The Five I’s of late life care, a term coined by Dr. Bernard
Isaac, are prevalent in the practice of geriatric medicine. They are Incompetence,
Incontinence, Immobility, Instability, Iatrogenesis [Polypharmacy], and
Invisibility. All five should be avoided to age successfully, retain autonomy,
and maintain independence. While some people believe the Five I’s are
inevitable, they are NOT. The Giants of Geriatrics is not a model of health, it
is a model for institutionalization. Healthcare in old age is moving from the
hospital back to the community. Longterm care requires a different mindset, as
people do not get well. Longterm care model is the asylum model revisited, the
beginning of the “slippery slope.”
In a Harvard talk to healthcare workers, Donald A. Davidoff, PhD,
presented his topic, A Cognitive Perspective of Normal -vs- Successful Aging.
To age well, people must be:
- physically active,
- mentally active, and
- have social networks.
Embracing this three-legged stool seems so simple, yet people
yearn for a magic pill or secret formula. Keep it simple!
In a study of physiologic
factors and neurogenesis, the mice who were “put to work”
lived longer than the mice with lots of leisure time. The “couch
potato” mice not working died sooner than those mice with a purpose. The
physically active mice had increased neurogenesis! Of course, mice studies
cannot be extrapolated to humans, but
this example demonstrates the value of remaining active over choosing a
sedentary lifestyle.
Health care in old age is
remaining active and engaged, getting diagnostics on time, and when necessary, moving
from the hospital or rehab facility back to the community. Long-term care requires
a different mindset, as people do not usually get well. Long-term care model is
the asylum model revisited, the beginning of the “slippery slope.” The facility
mandates mealtimes and food choices [called “feeding”] and schedules are not
personalized to the patient. Decisions about care and treatment are standardized
instead of person-centered. This is why Americans dread the thought of nursing
home admittance.
It is confounding to me
as a gerontologist that older people believe they can live on fast food, maintain
a sedentary lifestyle, and drink alcohol with abandon. Taking charge of your
life and making simple changes may help you avoid the Five I’s. More later.
AgeDoc
Photo Credit: Philippe Leone, Unsplash.
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