Not a single fall: A geriatrician’s help

She was 85, with oval glasses, a lavender shirt, and a smile. Small but sturdy, Jean Gavrilles had come in walking steadily, no support required beyond her orthopedic shoes. She said her internist had recommended she come in to see Dr. Jeurgen Bludau, a geriatrician.

She mentioned lower back pain over the last few months, arthritis in her fingers, high blood pressure, glaucoma, some recent “bathroom problems” that required her to wear a pad, and a lung nodule.

A widow with a home near Boston, she had long lived alone except for her Yorkshire terrier. She did her own cooking and cleaning, and managed her own medicine and her bills. She told Dr. Bludau about her day, and her diet, in response to his questions.

Then the doctor asked her to sit on the examining table. She struggled to climb up, her balance teetering on the step. The doctor spent much of the exam time in looking at her feet.

She was doing well, he said—mentally sharp and physically strong. The danger was losing what she had. The single most serious threat she faced was not the lung nodule or the back pain; it was falling.

The three biggest risk factors for falling are poor balance, taking more than four prescription medicines, and muscle weakness. She had two, or even three, of the risk factors, putting her at grave risk of a debilitating fall. Her balance was poor; she walked with splayed feet, and her feet were swollen, with her toenails unclipped. There were sores between the toes, and the balls of her feet had thick, rounded calluses. And she did not seem to be eating enough to keep up her strength. She admitted having lost about seven pounds in the previous six months. She was on five prescription medicines, one of which risked dehydration, which may cause dizziness.

His job was to support her quality of life—here, to help her retain as much function as possible, he said. So he had Jean see a foot doctor (a podiatrist) every four weeks, for better care of her feet. He switched one medicine so it wouldn’t cause dehydration, which could make her dizzy and maybe fall. He recommended a snack, and getting rid of the low-calorie and low-cholesterol food, and having friends or family join her at meals, so she would eat more, and build her strength.

Nine months later, Jean turned 86. She’s eating better, and has gained a pound or two. She still lives comfortably and independently in her own home. And she has not fallen, even once.

Advice for elderly people and their patient advocates: Get a geriatrician!

Read a story about a frail elderly woman, or Dr. Atul Gawande’s source story in the April 30 issue of the New Yorker.

She didn’t fall that far: A nursing home lawsuit

Joy’s story:

My Mom was in a nursing home & fell. They called me, & said it was OK during the night, to come in the morning. When I got there I couldn't believe it! - she looked like she was in a fight with Mike Tyson & lost. She's 93, had a big hematoma on head - eyes all black, nose broken, really bad. I asked why 911 was not called to take X-rays. They said the doctor didn't feel it was necessary. I fought with them for 2 days. Then they called & said she was sent to hospital "unresponsive." EM couldn't believe what bad shape she was in & never brought in. She was never the same.

I got a lawyer; he took pictures & we have waited. He calls today & says the nursing home has problems with their Insurance & want us to settle for $25,000; she gets $15,000. He said to take it because of the Insurance problem. A friend of my husband’s father had the same thing happen, only he died; same lawyer, same pitch - $25,000 and they get $15,000. Is that the going rate after what they suffered?!

This lawyer wants to go after the nursing home she's in now since after she was sent to the ER from the other nursing home & kept in the hospital, they asked if I wanted her in the nursing home next to the hospital, actually their name too. I checked it out and it seemed very clean, so I said yes. At this point she was all banged up but could walk.

She was admitted & a very short time later I got a call: “your mother fell!” I couldn't believe it. Back to the hospital, this time with a broken hip. She's 93 so I didn't agree to surgery, & the doctor said she probably won't last till the end of the year (he was wrong). But she never walked again & is in pain; she takes painkillers, & is usually in bed.

I couldn't go after them because where do I put my Mom then? The lawyer said, when she passes he can go after them but I don't think I will pick him.

What advice would I tell other daughters? I'm not a great one to ask. I had my Mom since she was in her 50's. It wasn't easy - she liked to run the show & be in charge, but was very good-natured. She didn't have much money since my Dad died young from a cerebral hemorrhage & botched-up brain operation. She took care of him for 5 years. It was terrible - we were only teens.

She was not in great health when we moved to Florida & declined, but I kept her at home & took care of her. At the same time, I raised my grandson, who had chronic Lyme disease, & took care of him. My daughter, his mom, is bi-polar & winds up living with us a lot. My husband is a big help (2nd one) but otherwise I got no help. My brother & his wife felt it was up to the daughter to do it.

I got through it, thank God, though I’m very tired, & my husband & I never got to go anywhere very much. It wasn't easy but I always felt it would be what God wanted me to do.

As far as the 2 nursing homes, the first didn't really care. I fought with them for 2 days as she laid suffering all bashed up with a broken nose, etc., to send her to the hospital. The other one seems to make her comfortable but is responsible for the broken hip. When I mentioned it the woman said she didn't fall that far!

Probably too long but that's only a bit of it.

Advice to adult children of frail elderly parents: Get a formal consult with an expert with professional training in pain relief (a nurse or doctor) to discuss options for pain relief.

Read another of our nursing home stories.

Cheatum was cheated: A nursing home lawsuit

This week the family of a Tennessee man won $4 million in a lawsuit against the nursing home chain that had cared for him. Cheatum Myers suffered numerous falls during his nursing home stay, one of which broke his hip. He didn’t get treatment for the injury for a week.

 And an infection around where Myers’ catheter was located led to a high fever complicated by pneumonia. He had one bedsore all the way to the bone on his heel.

 Mr. Myers died in 2005, and the lawsuit claimed it was because of the lack of care.

Advice to the adult children of frail elders: Check the quality ratings of nursing homes with your state’s department of public health.

Read another lawsuit story, or read the source story in the Daily News Journal.

Fortunately for me, he didn’t listen: Missed diagnosis

It took Madison, North Carolina resident Peter Griffin nearly 30 years to receive the medals he earned in Vietnam and just as long to acknowledge something he brought back with him from the war - post-traumatic stress disorder (PTSD).

“I was 17 when I joined and only 18 when I shipped out to Vietnam,” he said. “Combat is difficult enough for hardened veterans, but so many of us in that war were still just teenagers.”

Peter served with the 101st Airborne Division and the 82nd Airborne Division. He earned the Vietnam Service Medal with two bronze battle stars, the Silver Star Medal, the Army Commendation Medal, the Presidential Unit Citation with oak leaf cluster and the Valorous Unit Citation.

Later, as a civilian policeman, he was injured in a fall from a roof while chasing a suspect. At a Veterans Affairs hospital for a checkup, he discussed with doctors the other symptoms he was experiencing.

He sought out a Department Service Officer (DSO), James Ward, while trying to get the Silver Star he earned during a battle in Vietnam. When Ward asked him to describe the incident in which he earned the medal, Peter became agitated and began having flashbacks. The DSO recognized his symptoms and encouraged the veteran to let him file a claim. “I told him I didn’t want him to do it because I didn’t want to be labeled with another disability,” Peter said. “Fortunately for me, he didn’t listen.”

A call from a VA hospital and a series of tests from doctors and psychologists confirmed the DSO’s suspicions and set Peter on a course of treatment to conquer the demons he had long lived with.

PTSD is the result of a psychologically distressing event that produces fear, terror and helplessness in the victim, representing a threat to the victim’s life or a loved one’s life. It shows itself in vivid and troubling flashbacks, emotional numbness, hyper-vigilance, poor sleep habits, poor concentration, and exaggerated irritability. Those symptoms are often accompanied by depression, anxiety, survivor guilt, suicidal urges, nervousness, drug or alcohol abuse, aggressive behavior and changes in cognitive functions.

Peter wrote his story in a book in the hope that “it will be a help to others out there suffering through the same hell I was going through.”

Thanks for your courage then and now, Peter.

Advice to veterans: Tell your story to a friendly advocate who’ll insist on helping you even though you’re just fine, thank you.

Read another story of an undetected condition, or read more of Peter Griffin's story in his book, “When you Hear the Bugle Call” (I don't get any money if you buy it), or in Steve Lawson’s article in the Reidsville Review.