Principles of Geriatric Care
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.
1: Sudden change comes from sudden
(or Alzheimer's disease does not begin overnight)
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.
2: Gradual decline may not be
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.
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.
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 &
Principle 7: There is ALWAYS something that you can do to
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
How is your
left knee? I replied.
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.
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
Dr. Stall's Home Page - Dedicated to
Geriatrics and Hospice Care
Copyright 1997-2006 Robert S. Stall,
Copies or reprint permission may be
requested in writing from Stall Geriatrics, 68 Stonington Lane #6, Getzville,