Older patients present unique challenges for doctors
Geriatric patients can face a host of ailments, but specialists offer support to those patients and their families.
Loosely defined as those over age 65, geriatric patients can face a host of ailments, but specialists offer support to those patients and their families.
Dr. John Carment, a member of the geriatrics department at OU Physicians, says geriatricians treat all common diseases affecting older adults, but the focus tends to be on non-drug treatment whenever possible.
Managing multiple chronic conditions
Unlike younger patients, he says geriatric patients might have competing and concurrent medical problems. “A chronic condition, like diabetes mellitus, can be treated according to standard professional guidelines (in a young, healthy person),” Carment says. “The same treatment may not be feasible — and could be potentially harmful — when applied to a frail 88-year-old with eight active medical problems.”
Carment says geriatric patients tend to have complex needs, such as cognitive impairment, declining function or multiple conditions, which makes it difficult for them to live independently and care for themselves.
A geriatrician is trained to identify so-called “geriatric syndromes,” which include frailty, recurrent falls, dizziness, unintentional weight loss, sensory impairment, cognitive impairment and urinary incontinence, among other issues.
“Knowledge of medications, drug-to-drug interactions and side effects that limit use of many medicines in older persons are also areas of expertise,” Carment adds.
OU Physicians neurologist Dr. Syed Hussain treats patients suffering from Parkinson’s disease, tremors and other neurodegenerative disorders.
He says there are some challenges with treating older patients, and it is most successful through a multidisciplinary approach with the help of a caregiver as well as family support, nurses, a therapist, social worker and the neurologist.
The essential role of the caregiver
Both doctors tend to work more with the families and caregivers of older patients compared to those of younger patients. Caregivers provide invaluable support to the patient, Carment says.
“This may be as simple as providing transportation to the grocery store or as involved as managing daily medications and assisting with self-care like bathing and dressing,” he says. “Caregivers are often the best advocate for older vulnerable adults and often serve as their ‘navigator’ through the complicated health care system.”
Caregivers also provide crucial emotional support for older adults, he says. “Most caregivers are friends or family to the patient and are not compensated for the time committed to caregiving,” he adds.
Hussain says caregivers play a critical role in the treatment of any geriatric patient — whether it is giving medications at the right time or identifying problems that might require medical attention.
Pelvic floor disorders: an awkward but necessary conversation
Problems emptying the bladder or urinary or fecal incontinence are other issues facing older patients. Such issues are known as pelvic floor disorders, says Dr. Jameca Price, a physician in the obstetrics and gynecology department of OU Physicians.
For people who are nervous about having a conversation about pelvic floor disorders, which can affect men and women, Price offers some tips. She says starting a conversation in which the person noticing the change mentions the frequency of bathroom visits is an option. Opening a conversation around activity level and whether or not there has been leaking is another way to broach the subject, she says
Finally, asking whether there is leakage when laughing, coughing or lifting heavy objects is another way to go about the topic.
“If your loved one thinks she may have a (pelvic floor disorder), offer to schedule an appointment for her with a primary care doctor, gynecologist or a urogynecologist for an evaluation,” Price adds.
Price says she provides a variety of treatment options for patients depending the severity of the condition, their general health and their wishes. “Often I recommend a combination of therapies,” she adds.
It can be difficult to talk about such problems, even to health care providers, Price notes.
“However, providers — and especially urogynecologists — are used to talking about these problems. And, to get proper treatment for pelvic floor disorders, you need to talk about them,” she says.