Putting It All Together Return to the Beginning
Let's test out your new expertise in the lives of your patients on the next one who walks in the door. She is Mrs. J. She is 55 pounds overweight and two months ago you made a referral for her to a nutritionist and told her to exercise at least five times a week. She never saw the nutritionist and has not exercised. She even denies that you mentioned either one. Instead of writing her off as an non-compliant, you gather up your trusty file of resources and…
Do a quick evaluation to check her short-term memory. Maybe she truly did not remember that you mentioned diet and exercise and is developing dementia.
Ask her about her hearing. Maybe she never heard you.
Discreetly find out if the nutritionist you referred her to is in her insurance plan. Maybe she can't afford to private pay and needs another referral.
Quietly ask her if she would be interested in meals-on-wheels or information about food stamps. Maybe she never saw the nutritionist because she can't afford healthy food.
Check to see if she lives in a crime-ridden neighborhood. If so, whip out your resource file and refer her to her local senior center where she can exercise safely.
Ask her if any of her friends would be interested in walking with her. Find the closest walking club on your resource list and give her the phone number so that she and her friends can all go together.
Check her chart to see if she might be a caregiver. It may be that she is so pre-occupied with caring for an ill husband that she cannot make it to the appointment or exercise. Look up "respite care" in your file.
And on and on… Of course, you wouldn't ask all these questions. You would focus on the ones that make sense from the information that you have about her. And you would have perhaps saved the life of a patient who before might have walked out of your office being no closer to good health than she was before. Good for you!
The many threads of elders' lives all come together in their health status and land in your lap. Now that you know a little more about what challenges they face and how you can help, you are ready to provide even better care to your older patients than you did before. While some recommendations may take a little extra time, something we all have less of these days, providing a little help early on may prevent a crisis that will require much more of your time later. The future of America and your patients is "gray." What can you do to make sure that your older patients now are well served and that you are ready for even more of them in the years ahead?
