The unique medical needs of old people is a topic that is cropping up more frequently in research and news reports — and it’s about time. For far too long, the elderly have had to put up with insensitive and even substandard medical care for a variety of reasons, and many elderly people themselves aren’t aware that their care hasn’t been up to snuff. So I reached out to Rosanne M. Leipzig, MD, PhD, vice chair for education of the Brookdale Department of Geriatrics and Adult Development at the Mount Sinai School of Medicine in New York, who has been vocal about the need for more specialized training, as well as sensitivity, in the care of geriatric patients. According to Dr. Leipzig, “There simply are not enough geriatricians to care for our elderly population in this country today”… but, she said, this doesn’t mean that anyone should settle for substandard care. Dr. Leipzig believes that internists and family practitioners can provide excellent care if they’re able to recognize the unique and complex needs of their older patients.
As a group, elderly people haven’t been widely studied in clinical trials and other medical research — and that’s dangerous, because drugs and illness often act differently in older bodies. It is important that a doctor caring for an elderly patient be attuned to the subtle changes that age brings, because common conditions such as heart attack, pneumonia or a urinary tract infection can present differently. Doctors need to be aware of whether older patients can follow their instructions or need help — and if so, who is at home to provide it. And, importantly, the patient’s own health goals need to be factored into treatment decisions.
Some people are lucky enough to retain physical and mental well-being into their 80s, 90s and — for more people than ever — past 100, but the reality is that most older adults lose some functional abilities as the years pass. This truth must be understood, addressed and factored into their care. Eldercare requires teamwork — and that team should include the patient and his/her family and other caregivers, as well as the health-care professionals, Dr. Leipzig pointed out, adding that the older person should remain the decision-maker. “As a culture, we tend to infantilize older people,” she notes. “It’s often done with the best of intentions, but we must remember that these are adults who have their own opinions and value their autonomy.”
Truly caring for the elderly often means letting go of the idea of curing their problems and looking more realistically at how to manage them, Dr. Leipzig said. “In this country, there’s a tendency to believe that high-tech, aggressive treatments are best,” she explained. “But in many older people, particularly those who are frail or demented, such treatments can result in increased suffering and decreased function, even when a ‘cure’ is achieved. We don’t deny people because of age, but if it’s not likely to help the patient achieve his/her overall goals, why do it?” Though these discussions are difficult for doctors, patients and families, they are important, she said.
Dr. Leipzig offered some advice on how to find a doctor who is up to date on geriatric medicine and sensitive to the needs of elderly patients. First and foremost, she says, be on high alert for any statements that suggest bias against, or lack of interest in, working with older people. Red flags would include remarks such as, “At your age, you just have to live with… (chronic pain, poor vision, recurrent falls).” Her suggestion? Find a different doctor. “There are always things that can be done to make life better,” she said. Instead, look for a doctor who recognizes the importance of quality of life and functional ability to aging patients, in addition to having excellent diagnostic skills.
To help you ascertain whether a particular physician is a good fit, Dr. Leipzig suggested asking the following questions…
