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June 2008 – Meeting the Needs of Older Adults
The natural process of aging brings about many changes in general health, physical functioning, psychological health, cognition (the ability to think, reason and perceive) and lifestyle. These changes progress at different rates for each person.
Disease and disability are much more common in people over age 65, and it’s not unusual for older adults to have multiple health problems. When specialized care is needed, primary care physicians may refer certain patients to a geriatrician, an internist who specializes in the diseases and care of older adults.
| In the Froedtert & the Medical College of Wisconsin Senior Health Program, Medical College of Wisconsin geriatrician Paul Hankwitz, MD, sees many patients who have complex health problems. Dr. Hankwitz also works with primary care physicians (internists and family medicine physicians) who refer their older patients to him, and sees patients for second opinions. |
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Dr. Hankwitz works in collaboration with the Froedtert & the Medical College Mind, Memory and Mood Clinic. Both are located in Community Memorial Medical Commons at North Hills, in Menomonee Falls, complete with on-site laboratory and imaging services that support both programs.
“Comprehensive health care for older adults is aimed at maximizing physical, cognitive and psychological functioning, with a goal of helping people stay as healthy and independent as possible,” Dr. Hankwitz said. “There are many special health issues — called geriatric syndromes — that are unique to older adults,” Dr. Hankwitz said.
Geriatric SyndromesA geriatric syndrome refers to a symptom or a group of symptoms that occur often among older adults and affect their quality of life. The term describes conditions that may have various causes such as dementia, falls, dizziness, incontinence and frailty. It’s not unusual for someone to experience two or more syndromes at a time.
“Many underlying factors tend to contribute to geriatric syndromes,” Dr. Hankwitz said.
For example, a patient’s major complaint — “I fall a lot” — usually does not represent one specific problem that the patient has. Falls may be caused by many factors, such as certain medications, impaired vision, a physical disability, cognitive deficits, arthritis, muscle weakness or another disease or other factors.
Dr. Hankwitz will conduct a thorough evaluation to search for the cause or causes of the patient falling. The evaluation includes treatment for the cause, a risk factor assessment and recommendations to reduce the risk of future falls.
Comprehensive EvaluationDr. Hankwitz conducts a thorough examination to determine the cause of problems, with a goal of maximizing physical, psychological and cognitive functions, which correlate with quality of life. Screening and counseling recommendations include:
- Comprehensive medical, family and social history that includes the patient’s physical activity level, alcohol and tobacco use, medication use, driving ability, urinary incontinence, living environment and social support. Family members are encouraged to accompany patients to help fill in gaps.
- Comprehensive physical exam and testing that includes taking blood pressure, weight assessment, hearing and vision screening, gait and balance assessment.
- Referral for cognitive testing for patients with memory concerns or functional impairment
- Referral for psychological testing for patients with anxiety/depression and other psychological problems
- Lab work to test lipid levels (for patients at risk for coronary heart disease), test for diabetes, test thyroid function, etc. (varies with each patient)
- Bone density for osteoporosis for women age 65 and higher)
- Testing for abdominal aortic aneurysm or AAA, for men ages 65-75 with a history of smoking or family history of AAA requiring repair (one-time test)
- Cancer screenings for colorectal, prostate, breast and cervical cancer (depending on sex, age and medical history)
- Immunization updates (may include tetanus-diphtheria booster, flu vaccination, pneumococcal vaccination and the new herpes zoster vaccine to prevent shingles)
- Health maintenance recommendations such as the use of aspirin for the prevention of coronary heart disease and stroke, and calcium and vitamin D supplements to prevent osteoporosis.
Following the evaluation, Dr. Hankwitz meets with patients to review test results, provide patient education and reinforce care recommendations. As needed, he refers patients to other care providers, such as a social worker to address living arrangements, a cardiologist for heart concerns or a gynecologist for a pelvic exam.
Medication Review“One of the biggest issues for older adults is polypharmacy — the taking of multiple medications,” Dr. Hankwitz said. “Some patients take as many as 10 to 15 medications, and we often see the symptoms of medication interactions. It’s not unusual for a person taking seven or more medications to have some form of adverse medication reaction. Patients may get prescriptions from different physicians and have them filled at different pharmacies, without any one care provider seeing the entire picture.”
Dr. Hankwitz carefully reviews each patient’s medications, paying careful attention to drug-drug and drug-disease interactions. A drug-drug reaction occurs when one drug interacts with another drug the person is taking, resulting in an unexpected effect. A drug-disease reaction occurs when a drug that is helpful for one disease is harmful for another disease the person has.
“Patients are urged to bring all of their medications when they come for their appointment,” Dr. Hankwitz said. “They should also carry a list of their prescriptions and over-the-counter medications with them at all times.”
Advance DirectivesDr. Hankwitz also advises patients to complete advance directives — a living will and a healthcare power-of-attorney document — to fulfill their end-of-life wishes. “It’s important for everyone — young and old — to indicate their preferences for future healthcare while they have the ability to do this,” he said.
Author: Marla Fraunfelder Date: June 1, 2008 Online Editor(s): Christopher Sadler
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