Tue, Jan 06, 2009 - Page 16 News List

‘Cookbook medicine’ won’t do for the elderly

Just as children require specialized medical care, elderly adults have different needs than patients half their age

By Jane E. Brody  /  NY TIMES NEWS SERVICE , NEW YORK

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The Martha Stewart Center for Living at Mount Sinai Medical Center in New York is like no medical clinic I’ve ever seen. It is brightly lighted and quiet — there is no television blasting. It has wide corridors and plenty of comfortable chairs with sturdy arms, and yet few people wait more than 10 minutes to see a doctor or nurse practitioner.

The center, which opened in 2007, was designed especially for primary care of older adults, many of whom have complex chronic medical problems like diabetes, heart disease and hypertension as well as debilitating conditions like arthritis and osteoporosis.

Just as a child is not a small adult and requires specialized care, adults over the age of, say, 65, are not just old adults and should not be treated like patients half their age.

The population of aging Americans is expected to mushroom in the years ahead. Geriatricians, the experts in elder care, are already in short supply, and their numbers will continue to shrink. But knowing the kind of care that these specialists provide may help older people and those who look after them learn to seek it out wherever they go.

“Cookbook medicine may be appropriate for younger people but is not always appropriate for older people,” Mark Lachs, a geriatrician at Weill-Cornell Medical Center in New York, said in an interview. He sees two dangers in how older adults are treated: overtreatment and undertreatment.

“If a high-functioning 80- or 90-year-old develops angina, aggressive treatment would be appropriate,” Lachs said. “Care should not be withheld solely on the basis of age.”

On the other hand, overtesting and overtreating older patients can result in debilitating side effects. Before deciding on tests and treatment, he said, “the doctor must take into account the whole picture of the patient, the patient’s family and life situation.”

SCREENING FOR LIFESTYLE

R. Sean Morrison is one of the geriatricians at Mount Sinai. “The overall goal is to help older adults achieve the best quality of life possible, given the limits of medical technology and knowledge,” he said.

When I asked how he would approach a new patient of 85, Morrison said he would start with a series of questions: “Tell me about yourself. What do you like to do? What are the things you would like to do that you cannot do anymore? What is your medical history? What medications do you currently take? What brings you here today?”

The geriatric exam itself would depend on the patient’s answers. “If the patient is a healthy 75-year-old who plays golf and tennis and has no functional limitations,” Morrison said, “the focus would be on preventive screening and advance care planning.

“But if the patient has functional limitations, the focus would be to restore and improve what can be restored and improved, such as reducing the risk of falls, addressing any acute medical conditions, and streamlining medications for chronic health problems so that the right drugs are taken for the right conditions.”

“You want a doctor who asks more than just about your medical conditions,” he added. The doctor should ask about the effect of medical conditions on quality of life, and then should explore what improvements are possible. “The focus of care should be on quality of life,” he said. “Too often, doctors lose sight of this goal when the focus is on treating specific diseases.”

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