Slow Medicine and Dementia
Physicians are trained to act quickly to address health problems, and there are more and more tools in their kits to assist them in this effort. Aggressive treatment is what most of us want when we end up in the hospital after an accident or with an acute episode of an illness. But more treatment does not always lead to better results.
“Slow medicine” is based on a realization that less can be more; that taking time to fully assess and think through the options as they apply to the individual patient in question, can be better care. Awareness that not all procedures result in longer life or effective cures is changing the way the medical profession practices. For example, annual mammograms are now being re-evaluated, physicians no longer recommend Pap smears to women over 65, men no longer undergo blood tests for elevated PSA levels. “Watchful waiting” is gaining traction for a host of conditions.
Slow medicine can mean something very different for the elderly. It is less about which proposed treatments is most effective; it is more likely to involve evaluations of chronic conditions for which there are no cures. It may mean not prescribing a drug just to make the patient feel as though the physician is “doing something.” It may mean deciding against an operation if it is more likely than not that the elderly person undergoing that operation will not regain independence post surgery. It may focus primarily on the quality of life. But it almost always means thinking thoughtfully about the benefits and drawbacks of aggressive medical treatment, be it a test, a medication or an operation.
Families caring for someone with dementia should be especially alert to the drawbacks of aggressive treatment.
- People with dementia do not generally fare well in a hospital setting. They do not understand why they are there, are disoriented, and are not supervised 24/7. The patient is susceptible to wandering, falling, and further emotional distress unless a family member is with them at all times. Many never return to their pre-hospitalization baseline after discharge.
- People with dementia may have adverse reactions to medications that they cannot report. Most medications have side effects. Those typically prescribed for dementia can result in nausea, dizziness, joint pain and insomnia.
The practice of slow medicine gives the physician, the patient and the family an opportunity to weigh the relative benefits and risks before taking action. For those interested in understanding more about what slow medicine means in practice, here are some books and articles to get you started:
Being Mortal, by Dr. Atul Gawande
Knocking on Heaven’s Door, by Katy Butler
God’s Hotel, by Dr. Victoria Sweet
Slow Medicine by Dennis McCullough
Patient Angst: When You Just Have to Say “No” to the Doctor by Dr. Annie Brewster