Graceful Health: What do you know about hernias?

Dr. Ron Vallario

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September is Healthy Aging Month, and Grace Cottage Family Health’s primary care clinic and Grace Cottage Hospital have each individually been recognized as “Age-Friendly” health care facilities by the Institute of Healthcare Improvement.

What exactly is “age-friendly” health care?

Age-friendly health care addresses the unique needs and wishes of older patients to help them enjoy a better quality of life. It is care that is safe and based on research showing the most important things to pay attention to as we get older.

We all deserve health care that meets our needs as we age. As a geriatrician at Grace Cottage, I seek to meet each individual patient’s needs. Geriatricians are primary care doctors who have additional training in treating older adults, especially those 65 and up.

One approach that helps me accomplish this is to consider the “4 Ms”: what matters, medication, mentation and mobility. These 4 Ms represent the four most important considerations for health care as we age. This “age-friendly” health systems approach is an initiative of The John A. Hartford Foundation and the institute in partnership with the American Hospital Association and the Catholic Health Association of the United States.

The first M is “what matters.” As you age, your needs and concerns might change. What matters most in life and health is different for everyone. What is your priority? Managing your health might be particularly difficult if you have multiple chronic conditions.

It’s important for us to share our concerns, goals, wishes, needs and experiences with all of our health care providers. The more you and your health care team know about what matters most to you, the better you can work together to line up your health care decisions with your health priorities. It is also important to discuss your priorities with family members, particularly your health care proxy, who will make decisions if you are unable to communicate with your health care providers. A living will or advance directive can also help your family understand your wishes for end-of-life care when necessary.

The second M is “medication.” You might take many medicines now, which can mean more side effects. Also some drugs affect us in new ways as we age. It is important to talk with your medical provider about any side effects that you experience. Also ask your care team to assess how your medicines interact with each other and tell your providers about any over-the-counter medicine or natural remedies you take.

Some medications have more serious side effects as we get older, including some over-the-counter drugs such as allergy medications. Many medications increase the risk of memory loss and falling even at low doses and should be avoided completely in the elderly. For example, the combination of opioids and benzodiazepines has a four-fold increase in fatal overdoses compared with patients taking opioids without benzodiazepines.

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The third M is “mentation” and includes two health care issues. Older adults are at risk for dementia (problems with thinking, memory and reasoning), and depression (ongoing sadness or loss of interest).

As you get older, you may go through a lot of changes — death of loved ones, retirement, stressful life events or medical problems. It’s normal to feel uneasy, stressed or sad about these changes. But after adjusting, many older adults feel well again.

Depression is different. It is a medical condition that interferes with daily life and normal functioning. It is not a normal part of aging, nor is it a sign of weakness or a character flaw. Many older adults with depression need treatment to feel better. Tell your medical provider if you notice any changes in your memory or mood.

The risk of dementia, particularly Alzheimer’s, increases with age. It is normal to be hesitant or resistant to learning how the disease will progress and effect your life. But there are benefits to talking about it:

You might experience a stronger connection to your emotions and identity.

Knowledge about Alzheimer’s can provide you the confidence to make important decisions about how you choose to live your life and plan for your future.

While there is currently no known cure for dementia, there are clinical trials that offer hope and might slow the progression of the disease.

The fourth M is “mobility.” It’s important to think about how to get around safely as we get older. Staying active helps us maintain our health and independence. Talk with your care providers about how well you get around at home or going from place to place. Tell them what’s working and what’s not. Particularly tell them about any falls you have had since your last visit. Ask how you can improve strength, flexibility and balance through physical therapy or exercise classes. Request a home safety evaluation for tripping hazards or missing handrails that can cause falls or if you feel unsafe getting around your home.

Older adults have unique needs. In a rapidly evolving health care environment, to prevent harm to older adults, improve their health outcomes and lower overall costs, health systems must adopt evidence-based models and practices that deliver better care to our rapidly aging population across all settings, including the home and community. The 4 Ms help us to accomplish that.

Dr. Ron Vallario has been Grace Cottage’s geriatrician since 2018. Before joining Grace Cottage, he was associate medical director/geriatrician at Summit ElderCare/Fallon Health and an assistant professor at the University of Massachusetts Medical School, both in Worcester, Mass. Prior to that, he was the medical director and a clinician at Mountain Valley Medical Clinic in Londonderry and an ER physician at Brattleboro Memorial Hospital.