Key Principles of Geriatric Care


by Robert S. Stall, MD


It is very important that older adults, their families, friends and health care providers understand several key concepts to ensure that older adults receive timely & appropriate health care services and advice.


Principle 1:  Sudden change comes from sudden problems

(or Alzheimer's disease does not begin overnight)

An older person that suddenly becomes confused‑‑but was alert and oriented the day or week before‑‑is having an acute problem such as an infection, medication side effect, stroke or even a heart attack. These and many other acute problems can be treated effectively if diagnosed properly and in a timely manner.  An older person often has unusual or subtle symptoms. Confusion may be the only symptom of a heart attack in an older person. A younger person would be more likely to experience the classic symptoms of chest pressure and arm pain.


Principle 2:  Gradual decline may not be Alzheimer's disease

Alzheimer's disease symptoms develop slowly. However, there are many other problems that develop slowly and may cause gradual decline. An overactive or underactive thyroid, vitamin B12 deficiency, poor nutrition, Parkinson's disease and depression are examples. Symptoms from these usually develop slowly and may mimic Alzheimer's disease.  Loneliness and social isolation can also cause gradual decline. Improved transportation, hearing aids or glasses, joining a health spa, volunteer work, kind words of reassurance or a big hug now and then can all have a remarkable therapeutic effect.


Principle 3:  Medication use in the elderly is a major drug problem in America

Many older people see several doctors, each of whom may prescribe different medications. These same people may also use over‑the‑counter medication regularly. They may even get their medications from more than one pharmacy, or from friends. It's not hard to see how medications may pile up and how difficult they may be to track. Even one drug that's not right for a person can impair function and decrease enjoyment of life. Imagine what five‑‑or ten, or fifteen‑‑can do.  Older adults should make sure their doctors know about all medications they are taking and question doctors about prescribed drugs. Are they necessary? What side effects should I watch for? Are they safe to take with my other medications? The doctor should also know about alcohol, cigarette and coffee use.


Principle 4:  Ageist attitudes are harmful

What do you expect at your age?  You're not getting any younger!  Do these statements sound familiar?  They are unjust generalizations and prejudicial statements that assume all older adults naturally become weak, sick and forgetful. Older people get sick from disease, not "old age".


Principle 5:  Seek and treat dis-ease, not only disease


Principle 6:  Strive to maximize quality of life & functional ability


Principle 7:  There is ALWAYS something that you can do to help!


A Story to Remember


I once saw a patient who was about to turn 100 years old. She had pain in her right knee. I asked what she thought was wrong.


What do you expect at my age?  she asked, shrugging her shoulders.


How is your left knee?  I replied.


Just fine, thank you she answered.


Then why doesn't your left knee hurt? Isn't it the same age as your right knee? I said.


She smiled too and understood what I meant.


Think about it.  Often.  I do.  It keeps me on the right track when I try to help my older patients.  Don't sell older people short. There is always something that can be done to help an older person lead a happier, more functional life, even in extreme old age.

For more information, or if you have comments or questions, please contact:

Robert S. Stall MD, 68 Stonington Lane #6, Getzville, NY  14068

Phone 716-636‑7531FAX 1-888-387-1238

Dr. Stall's Home Page - Dedicated to Geriatrics and Hospice Care

Copyright 1997-2006 Robert S. Stall, M.D.

Copies or reprint permission may be requested in writing from Stall Geriatrics, 68 Stonington Lane #6, Getzville, NY  14068.