May 15, 2024
3 Min Read
Marc Agronin, MD, Adult & Geriatric Psychiatrist
As the US population ages and neurocognitive disorders reach epidemic proportions, all clinicians need to be well-versed in geriatric care, especially in primary care and rural areas.
The statistics about our aging population should be well recognized by now: the percentage of Americans 65 years and older will increase from approximately 17% of the population to 23% by 2050, representing a 47% increase to nearly 82 million individuals. On the whole, these individuals are more diverse, better educated, more likely to be employed, and living longer than ever before.
On the flipside, aging is the number one risk factor for Alzheimer’s disease and other neurocognitive disorders, which are now at epidemic proportions and expected to double in the next 25 years. It is thus imperative for all clinicians to be well-versed in geriatric care issues, especially in primary care settings, which represent the point of entry into the medical system for the vast majority of older individuals, especially those living in more rural areas.
As a geriatric psychiatrist who runs a memory disorder center in south Florida – the true epicenter of aging and Alzheimer’s disease in our country – I offer three pearls to guide practical, effective, and inspiring care for older patients:
Challenge your assumptions about aging.
Look for the strengths of aging.
Build a relationship.
Challenge Your Assumptions About Aging
Appearance and verbal reports can be deceiving. Age is truly only a number for many individuals and may lead us to make ageist assumptions about our patients. Do not assume that someone is cognitively impaired just because they are older, slower, and less robust than younger patients. Do not assume that just because someone reports (or appears to show) cognitive impairment that they have dementia (what we now call major neurocognitive disorders).
There are many factors that can slow and impair cognition, and these warrant investigation and treatment. You would hate to miss a medical or psychiatric condition causing cognitive impairment that could be reversed with treatment. And just because someone has cognitive impairment does not mean they have Alzheimer’s disease. There are many other forms of major neurocognitive disorders that manifest in aging individuals, and having the right diagnosis can make all the difference.
You would hate to miss a medical or psychiatric condition causing cognitive impairment that could be reversed with treatment. And just because someone has cognitive impairment does not mean they have Alzheimer’s disease.
Look for the Strengths of Aging
Aging individuals come to us with problems that need solving, and it’s tempting to conflate the older person in front of us to a series of diseases that only bring decline and eventual death. Take a step back and learn about the person in front of you and all that they have gained in life, not in spite of getting older, but because of it. These age-emergent strengths include wisdom, resilience, and creativity. The more we learn about these strengths, the better we are able to leverage them in the service of helping the patient.
Build a Relationship
Connections with older patients are often intermittent and brief, interposed between layers of staff and other providers in ways that can obscure the whole of the person we are treating and limit how well we get to know them. And yet, being able to provide optimal healing often flows from the individualized empathy, interest, and optimism we bring to our patients in ways that transcend the rote treatments and algorithms we apply.
There is a complexity to aging patients that demands more time than insurance plans pay for, more investigation than electronic medical records capture, and more patience than we are trained to give. We have both the responsibility and the opportunity to rise above these limitations when working with aging patients. Doing so not only makes for healthier patients, but brings a heightened and healthy sense of purpose and meaning to ourselves as clinicians.
Any views expressed above are the author’s own and do not necessarily reflect the views of HealthCentral LLC.
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