Working with your older patient: a clinician's handbook

As the population ages, clinicians are seeing more and more older patients, and they are seeing them with greater frequency. In 1991, older people averaged eight visits to a physician per year. Some researchers anticipate the number of physician visits by the growing population of people age 65 to 74 will nearly double between 1980 and 2040. Care of older people offers special rewards and presents special challenges. One of these challenges is in the area of communication. What are the most effective ways to interact with older patients? How can difficult-to-discuss topics be broached? Are there some communication strategies that can help older patients who are experiencing confusion or memory loss? With these questions in mind, the National Institute on Aging (NIA), part of the National Institutes of Health, developed this handbook.

Facilitating Diagnosis and Promoting Adherence to Treatment

This handbook is aimed at two audiences. It offers physicians-in-training and other health care professionals an introduction to needed communication skills in dealing with older patients and their families, and it provides both a review and continuing education for more experienced clinicians. The handbook describes and explains issues pertinent to older patients, and .suggests practical techniques and approaches to facilitate diagnosis, promote adherence to treatment, make more efficient use of clinicians' time, and increase both patient and provider satisfaction. Written for NIA by Barbara Gastel, M.D., the manuscript has benefited from thoughtful reviews by physicians, nurses, social workers, and other health care professionals caring for older people. It is important to make three points. First, while not intentionally ageist, clinicians may, without realizing it, allow societal stereotypes about aging to creep into everyday medicine. These attitudes do not reflect what research and practice tell us. For example, many physicians focus on the chronic nature of illness in older people and may be less vigilant about acute problems. Second, these suggestions may at first glance appear time-consuming and difficult under current reimbursement systems. On closer reading, however, many of the approaches, such as detailed history-taking or testing for cognitive function, involve an initial investment of time that leads to a long-term gain for both patient and physician. There are several ways to implement these ideas to increase efficiency. You may, for instance, want to get to know your older patient over a few visits instead of trying to work everything into one session. Finally, while this handbook presents some common themes about older patients, it is important to stress the diversity of aging America. The average doctor will see many healthy and independent older patients, as well as some who are frail. We hope that the techniques offered here encourage you to view older people as individuals, with a wide range of health care needs and questions. Richard J. Hodes, M.D. Director National Institute on Aging