Quantity of Life vs Quality of Life: That Is The Question!
Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.
I made a house call yesterday and met an elderly lady who'd fallen, broken her arm, spent some time in rehab, and then returned home independently. Obviously, she is a success story in that she has regained a relatively high level of function. Interestingly, she did not make the connection between an elective hip replacement for chronic ongoing pain vs urgent repair of broken hip. Granted, both lead to loss of function but she kept referring to having had a hip replacement despite being fully functional, running even, prior to her fall. When I pressed further, she finally admitted that she'd broken her hip. So I tried to explain why she hadn't had a hip replacement per se.
In any case, she'd been without a physician for the last several months as her primary care provider had retired. She insisted that she needed her temazepam 30 mg nightly for sleep, which she'd taken for the last 15 to 20 years after failing Dalmane & Ambien. On the other hand, she had a bottle or two of Norvasc which she wasn't taken despite an elevated blood pressure. Now, she was a well educated person, who was aware that hypertension is a silent killer. Yet, when pressed, she couldn't explain why she was taking something that would reduce her risk for stroke while insisting on something that might increase her risk of falls & fracture (she insisted that her 2 falls had nothing to do w/her benzodiazepine).
I bring up this vignette because an analysis of the Global Burden of Disease was published 2 days ago in JAMA looking specifically at the state of our country's health from 1990 to 2010. What's striking is that while all-cause mortality has decreased over this 2 decade period of time with concomitant 3-year increase in healthy life expectancy, the number of years lived with disability actually increased. In other words, while our quantity of life has increased, our quality of life has decreased. Even more striking is that while US life expectancy has increased, increase in life expectancy in other countries has outpaced ours such that we're slipping backwards on a global scale.
Which brings me back to my new patient who is well aware of hypertension's reputation as a silent killer. And despite this knowledge in a well educated patient, she couldn't explain why she wasn't doing more to maintain her current level of function and quality of life. This is why our national health is circling the proverbial drain. We know what we need to do but we don't have the collective conscience to act upon our knowledge.
