Clinical Geriatrics

As we start the New Year, it is important that we all consider planning ahead. This is particularly true if you are an older person facing what is not only the coldest but also often the loneliest and most difficult time of the year. Winter can be a wonderful time of beautiful fields covered with snow, sleigh bells in the air, snow squishing under our feet, and indoor gatherings of family and friends. It can also be a time when some find themselves isolated, unable to go outside due to the risk of falling on snow or ice, cold beyond endurance, and heating bills that can numb the senses and force one to decide whether to cut back on food or lower the temperature in the living room.

While considering what lies ahead for elderly individuals, I came up with the following list that I hope will be useful when you advise your older patients and their families how best to prepare for the winter season ahead. Coincidentally, they all start with the letter “F”—which can help us to remember them better, as all are important to consider and discuss with your older patients.

Feelings

Depression is at its highest after the holiday season. Whether it is due to a feeling of loneliness, a “let-down” after the holiday season celebrations have ended, many months of darkness, isolation, and a feeling of being “shut-in,” or some other factor, we need to be aware that this is the time of year when suicide risk is high, and many persons turn to alcohol. It is important to make sure that all elderly persons have regular contact with family and/or friends and trips arranged to senior centers or other social venues when possible. Make sure that you look for early signs of depression in your patients, and intercede early.

Frozen

Every year people die from hypothermia, with elderly persons particularly at risk. Mechanisms of shivering and nonshivering thermogenesis are impaired more frequently in the older person, and the high cost of heating fuel may lead one to lower his/her ambient temperature to dangerously low levels. Prevention is key.

Flu

Winter has the highest rate of influenza, and the elderly are particularly vulnerable. Being inside in close proximity to others is thought to be a major risk in spreading this potentially life-threatening illness. Good handwashing hygiene and influenza vaccines can save lives.

Fire

Winter is the peak time of the fire season. Whether it is a spark from a fireplace, a misplaced electric heater, or loose clothing dangling over a stove that was left on, caution is advised. Fire detectors should be properly placed and new batteries installed. A fire extinguisher should be readily available and the older person taught to use it.

Finances

With the start of the New Year and the holidays just behind, many older persons find that they are short of money at this time of the year. Planning ahead and use of a budget can be useful, as can a direct deposit of social security or other income checks since the weather can make it difficult to deposit checks mailed to the home.

Food

It is not by chance that many elderly persons live primarily on nonperishable food in the winter. While it is possible to obtain all of the necessary nutrients to remain healthy in this way, many subsist on foods that fail to provide adequate protein and other key nutrients or that contain too much salt. Plan ahead, and make sure that a proper mechanism exists for older persons to get the healthful food they need.

Falls