Key Principles of Geriatric Care by Robert S. Stall, MD
It is very important that older
adults, their families, friends and health care providers understand several
key concepts to ensure that older adults receive timely & appropriate health
care services and advice.
Principle 1: Sudden change comes from sudden problems
(and
Alzheimer's disease does not begin overnight)
An older person that suddenly becomes
confused - but was alert and oriented the day or week before - is having an acute
problem such as an infection, medication side effect, stroke or even a heart
attack. These and many other acute problems can be treated effectively if
diagnosed properly and in a timely manner.
An older person often has unusual or subtle symptoms. Confusion may be the only symptom of a heart
attack in an older person. A younger
person would be more likely to experience the classic symptoms of chest
pressure and arm pain.
Principle 2: Gradual decline may not be Alzheimer's
disease
Alzheimer's disease symptoms develop
slowly. However, many other problems develop slowly and may cause gradual decline. An overactive or underactive
thyroid, vitamin B12 deficiency, poor nutrition, Parkinson's disease and
depression are examples. Symptoms from these usually develop slowly and may
mimic Alzheimer's disease. Loneliness
and social isolation can also cause gradual decline.
Principle 3: Medication use in the elderly is a major drug
problem in
Many older people see several doctors,
each of whom may prescribe different medications. These same people may also use over‑the‑counter
medication regularly. They may even get
their medications from more than one pharmacy, or from friends. It's not hard
to see how medications may pile up and how difficult they may be to track. Even
one drug that's not right for a person can impair function and decrease
enjoyment of life. Imagine what five - or ten, or fifteen - can do. Older adults should make sure their doctors
know about all medications they are taking and question doctors about
prescribed drugs. Are they
necessary? What side effects should I
watch for? Are they safe to take with my
other medications? The doctor should
also know about alcohol, cigarette and coffee use.
Principle 4: Ageist attitudes are harmful
What
do you expect at your age? You're not
getting any younger! Do
these statements sound familiar? They
are unjust generalizations and prejudicial statements that assume all older
adults naturally become weak, sick and forgetful. Older
people get sick from disease, not "old age".
Principle
5: Seek and treat dis-ease,
not only disease
The
practice of geriatric medicine - care of older adults - is truly holistic. With modern medicine's focus on curing
specific ailments, it is easy to forget the broader definition of the word
"disease". Put a simple hyphen between the first 's' and 'e' in
"disease" and a whole new world of possibilities emerges. By focusing
on DIS-EASE - not just disease -
everyone, including older people themselves, can broaden their scope of
investigation, treatment options and perhaps most importantly, their
expectations.
Principle
6: Maximize quality of life &
functional ability
These
are the primary goals when caring for an older adult.
Adding days to the life of an 80 or 90 year-old is much less important
than the quality of the life – how much each day is valued and enjoyed. Similarly, loss of bodily function (and often
with it, loss of independence and control) is usually of greater distress to an
older patient than the prospect of death.
Principle
7: There is ALWAYS something that can
help!
Add a medication. Stop a medication. Change the dose. Give advice.
Explain a diagnosis. Discuss a
symptom. Set goals. Shoot the bull. Tell a joke.
Laugh. Listen. Hug.
Smile. These are just some of the
things a doctor can do to help. Doctors and other health professionals are
limited only by their interest, effort, and creativity in finding ways to
improve a patient’s well-being.