A recent study in the journal Aging Cell examined the effect of human growth hormone (hGH) levels on lifespan.  It turns out that people in their 90's with LOWER hGH live longer than those with higher hGH levels.  Why does this matter?  It flies in the face of the "anti-aging" therapies offered by "anti-aging" doctors who inject their patients with hormones, claiming to help them achieve "normal" levels when those hormones begin to drop.

The theory behind these "anti-aging" treatments is this: your body maintains a certain level of hormones like growth hormone, estrogen, and testosterone through your 40's and 50's, but then these hormones begin to diminish.  Around this same time, your body begins to feel the effects of aging.  If we could just boost those hormone levels back to what they were when you were 20, you would feel younger and live longer, right?

Wrong.

This study supports what many of us in geriatric medicine have suspected all along: the hormonal changes that come with aging are adaptive and protective.   In other words, it may be good for you to have lower levels of these hormones as you enter your 70's, 80's, 90's and beyond.

We can't avoid aging, so how can we avoid its effects?  What frightens us most about aging is the frailty that comes with it.  There are simple things that we can do every day to fight frailty.  I outlined them in my book, How to Keep Mom (and Yourself) Out of a Nursing Home.  They are simple- keep moving, eat fresh, maintain social connections, and pay attention to crucial systems like your urinary and circulatory system.  I wish there were a "magic shot" that would keep us all young, but hGH is not it.  The only proven way to remain vital as we age is to keep taking common sense steps like exercising and eating right.  Your body will respond, at any age.  It was designed to.

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A recent NY Times article by Dr. Pauline Chen blasts the emergency room as the worst place for older adults to seek medical care.  I agree- my practice has been proclaiming this message for years- but we disagree on the solution.  The article recommends we try to “geriatricize” the emergency room, by training doctors, nurses and health care workers in methods that will cater to older adults’ unique needs.  Dr. Chen references a study in Health Affairs that offers some suggestions: building separate emergency rooms dedicated to geriatric patients, training thousands of discharge planners who are skilled at coordinating complex care, and utilizing telemedicine technology to prevent rehospitalizations.  It sounds wonderful, and costly.

Shockingly, neither the Health Affairs study nor Dr. Chen mention the best and least expensive solution to this issue: home care medicine.  No matter how “senior-friendly” a hospital tries to make its emergency room, ERs will never be able to shake the pressure to “treat ‘em and street ‘em.”  As the article correctly points out, speed is required in a functional emergency room, sabotaging any chance for quality geriatric care.  The ER can never match the home as the ideal setting for providing urgent medical care to the older adult.  Concerned that the patient with cognitive impairment can’t give an accurate history in the hectic ER?  Keep him in his familiar home environment and enjoy the luxury of time to ask good questions.  Worried about adequate coordination of follow-up care?  Talk to the daughter who is sitting on the couch next to the patient.  Nervous that the discharged patient may fall at home, or fail to take her medications properly?  Look around for fall risks, and inspect her pillbox on the kitchen table.  These solutions are already in place, if one chooses a doctor who makes house calls.  We do exist, and we even have our own professional organization.

My practice, Doctors Making Housecalls, recently looked at our internal data, and found that we have reduced ER visits among our older patients by more than 40% over a 16 month period, when compared to a similar group who did not have a doctor who makes house calls.  Efforts are being made nationwide to prove the value of home care medicine.  The new health care law includes a demonstration project, Independence at Home, which seeks to do just that.  The best way to improve an older adult’s ER experience is to keep them from going there in the first place.  Rather than spending our limited resources trying to transform frenzied emergency rooms into comfortable senior citizen hangouts, let’s focus on providing better access to care in the place where seniors are most comfortable: their own homes.

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Dr Fisher speaks to Bill Lumaye on 850AM WPTF about dementia.

What is dementia?  What causes it?  Is it treatable?  How do I recognize it?  Can I prevent it?

Listen below for answers to these questions and more.


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