Managing Along the Health Continuum

We have many older adult clients (defined as those over the age of 80) who began working with us 10-15 years ago. At this point, we have taught them and their family members to pay close attention to subtle changes in health status and to notify us immediately so that we can take quick and appropriate action.

Overall, our goal is to prevent a crisis (e.g., becoming seriously ill, having an accident/fall for which hospitalization is required). For example, just last month, two different clients called to report what appeared to be mild symptoms — but that were indicative of greater problems had they gone untreated.

Read further to learn more about managing similar situations should they occur in your life.

«I can’t hear very well. I’m a little bit dizzy and my balance is off.»

John is 87. He called on a Friday afternoon and described his symptoms. Considering that one in four older adults in the United States fall each year, resulting in more than 32,000 deaths, preventing falls is something we constantly emphasize.

Our actions involved a call to his primary care physician, a trip to an urgent care center for an evaluation of his ears, wax removal, and a plan for irrigating his ears over the weekend. We agreed to alter his weekend schedule to keep him close to home/not driving and to make sure he was not alone.

By Monday, he was still not back to normal. So, we called his primary care physician who scheduled a same-day appointment, conducted a thorough examination, and removed more wax. John then saw his audiologist who found his hearing aids were malfunctioning due to wax debris (that’s why his hearing was off).

Fortunately, after a couple of days, he was back to normal. Further, we now have a plan in place for him to visit his audiologist every 3-6 months. This will prevent an alteration in his balance and keep his hearing aids functioning properly.

Phew! Crisis averted. But notice that we didn’t just solve today’s emergency… we took clear, proactive steps, based on John’s diagnosis and health, to minimize the likelihood of reoccurrence in the future.

«I think I have symptoms of a urinary tract infection.»

Urinary tract infections occur in about 20 percent of women over age 80, and 25-50 percent of women living in nursing facilities. If left untreated, a urinary tract infection may lead to a form of sepsis called urosepsis, a condition with a mortality rate of 20%-40%.

And so, when we received this call from our client Maureen, who was experiencing pain when going to the bathroom, we acted immediately. Our goal was to treat appropriately and prevent progression that can lead to hospitalization and suffering.

We called Maureen’s primary care physician, obtained an order for two different urine tests, started her on an antibiotic, increased her daily fluid intake, and began checking in daily. After two days, with symptoms not resolving, we used her patient portal to check the result of the urine test. Next, we contacted the on-call physician covering over the weekend who changed the antibiotic to one that was more appropriate for the bacteria identified.

We watched closely over the next several days for any signs of side effects from the more potent antibiotic and had a follow-up urine test done once the drug was finished. Fortunately, Maureen tolerated everything nicely and was soon doing just fine.

Crisis averted again!

Steps to Take

Here are some recommendations for managing changes in health care status — no matter how benign they may seem and regardless of a person’s age:

• Pay close attention to subtle changes in your body. If a change is noted, don’t wait — talk it over with your care partner (if you have one) and develop a plan of action.
• Check in frequently. For older adults in particular, frequently ask how they are doing or if they have noticed any changes.
• Start with your primary care physician. This person knows you and knows your medical history. He or she can help determine whether further action is needed and work with you to plan next steps.
• Monitor progress. If the outlined plan does not result in improvements, reach out to your primary care physician with a request for modification. Our physicians rely on us for observation, data collection, and reporting. We need to take that responsibility seriously.
• If a specialist is needed. Ask your primary care physician for assistance in obtaining an urgent appointment and be sure all the information the primary care physician has about the situation is relayed to the specialist.
• Use your patient portal. This is the best way to track test results and obtain visit summaries.

Watchful Waiting

In the client examples noted above, fast action was taken, resulting in positive outcomes. However, there are many situations in which things are not resolved as quickly or in which immediate intervention is not required.

Instead, “watchful waiting” is recommended. This refers to an approach in which time is allowed to pass before medical intervention or therapy is used. If your physician recommends this approach, it is important that you continue to gather data and remain in close contact with your medical team, so that intervention can occur if necessary.

If you remain concerned and would feel reassured by an intervention (especially an in-person appointment), be open and honest about your worries. Be sure you feel heard and ask to be seen if that is what you desire.

Summary

Each of us has a responsibility to pay close attention to our bodies and to reach out for assistance when things don’t seem quite right.

For the older adults in our lives, some of whom may no longer have the self-awareness or who prefer to ignore symptoms (thinking that things well get better on their own), we need to be especially diligent with our observations and, if necessary, insist upon acting.

Overall, having an established relationship with a primary care physician well in advance of having to call upon them, will facilitate working together, prevent future crises, and reduce suffering in ourselves and in those we love.