Talking With Your Older Patient: A Clinician's Handbook
Considering Health Care Perceptions
The best way to learn what is and is not acceptable is to communicate directly with patients and caregivers.
"I'm 30 . . . until I look in the mirror."
Mrs. Hill is an 85-year-old nursing home resident. She has lived in a facility since advanced heart disease made it impossible for her to live independently. Her adult children feel that life in a nursing home must be a nightmare. They want to do something, but they don't know what. Moving her to one of their homes isn't an option; visiting her makes them feel depressed. One day, her doctor chats with Mrs. Hill about life in the home. She tells him that this is one of the best times of her life—people prepare and deliver her meals, she has a comfortable room with a view of the gardens, and the place is very peaceful. Mrs. Hill is quite happy and has no desire to move.
For Mrs. Hill, a life her children find unacceptable is, in fact, just fine with her. What seems intolerable to a 40-year-old may actually be preferred by a 90-year-old.
In the past century, the nature of old age has changed dramatically. In the early 1900s, the average life expectancy was about 49 years—today, it is nearly 80 years. With longevity, however, comes the sobering news that older people may live for years with one or more chronic, potentially disabling conditions. This means they will have an ongoing need for medical services.
No single characteristic describes an older patient. Each person has a different view of what it means to be old. A 68-year-old woman with an active consulting business is likely to deal with a visit to the doctor quite differently from her frail 88-year-old aunt who rarely ventures beyond her neighborhood.
The perspectives that follow are common among older people—and important to consider when talking with older patients.
Views of Physicians and Clinicians
In the past, older people have held doctors in high esteem and treated them with deference. This view may change over time as aging baby boomers are likely to take a more egalitarian and active approach to their own health care.
Today, many older people don't want to "waste the doctor's time" with concerns they think the clinician will deem unimportant. Patients sometimes worry that if they complain too much about minor issues, they won't be taken seriously later on. Or, they are afraid of the diagnosis or treatment. They may worry that the physician will recommend surgery or suggest costly diagnostic tests or medications.
Some patients do not ask questions for fear of seeming to challenge the clinician. On the other hand, some older people, having ample time and interest, will bring popular medical articles to the attention of their providers. This kind of active patient participation can provide an opportunity for communication.
Views of Aging
Ageism can work both ways. Doctors can make assumptions about their older patients. Older people may unwittingly assume the stereotypes of old age. Expectations regarding health diminish with age, sometimes realistically, but often not. Older people with treatable symptoms may dismiss their problems as an inevitable part of aging and not get medical care. As a result, they may suffer needless discomfort and disability. Some may not even seek treatment for serious conditions.
The process of aging may be troubling for older adults. It can be especially hard for people who once bounced back quickly from an illness or were generally healthy. Experts observe that baby boomers bring different expectations, experiences, and preferences to aging than did previous generations. For instance, some boomers are likely to want to participate actively in health care treatments and decisions. They may also search the Internet for health information.
Values About Health
Although physicians typically focus primarily on diagnosing and treating disease, older people generally care most about maintaining the quality of their lives. They are not necessarily preoccupied with death. In fact, many older people are relatively accepting of the prospect of death and seek chiefly to make the most of their remaining years. Younger family members, who commonly must make life-and-death decisions when an older person is incapacitated, may be unaware of the patient's views and preferences.
- Let older patients know that you welcome their questions and participation.
- Encourage older adults to voice their concerns.
- Be alert to barriers to communication about symptoms, such as fears about loss of independence or costs of diagnostic tests.
- Expect those in the baby boom generation to be more active participants in their health care.
Fecha de publicación: Octubre 2008
Última actualización: Marzo 24, 2014