of the Older Adult Am Fam Phys 2024 June;109(6):498-500.

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