Elaine Herscher

By Kathryn Stambaugh

Geriatric Services Director

In early July, my mom fell. At age 81, it wasn’t her first fall, but this time she really hurt herself – a compression fracture in her spine. She had just gotten her toenails cut, and the nurse rubbed lotion on her feet (normally the best part!). Mom’s slippery feet moved inside her summer sandals, causing her to lose her balance and hit her rear end on the floor, hard. 

The statistics about falls among older adults are jarring:

• More than one in four older people falls each year. 
• Falling once doubles the chance of falling again. 
• One in five falls causes a serious injury such as broken bones or head injury. 
• Even minor falls without injury can be significant, as fear of falling can lead to reduced activity, which in turn can cause weakness (ironically increasing fall risk), isolation, and loneliness (as bad for health as smoking).

My mom was lucky in many ways. She didn’t hit her head. She didn’t bleed internally, which feels like a miracle because she takes an anticoagulant. Her attentive and capable husband took her to the ED, where she received excellent care. Her insurance covered a custom brace that takes pressure off the fracture to support healing.

Ten weeks later, Mom remains weak and off-balance. She uses a walker and seems more frail. Still, she stays positive, leaning into the can-do attitude and humor that served her well throughout her career as a medical social worker. She walks down the hall in her building for exercise, cherishes visits with friends and the occasional meal out, and jokes that she doesn’t want everyone to know she’s feeling better because “once they think you’re well, they stop bringing pies.”

There is a lot we can do in primary care to reduce fall risk, including:

1. Ask patients if they have fallen or are afraid of falling. These evidence-based questions are prompted annually in Care Gaps for patients aged 65+.  Use .FALLSCREENFOLLOWUP to identify next steps for a positive fall risk screen.
   
2. If a patient reports a fall, get more information.  What happened?  Confirm a fall vs syncope.  Check gait and balance using a tool such as the Timed Up and Go (available as a flowsheet in Epic and with the dotphrase .TUG).
   
3. Share fall prevention resources with patients:
   My Mobility Plan (Home Safety Checklist)
   What You Can Do To Prevent Falls
   
4. For recurrent falls or a gait disturbance, complete a multifactorial fall assessment or refer to LifeLong’s Geriatrics consult service by routing a telephone encounter with any relevant background and your specific consult questions to pool “P SA185 Geriatric Consult Over 60” or directly to Michael Goldrich, MD.

By now LifeLong staff have received cybersecurity awareness trainings that have been sent to us through our email.

According to Scott Schindler, Chief Information Security Officer, it is highly important to take the trainings in order for LifeLong to stay vigilant against cyber threats.

Normally there will just be one subject a month, but during the month of September he plans to send out videos covering two topics: Smishing (SMS -text- phishing) and Password Management. Each topic will contain two videos and an explanation of LifeLong policy:

• An approximately 5- to 7-minute training video
• An approximately 1- to 2-minute follow-up (usually humorous)
• Policy or internal guidance for the monthly topic

Starting in October he will cover just one topic per month.

The email containing the training links will come from do-not-reply@training.knowbe4.com.

Please look out for the emails and take the time to watch each of the videos to help keep LifeLong safe. For easy access KnowBe4 icon can be found on the intranet homepage and drop-down menu.

The IT Department has extended the previous deadline of September 1 to September 15. All staff working remotely who have been issued a LifeLong laptop or desktop must have their laptops or desktop updated ASAP. Please submit a Helpdesk ticket so IT can schedule the security update. The security update will take approximately 30 minutes to complete. Security updates must be made by September 15, 2023. If you do not complete the update by then, you will not be able access LifeLong’s network or resources after that date.

Recently Julie Rovner of Kaiser Family Foundation Health News interviewed LifeLong’s Dr. Michael Lenoir about racial disparities in medicine. Aside from practicing as an allergist-immunologist in his Oakland clinic, Dr. LeNoir is founder of the African American Wellness Project, formed in response to inequities in healthcare delivery.

The interview ranged from what to do about the increasing incidence of maternal mortality among Black women, to unconscious bias in medicine, to how to educate and train more Black physicians.

Here are some excerpts from Dr. LeNoir’s remarks:

About starting the African American Wellness Project: “It goes back to 2002, when as a doctor in a community that had people of color, physicians of color, I recognized that there was a difference in how African Americans were treated both professionally and personally….I (saw) the differences in how Black people were treated as opposed to whites. And I see the respect that was given to white physicians that was not given to Black physicians….And so that’s when we started the African American Wellness Project to educate African Americans how to deal with some of the aspects of early detection, disease prevention, exercise, and things like that.”

Combatting unconscious bias against patients of color: “A black person should call it out when they see it. That’s the big thing. I think we’re much too docile in the healthcare system…If we get as mad about healthcare that is disrespectful and unequal as we do when someone cuts in front of us in the Safeway line, we wouldn’t have that problem.”

Bringing more Black doctors into the Healthcare system: “The parameters to choose people for medical school need to start earlier, and they need to encourage Blacks, especially Black males of talent, so they can go on and do some things that are necessary to get into medical school.”

Impact of the Supreme Court’s decision banning affirmative action in colleges: “I believe diversity in California is probably 50 percent less than it was in the days when we had more liberal affirmative action guidelines. And so in those days, we were reporting 24, 25 Black students in these classes. That’s not happening anymore. So … I do worry.” 

If he could change one thing to make healthcare more equal: “I think it would be making certain that the system has the tools to detect two types of unconscious bias: this personal unconscious bias on the part of providers, but (also) this institutional unconscious bias. And I think we have to attack that first. Institutions don’t look at African Americans the same way.” 

Click here for the complete interview

Rejoice! Just for today we take a break from the dog days of summer to bring you International Cat Day, celebrating the 600 million felines on the planet.

The day was created on August 8, 2002, by the International Fund for Animal Welfare to raise awareness about the world’s cats and support ways to protect them. Historically, the domestic cat has been both worshipped and maligned.

In ancient Egypt, Mafdet was the first known cat deity, thought to be a protector against snakes and scorpions. The Greeks and Romans used them for pest control and only the wealthy owned cats. But things went downhill for felines from there. During the Middle Ages, cats were thought to carry the Black Death, and through the centuries we all know about their association with evil sorcery and bad luck.

We are well aware, Cleopatra’s time notwithstanding, that not everyone is a fan. Cats are not dogs (although, as you’ll read below, some of ours think they’re dogs.) Cats don’t greet you at door with a big smile and wag of the tail. They are more likely to whine at you accusingly when there’s no food in their dish and sniff off ungratefully after you comply with all their requests.

However, a soft fluffy cat purring gently in one’s lap is a thing of beauty. They are a great source of calm, and when they’re kittens, a great source of amusement as they zoom around and get into all your precious stuff.

In a recent, perhaps very unscientific, survey, two thirds of cat owners said they would rather spend an evening alone with their cat than with their significant other. (This may say more about the state of our relationships than about our love of cats.)

There are many much-loved, if not suspiciously eyed, cats among us at LifeLong. CEO David B. Vliet has a cat named Romeo (pictured with David on the Intranet page) who is perpetually underfoot. David suspects that Romeo weaves around his feet to get him off balance because he’s secretly plotting his owner’s demise.

Arcelia Valadez, Patient Accounts Lead, has a kitten called Baby, who was abandoned by her mother. Proving that cats and dogs get along better than their reputations, Arcelia says that Baby tries to breastfeed from one of her dogs, whom she has decided is her mom.

Again with the dog-like behavior, Development & Communications Director Sylvia Hacaj’s cat Chase likes to accompany the family for walks around the neighborhood. “He follows along like a puppy,” Sylvia says. Chase was a neighbor’s cat originally, but he spent so much time around Sylvia’s house, the neighbor decided he’d rather live with them.

To celebrate today, International Cat Care, the custodians of this holiday, suggests some extra play and attention for our furry felines. If that doesn’t do the trick, maybe just a nice nap.