BedsideManner / GERIATRICS

(2023/09/30)

The elderly couple consulted with the young doctor and told him they would like to engage in sex and wanted to make sure they were doing it properly for their age. While it seemed like an odd request, he took them into the examination room and let them go to town. At the completion, he told them they were doing just fine and all should be well. He even congratulated them on such an exceptional performance. The next week, and the week after that they were back in his office making the same request and he let them engage again. Becoming suspicious by the forth week, he asked, “You folks seem to be doing everything just right. Why do you keep coming back here?” “Well, doc,” replied the old man, “at the nursing home we have no privacy, and a hotel room is eighty-five dollars. When we come here, our Medicare co-pay is just ten bucks.”

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Treating the elderly is a special field. These patients need an entirely different approach to care and that’s why there are specialists who treat them. However, most everyone sees elderly patients at times. Those of you who master bedside manner will see more than others since your younger patients who would never go anywhere else are going to bring their parents to see you.

The elderly may require more time for you to hear their complaints and for you to explain treatment options. If you are a rushed practitioner you will fail at treating the elderly. They can be a challenge because they may not understand your explanations and they may not be compliant in following treatment protocols and postoperative directions.

The elderly often move, explain, and understand more slowly, resulting in delays that can frustrate you. Something as simple as asking an elderly patient to give you their list of medications can take an inordinate amount of time. Making provisions to get all necessary information before the appointment will help avoid wasted time.

You must be willing to explain everything several times, utilizing simple drawings and written instructions that you will copy for them to take home. It is best to have an elderly patient come to see you with a younger person or a spouse who may help to remember what you tell them and to help them decide upon treatment options. If you see they are confused, you should offer them time to “think it over” and reschedule.

If an elderly patient is in your treatment room alone, always ask if they are with someone. Now is the time to bring back their company, or you will have to explain everything twice when they announce they’d like you to repeat what you just told them to their spouse, sibling, child, or caretaker.

The elderly are often hard of hearing and intolerant of loud music. Consider turning down the volume of your treatment room music so that they can better hear your explanations. If you have the option to play calming music, do so.

You should expect questions that may be repeated several times. Be tolerant and willing to repeat your explanation and speak louder if necessary. But don’t start out assuming they can’t hear you, as yelling is insulting if their hearing is fine.

Taking a few more moments to clarify things is very much appreciated by the elderly and those accompanying them to see you. Try to project into the future when you may appreciate some kind young practitioner taking the extra time to help you when you are old.

For many older patients the relationship with a doctor is one of the few opportunities they have for conversation and the visit is often enjoyed, especially if you are amiable. Some patients may actually feign complaints to visit with you. It is imperative to keep this in mind when making a diagnosis. If unrecognized, the phenomenon (doctor visit social time) can lead to unnecessary tests and treatment.

You never want to discount a patient’s complaints, but if you suspect they are using medical excuses to visit with you, have a heart and humor them as best as your time allows. The visit may be the best medicine you could ever prescribe. If they visit frequency or time involved becomes intrusive, you may have to refer the patient for specialty evaluation, telling them you no longer have any solutions for their symptoms.

If you have the time, try to set up ongoing appointments at three-month intervals telling the older patient you want to check on them regularly. This gives them something to look forward to, and the ten minutes you offer is an act of kindness that can make you feel alive.

Comments

• Bruno Azevedo (2023/10/11 09:22)

I completely agree with the content of the blog. It is crucial in the field of healthcare to treat elderly patients with respect, much like we do with children, and incorporate a caring and compassionate approach. The elderly population faces unique challenges, including physical frailty, cognitive decline, and a heightened sense of vulnerability. It is my belief that we should strive to accommodate their requests as much as possible, without compromising the quality of care we provide. When doctors demonstrate respect, they acknowledge the dignity, autonomy, and wealth of life experiences of elderly patients. This, in turn, promotes a sense of empowerment and trust, facilitating effective communication and collaborative decision-making. Simultaneously, adopting a compassionate and nurturing demeanor reminiscent of caring for children can address the emotional and psychological needs of elderly patients. This approach can alleviate their anxieties, instill a sense of security, and enhance the overall comfort and positivity of their healthcare experience. Striking a balance between respect and nurturing care acknowledges the multifaceted nature of aging and allows healthcare professionals to deliver comprehensive and holistic medical care that addresses both the physical and emotional well-being of elderly patients. In summary, it is imperative to listen to elderly patients in the dental setting to tailor their care to their specific needs and reduce anxiety. Dentists can employ various strategies to foster a sense of trust, comfort, and understanding, ultimately making dental visits a more positive and less stressful experience for older individuals.

• Karen Kimzey (2023/10/10 22:59)

I worked in public health for six years before starting my residency. In that time, I\\\'ve experienced a few patients who would return for the \\\"doctor visit social time\\\". It took a few visits to realize that nothing was wrong and they just needed a little kindness. I\\\'ve also had geriatric patients come in with a ziploc bag of pills but they are unaware of what they are for. I remember one patient that had memory loss and would ask the same questions every time - \\\"Why am I here? Is this going to hurt? Who are you?\\\" At the second visit, I was confused but then I realized it was something beyond her control so I\\\'d answered them and would do my best not to make her feel any different. A family member was always present so they could see the challenges that presented with a patient with memory loss. I also had a couple of patients that had back issues and I learned to be cognizant of making their neck comfortable for treatment.

• Julie Brann (2023/10/10 21:03)

These are all great suggestions! I have a love/hate relationship with elderly patients. Sometimes it can be frustrating and time-consuming to get in all their meds and repeat yourself multiple times. But, they can also be so sweet and thoughtful. I do enjoy talking with them! I think setting up three-month evaluations to check on them is a great idea.

• John Millar (2023/10/01 12:05)

This blog is filled with some great, practical insights. First and foremost, recognizing that \"The elderly often move, explain, and understand more slowly, resulting in delays that can frustrate you\" is critical. Knowing this, you can adjust accordingly, and avoid this frustration. If you know you have the time, the pressure isn\'t there and, like you said, that time could be the best medicine/treatment that you could provide. Additionally, asking the elderly patient if they have someone there with them prior to going through everything is a huge time saver. Something I had never thought of, but will definitely be cognizant of moving forward. This blog and the HMO blog from last time show that it usually comes down to time. If you create the time (and you 100% should), you will be able to treat the elderly in such a way to avoid any untoward outcomes or stress. An aside, I was cracking up at this line: \"Something as simple as asking an elderly patient to give you their list of medications can take an inordinate amount of time.\" So true and just so brutal when it\'s happening.

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