The Geriatric Care 5M’s
I’ve known since I was very young that someday I would be The Mayor. I didn’t apply for The Job, and we didn’t actually talk about it, like, ever. It was one of those things that are just always known and taken for granted by the people involved. When I was “called into service” when Pop first started having some issues with his heart and the Atrial Fibrillation, I didn’t know anything at all about eldercare, geriatric medicine care, cancer, or any of the other things that got thrown at me through the year.
The Job is Trial by Fire
Once I convinced my parents to transition all of their medical needs and team to Las Vegas, things became so much easier for me. I took them to my general practitioner, who I have loved for about 15 years now. In retrospect, we firmly believe that her attentive and detail-oriented care kept Pop alive for several more years than he would have, and the same goes with Mom.
What we didn’t think to hire—despite their stellar, free military insurances—was a Geriatrician. It never once occurred to me to look into finding a doctor that specializes in the care of the elderly. Was I remiss as The Mayor for not going down this road? I don’t know. Maybe in some people’s minds it was an oversight on my part, but you know I sleep just fine at night with all of my decisions.
What I did, instead, was commit to educating myself about everything and anything that might improve the quality of life for my parents. And I think I’ve done a good job. I’m sharing so much of what I learned on this website, writing blog after blog about how to properly care for your loved one, showing them dignity and respect in their Golden Years, holding their hand and advocating for them as they slow down.
If I had a geriatrician, the Five M’s represents something commonly referred to in that practice, and refers to the different areas of focus for dealing with people with declining cognitive and overall health.
Let’s look at the Five M’s and see what valuable information we can glean from them:
Multi-Complexity Geriatric Care
This refers to treating and caring for the whole person, inclusive of their illnesses and problems, but not discounting what gives them comfort or joy during these declining years. It is a noble idea that I wholeheartedly endorse. From the medical side, my parents are polar opposites, and required different care:
Pop had multiple cancers, and multiple issues that needed to be dealt with. While it never bothered him, the A-Fib had him undergoing testing on a regular basis, in addition to the six cancers he survived before finally passing. He was on multiple medications at that time—my least favorite being the dreaded Coumadin—that made every visit and test a mess. Even before he went to the dentist he needed to go off the Coumadin “just in case”. The multi-complexity for his declining years was centered on medications and treatment—keeping him as comfortable and safe as possible.
Mom is on no meds. Seriously. They even tested her for a Urinary Tract Infection recently…it was negative. There is, quite literally, not a damn thing wrong with this lady’s physicality. She doesn’t even wear her glasses or her hearing aids anymore. Nobody can even believe she is 93 years old she looks so damn good. She does have dentures, though! Everything she is suffering from is in her brain. The dementia continues to ravage her personality and overall satisfaction with life. She isn’t multi-complex. She isn’t even complex. She has fallen into severe dementia. It’s a very sad, simple diagnosis.
So the complexity involved with your loved one’s care may or may not be complex, but it is certainly a moving target. Every time I thought we had Pop’s medications under control, something else would happen. Every time I think Mom has plateaued in her decline, she surprises me with something new. It’s a moving target.
Mind
You and I both know the statistics about cognitive decline, and the obscene number of elderly who are suffering dementia or Alzheimers in America. It’s really sad to be living in that statistic for me, and I’m sure for you as well.
But there is another, quite insidious, mental problem that is plaguing our elderly that geriatricians need to be aware of: Depression. The number of elderly who are falling into deep depression and ultimately taking their own lives is a skyrocketing figure, and needs to be addressed. I’m not talking about any type of “assisted death”—I’m a big fan of that plan—I’m talking about people who feel insignificant and unimportant in their lives and families and decide to end it all.
This one factor, alone, makes the case for a very strong medical professional to be involved in your loved one’s life. In our case, we have an amazing general practitioner, but if you aren’t able to find one in your area that meets your needs, expand your search to a geriatrician so that you can properly care for your parent.
Mobility
Mom has used a walker constantly since she broke the hip almost four years ago. She is unsteady, and needs the balance that her walker provides. This is the only medical assistive device she has ever needed, and she will use it forever. Pop had no need for walkers or wheelchairs while in our house, with the exception of his recovery periods after the kidney and shoulder cancers.
But someone needs to monitor their gait—the medical term for how you walk—and their ability to balance themselves, particularly coming out of or into a chair. While we didn’t use a geriatrician, we received fantastic care and excellent advice from the people who did physical therapy with both of my parents over the years. I feel very strongly that physical therapists are a wealth of information many people don’t take good enough advantage of in the recovery period. Make sure you take the time to really speak to the recovery team about mobility, and how you can support their efforts with your loved one.
Paying attention to the recovery team is why I think Mom fell only once, despite the statistics to the contrary.
Medications
This is a tough category for me personally, because I had such trouble with Coumadin with Pop that I just wanted him off of it. That, obviously, wasn’t what his medical team thought was best, so we continued with it until he went into Hospice. You really do need a strong “quarterback” who will monitor all of the medications your loved one is taking, and I knew enough to know that wasn’t me. It wasn’t my forte, and it wasn’t something I felt comfortable weighing in on, which is why you need a strong geriatrician to supervise all of the specialists. The act of de-prescribing—stopping unnecessary medications—is extremely important for the mental and physical health of your loved one, and should not be ignored.
My biggest concern with having different doctors prescribing things to Pop was the potential for adverse medication effects. It struck me as quite possible that a doctor might prescribe something to Pop without noting his current medications, and I would end up literally poisoning him in the name of medicine.
Matters Most
If you recall Pop’s journey, he decided he was done, and was dead in eight days. With Mom, she has always said she wouldn’t be done until “God called her home”, so she will rage against the dying of the light. Two very different philosophies on aging and dying, and two very different patients for this Mayor to monitor.
The most important factor for your medical team is that they respect the patient enough to understand what truly matters to them. Pop always told me he didn’t want “anybody to wipe his ass”, so he left the party before that could happen. Our doctor knew that, and was a team player in the end, despite her overwhelming desire to solve every medical problem. Pop wasn’t depressed at all—his mind was as sharp as ever—he simply lived life on his own terms. The salient point is, whatever is the most important thing to your loved one needs to be communicated to—and respected by—your medical team. You can’t be working at opposite ends or you won’t meet the ultimate goal of dignity and respect in dying.
How Can The Mayor Use This Framework For Geriatric Care?
Everything I read, and everything I write, is with an eye towards being the very best Mayor I can be for my mom. She is my sole focus, so everything I consume is through the lens of her aging process, her mental health needs, and the things Pop told me for years and years about what to do when things go to shit.
Use the framework of the Five M’s in any way that serves you, knowing that the most important thing is that you find a strong medical team that will adhere to the important aspects of geriatric care discussed here.
You’re doing a great job, you know. Keep it up~
THANK YOU FOR READING THIS FAR
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Resources
https://www.healthinaging.org/tools-and-tips/tip-sheet-5ms-geriatrics
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