Four Key Principles of Geriatric Care

by Robert S. Stall, MD--Internist/Geriatrician


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It's important that older adults, their families and friends understand four key principles to ensure that older adults receive timely & appropriate health care services and advice.

1) Sudden change comes from sudden problems.

If an 80-year-old person appears confused or disoriented--and was alert and oriented the day or week before--he or she is almost certainly having or has had an acute problem such as an adverse reaction to a new medication, urinary tract infection, pneumonia, heart attack or stroke. However, confusion may be the only symptom of these acute problems.

In contrast, a 30-year-old adult would likely have typical symptoms stemming from the acute problems such as fever, shortness of breath and productive cough, symptoms of pneumonia; and chest pain or pressure, symptoms of a heart attack.

2) Gradual decline may not be Alzheimer's disease.

Alzheimer's disease is a chronic, progressive dementia developing over months to years. The disease impairs thinking ability and in its final stages, it impairs physical functioning. A decline in physical and mental functioning, however, is not always indicative of Alzheimer's disease.

Chronic metabolic illnesses--thyroid gland disease, vitamin B12 deficiency, Parkinson's disease and medication side effects (see next section), for example--may develop over months to years, causing an elderly patient to "slow down," become "confused" or feel tired and weak.

Mood problems such as depression may also mimic dementia.

Loneliness and social isolation are very common, and can often be helped simply through kind words of reassurance, improved transportation, hearing aids or glasses, senior center involvement or volunteer work. A big hug can have a profound therapeutic effect, too.

3)Medication use in the elderly is a major drug problem in America.

Many older adults see several doctors, each of whom may prescribe one or more medications. These same patients may buy their own over-the-counter medication on a regular basis. Even one drug that's not right for older adults can impair their ability to function and decrease the quality of life they enjoy. Imagine what five can do. Older adults should avoid prescribing medications for themselves and question doctors about prescribed drugs: Are these medications necessary? What are the side effects of these drugs? Do they interact with other drugs?

4) Ageist attitudes can be harmful.

"What do you expect at your age? You're not getting any younger!" Do these statements sound familiar? These are unjust generalizations and prejudicial statements that assume all older adults naturally become weak, sick and forgetful. Older adults become sick from diseases; they don't become sick just because they're old.

In Summary... A patient I treated several years ago, Ms. Vi Tality, was 95 years old. She complained of pain in her right knee. Shrugging her shoulders, she said to me, "What do you expect at my age?" I asked her about her left knee. It was fine. Puzzled, I said, "Isn't that knee just as old as the other?" She smiled and understood what I meant.

Think about it. I do. It helps me keep my care of older patients on the right track.

5/29/98

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Robert S. Stall, M.D., 14 Heritage Road West, Williamsville, NY 14221
Phone: (716) 636-7531 FAX: (716) 636-7532
WWW: http://www.acsu.buffalo.edu/~drstall/index.html!

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