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Friday Oct 28, 2016

Treating Elderly as Treasures Improves Empathy, Care Quality

My first experience caring for the elderly didn't go as well as I had envisioned. In fact, I only lasted two days.

Of course, this was long before I became a doctor. When I was 17, my mom, who is a nurse, encouraged me to try working as a personal care assistant at a nursing home. I wasn't ready for that level of personal care yet, but I didn't give up on the nursing home altogether. I quickly regrouped and took a job as an activities assistant at the same facility. I enjoyed two years there, helping keep the residents stimulated and active.

Every day, 10,000 Americans turn 65. By the time the last baby boomers reach that age in 2030, 18 percent of the U.S. population will be 65 or older. Unfortunately, some people have difficulties when it comes to providing care for the elderly, whether it is because of the complexity of patients' illnesses and physical frailty, the sensory overload of the nursing home environment, or communication difficulties due to generation gaps, hearing loss or dementia. I understand all this because I had to overcome these hurdles myself while developing the comfort level I now have in this arena. I also had to learn to face my own mortality and fears about the aging process. 

Thankfully, I had many mentors along the way who helped me understand the value of increasing my patient exposures early on. As a young adult, I remember being urged by many earnest nurses and patients to take advantage of those formative years as a means of increasing my insight and aptitude when I became a medical provider.

One of those nurses was my mom. While I was in college, I took a nurse aide course that she directed. I was soon working in nursing homes and health centers as a certified nursing assistant. This time, I was ready for the job and determined to get ground-level experience in the field of medicine before working my way up.

These experiences helped shape who I am today -- a practicing family physician who enjoys weekly rounds at two nursing homes and has a patient panel that is roughly 50 percent geriatrics.  

In addition to my early work experiences, the way I relate to geriatric patients was influenced by my cultural background and experience with my own family. If you were fortunate, as I was, you discovered long ago that the elderly are among life's greatest treasures. I hope you had the privilege of knowing your grandparents. I cherish the memories of mine.

I grew up in a large Italian family centered around its elders, and I can remember sitting at a table in my childhood home in front of big bowl of pasta gagootz and hearing my mom's paternal grandma encouraging me to eat the food she'd made herself, fresh from the garden: "Mangia!"

Years before, when my great-grandpa was alive, I used to sneak down to their basement apartment in my grandparents' house to share a bowl of Cheerios with them while they listened to their little hand radio or watched the little black-and-white tabletop TV.

You can learn a lot from the elderly by listening and paying attention. A more subtle benefit is exposure to the inevitable aging process. As a child, I was intrigued by the age spots on my great-grandparents' skin and I remember seeing Great-grandma with scrapes and bruises on her arms and face from her frequent falls.

I also recall going with my dad and brothers to visit my paternal great-great-grandparents at their duplex for pasta, red sauce and meatballs. My dad's grandma loved to tell jokes and often used her sharp wit to playfully torment my poor, frail great-grandfather.

I also vividly remember watching my once vibrant great-aunt slowly fade away due to the devastating effects of Alzheimer's disease. She was the first in my family to suffer from this awful disease.

My first visit to a nursing home was to visit my mom's maternal grandma. She was waiting for us in the family room seated in her wheelchair, where the aides had placed her. I remember the chemical smell, the sterile halls, the linoleum surfaces and the tile floors. Great-grandma's legs always seemed swollen, and sometimes she would have oxygen on. She passed away not long after that visit from congestive heart failure. About 20 years later, her daughter, my maternal grandmother, died after a long and valiant battle against lung cancer.

I am overcome with emotion when I think about watching my dad receive the news that his mom had died suddenly from a ruptured cerebral aneurysm. She had just entered her golden years. 

I am also struck by the sudden frailty of my one remaining grandparent, who has been confronted with the passing of many loved ones and now faces his own mortality after a series of hospital visits for heart trouble. 

I am certain that these and many other life experiences helped mold me into the physician I am. As a family physician, it is so re-affirming and rewarding to receive positive feedback from my geriatric patients, who often have lost spouses, parents and many other loved ones in their long lives. Many of these patients have expressed how meaningful it is for them to have someone who actually listens with patience and empathy, while taking the time to provide information and education. 

The point I want to emphasize is that when we provide care for the elderly we are not only treating a patient but also someone's cherished parent, grandparent or great-grandparent. I find that my empathy is much greater and my quality of care is so improved when I treat these patients like I would one of my own family members. All it takes is willingness and a caring heart.

Kurt Bravata, M.D., is a family physician who practices primary care, geriatric medicine and addiction recovery in rural southwest Missouri. 

Posted at 11:48AM Oct 28, 2016 by Kurt Bravata, M.D.

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