Heads You Win, Tails I Lose
Kevin Pho, M.D in his medical blog, Kevinmd.com, invites a discussion concerning whether elderly patients should choose premature death at home rather than being subjected to the complications that are associated with geriatric admissions. He concludes that elderly patients admitted to emergency departments should be given the opportunity to choose going home rather than being admitted to a hospital.
An elderly patient should not be forced to forgo necessary treatment for a readily treatable condition and thereby face certain death in order to avoid death by “complications” faced by elderly patients who are admitted. This is certainly a choice between a rock and a hard place.
It is a mistake to assume an elderly patient cannot safely be cared for in a hospital setting. The morbidity our elders face is to a great extent avoidable by assuring that they are kept clean, hydrated fed and as active as their condition permits. Adverse changes in their condition should be promptly recognized and properly and timely treated. This is the level of care all patients deserve.
Because elders are more fragile they require more attention but tend to get less. Elders suffer more complications and more serious consequences not simply because they are fragile but more importantly because they to not receive the surveillance and attention they require.
The costs imposed on medicare are magnified because of inadequate treatment which results in needlessly prolonged geriatric admissions and re-admissions and prolonged and useless rehabilitation admissions.
When these patients fail to thrive they are simply fulfilling expectations. This is a self-fulfilling prophecy. The expectations need to be changed.