@sean9n
Here’s another clip of a woman reading Trump’s words verbatim from a recent rally in Mississippi that puts a giant magnifying glass over how gone he is cognitively and unfit he is for office.View quoted post on X
An older patient in a nursing home gets a bladder infection and becomes confused. The people around him decide he can’t make decisions anymore. One physician who spent years managing nursing homes says that is how “we can have people dying from bladder infections.”
Alan Lindemann (@RuralDocAlan) is an OB/GYN who practiced in rural North Dakota, where, he says, you do what you have to do. That included a lot of time running nursing homes.
He describes the sequence in plain terms. Someone over 70 gets a bladder infection. The infection makes them confused. Then the people around them say, “Oh, well, he can’t make any decisions. He’s confused. So let’s just let him die.”
Asked how common that is, he says, “I would say it’s quite common.”
Part of the problem, in his view, is that people confuse two different orders, do not resuscitate and do not treat. He gives a case he didn’t manage himself: a woman in her 80s with a do-not-resuscitate order had an asthma attack, and her family pointed to the DNR. So she couldn’t be intubated, and she couldn’t be sent anywhere. “There was confusion there,” he says, “and I think there’s a lot of confusion.”
The patient who got him writing about it was 93. He told Alan he wanted to be treated like a 73-year-old. To Alan, the request itself showed capacity: because he could ask that question that way, “he had some ability to think and consent and also refuse treatment.” As long as Alan was there helping him, he got the treatments he needed. He was still worried about it.
What Alan wants clinicians to keep, in his own terms:
1. Confusion in an older patient is a reason to look for infection. “Every time somebody gets confused, we should be thinking in terms of sepsis,” starting with the most common causes, a bladder infection, a kidney infection, or urosepsis.
2. A bladder infection gets treated. “We should never, for example, decide to not treat somebody for a bladder infection.”
3. Setting changes the care. An 85-year-old who comes into the emergency room is probably going to get a different kind of care than in the nursing home, he says, because they’re not going to be automatically dismissed based on their age.
4. Everyone in the room needs to know the difference between the two orders: doctors, nurses, patients, and their relatives.
He was about to turn 75 when he recorded this, and he is clear about his own care:
“I will go down fighting for the difference when it comes to my own life.”
Listen to the full conversation on The Podcast by KevinMD. Link in the replies.
Search "The Podcast by KevinMD" wherever you listen to podcasts
What does your unit or facility do to make sure a do-not-resuscitate order is never read as do not treat? #ThePodcastbyKevinMDView quoted post on X
www.tiktok.com TikTok · Sean Ninan 
www.tiktok.com TikTok - Make Your Day TikTok - trends start here. On a device or on the web, viewers can watch and discover millions of personalized short videos. Download the app to get started. Thinking about things we measure in older people with frailty on a daily basisView quoted post on X
NEWS?
Bloods?
Heart sounds?
Lung fields?
There are times when all of this tells you nothing.
What do you think geriatricians are interested in?
