Answers to your questions about successful aging

May 28, 2010

A recent "Aging in Iowa" Opinion package on caregivers and physicians solicited question for Brian Kaskie, an associate director at the University of Iowa Center on Aging. Below is a reader's question and an excerpt of Kaskie's answer.

Question: How is someone who specializes in geriatrics trained differently than my family doctor?

Answer: A geriatrician is a medical doctor who has completed formal education and training in providing care to older patients. These individuals typically are recognized in one of two ways.They can earn a board qualification in geriatrics from the American Board of Internal Medicine or the American Board of Family Practice. These individuals also complete a geriatric fellowship program which entails one to three years of targeted work with geriatric patients upon completion of a residency in internal or family medicine.

Geriatricians should be distinguished from physicians who claim to be geriatricians or have expertise in geriatrics solely because they have accumulated a significant amount of experience working with older patients. While having a large percentage of older patients in practice certainly may correspond with a physician acquiring knowledge and skill to care more effectively for older patients, such experience should not be confused with those who have completed formal education and training.
Informally speaking, a geriatrician is more likely to recognize the complex nature of the aging process, and understand that maintaining health and managing disease and disability are produced from biological, psychological and cultural factors. Geriatricians are equally likely to provide care in consultation with both medical specialists as well as allied health care providers.

A geriatrician is more likely to place emphasis on how older adults can engage in health promotion programs designed to maintain their health, offer preventive services such as screening for depression and memory problems, account for prescription drug interactions among older patients with disease and disability, be more aware of home and community based options for long-term care, and engage older patients in discussions about a pain free, self-directed end of life.
I was once told that a geriatrician knows that speaking louder to an older adult with a hearing problem is not as effective as looking directly at the patient and speaking slowly. So, if your doctor tends to raise her voice or not look at you when she speaks, then she probably isn't a geriatrician.



Question: What are the most important things I can do for my health to make sure I can live at home longer?

Answer: The first thing you can do is increase your health literacy. That is, learn as much as you can about growing old and how to age optimally. Learn about the difference between normal aging (e.g., it's normal to forget where you put your keys) and disease or disability (e.g., it's not normal to forgot what your keys are used for), learn about long term and end of life care, and seek out health care providers who encourage you to acquire information about how you can participate in your own healthcare.
Next you need to actually engage in healthy behaviors. If you are not doing so already, you need to start eating right, exercising and reducing unhealthy behaviors like smoking. You should participate in wellness programs and obtain routine screening for health and mental health problems. You should compile your own personal medical records so that when the time comes that you have to see more than one doctor, you can have important information about your medical history and prescription drug use readily available.
Being able to stay at home as long as possible also requires some planning. For example, given the need for nursing home care usually corresponds with the lack of being able to do things such as feeding or bathing yourself, you need to think about how you can modify your home to help you perform these activities. How would you have meals prepared or delivered when the time comes you can no longer do this yourself? Have you modified your bathroom so your tub is easy to step into and features a grab bar?
You also need to think about making an investment in staying at home. All too often, older Iowans are reluctant to spend money on modifications, respite programs or other services that allow them to stay home. Instead, they save their money in order to pay for nursing facility care. To some, this may be a penny wise but pound foolish approach. What should you do? You should recognize that staying at home is going to cost some money but it certainly doesn't cost as much as moving into an assisted living or nursing facility.
You also should talk to your family and loved ones. Staying at home may require that members of your family help you out more than they might think they need to. You may need to prepare them for the idea that someone needs to be available to get groceries for you, or come over twice a week and help you with exercises or provide some relief to your spouse.

Perhaps the biggest barrier for some people is their pride and how they equate being at home with being able to come and go as they please. With these people, any changes in their home or restriction on their activities are viewed as a step towards dependence and frailty-things that are not easily associated with being independent and living at home. For example, some people perceive that putting in a wheel chair ramp, moving laundry to the upstairs or paying a neighborhood kid to take care of your lawn seem like they are acknowledging that they need some help. However, the people who are more likely to stay at home longer are those that accept that this is an inevitable part of growing older. Staying at home means you need to make some choices and direct your own care. People who do not make these choices and do not actively direct their own care often find themselves having no choices when the time comes their doctor says "I think you need to move into a nursing home."