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Caring for Older Patients at the Latest WCM-Q Grand Rounds

The latest developments and challenges involved in providing healthcare to older patients were discussed at the latest Weill Cornell Medicine-Qatar (WCM-Q) Grand Rounds.

Dr Mai Mahmoud, Assistant Professor of Medicine at WCM-Q, identified health issues and common challenges related to older adults and explained how healthcare providers can use evidence-based practices to create effective ‘care’ plans.

WCM-Q Grand Rounds Dr Mahmoud

Dr Mai Mahmoud

According to Dr Mahmoud, also a consultant in Internal Medicine and Geriatrics at Hamad Medical Corporation, the global population is aging. According to data from World Health Organisation, between 2015 and 2050, the proportion of the world’s population aged over 60 will rise from 12% to 22%. By 2020, there will be more older adults than children under 5 years old globally. In the US, it is predicted that adults over 65 will account for more than 50% of healthcare visits.

Dr Mahmoud said that societies and healthcare systems should prepare for rise in the aging population by creating age-friendly environments, both within health institutions and in the wider community. She added that she is glad to see healthy ageing as a priority in Qatar National Development Strategy 2018-2022.

With age, the organs of the body lose their physiological reserve of cells, which function somewhat like spare parts that allow each organ to maintain its function during an insult, like an illness. Also, there are more medical conditions that require medications, so we often have the additional issue of polypharmacy and the side-effects of medications to consider. All these challenges make older patients more vulnerable to severe diseases and complications, compared to younger population.’

Dr Mahmoud noted that these changes are not linear; some older patients remain highly active while some are partially or totally dependent on others.

Other Healthcare Issues of Older Patients

Dr Mahmoud also explained the risk posed by falling, the leading cause of non-fatal injuries in patients 65 years and older. Complications following falls, such as fractures and problems arising from surgeries, are also a common cause of death among older patients. Older patients most at risk are those suffering from dementia, poor vision, osteoarthritis, general frailty, sarcopenia (loss of muscle mass), cardiovascular disease, central nervous system diseases and complications from diabetes mellitus and certain prescription drugs. Dr Mahmoud emphasised the importance of assessing the risk of falls, and how healthcare professionals should work with patients to reduce the risk.

Other issues older patients often face include urinary incontinence, specific age-related recommendations for treatment of hypertension and diabetes, and health problems caused by hospitalisation, including delirium (acute disorientation and confusion), often caused by unfamiliar settings.

To mitigate these issues, healthcare practitioners must understand the health issues of older patients in a holistic manner, conduct frequent patient evaluations, manage medications with care, and assess the patient’s mental state as often as possible. Healthcare professionals should also be aware of the American Geriatrics Society’s Beers Criteria (named after Mark Beers MD) for drugs that should be avoided in older patients. Older adults should also receive vaccines and screening as recommended.

Despite the challenges presented by aging, Dr Mahmoud stressed the importance of refraining from pre-judging older patients, pointing out that many older people continue to be productive, socially engaged, physically active and artistically creative in their later years.

The activity was accredited locally by Qatar Council for Healthcare Practitioners-Accreditation Department (QCHP-AD) and by the Accreditation Council for Continuing Medical Education (ACCME). Visit qatar-weill.cornell.edu for updates and more information about the WCM-Q Grand Rounds.

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