The current “state of elderly patients” update

Last winter I discussed women who were suffering from various maladies after the covid vaccine. This go round, I want to talk about the elderly population.

I see the entire age span, my youngest patient is 6 and my oldest patient is 97. The trends I am seeing in those over age 65 right now are so very sad. This post is sparked by a particularly rough day at work this last week. I had one morning where I saw several of my elderly patients and the changes I saw in them from 12 weeks ago has become too profound to attribute to aging alone.

First off, the number of Lewy Body dementia patients I have right now is unheard of. Lewy Body Dementia is not common. You see much more Alzheimer’s and Vascular types of dementia. I would see maybe 1 Lewy Body every couple of years. Right now, I have FIVE that have been diagnosed in the last 6-12 months. The deterioration in their cognitive status is rapid and profound. Hallucinations, paranoia, word salad, rapid weight loss, not sleeping, it is a full time job for their caregivers to keep them safe. I see the look of pure exhaustion on their spouses and kids faces.

I have another case in a 70’s year old who cannot stay healthy. Keeps catching respiratory viruses over and over. Infectious disease did decide to run an advanced immune panel and they IgG deficient across the board. Sleeping 18 hours per day, pneumonia over and over, I sent them to the ER when I had them in office this last week because they were on the last day of round 2 of antibiotics for pneumonia, and they were struggling to move air and heavy chest rise plus sweating. Walking was very unsteady, having increased falls. They looked absolutely awful. I referred to neuro (which will take at least 8 months to get into), and after a blood pressure check and SpO2 that did not look good in my office I sent them to the ER. They looked positively frail and very sick. How they even made it to my office that morning I will never know, I am surprised they did not pass out from low O2 alone. No history of lung issues, non smoker, active and healthy until 18 months ago when health started to rapidly deteriorate.

Widow patient in their 80’s, who is normally perky and full of energy and sass and could probably run circles around me, came in this week. I went to the lobby to bring them back and they could not get out of the chair. This was 100% not normal. I walked over to them and another patient in the lobby stood up to come help me (bless his heart). Assisted the patient to standing position, asked if they were ok, nodded they were, took 3 steps and down we started to go. Got a chair behind them quickly and they were sweaty, pale, nauseated. Started rapid cycle blood pressures and they were in the 160/90 range. After 10-15 min they were feeling better, and wanted to come back to be seen, refused a wheelchair. As we walked to my office they could not maintain a straight line of walking. We get to my office and I asked what was going on, turns out they ALSO had been fighting pneumonia for 2 weeks, and were due to see primary care that afternoon for follow up. Stated “I just can’t get over this lung stuff and breathing is hard”. “I keep falling for some reason, I broke my wrist again, I just got the brace off a week ago”.

Two other patients, carbon copies of each other. One was septic and inpatient for a week due to a scratch on the leg from a shrub that became infected. Leg has a huge pocket that has not been drained, just throwing IV antibiotics at it. Another was hospitalized for a week for urosepsis, and BOTH patients were so brain foggy and could not find words to answer questions. They both appeared dazed, as if they had just smoked a bunch of marijuana and had a couple beers on top of it. Poor balance, walking issues, cognitive decline.

All of this on top of the 20+ that have died since 2021. I fully understand the circle of life, I have patients die on a regular basis. I spent many years in the ICU where patients died frequently. As my grandmother used to say “the old will die, and the young may die”. She lived through the Great Depression and would be 110 years old if she were still alive. Elderly do die. But the amount of illness they are experiencing right now, with comorbid cognitive decline, is something I have not seen as profoundly prior to now. I am sending more people to geriatric neuropsych testing and neurology for MRI than I ever have before. The rapid decline and the number of cases is not normal and is far above baseline. I fear what will happen if this age group gets a covid and flu and RSV shot this fall. Winter will be ugly.