From Ronald Hoffman, MD, ANH-USA Board President and Medical Director
There’s a maxim I recall from my hospital training in the 80s: “GOMERs go to ground.”
It was one of the sardonic 10 Commandments from Samuel Shem’s (real name Samuel Bergman, MD) “The House of God”. The 1978 book became anodyne to our arduous residency training when we routinely pulled 100 hour+ weeks. Exhausted and beleaguered, our “esprit de corpse” (deliberate pun) was buoyed by Shem’s cynical humor.
GOMER is an acronym for “Get out of my emergency room!” and refers to the endless parade of elderly debilitated patients who seemed the banes of our existence. We were on overload, and every new admission of a complex senior with limited life expectancy meant a diversion from caring for our more viable charges. Sounds cynical, but we young doctors were in survival mode.
And, as if in confirmation of Newton’s inexorable laws of gravity, our frail admittees would often go to ground. Each fall guaranteed another long convalescence on our wards, with the risk of more medical complications, straining our patient care responsibilities to the breaking point.
The CDC informs us that:
- Each year, three million older people are treated in emergency departments for fall injuries.
- Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
- Each year at least 300,000 older people are hospitalized for hip fractures, 95% of which are caused by falling.
- In 2015, the total medical costs for falls totaled more than $50 billion. Medicare and Medicaid shouldered 75% of these costs.
We tend to think of fractures as merely the consequence of weak bones. DEXA bone density tests yield an estimate of the 10 year likelihood of a major fracture. We pump patients full of medications to forestall their bone loss, but it’s falls that actually precipitate most fractures.
Many factors converge to undermine our balance as we age:
Vestibular system: The inner ear contains the vestibular system—a complex set of fluid-filled tubes that contributes to our sense of balance. Semicircular canals oriented in three dimensions contain fluid and tiny particles that slosh around like snow globes with movement, sending nerve impulses to the brain via tiny hair-like mechanoreceptors.