Takeaway
Many older patients struggle with losing independence. Healthcare professionals can partner with them and their loved ones to ease challenging transitions.
Lifelong Learning in Clinical Excellence | April 30, 2025 | 2 min read
By Jessica Park, MD, Johns Hopkins Medicine
“Hi Ms X, it’s good to see you again. What brings you in today?”
As a hospitalist specialized in inpatient medicine, I expected my job to lack continuity of care. Or so I thought. Here is Ms. X whom I’ve treated four time in the past two years. She’s an 85-year-old woman with a variety of chronic medical conditions who lives by herself. She has a daughter who lives half an hour away and gets groceries for her. She came in because she fell.
“How did you fall?” I asked.
“I tripped over a telephone wire when I was trying to get to the bathroom with my walker. I couldn’t get up, so I called an ambulance.”
Ms. X had fallen numerous times, and every time she has similar stories of why she fell. This time, she broke her hip. She worked with physical and occupational therapists in the hospital who recommended a rehab facility with a transition to a more supervised setting, that she declined as she always does.
“Doc, I would never move to a nursing home. I’m happy where I am, and have lived in my house for five decades. I have my friends and daughter who check on me. Don’t worry about me.”
I called Ms. X’s daughter to provide a medical update. “Here we go again. It’s not safe for my mom to be living by herself. I’ve told her many times, but she’s one stubborn lady. What can I do?” I hear her sigh through the phone.
Ms. X’s story resonates with me because of my own grandmother who lived as a widow for many years. Like Ms. X, she fell and had fractures. Despite recommendations from doctors, she always chose to return home after each brief hospital stay. Every fall resulted in another broken bone; she grew weaker and more confused. Eventually, she moved into a nursing home.
For patients like Ms. X and my grandmother, it’s hard for them to let go of independence; perhaps because it’s a sign of mortality. I often wonder about what the right thing to do is as a doctor for older patients. I continue to arrive at making recommendations and then deferring to them to make informed decisions about their own bodies.
As I interact with these patients, I envision my own body and mind getting weaker one day. When I get to that point, I hope my doctors and loved ones will hear what I have to say.
I encourage us all to listen carefully to what’s most important to our older patients to build trust and provide the best care possible.
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This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.