| The elderly person can have special problems that require equally
special understanding for diagnosis and help. There are many underlying
psychological changes. Although these changes are normal, they may
alter the way an elderly person responds to disease and is able
to cope with physical problems.
Understanding is important, but surprisingly, medical schools have
only recently begun to educate their students about normal aging.
Physical disease in the elderly may be more difficult to detect.
Signs or symptoms may be diminished or absent. They also may be
delayed at onset or not characteristic of the same disease in a
younger person. For example, an elderly heart attack victim may
have no chest pain because of age-related nerve changes. An elderly
person with a severe infection may not be able to produce white
blood cells to fight the infection or even produce a fever.
Physical disease may show as a mental change. The same elderly
heart attack victim with no pain may have symptoms only of confusion
because of an insufficient blood supply to the brain. The patient
with pneumonia may be called senile because a lack of oxygen slows
brain functioning. It takes a sharp mind to notice changes in an
elderly person's thinking and recognize physical disease as one
the culprits. All too often, people with new thinking problems will
be called senile, and ignored or put in an institution. Their underlying,
often treatable, illness will go undetected.
Drugs in the elderly may act differently, interact frequently,
and be harder to control. Since elderly persons tend to have many
medical problems, they often take many medications and the risk
of drug toxicity and drugs interacting with other drugs rises enormously.
In addition, some elderly patients take drugs for problems that
they or their physician have long forgotten, or for problems that
have been long resolved. They may also be taking over-the-counter
medications without the physician's knowledge.
Because of the changes that come with aging, the older body and
brain handle drugs somewhat differently. A good health care professional
is aware of this and adjusts drug doses appropriately for the patient's
age, kidney, liver and brain functions. Drug dosages and use must
be monitored regularly and carefully.
Medical problems of the elderly are frequently multiple. As we
age, we can develop new and complicating health problems. The geriatric
health care worker has to keep in mind these multiple ailments and
treat them as carefully as possible without jeopardizing the "whole"
patient. This can be complicated, especially when the treatment
for one problem condition may exacerbate another.
Along with multiplicity, health problems in the elderly are frequently
chronic. This is an enormous burden for the aged patient in terms
of physical health, life satisfaction, and finances. Remember, about
half the medical expenses of this country are for treating chronic
problems. Most of this expense is borne by the 10-15% of the elderly
population. In fact, older adults visit their physicians six times
for every five visits by the general population. They are hospitalized
twice as often, have longer hospital stays, and use twice as many
prescription drugs as younger persons. Obviously, the medical problems
of the elderly are special and often complex. Although aging is
not itself a disease, geriatric health care workers must be knowledgeable
of this normal life process and the many special problems that accompany
aging.
A good rule is to find a physician who is interested in the health
care of elderly patients. Many doctors display little interest in
geriatric health care. Their interests may lie elsewhere. You do
yourself and those physicians a favor by seeking a competent clinician
concerned with the special problems of aging. There are many clinicians
who find this work rewarding and those who are genuinely interested
will generally give the best care. |
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