Prince Philip & Geriatric Medicine

If you've been following the international news, especially that coming out of the United Kingdom, you probably read that Prince Philip, Duke of Edinborough, was released from the hospital after spending 5 days to treat a bladder infection, just in time to celebrate his 91st birthday yesterday.  Now, you're probably asking yourself why someone would need to be hospitalized for a bladder infection?  I suppose one could blame this on his status as a member of the royal house.

However, I believe it's more a reflection of geriatric medicine, specifically care of our elderly.  While physicians on this side of the pond tend to have a higher threshold for hospitalization, we also tend to have a lower threshold for our frail elderly who can more easily turn bad at the drop of a hat.  I know what you're saying and I hear you.  It's only a simple localized bladder infection, not a systemic kidney infection prone to worsening into urosepsis (infection leaking into the bloodstream).

But the fact is the elderly don't always respond quite the same as you & me (assuming you're not 10 years older than me as the standing definition of elderly!).  They don't always develop a fever from infection.  Nor do they always complain of painful, frequent & urgent urination due to bladder infection.  Instead, a previously lucid individual might present with confusion.  Or s/he might complain of sudden fatigue & non-specific malaise.

It's our responsibility as physicians in general & geriatricians, specifically, to listen closely to our patients and be leery of any change in status.  More importantly, we also need to look for drug-drug & drug-disease interactions as well as make every attempt to simplify & reduce what is most likely an egregious case of polypharmacy.  In the end, we focus on function and quality of life as the goals, rather than on disease specific markers.

The sad news is that 15 minutes isn't nearly enough time to thoroughly care for our elderly in the manner in which they need & deserve.  Frailty & debility.  Falls & fractures.  Poor hearing & eyesight.  Depression, dementia & delirium.  Incontinence.  These are the basic syndromes that need to be addressed and  yet we haven't even begun to tackle the common organ specific issues such as coronary artery disease, heart failure, hypertension, diabetes, stroke, kidney failure, etc.  Let's fix the system before we find ourselves in need of geriatric care.

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