Sharon Baker’s column continues from last week:
Dr. Val Johnson published a report called “Ageism in Health Care and How Dangerous it Can Be.” The following cases were provided as examples of misdiagnosed individuals because of preconceived notions based on age:
♦ An elderly woman was active in retirement, chairman of the board at a prestigious company, an avid Pilates participant and the caregiver for her disabled son. A new physician at her practice recommended a higher dose of diuretic (which she dutifully accepted). Several days later she became delirious from dehydration and was admitted to the local hospital. Due to her age, she was diagnosed with advanced dementia and hospice care was recommended at discharge. All she needed was IV fluids.
♦ An attorney in her 70s who had a slow-growing brain tumor that was causing speech difficulties, too, was written off as having dementia until an MRI was performed to explore the reason for new left-eye blindness. The tumor was successfully removed, but she was denied brain rehabilitation services because of her “history of dementia.”
♦ The last example was of an 80-year-old patient, who was presumed to be an alcoholic when he showed up to his local hospital — actually he had a stroke.
I know my profession is not intentionally doing anything to insult or mismanage patients. Frequently the number of patients, complexity of procedures and number of medications are extremely difficult to manage. So what to do? I suggest the following tips for patients to maximize interactions with healthcare providers:
♦ Keep a list of medications, past illnesses, hospitalizations and surgeries on your phone or on a list. Bring them with you to all encounters with healthcare providers.
♦ If there have been multiple tests or reports that are not on a readily available electronic records system, keep them in a notebook and bring a copy with you. This can clarify helpful information quickly.
♦ Make sure a friend or relative has access to this information as well in the event you are too ill to speak for yourself.
♦ Become familiar with “normal” expected changes of aging — e.g. need for glasses vs. a sudden change in vision.
♦ If you notice physical or mental changes in yourself, or they are shared with you by an observant friend or family member, get it checked out with your primary care provider.
♦ Have someone who knows you well accompany you to your appointments or hospitalizations to take notes or clarify information in case you can’t because of medication effects or impaired consciousness.
♦ Write down your symptoms and questions before your visit and don’t be afraid to ask questions.
♦ If something is not taken care of, bring it up again. Health professionals are very busy and might have forgotten something.
♦ Make sure you have advance directives completed and on file with your primary care office and the hospital of your choice. Whether young or old this should be done!
As providers, we need to listen carefully and thoroughly to complaints and be careful about generalizing. A few suggestions:
♦ Introduce yourself! This is still sometimes not being done. Address the older adult by name and title and speak to them directly rather than to whoever is accompanying them.
♦ If this is impossible because of the illness, be sensitive to their presence when having conversations about them.
♦ When seeing behavioral disturbances during the first encounter with a patient, don’t assume that’s what they are like at home.
♦ Remember there are many reversible causes of mental status changes in the elderly, and presume that patients are normally functional and bright until proven otherwise.
We should all work together to start changing our perceptions about aging and embrace aging for what it is — a normal process of living that doesn’t necessarily mean disability, disease and decline.