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Health December 2012

Aid for Age

I’m Me, Doc, Not a Stereotype

By Tait Trussell

Interactions between older persons and physicians are influenced by the expectations and stereotypes that each party bring to the table, the GSA analysis said.

A new study by the Gerontological Society of America (GSA) explores the changes associated with aging and recommends ways for better communications, especially between doctor and patient.

Persons 65 and older numbered 40.4 million in 2010 (the most recent count available). That’s an increase of 15 percent from 2000. By 2020, the number of seniors is projected to reach 55 million.

Obviously, what is true for one 75 year old may be far different for another. But there are many commonalities.

The Administration on Aging compiled data which indicate that only 40 percent of non-institutionalized seniors reported their health was excellent or very good.

Most older adults, however, have at least one chronic medical condition such as hypertension, arthritis, cardiovascular disease, diabetes, along with many other problems.

Because of this, seniors make nearly twice as many visits to doctors (average 7.1 office visits) as do adults 45 to 65 (3.7 office visits).

The American Society of Consulting Pharmacists reports that seniors 65 to 69 years of age take an average of 14 medications per year. Seniors 80 to 84 take an average of 18 medications per year.

Interactions between older persons and physicians are influenced by the expectations and stereotypes that each party bring to the table, the GSA analysis said.

For example, “there is some evidence that health care professionals are more condescending and have less patience when interacting with older adults. They also spend less time with older patients, taking a more authoritarian role, provide less information (e.g, about medications, and often fail to address important psychosocial and preventable factors (e.g. quitting smoking).”

On the other hand, “older patients may withhold information about symptoms or conditions that they perceive to be ‘normal’ for their age — for example, pain that could be diagnostically important.”

Communications between seniors and doctors could be further complicated by age-related problems, including declining memory, slower processing of information, and lessening of influence over one’s life.

The GSA publication provides evidence-based advice for face-to-face communications with old folks.

While every senior is different, some changes are associated with normal aging. Hearing loss, for example, is the third most common chronic condition. Significant hearing loss affects about 30 percent of people age 65 to 75. For those 75 and older, the prevalence is 40 to 50 percent.

“Normal” hearing loss for seniors comes from a lifetime exposure to noise. Loss is focused in the high frequency sounds, as you may well know.

Age-connected vision defects are linked to small print, dim light, and reading scrolling. About one in six seniors over 70 has problems seeing in the distance. Nearly every person over age 55 needs glasses at least part of the time.

Nearly every senior has problems with night driving. Considerable difficulty may indicate the sign of a cataract. Cataracts are common among older people but they are not a normal age-related change, the report said.

Age-related changes in language comprehension are caused by a gradual decline in working memory. That is the system in our brain that provides “temporary storage and manipulation of information necessary for complex cognitive tasks (including language comprehension).

“Reduced information processing speed and capacity leads to problems in understanding complex sentence structures. Grammatically complex sentences put more strain on processing resources because the listener must keep more information ‘in mind’ in order to understand the whole sentence,” according to the GSA report.

“Older adults also produce less grammatically complex sentences, probably as an accommodation to their own declining working memory capacity.”

Long-term memory is no problem for most seniors. But older adults may have more trouble bringing back certain types of information, such as people’s names. “It is very common …to have a ‘tip-of-the-tongue’ experience when trying to recall the name of a famous person.”

Cognitive changes are quite variable. A decline in mental ability that’s severe enough to interfere with daily living is dementia. Some 60 to 70 percent of dementia cases are attributed to Alzheimer’s disease.

As for relationships with doctors, stereotypical beliefs about seniors should be recognized. The GSA report recommends engaging the patient in a brief conversation that may provide a more accurate basis for assessing the person’s linguistic facility, cognitive capacity, and hearing ability.

The objective is to initiate a conversation to gain “patient generated” information to help the doctor more accurately judge the patient’s capabilities.

Doctors should try to maintain eye contact with their patient, instead of focusing on the patient’s chart or the computer screen. Don’t rush through information. Avoid sending the message that you are preoccupied, busy or disinterested in what the patient has to say (one hand on the doorknob).

“Adapting your style of communications,” the report recommends, “to the actual, not stereotyped abilities of the patient will provide a foundation for more effective interactions.”

And remember, just as you depend on the doctor, the doctor depends on you to provide full information.

 

Tait Trussell is an old guy and fourth-generation professional journalist who writes extensively about aging issues among a myriad of diverse topics.

Meet Tait