An anecdotal story about the rock band Van Halen recently became a teaching opportunity for geriatrician Andrea Wershof Schwartz.
In an essay published in the January JAMA Internal Medicine, Dr. Schwartz relates a story about the rock band’s 1982 touring contract rider that stipulated that bowls of M&Ms be provided, but without any of the brown-colored candies.
“This unusual request was the pretext for several canceled performances,” Schwartz said. "If the band discovered on arrival that there were indeed brown M&Ms in their dressing room snack bowl, they would refuse to play the show.”
Schwartz realized that the small detail was used by the band to determine whether big details might also be overlooked. If the venue couldn’t be relied upon to remove M&Ms from a bowl, how reliably would the complex stage be constructed, for example?
She quickly understood that these same concepts can be applied to geriatric medicine.
“Three simple geriatric assessment tools can help us pay closer attention to identify the ‘brown M&Ms,' the details that should prompt us to look further into the overall function and frailty of our older patients," she said.
Schwartz reminds health care providers to pay attention to their patients’ gait, as the speed with which a patient walks is an important predictor of mortality and indicator of frailty.
Another important indicator of overall health is the ability to don or remove socks and shoes. Patients who have a hard time donning socks might lack balance, vision, flexibility or muscle strength -- all contributing factors to an elderly patient's ability to live independently.
Finally, it’s important to pay attention to patients’ toenails, as the presence of overgrown toenails can indicate a patient’s support network is lacking.
As Van Halen's M&Ms did for the band, the little details of geriatric medicine go a long toward assuring a patient is receiving the best care possible.
