Health care changes as we age

Published Sep 30, 2018 at 9:00am

If you or someone you love is getting older and frail, be sure the doctor is right for you. There are two specialties which may be perfect for those who need a lot of extra attention.

One is a Geriatrician and the other is a Palliative Care Specialist. 

A geriatrician is a physician, usually a family practice doctor, who specializes in caring for elderly patients. These specialists usually work in teams, with nurse practitioners. They can work along with the patient’s regular doctor or take over. 

As we reach the elderly part of our life, many of us have high blood pressure, cardiac disease, lung disease, diabetes, etc.

Managing patients with multiple problems may require a specialist and also someone who is patient and understanding. Treatment is a little different for older folks – perhaps not as aggressive. Some medications may be cut back as we age.

We may also require help. We may need someone to come in a few hours every day, to stay at night, or even around the clock care. Your geriatrician will help the whole family deal with these issues. Can the patient still drive? Does he or she need a wheel chair or a walker? Does she need an alert button in case she falls? Does she need Meals on Wheels?

Geriatricians are also involved in helping older persons who need to change their living arrangements. They understand assisted living and skilled nursing and will guide patients and families through the process of being placed in such a facility. He or she may then continue to follow the patient and guide their care.

The second specialty is the Palliative Care Specialist. This is also a team approach with several doctors and nurse practitioners keeping an eye on patients. Palliative care is necessary when a patient is not expected to recover from a fatal illness. This may be caused by cancer, heart failure, stroke, chronic obstructive pulmonary disease, kidney failure, Alzheimer’s disease, etc. Each of these conditions causes specific symptoms such as pain, shortness of breath, or psychological problems. 

Hospice and Palliative Care is the local agency that cares for patients with a terminal illness. Insurance covers Hospice care and this organization will continue with many of the issues discussed above in this article. 

A palliative care team or the Hospice team will treat the symptoms to make the patient comfortable, understanding that there will not be a cure. There are many issues for dying patients. One is the diet. A special diet may be needed, so that the patient can swallow. If the swallowing mechanism has failed, the patient will need to be tube fed. This can be done at home, or perhaps in a nursing home. Such a patient may also be incontinent, requiring round the clock toileting and diaper changing. 

Pain is often a symptom, late in life. The general rule is to try to use non-opioid pain killers such as ibuprofen. If that is unsuccessful, mild opioids should be tried, and at the end of life the patient may be given strong opioids such as morphine to relieve pain.

You may feel that you or a loved one needs to see one of these specialists. Your family doctor may suggest a specific doctor. Locally, Hospice and Palliative Care can advise on these issues. Call them at 315-735-6484.