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See a Specialist
What do you expect at your age?" That's how doctors used to dismiss elderly patients' complaints about maladies like joint pain, fading eyesight, sexual dysfunction, memory glitches, chronic pain, lack of energy and a glum outlook on life. Today, that comment would be a signal to take off that paper examining robe, climb into your clothes and get another opinion — from a doctor who specializes in the medical, psychological and social problems of the aging. These specialists, known as geriatricians, don't offer miracle cures, "but function can often be improved," says Dr. Christine Cassel, who oversees the Henry L. Schwartz Department of Geriatrics and Adult Development at Mount Sinai Medical Center, the first hospital in the nation to set up a department of geriatrics. "If diseases are not curable, that doesn't mean you can't help patients," Cassel says. "You can make them feel better mentally and physically, and you can make them function better. But it often takes an expert to identify what's wrong." Geriatricians are internists, family-practice physicians or psychiatrists who have taken a fellowship in geriatric medicine. They then must pass an examination to earn a Certificate of Added Qualification in Geriatric Medicine, which means they're "board certified" in this subspecialty. It's a new field. "Most medical schools — Mount Sinai is an exception — don't teach much about the special issues in aging," Cassel says. "Still, the elderly can get good care without going to a specialist as long as their physician keeps up with modern medicine and reads the literature." If you want to stay with your doctor but would like to consult a specialist, "Don't say, 'I'm leaving you.' Just say, 'Let's get another opinion,'" Cassel suggests. "Many geriatricians will do consultations and send a letter back to the patient's regular physician." A geriatric examination takes about an hour and a half. It includes a physical exam and a thorough medical history; the doctor asks about every bodily system to find out how the patient functions day to day. "Despite the stereotype, older people are not complainers," Cassel says. "A doctor may have to ask the patient about his digestion before he'll admit, 'Oh, I have a pain in my belly.'" The consultation is usually a team effort, involving some combination of doctor, social worker, nurse, physical therapist and pharmacist. "Social workers are essential partners. They know everything about the community resources available to help old people," Cassel says. Geriatricians understand the problems of "polypharmacy" — the taking of many different medicines. "Older people metabolize drugs differently than younger people do, and they're more susceptible to adverse effects from the medicines they're taking," Cassel points out. "Sleep disorders and confusion that looks like early Alzheimer's can be a result of polypharmacy." Depression is another condition often missed by physicians who don't have expertise in geriatrics. "Sometimes doctors will say, 'At your age, it's not
worth doing cardiac surgery, or surgery for a spinal problem or a hip
replacement, because the risks are too great.' But they may say that
because their hospital doesn't have a lot of experience doing surgery on a
90-year-old," Cassel says. (This, of course, is exactly the kind of
experience a geriatrician does have.) FOR ALZHEIMER'S CAREGIVERS The 17th annual Mayoral Conference on Alzheimer's Disease (Nov. 2 at the Hilton, Sixth Ave. and 53rd St.) updates professionals and caregivers on the latest medical advances and offers 11 workshops aimed at making caregivers' lives less difficult and stressful. (There's also a workshop in Spanish.) Topics include "Early Stage Alzheimer's: Families New
to the Disease," "Late Stage Alzheimer's Caring With Comfort
& Compassion" and "Enriching the Alzheimer's Person's
Life." The cost for caregivers is $50 (scholarships available). To
register, call (212) 442-3086. |
