Q: What perils do older adults encounter as they travel through the health care system?
A: The journey usually begins in the doctor's office, so let's start there. In general, physicians tend to focus on different organ systems. The heart. The lungs. The kidneys. They don't focus so much on conditions that cross various organ systems, so-called geriatric syndromes. Things like falling, becoming confused or dealing with incontinence.
Q: What can people do about that?
A: Older people are often unwilling to bring these issues to the attention of their doctors. But if a family member is accompanying the patient, they should speak up.
In some practices, a nurse practitioner may be more attuned to these issues than the physician. So, it's a good idea to learn who in the medical office you go to is good at what.
Another approach is to request a geriatric assessment or consultation that will bring these issues to the forefront.
Q: How do geriatric assessments work?
A: A geriatric assessment does two major things. It looks at the whole person. And it focuses on that person's functioning -- on what they can do. Can they dress themselves, walk, get to the bathroom? Can they cook meals? Take a bus downtown? Balance their checkbook?
An outpatient geriatric assessment is typically 11/2 to two hours and conducted by an interdisciplinary team. A social worker or a mental health professional will ask about the person's family situation. Are they living alone? Do they have support? A nurse practitioner will look at physical function. And a physician will go over medical concerns and examine the cognitive performance of the individual. Then, the team pulls all these pieces together to look at what's going on with that person.
When someone starts being frail -- having consistent difficulty doing things -- an assessment of this kind is often a good idea.