Meeting the Needs of Older Patients

Elderly-Addicts-Suffering-in-SilenceIt’s no secret the world is getting grayer – not with respect to climate, but in terms of population advancing in years. In 2013, there were nearly 579 million people age 65 and older around the globe. By the year 2050 it is projected to be over 1.45 billion.

Are you prepared to meet the needs of your older patients? Along with age-related physical declines, which may be prevented or delayed with effective interventions and certain treatment, older patients may be coming to you with mental health issues.

Dementia

Chief among these is dementia, which affected an estimated 35.6 million people worldwide in 2010.  That number is projected to double every 20 years, reaching 65.7 million in 2030 and 115.4 million in 2050.

Granted, most physicians and care providers won’t be around themselves in 40 years, but this doesn’t negate the need to pay attention to the needs of older clients now. Some of these may be your neighbors, friends or even family members. They are certainly neighbors, friends and family members of someone.

Although you may not specialize in geriatric medicine, you can be on the lookout for certain behaviors that may signal the onset or presence of dementia and make necessary referrals to a treatment specialist. Common behaviors include aggression, agitation, depression, psychosis and discussion of sleep disturbances.

Depression

Another major late-life disorder is depression. Nearly 20 percent of the elderly have a depressive disorder and more than 3 percent have major depression. Among those older than75, depression is even more prevalent, about 7 percent.

Take the example of a single woman, late 70s, who lives alone and has a three-month history of depressive symptoms in the context of a stroke the year before that led to mild cognitive deficits, slower gait and apathy. She requires medical assistance for several problems, including hypertension, diabetes and heart disease. The challenge facing her geriatric psychiatrist, if she has one, or her primary physician include determining if her depression is the result of post-stroke depressive disorder, medication-induced depression or an evolving vascular dementia. Each differential diagnosis has implications for management and prognosis.

Other Issues

Although not as prevalent as dementia and depression, older patients may exhibit signs of anxiety, psychosis or substance abuse. There has been concern that those of the Baby Boomer generation, who turned 65 in 2011, may begin to show an increase in substance abuse and mood disorders as they get older.

What You Can Do

Since turning back the clock isn’t an option, what can you do to better meet the needs of your older patients? Key to this is sensitivity to what they’re experiencing – whether it shows up as a medical condition or is a suspected mental health issue.

Be empathetic. Listen to what they have to say. Observe the nonverbal communication to pick up signals that something else may be going on that the patient isn’t able to articulate. Making time for communication with elderly patients and significant family members can help identify problem areas that can be addressed, either with physical therapy, medication, referral to a geriatric psychiatrist, or to a health care facility for rehabilitation or long-term care residency.

Above all, show compassion. After all, everyone is getting older every day, including physicians and care providers treating the elderly. Don’t we all deserve to be treated with respect and dignity?

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