"I'm thirty... until I look in the mirror"
Mrs. Hill is an 85-year-old nursing home resident. She has lived in the facility since advanced heart disease made it impossible for her to live independently. Her adult children feel that life in a nursing home must be a nightmare for her. They want to do something, but they don’t know what. Moving her to one of their homes isn’t an option—and visiting her makes them very depressed. One day, her doctor decides to chat with Mrs. Hill about life in the home. She tells him that this is one of the best times of her life: People prepare and deliver her meals, she has a comfortable room with a view of the gardens, and the place is very peaceful. Mrs. Hill is quite happy and has no desire to move.
As the song goes, “One man’s ceiling is another man’s floor,” and in the case of Mrs. Hill, a life her children might find unacceptable is, in fact, just fine with her. What is intolerable to a 40-year old may be fine for a 90-year old. The only way to learn what is acceptable and what is not is to communicate directly with a person and his or her caregivers.
In the last century, the nature of old age has changed dramatically. In the early 1900s, the average life expectancy was about 49 years—today, it is nearly 80 years. With the good news of longer life, however, comes the sobering news that most older people will live for years with one or more chronic condition, requiring ongoing reliance on physicians and the health care system.
No single characteristic describes an older patient. Each person has a different view of what it means to be old. Many say that they don’t feel old or forget that they are old until they look in the mirror. A 68-year-old woman with an active consulting business is likely to deal with a visit to the doctor quite differently and require a very different approach than her frail 88-year-old aunt who has rarely ventured beyond the neighborhood where she has lived her entire adult life.
The perspectives that follow are common enough among older people—and important enough to effective communication—that you should be especially aware of them.
Views of Physicians
In the past, older people have held doctors in high esteem and treated them with deference. This may change as aging “Baby Boomers” are likely to take a more egalitarian and active approach to their own health care. Still, many older people do not want to “waste the doctor’s time” with concerns they think the physician will deem unimportant. They do not ask questions for fear of seeming to challenge the clinician. On the other hand, some older people, having ample time to read, will bring popular medical articles to the attention of their physicians. Try to view this active patient participation as cooperative.
Ageism can work both ways. Older people may unwittingly assume the stereotypes of old age. Expectations regarding health diminish with age, sometimes realistically, but often not. Older people with treatable symptoms tend to dismiss their problems as an inevitable part of aging that do not require medical care. As a result, they may suffer needless discomfort and disability. They may not even seek treatment for serious conditions. The process of aging may be troubling for older adults who once bounced back quickly from an illness or who were generally healthy.
Patients may be afraid that their complaints will be dismissed as trivial or that if they complain too much about minor issues, they won’t be taken seriously later on. Some older patients don’t mention symptoms because they are afraid of the diagnosis or treatment. They may worry that the physician will recommend surgery, suggest costly diagnostic tests or medications, or tell them to stop driving.
Aging “Baby Boomers” bring different expectations, experiences, and preferences to aging than did previous generations. Their needs vary from their parents’ generation. People between the ages of 50 and 64, for example, are more likely than those over the age of 65 to want to participate actively in health care treatments and decisions, take complementary or alternative medicine, and search the Internet for health information.
Values About Health
Although physicians typically focus primarily on diagnosing and treating disease, older people generally care most about maintaining the quality of their lives. They are not necessarily preoccupied with death. In fact, many older people have become relatively comfortable with the prospect of death and seek chiefly to make the most of their remaining years. Younger family members, who commonly must make life-and-death decisions when an older person is incapacitated, may be unaware of the patient’s views and preferences.
<< Back | Next >>
