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Getting a Grip on Geriatrics : Older Patients Urge the Medical Profession to Prepare for the Aging of America


A common gripe among older Americans is that, too often, when they talk to a doctor, what they hear is: "It's just old age."

--Dr. Kenneth Brummel-Smith, USC School of Medicine

Jerald Hoover, 71, remembers that it began two years ago.

"I had been in perfectly good health, and then one day I started to write a note to my son, and I had difficulty beginning simple words. A few days later, after I had finished a round of golf, I couldn't add up the score properly.

"I didn't know it at the time, but they were signs of a stroke."

Soon thereafter, Hoover, of Hacienda Heights, happened to be scheduled for his annual physical, and mentioned to his family physician of 15 years what had happened. The doctor suggested that he also see a neurologist, whose tests turned up the fact that the patient had suffered a minor stroke.

Things went downhill from there, Hoover said: "The neurologist put me on medication in addition to what my own doctor had put me on. Looking back, I was being over-medicated, but didn't realize it."

Over-medication is but one of the complaints of older Americans in their relationships with physicians. And doctors, for their part, justifiably feel that seniors could often do more to help at this time of their lives when health problems are so common.

And all of this happening while the nation's population grows increasingly older.

As Dr. Edward Schneider, dean of the Andrus Gerontology Center at USC, has repeatedly told his colleagues: "Officially or unofficially, you will be in geriatrics by the end of the century. Unless you are a pediatrician or an obstetrician, the average age of your patients in the year 2000 will be 65 or over." In anticipation, curricula at medical, dental and pharmaceutical schools are being revised to add more hours dealing with the medical aspects of aging and older Americans.

But as of now--although physicians increasingly are more sensitive to the special needs of seniors--everything isn't what it could be. As Hoover can attest:

"There should be more communication between older people and their doctors. I was taking six different medications. If only my doctors had said: 'Look, you've had a minor stroke. The consequences will be as follows. The medicine you are on will do this to you. And also you are apt to become depressed.' "

Instead, Hoover was confused at what ensued: "I found that I didn't give a damn about anything. I no longer wanted to play golf. I tried to read and I couldn't. I had insomnia. I didn't want to talk to anybody. I just wanted to lie around the house."

Then came two dreadful days, about seven months after he had gone for his physical, when Hoover reached the point where he went entirely without any sleep --even 10 minutes. "I told my wife, 'I've gotta get some help.' She drove me to a hospital, to the emergency section, and I overheard a nurse say: 'This guy says he can't sleep!' "

But he was admitted for two days, and sleep eventually returned. After that, his wife, Betty, enrolled him in a stroke therapy class at another hospital. It was there that he heard about the Clinical Gerontology Service of Rancho Los Amigos Hospital in Downey.

"When I went there, one of their first moves was to take me off all medicines except two--and those two were gradually tapered off and eliminated. Now I feel great.

"I learned that I had been over-medicated. Not only had my previous two doctors apparently not been communicating with each other, they certainly weren't telling me anything, not anything I could understand. Whenever I visited them, I got the impression they didn't want to see me."

Hoover now has new doctors, and offers this advice to other older Americans:

"Get answers to any questions you may have. If the doctor can't or won't give you an answer, get another doctor. In my case, I would very much have liked to know more about my stroke, the effects of the medication, and what I could do to prevent another one.

"The older you get, the more you should question things. After all, you know from experience that diagnosis is the greatest guessing game in existence. Don't let yourself be intimidated by your doctor."

Most physicians, however, are aware that the fact of aging may be a stress in itself. There is also a reality: "I'm certain that the more frail and debilitated the patient, the more difficult it is to convince that person of a significant future," said Dr. Morton Glassman of Tarzana.

Glassman, 61, who retired as an internist two years ago ("I was fed up with everything"), made another point: "Very often, older people put on the physician the disappointment they have to face for themselves."

But, he continued, "as an internist, you really are one on one. And I always wanted to do the best for any person, regardless of age. The objective of a physician is to restore you to the best health possible--and there shouldn't be any differentiation regarding age to achieve this medical ideal."

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