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Ohio Department of Aging Boomerang: It all comes back to you!

Boomerang: It all comes back to you!

My Community - June 2013

With a shortage of geriatricians, elder care takes a village
A slower approach to medicine puts the person before treatment

By John R. Ratliff, Boomerang staff writer

Florence is a 79-year-old woman with high blood pressure, osteoarthritis and a tumor on her lung. Yet, during her checkup, Dr. Henry was most worried about her feet. He thoroughly examined both of her feet, looking closely at the soles and her toes, particularly in between them. He then referred her to a podiatrist for regular foot care and concluded their appointment.

Geriatricians are specialists trained to manage the multiple illnesses and chronic conditions associated with aging.Dr. Henry wasn't ignoring Florence's other medical issues, but rather focusing on the one that he felt posed the biggest risk to her quality of life and independence: her high risk for falls. He recognized that her swollen feet and sores between her toes could be signs of serious conditions that, combined with her poor balance, could lead to a life-changing fall.

Dr. Henry is a geriatrician, a specialist trained to manage the multiple illnesses and chronic conditions associated with aging and who treats the whole person, not just symptoms and diseases. Each of us ages in a unique way; thus each of us deserves to be treated and understood as an individual, not a collection of diagnoses. Medical professionals who do not take this approach can misidentify serious symptoms as "normal" to the aging process. Or they may aggressively treat conditions that do not have as significant an impact on quality of life as the treatment.

Geriatricians are not for everyone; a fairly healthy person can probably expect to receive adequate care from his family doctor. Further, geriatricians are in relatively short supply. However, you and your loved ones can get geriatrics-like care by slowing down the doctor-patient relationship. Dr. Dennis McCullough, a geriatrician and faculty member at Dartmouth Medical School, advocates for what he calls "slow medicine."

According to Dr. McCullough, older people benefit when their doctors and their family members better understand what it is like to be old. Like geriatrics, slow medicine means that the doctor, the patient and the family members do a better job of listening to the patient, and they allow and take the time with the patient to make decisions about what is best for her. As Dr. McCullough said, "Life for patients and their families improves when decisions unfold slowly and away from doctors' offices and hospitals." Your loved one may benefit most from this approach if she:

  • Is very frail and has multiple medical problems;
  • Is not frail, but has multiple medical problems and limited social support; or
  • Has multiple medical problems primarily associated with aging.

The slow medicine approach isn't just for your mom, either. The best time to start using this approach, according to Dr. McCullough, is in our 60s and 70s. If you or a loved one does not have access to a geriatrician, you can and should take a more active role in slowing down the medical relationship. Brush up on health issues and evaluate the doctors you or she sees. Talk to friends who have similar conditions about the type of care they get from their doctors. Most of all, get out of the passenger seat and take an active role in advocating for care that maximizes your quality of life above all other factors.

At her follow-up six months later, Florence's blood pressure was still elevated, but under control. She was managing her arthritis with medication and the tumor in her lung was unchanged. But, most importantly, she had not fallen and still lived independently in her own home, thanks mainly to a doctor who looked beyond the symptoms and saw the person.

Image courtesy of the National Cancer Institute


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