Saturday, March 5, 2011

Patient navigators, frail seniors

I have long held that all seniors should have a patient navigator. Not someone they must pay for, but someone who will help guide them through the healthcare system. Some are calling for them to be nurses, others, like midwives or doulas, help a frail senior navigate their last days on earth.

Some are more like shamans, as they focus on the spiritual side of death and dying.

There is often no reason for patients who are frail, in pain and hospitalized, to be sent to an ER, and forced to have a battery of tests. A typical ER response for a frail senior is an overreaction on the part of a family member who cannot cope, or a long-term care, or retirement home, who ignore DNRs and advanced directives. You can read real cases on Toronto Emerg. They're called GOMERS. Others call them FTD, failure-to-die. Like the doctor who told me, about his patient, "She just won't die!"
I explained that she wasn't ready to go yet. She had more to do, or she thought her daughter wasn't ready. We must listen to frail seniors, show compassion, treat what they want treated, and listen to them.

Once an ambulance is called, a senior is faced with firefighters, ambulance crew, ER staff, a CT scan, specialists, evaluations, referrals, and re-referrals, oxygen, swallowing assessments, psychiatric evaluations, rehab, according to Dr. Sloan.

A Bitter Pill, by Dr. J. Sloan, illuminates this argument for me.

Dr. John Sloan | (podcast interview)

4 Nov 2009 ... A Bitter Pill: How the Medical System is Failing the Elderly. (Greystone, 2009)

He is one of those rare breeds who advocates for his clients, focusing on their well-being, not their ill-health. He recognizes the individual situations of each of his patients, and explains that frail elderly, on 12 medications, probably need different care. We know that pharmaceutical companies DO NOT test drugs on patients with multiple comorbidities. We know that drugs are tested on people under age 65, including chemotherapies, and we do not know how a senior will react. My father, having had radiation for a brain tumour that returned, should not have had it. It resulted in delirium, after an undiagnosed urinary tract infection (I blame the ER for that one), and he simply was not emotionally present when my mother died on their living room couch.

For other seniors, high blood pressure is preferable to low blood pressure, when they pass out and hurt themselves. It is a grand call for physicians to seriously examine their geriatric practices.

Guiding Lights:

March 05, 2011
...nurse Shawna Bond, a patient navigator at Victoria...d be Whitfield's advocate and could be counted...growing evidence that patient navigation -- - . They may advocate on behalf of system who do some patient-navigation type work...
...being empathetic, flexible, patient, a good listener, and having...never even heard the term " patient navigator," let alone been...aboriginal rights and benefits; advocate for patients admitted to pledged that every cancer patient in Ontario will have access...

Patient Navigator

March 03, 2011
...nurse Shawna Bond, a patient navigator at Victoria...d be Whitfield’s advocate and could be counted...growing evidence that patient• They may advocate on behalf of patients system who do some patient navigation-type work...

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