Louisville Medicine Volume 67, Issue 9 - Page 15

COMMITTEE AGE IS JUST A NUMBER “T AUTHOR Kathryn Vance here’s no ‘just’ in geriatrics. Everything is a big deal in geriatrics.” Dr. Christian Furman, Medical Director of the University of Louisville Trager Institute, presented “Optimal Aging & Medical Directives” to the GLMS Senior Physicians Committee on Jan. 4, 2020. Dr. Furman holds the endowed Margaret Dor- ward Smock Chair in Geriatric Medicine and is Professor of Geri- atric and Palliative Medicine at UofL. She explained the nuances of geriatric care from the perspective of both the physician and the patient, helping members to understand the process of decision making from each side. In geriatric care, each patient must be evaluated thoroughly, with emphasis on functioning, and there is rarely a universal answer on how to treat each person’s symptoms. While all patients are different, there are three elements that she said are essential to both reaching old age, as well as thriving in old age. “Nutrition, exercise and avoiding cigarette smoke, those are the big three,” she said. Eating a diet rich in fruits and vegetables and limiting intake of red meat are also important in maintaining good health. Exercise is key to maintain muscle tone, stamina and balance, thus reducing falls risk. “It’s never too late to start walking or lift- ing weights…or even doing tai chi,” she said, mentioning several patients who started high-intensity training at 90-years-old. After a question, she clarified that high-intensity training for the average person doesn’t mean running marathons or lifting barbells. Using light weights with multiple reps helps to keep patients active. Dr. Furman also stressed that exercise also helps to avoid frailty, something she sees all too often with geriatric patients. “Frailty is a multisystem reduction in reserve capacity of organs at or past the threshold of clinical failure,” she said. “Not just one organ, this is multiple organ reduction all happening at once.” To prevent frailty, she explained, patients must ensure that key organ systems maintain adequate physiological capacity above their usual level. They must stress themselves and their organs with regular exercise. While physical improvements to one’s health are crucial, we must also be our own health care advocates when it comes to medical treatment preferences. There are two types of advanced planning tools: traditional and actionable. The traditional advanced planning tool is one that many people are familiar with: an advanced directive or living will. In short, an advanced directive confirms wishes for what treatment should be given or withheld in the future. It has little to no impact on imme- diate care. This does not take effect immediately, but only in the future if a patient no longer has decisional capacity. The actionable advanced planning tool is the Medical Orders for Scope of Treatment (MOST) form. This form outlines the direct and relatively immediate impact on a patient’s course of care, or, what happens tomorrow. This document should travel with the patient at all times: from specialist appointments, to ambulance transport, to the emergency room, to a nursing home, etc. This document must be signed by a physician—it’s an official order from a doctor. This document is generally designed for people who have less than a year to live and should be redone annually or when there is a change in condition. This document should be considered in addition to an advanced directive or living will, as it is much more robust and covers the full spectrum of a patient’s wishes. While an advanced directive covers just DNR and tube feeding preferences, the MOST form spells out what medical interventions have been rejected or chosen by the patient. In closing, Dr. Furman stressed that in geriatric care, whether that be for our own physicians and families or the patients we are treating, age is just a number. “It’s really not about age, it’s about function,” Dr. Furman said. “I’ve got 50-year-olds in a nursing home and I’ve got 90-year-olds who are water skiing. It’s all about the function.” Kathryn Vance is the communication specialist for the Greater Louisville Medical Society. FEBRUARY 2020 13