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February 2007

Preventative Health Measures for the Homebound Elderly

A new book crossed my desk the other day, What’s Age Got To Do With It, in which the author interviewed 100 elderly people with an active lifestyle. These individuals, ranging in age from 67 to 122, were playing tennis, barefoot water-skiing, and generally out enjoying the good life. Well and good, I thought, but what about all of my patients? The Call Doctor Medical Group has concentrated on the homebound elderly and infirm for over fifteen years, trying to improve the functional status of those less fortunate than the athletes above. Over the years, one develops a bias in medical care; this bias is best described as what works, rather than what is the conventional wisdom. Since our patients have a median age of 82 years, it was clear to me that the concept of preventative medicine for homebound elderly needed to be thought of as a new concept, not one based on the body of science generally done on much younger patients.

The medical profession is in virtual agreement that the control of high blood pressure at any age is beneficial. More recent is the conviction that control of systolic blood pressure (the higher number of the two) is quite important to prevent strokes and heart attacks, especially in the very old. Likewise, we are in agreement that control of blood sugar (keeping below 140) is important for the long term, but two newer concepts arise. First, we now have dramatic medication breakthroughs that can get many patients off insulin and still prevent the ravages of high blood sugar. Secondly, the patient who develops diabetes very late in life may need less aggressive management because they will simply not live long enough for the chronic damage to heart, eyes, kidneys and blood vessels to occur.

Similar questions must be asked on virtually every commonly accepted preventative health measure: mammography, PSA testing for men, colonoscopy, stress EKG, etc. These measures have simply not been studied in the very old (75 or older), and are not without their own inconvenience, discomfort and risks. It may be that those fortunate to live this long may simply be of a better gene pool and have “lived through” the risk of many common diseases studied in the younger age groups. The wise patient should always ask his or her physician to explain the “Risk vs. Benefit” of a given preventative health test. Be careful in blindly following a “protocol” explanation of “that’s how we always do it.”

That said, certain simple measures can now be said to be of universal benefit in the adult population. They are:

  1. Take a buffered baby aspirin (81mg) daily if there is no bleeding tendency. 
  2. Take 800-1200 units of Vitamin E daily (delays strokes, heart attacks and onset of Alzheimer’s disease).
  3. Stop smoking at any age (the single most important thing you can do).
  4. Lose weight, but not to the level you think: life insurers find that the thin patient is at increased risk for premature death compared to the “pleasantly plump”.
  5. Exercise to whatever level you can.
  6. Consider hormones (e.g. estrogen) after menopause to prevent osteoporosis. All older men and women who cannot take hormones should take calcium.
  7. Get a flu shot annually.
  8. Control high blood pressure and consider using the new “ACE Inhibitor class of drugs” which are clearly better with fewer side effects.
  9. Control diabetes and consider using the new drugs that may allow you to stop insulin.
  10. Perform the stool “occult blood” test annually to check for colon cancer.

Note: I did not choose to list any of the medications used to control cholesterol. This very complex issue is still quite controversial since little or no data exist to show increased lifespan, although reducing cholesterol in younger people clearly reduces the incidence of strokes and heart attacks. Indeed, it is clear that people with cholesterol below 140 are at increased risk of premature death!

You will note that very little cost is involved in my Top Ten preventive health measures. Indeed, the most important ones, such as smoking cessation, diet and exercise, are free. It is my hope that homebound patients will have increased access to good medical advice now that physicians can be adequately paid by Medicare for house calls.

Reprinted with permission of:

C. Gresham Bayne MD
President, Call Doctor Medical Group, Inc.

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