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Live Life On Your Own Terms

Why experts are of two minds about the value of cognitive screening. 

2 mindsAlmost 6 million Americans have Alzheimer’s disease, and just about everyone over 65 has at least some fear of getting it.

The first step in finding out if any dementia – and Alzheimer’s is a terrible form of dementia – is a cognitive screening.

Cognitive screenings, such as the Mini-Cog, Memory Impairment Screen, General Practitioner Assessment of Cognition, Mini-Mental Status Examination, and the Montreal Cognitive Assessment, take five to ten minutes. They involve doctors asking patients with no obvious symptoms of mental decline to recall words, draw a clock face, spell a word backward, remember a sequence of words, and similar tasks.

Since seniors have a higher risk of Alzheimer’s, memory or thinking problems, or other cognitive impairment, does periodic cognitive screening make sense? The answer depends on which experts you ask.

The Problem with Too Much Medical Care

elephantWhile only 7.3% of adults aged 18 to 44 have Multiple Chronic Conditions (MCC), almost nine times as many 65 or older do (61.6%). And that can lead to something straight out of John Godfrey Saxe’s 1872 poem, The Blind Men and the Elephant.

That’s because Multiple Chronic Conditions usually call for multiple medical specialists, and, like the blind men in the poem, too many focus on their own areas of specialization and fail to see the whole elephant. This narrow view can produce wide-ranging consequences.

“Once you get three, four or five and six diseases, several things happen,” says Dr. Mary Tinetti, chief of geriatrics at Yale School of Medicine. “[A]lmost guaranteed, trying to get one of those diseases under control is gong to make one of the other diseases worse.”

Be safe at congregational worship

worshipAs Virginia’s reopening continues, churches, synagogues and mosques are reopening their doors – and that’s good for seniors who’ve been self-quarantining for months.

Seeing and talking in person with friends from your congregation is good for psychosocial and mental health. So is the sense of joining them in connecting to a higher power.

But if you’re over 65, you’re still at higher risk of Coronavirus infection.

That’s why it pays to make sure your place of worship and you yourself are following the CDC’s Guidelines for Communities of Faith.

The good news and bad news about virtual physical therapy

virtual ptIn 2005, when the first national telehealth network launched, telemedicine was intended to give primarily rural patients access to faraway doctors and specialists. The COVID-19 pandemic has changed all that. With high-speed and high-definition Internet, people sheltering at home or with “elective” healthcare needs can consult their doctors virtually instead of in person.

As I wrote here and here, telehealth is great for seniors who want to see their primary care doctors or specialists without risking infection.

Surprisingly, telehealth can also work well for physical therapy – provided you’re willing to make several tradeoffs.

The good news is that physical therapists can diagnose and treat many conditions virtually – not just relatively minor conditions, but also post-surgery or after a broken bone or torn ligament.

Telemedicine isn’t just good for primary care.

telemedicineLast month, as Virginia was starting to reopen, I wrote about the advantages of using telemedicine for primary care. It turns out that, thanks to modern high-definition video, it’s just as good for many kinds of specialist visits, too – particularly periodic visits for managing chronic conditions.

Obviously, telemedicine eliminates exposure to possible Coronavirus infection. But it also saves you the time and bother of driving to a specialist’s office and the delay of sitting around in a waiting room. It also lets specialists see more patients per day. That’s good for both of you, because you won’t need to schedule appointments as far in advance.

While telemedicine doesn’t work for every condition and every specialty, you’ll be surprised how many it does work well for: