Seniors in the Office: A Tailored Approach

In their day to day work, Physicians see a variety of patients from all walks of life trundling through their doors. Young, old, rich, poor and every in-between, health is often the common unifier that brings citizens together under a singular banner. It knows no recession, price-range or tax bracket, and it's a necessary amenity for everyone. However, new research suggests that physicians will soon see a very specific demographic in larger numbers than ever before: the elderly.

An Amednews article cites a recent gerontological survey which suggests that in the next two decades, the population of seniors will increase drastically, accounting for nearly 1/5 (20%) of the American population. What's prevalent to physicians here is the fact that senior citizens are, on average, twice as likely to make a visit to the doctor's office than are younger citizens. In fact, The National Center for Health Statistics posits that seniors are among the most heavy users of doctors offices, averaging roughly 7.4 annual visits versus the 4 annual visits of the general population. The number is exceeded only by babies younger than one year old, who visit a doctor 9.4 times annually.

Seniors Online
These stats hardly qualify as "ground-breaking news" though. Natural aging requires more vigorous upkeep, and physicians know this...however, certain nuances in the growing senior population should have physicians taking notice. For starters, the nature of senior communication is changing. In her article Older Patients Join Crowd Consulting Dr. Internet, Pamela Lewis Dolan touches on a survey by the Pew Internet & American Life Project. The survey of 2,870 adults finds that more than half of the senior population was already online regularly, and half of this population is willing to implement the internet to manage their health. This new trend helps dispel a prominent myth that seniors are averse to integrating technology when it comes to handling their day to day tasks.

If the online development seems uncharacteristic for the elderly, it shouldn't be. Aging baby boomers want to take the reigns when it comes to their health, and any opportunity to manage it on the their own terms and accord is a positive step forward. "It's also possible that many seniors who weren't interested in online communication are changing their minds, whether they're baby boomers or not," says Hardeep Singh MD, MPH assistant professor of medicine at the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston.

So what does this mean for physicians? It means they can catch the zeitgeist and steer the tide. When physicians show excitement about communicating online, patients will follow suit, and the elderly are no longer an exception. Physicians should routinely check with their patients (annually if possible) about a patient's preferred mode of communication, and shouldn't be squeamish about inviting seniors to use the internet to communicate. For example, physicians can direct patients to trusted healthcare sites, and for both urgent and non-urgent matters, they can open up internet channels for physician-patient communication. It gives seniors another arrow in their quiver in the push to fortify public health in an avenue that didn't exist before.

In the Office
Still, these are just trends, not catch-all rules. Not every senior will want to take their health management online, and so in-office communication is of the most vital importance. In the case of seniors, this level of communication should be tailored exactly to their needs, and a general "one size fits all" approach to in-office discussion shouldn't be applied.

The Center for Disease and Prevention estimates that roughly 2 out of three seniors struggle to understand information that's given to them by a physicians, for various reasons. The organization has even set up a comprehensive outline and course of action for physicians to take when interacting with the elderly. Some of these pointers are as routine as minimizing background noise, keeping arms and other non-verbal indicators to a minimum, limiting technical jargon, using pictures and diagrams to emphasize key-points and providing patients a clear view of moving lips when speaking to them. Others are more in-depth, like assessing a patient's cognitive faculties throughout a discussion, providing follow-up questions to check understanding and having patients repeat back pertinent information after receiving it.

Through it all, tact is the most important here. While it's certainly not outlandish to assume an elderly patient needs additional assistance (roughly 36 million Americans have hearing loss, 47% of them in the "elderly" range), physicians must do their best not to appear as if they're condescending. According to Janet Schick, PhD one of the most pressing consequences of hearing loss isn't actually the loss of sense, but the feelings of isolation that accompany it. Any effort to make an elderly patient feel included in the discussion is a worthwhile one.

Slow and deliberate speaking with an air of exasperation can be interpreted as patronizing, and the unpleasant interaction can quickly "turn patients off." Instead physicians should be aware of patient's status as seniors, and seamlessly integrate a customized approach to caring for them into their routine. Subtle changes like good lighting, attention to sentence structure, open-ended questions, genuine listening and (where applicable) a good understanding of a patient's cultural beliefs and values goes a long way in forging a good partnership. "A patient emerging with full info and a sense of trust in their physician could make the difference between life and death," says Jake Harwood, a professor in the department of Communications at the University of Arizona in Tucson, and an advisory board member who oversaw the Amednews gerontological report.

At Risk Scenarios
It's not just about rapport. Besides simply maintaining good working relationships, customized senior interaction becomes crucial regarding seniors' different safety needs. Kevin B. O'reilly cites a report by the New England Journal of Medicine that profiles more than half a million preventable drug-related injuries which have occurred among elderly outpatients annually. Most shocking is that 25% of these injuries can be attributed to poor drug packaging and labeling.

A prescient need for re-structuring medical care for elderly and medicare patients is highlighted by the fact that four kinds of commonly prescribed drugs (Warfarin, Insulins, Oral hypoglycemic agents and oral antiplatelet agents) account for 70% of preventible drug hospitalizations for seniors. The tricky part of the scenario is that physicians often prescribe these drugs to seniors out of necessity, because of aging's effects on the body.

Experts agree there's no quick fix panacea, but an intensive safety approach and that includes "an appreciation of older patient's physiology which differs from that of younger patients," can make great strides in reducing preventable disasters (Sharon Brangman, MD, Managing 4 Risky Drug Types Sending Seniors to the ED). Senior's bodies don't clear drugs from their systems as quickly as younger patients and when they do it's at a much lower rate. This dynamic increases the risk of overdosing dramatically. Additionally, unpredictable dosing reactions can also throw a senior's system out of whack in ways a younger person's wont. Resilience to changes also decreases with age.

In many ways, the role of a physician treating a senior is analogous to that of a pediatrician. With any prescription, physicians need to actively monitor dose responses with regular checkups. Physicians should keep an extensive and accurate list of medications for each patient (this reduces contraindications) and earnestly counsel patients to report significant side effects after the visit. Educating patients can be the most difficult element, in some cases taking upwards of an hour, but the additional time spent gearing a senior patient for a new prescription is much better than emergency difficulties that could come down the road. An ounce of prevention equals a pound of cure.

The Future for Seniors
As the human population only gets older and seemingly wiser, physicians must actively account for the changing of the guard. By making specific preparations for the elderly, and by constantly refining and re-evaluating their in and out of office techniques and the sun not much brighter, but actively preparing for a specific swath of patients not only enhances the efficacy of a practice, but fosters greater health and security for everyone passing through.

References
Dolan, Pamela L. "Older Patients Join Crowd Consulting Dr. Internet."
Amednews.com. American Medical Association, 22 Oct. 2012. Web. 11 Nov. 2012. .

Graham, Judith. "How Often Do Americans See Doctors?"
Triage. Chicagotrubune.com, 6 Aug. 2008. Web. 11 Nov. 2012. .

Krupa, Carolyne. "Gerontologists Outline How Doctors Can Bridge Communication Gap with Older Patients."
Amednews.com. American Medical Association, 29 Oct. 2012. Web. 11 Nov. 2012. .

O'reilly, Kevin B. "Managing 4 Risky Drug Types Sending Seniors to the ED."
Amednews.com. American Medical Association, 1 Oct. 2012. Web. 11 Nov. 2012.