There are many fabrications on how to take care of geriatric patients at the palliative care center, particularly in Los Angeles. However, when you have the right doctors and carers at hospice Los Angeles or Pasadena, it is easy to concentrate on the real truths to give your elderly loved ones the best possible care.
It happens all too often. An older person needing palliative care visits their primary care doctor to get medical clearance for a knee replacement. The elderly patient has more than one disease or medical condition, perhaps some mild cognitive impairment, and is taking many medications. Although this is the case, they feel quite healthy, however, they do experience severe pain when walking, and want to go ahead with the procedure.
The doctor gives the patient the green light for the surgery. After the knee replacement, the patient starts to heal, but experiences complications from delirium and is relocated to a palliative care facility like those found in Los Angeles. Sadly, the patient never recovers enough cognitive and physical function to go back home. Most of the time the doctor who gave the patient the go-ahead for the surgery, and also the orthopedist, do not even know about the patient’s outcome.
Myth 1: Geriatrics is bound to have bad results after surgery because they usually suffer from poor health
The truth: Doctors at hospice like those in Los Angeles can reduce the risks that elderly patients have and coincide with the patient’s aims and want they want. As a matter of fact, there is an Age-Friendly Health System framework that helps to achieve, “aims to follow an essential set of evidence-based practices; cause no harm, and align with What Matters to the older adult and their family caregivers”.
Over 800 care sites throughout the United States have adopted and incorporated these foundational principles of age-friendly practice, which are referred to as the 4Ms:
What Matters – Know and adjust care with each elderly patient’s individual health outcome goals and care preferences such as, but not limited to end-of-care, and overall settings of care.
Mentation – Ward off, identify, treat, and manage dementia, depression, and delirium throughout all settings of care.
Mobility – Make certain every elderly patient moves around safely each day to keep the same level of function so they can get back to what they normally do.
Medication – If the patient requires medication, use age-friendly medications that don’t negatively affect the person’s mental status and function, and do not intervene with What Matters to the elderly adult, with their on going Mobility, and their level of cognition and Mentation throughout their care.
Leslie Pelton, who is the Senior Director of, Age-Friendly Health Systems Institute for Health Care Improvement (IHI) Team says, “The 4Ms evidence-based framework has demonstrated impact on outcomes that matter to older adults and to health systems — patient satisfaction, length of stay, and any incidence of delirium.”
Myth 2: Routine surgical procedures, for example, a knee replacement, have very little risk to an elderly patient
The truth: Elderly patients have a higher possibility of poor outcomes for the same procedures that are usually low-risk for younger people. For instance, age and a high Charlson comorbidity index have been known to increase the rate of discharge to an extended care facility after a knee replacement by 40 percent.
Myth 3: When treating an elderly patient, the most important factor is survival
The truth: Many elderly patients would do without surgery if there wasn’t a high probability of functional (74%) or cognitive (89%) impairment. However, this is also true if the treatment burden outcome was low. For a lot of elderly people, the fact that they may have to spend the rest of their lives in a nursing home is worse than dying. However, not many patients are warned of the possible outcome, or does anyone do anything to stop this from happening.
The actual fact is that many hospitals think that a successful surgical result is defined on quality measures such as surgery and followed up hospitalization without any infection of an incident of a fall, and discharge alive to an experienced nursing facility.
This is the complete opposite of what many patients think is a successful outcome, which is separate from living in their own homes. Below is a summary of the differences between a patient’s and a hospital’s view of a successful outcome, which brings focus on the massive division.
What does a patient consider as an outcome failure?
- Put in a nursing home for long-term care
- Can no longer function
- Can’t be with loved ones at home
What are hospital quality measures of success?
- Successful surgical outcome
- Discharged alive to a nursing facility
- No post-operative infection or any incidence of a fall
Leslie Pelton, Senior Director, Age-Friendly Health Systems Institute for Health Care Improvement (IHI) Team says, “When the discussion with the older adult and their family begins with What Matters, the care team moves away from assumptions, and can plan for the care and outcomes the older adult wants.”
Myth 4: Delirium is a normal and slight side effect of surgery and hospitalization in elderly adults
The truth: Delirium, is usually known as ‘confusion’, ‘disorientation’, or just plain ‘out of it’. It is a sudden and fluctuating change in the patient’s level of consciousness, attention, cognition, and even slowed or agitated motor function. The main symptom is inattention, the incapability to focus or keep their focus.
Delirium is normal with elderly patients and is usually a consequence of a medical illness such as an infection or drug side effects. It is particularly usual when responding to stress with those that just have a mild pre-existing cognitive or brain dysfunction, or frailty. When delirium happens is generally linked to serious negatives outcomes for patients.
Myth 5: You can’t stop the risk of delirium developing in older patients
The truth: Prevention is important. Even though delirium can happen in any situation or care setting, surgery and other high-risk interventions can cause harm to elderly patients.
However, doctors can take the necessary steps to lower the risks of delirium.
