You’re more than just a patient in a higher age bracket.
As you reach your mid-60s and beyond, you need a primary health provider who’s attuned to changes in your body, mind and life. If it’s time to find a specialist focused on older patients, whether for yourself or a family member, here’s what to check for in your next clinician.
1. Specialists who listen
Try to find “someone that talks to you,” says Marge Dean , a geriatric nurse practitioner in Amarillo, Texas. “And explains. And listens to what you have to say,” says Dean, a faculty member with the Texas Tech University Health Sciences Center. Good listening ability is the first personality trait to look for, agrees Dr. Michael Wasserman, a geriatrician and board member of the American Geriatrics Society’s Health in Aging Foundation. Geriatricians are physicians dedicated to the care of seniors. As such, Wasserman says, “I’ve spent my life advocating for older adults.”
2. Life-span experts
In high demand and short supply — that’s the reality with geriatric specialists, particularly as the U.S. population ages. “There are 7,000 board-certified geriatricians in the country, and the number’s going down every year,” Wasserman says. The fact is, you may not have access in your area. Not to worry — family doctors can keep you covered at any age, says Dr. Wanda Filer, president of the American Academy of Family Physicians. More than half the patients she sees in her York, Pennsylvania, practice are at least 60, Filer says, with many significantly older. “We take care of the entire life spectrum,” she says. “So newborns to the end of life.”
3. A reliable practice
Start your search by talking to friends and neighbors, Filer suggests. Ask which practices in your community are accepting new patients. “Call the office and find out: What does their waiting list look like?” she says. “Do they accept your insurance?” That includes inquiring about the various Medicare plans. And ask whether you can reach someone when the office is closed, she says. “Heaven forbid you end up in the hospital — and we do our darnedest in family medicine to keep people out of the hospital, because it’s not a good place as you get older, sometimes.” After-hours availability can help prevent hospitalizations, she says.
4. Comfort level
You should feel comfortable when you step into the waiting room, Dean says. “Does everybody talk to each other? Do they get along, all of the staff?” A welcoming atmosphere sets the tone. “In some places, you feel like you’re on edge the whole time and you’re not sure why,” she says. Wasserman adds that during visits, making sure patients don’t have a sense of being rushed is an art: “You want a doctor who doesn’t make you feel like they only have 10 minutes to spend with you,” he says.
5. Evidence-based treatment
Wasserman says he takes a “really conservative” approach to treating aging patients, because there’s little data to back many treatments that are commonly used. “You need clinicians who show a lot of caution before putting an older person on a medication, before sending him off to a specialist, before doing tests and before putting him into the hospital,” he says. “Because we actually have very little evidence that a lot of those things are beneficial.” Examples of excess include giving cholesterol medication to people over 80 who’ve never had a heart problem, he says, or pursuing aggressive treatment for prostate cancer in men of that age.
6. Medication management
Geriatric specialists often streamline medications by eliminating drugs patients no longer need or that aren’t appropriate for their age. “Over 65, nonsteroidal painkillers can damage kidneys, for instance,” Dean says. Pharmacists play an important role in geriatric health care by taking time to talk to and look out for their older patients. Make sure you use a single pharmacy, Dean advises: “You need to have one place where it’s got all your medicines.” That makes it easier for pharmacists to pick up on potential side effects and be alerted to drug interactions.
7. Special considerations
Just as pediatricians don’t treat children like “little adults,” Filer says, experts recognize that older adults have special considerations, too. “A medication dose I might give a 50-year-old is probably going to be too much for an 80-year-old,” she says. When prescribing, she says, the idea is “go low and go slow. We give then a lower dose.” If a dose must be increased, she adds, that will be done far more slowly in seniors. “They tend to have less lean body mass,” she says. “And their liver and kidney metabolism is often very different.” Similarly, diseases that appear one way in a 30-year-old patient may present very differently in that patient at 80.
8. Age-appropriate testing
Too-low levels of vitamin D, thyroid hormone and other deficiencies that affect bone health, the nervous system and various bodily functions tend to increase with age, Dean says. Geriatric specialists monitor these levels with blood tests, she says — and staff figures out how to get testing covered by insurance so patients aren’t stuck paying out of pocket. “None of my patients has $300 just to toss out for B-12 testing,” she says. “That’s ridiculous.” When you reach 65, you’re entitled to yearly mental-status exams to check short-term memory and executive function. It’s not daunting, just part of the conversation during your routine Medicare wellness exam.
9. Quality of life
Care of older adults goes beyond the boundaries of the office visit. It includes probing for signs of isolation or loneliness that so many seniors experience. Asking patients about social support systems is routine, Filer says. “‘Who’s in your life?’ ‘Hey, who brought you here today?’ or ‘Do you have food in the refrigerator?'” Family physicians do make house calls at times, she adds. “Sometimes getting into the house can make a big difference, and you get to see where people live,” she says. “Is it clean? Are the floorboards in place? Do they have a lot of stairs they have to get up to? Should I give them a hospital bed?”
10. Family and privacy
When considering a practice, ask about its philosophy on family members, Filer says. “There are times I’ll have patients I want to see alone, when I have some very delicate questions to ask them, for instance about abuse,” she says. “But there are other times when you want the family member in there.” As the patient, address your preferences with the staff upfront, she says: “How much will you protect my privacy if that’s my choice? How much will you allow designated caregivers to be part of my team? How can we incorporate that?”
11. Dignity and respect
Geriatric specialists communicate well with people who have memory loss or dementia if they’re alone or accompanied by family members. “Whether they’re cognitively impaired or not, or demented or not, [practitioners] need to look the patient in the eye and speak to them as if they’re the only one in the room,” Wasserman says. “They must respect people regardless.” Most people with dementia can still answer many questions and provide important feedback for clinicians, he says.
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11 Things Seniors Should Look for in a Health Provider originally appeared on usnews.com
