BY LESLIE CHAMPLIN
 |
The aging of America promises a sea change in the way family physicians practice medicine. The first ripples have already arrived. Americans 65 and older made more than 20 percent of all the office visits to family physicians in 1999, according to the National Center for Health Statistics. In a few decades, the ripples will be a gray tsunami. As noted in the story at left, this age group is expected to double from 35 million to more than 70 million by 2030. Then, say researchers, seniors will make 30 percent of the office visits to family physicians and constitute 60 percent of FPs' hospitalized patients.
Knowing how to care for older adults is an essential skill for FPs, and communication is the key, says Robert Parker, M.D., assistant clinical professor of geriatrics and family medicine at the University of Texas Health Science Center at San Antonio.
Numerous studies have demonstrated that poor communication results in missed diagnoses, patient noncompliance, potentially toxic drug interactions, unnecessary hospitalizations and overall poor health.
Offer respect, empathy
Caring for the elderly comes with a few ground rules, according to Parker, who has lectured at the American Geriatrics Society annual meetings and the Conference on Patient Education sponsored by the Academy and the Society of Teachers of Family Medicine. The first ground rule: Establish a respectful relationship. Most older patients grew up when addressing adults by first names was taboo.
"It's important with elders to address them as Mr. Jones or Mrs. Smith until they tell you otherwise," Parker advises. "If you use their first names, ask their permission. They will think it's impertinent to do otherwise."
More difficult is developing empathy. Young physicians can't always relate to the losses in abilities and quality of life that can accompany aging, says Parker.
Help patients "get it"
Geriatricians have some advice: When elderly patients nod with understanding, doubt their comprehension. When they list their health concerns, pry. When they accept a written handout, assume they can't understand it.
Why? Because, when caring for older patients, family physicians swim against a tide of challenges -- from undetected dementia, to multiple "chief complaints," to die-hard myths and cultural beliefs.
Studies indicate that physicians frequently miss cognitive impairment in elderly patients, says Parker. The result: Patients nod as if they understand what the doctor tells them; in fact, they absorb none of the information or confuse its details.
"Frequently, patients who are demented have social skills that are very well-preserved," he says. "But they don't understand or comprehend the information they are given."
In addition, family physicians must determine their patients' health literacy.
"The illiteracy rate in the general population is about 5 percent," says Parker. "But it's much higher in the elderly. Many older patients read at the sixth-grade level." However, most health literature is written at an eighth-grade level or higher.
Combat myths
Most difficult to address are long-held beliefs, Parker adds.
Elderly people may be ignorant about advances in preventive care. When patients refuse a flu shot, they may hearken back to early vaccines "and tell you the vaccine made them sick," Parker says. "Many older patients believe that cancer is always fatal, so they delay getting a diagnosis or treatment. And some cultures believe it's fate, so the patients will do nothing to intervene."
Equally damaging myths: Memory loss, chronic pain, depression, incontinence and other conditions are part of aging. These beliefs can prevent patients from even mentioning such topics. So the family physician should. When patients realize such problems can often be treated, they -- or their family members -- may request help.
"That is what is so gratifying about family medicine and working with the elderly," says Parker. "In no other specialty can you do such small things for people and make such a huge change in their lives. When you listen and provide information, they are genuinely thankful."
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
FP Report is published by the
AAFP News Department.
Copyright © 2004 by
American Academy of Family Physicians.