Friday, February 21, 2014

ISO A More Practical Way to Define Geriatrics

As I mentioned in my last post about health and aging, I've found over the past few years that many people aren't quite sure of what geriatrics is, or how a geriatric approach might be relevant to their work in health or in aging.

This is understandable. After all, the term "geriatrics" is not widely used outside of healthcare. And even within healthcare, many doctors believe they are practicing geriatrics...when in fact they are just taking care of the elderly, in much the same way as they would take care of any adult.

And herein lies the rub. Geriatrics is not just about taking care of the health of aging people, it's about how you provide such care.

The problem with explaining geriatrics as the health care of aging adults -- or older adults -- is that this definition is vague about what is different about this form of health care, and why it needs to be different.

So, I've been trying to find a way to be more specific about what geriatrics is, as I write for family caregivers and for the tech community.

Here's how I explained geriatrics to an audience at the recent Health Technology Forum event about older adults.

A More Specific Definition of Geriatrics




























I then presented a list of "issues that come up as people age." This list emerged as I thought through two questions:
  • What kinds of problems are very common when it comes to the healthcare of aging adults?
  • What kinds of things trigger the need for a "geriatric approach"? By which I mean, what kinds of issues require healthcare professionals to provide care that is different from what we provided to people when they were younger?





























Now, we could of course come up with still more issues that prompt a need for a geriatric approach, such as limited life expectancy. But for now, I'd say the five issues I list above are the underlying drivers of most of what I do as a geriatrician.

Who needs the geriatric approach? Who should practice the geriatric approach?


Here's a message that I really think we in geriatrics should try to get out to the world:

Geriatrics is NOT just for geriatricians. (Or other specially trained health professionals, for that matter.)

To assess people for these issues, and to modify our help accordingly, is something we should all be doing, if our work is to support the health and wellbeing of others.

And many, many people are affected by the age-associated issues above.

In fact, most of these issues are not caused by old age per se. These issues affect a sizeable minority of younger people, often due to serious medical problems.

And even when these problems are brought on by "aging" -- by which I mean a combination of gradual wear and decline in the body's system, along with accumulating damage from less healthy lifestyle factors such as smoking, diet, and stress -- it should be obvious that different people develop these problems at different ages. 

Some unlucky people need a geriatric approach to healthcare as early as age 55. Others don't. They are relatively unscathed even to age 95, and continue to live their lives much as they have done, although they are surely quite vulnerable in body and mind (which is why the prescribing of certain medications should be avoided, for instance).

What should we call these "things that happen as people get older"?


This question has been stumping me a bit. Physiologic vulnerability, multimorbidity, functional impairments, geriatric syndromes, chronic caregiver involvement: they are really influential when it comes to the health and healthcare of aging adults, but they are not exclusive to older age. (Well...maybe the geriatric sydromes are.)

So I'm not sure what to call these issues. Ideas?

If you have feedback or suggestions as to how we can explain the geriatric approach, so that others can leverage it and implement it more widely, I'd love to hear from you in the comments below.








4 comments:

  1. Hi Leslie,

    This is a really interesting and challenging question you raise. It feels a bit to me like (yet another) symptom of two tremendous challenges we face in America:
    (1) most people really mean 'sick-care' when they use the term 'healthcare' - this is especially true in the "healthtech / innovation" crowd, since VCs fund and there's profit in sick-tech, e.g. drugs, tests, gadgets that can be patented, etc.
    and
    (2) we are very unwell in America today.

    I just heard a Pediatrician speak last night and he told the (health professionals) crowd how taking a History today is dramatically more peppered with issues than it was 20 years ago (e.g. grandparents died of heart disease, cancers, parents and siblings and cousins with allergies, asthma, ADD, etc. etc.).

    My grandmother, nearly 97, is clearly experiencing 'life issues' (in an assisted living facility, with less independence, fear of falling, so with a walker, ankles and feet swelling (perhaps from her meds), etc.)

    My mother (her daughter), who died at 66, was clearly experiencing 'health issues' (manifested in colorectal cancer, then of course fall-out from chemotherapy, radiation and surgeries).

    But I don't really separate the two. Life is Health. Health is Life. Unfortunately, the tech crowd is driven by 'innovation' and 'progress' and 'profit' motivations, where these subtle differences are insignificant.

    It's interesting to me that some Acupuncturists I know in NYC see 'patients' from 2 years old to 92 years old. I think the Traditional Chinese Medicine mindset is more about Balance=Health=Life and that's true every day one's alive on this planet... I assume treatments vary, but optimal vitality is always the goal, whether that's about reducing pain/inflammation/stress or nurturing spirit/awareness/acceptance to the life stage one's in.

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    1. Hi Elizabeth,
      Thanks for this comment.

      Hm, well, in truth when I listen to the tech innovators I feel that they are actually much more interested in prevention and "wellness" than in helping people who are already chronically afflicted by health problems. And when they are interested in a chronic illness, they tend to focus on just that illness. Whereas most older adults have multiple chronic illnesses. (But maybe I am mostly noticing those with a consumer-facing focus; serving healthcare providers is a whole other ballgame.)

      I think the pediatrician's comment reflects the fact that prevention and wellness have become much more complicated, because we have so much information to consider. What we know about health & wellness keeps mushrooming, plus now we are able to collect astonishing (and growing) amounts of personal data. No one knows how to keep up with this.

      My own interest these days is in how we help those older adults who need a modified form of healthcare. Many can be considered chronically "sick" yet there is lots that can and should be done to optimize their wellbeing, their quality of life, and to prevent/delay complications and decline.

      Your grandmother is having life issues, and they track back to underlying health conditions. In many cases such as hers, there are things that could be done to optimize those health conditions.

      This in itself isn't sufficient, of course; should be done along with addressing spiritual, social, emotional, relationship, and other angles too!

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    2. I think data overload is a very real and painful problem - for both providers and consumers. And yes, there are a lot of apps and gadgets focused on prevention and 'wellness', but they add to that data overload problem, and usage drops off...

      Re: geriatics and aging - I wonder if part of the problem is that now we talk about the chronically ill in such a negative way in the US (e.g. "they make up 5% of pop but cost us 30% of the total medical bill" <<< not sure of the numbers, just by way of example), plus the ACA creates more political finger-pointing re: subsidies, etc... so it's a very delicate area that people are afraid to focus on - at all, let alone holistically. Thus the medical community still speaks in terms like multimorbidity, etc. but the 'innovation' community is sort of scared to address that population...

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    3. Interesting thoughts!

      Well, I think many of the current problems re people not paying enough attention to "geriatric" issues predate the ACA. But it's possible that raising the premiums of younger healthy people to subsidize the care of those with more needs could reinforce a negative attitude towards aging people.

      I find that people do often bring up personal responsibility and wellness when chronic illness comes up. I was truly surprised when someone started on this line of talk at an event about caring for an aging population.

      I think if a group of people are costing 30% of the medical bill, that means we need to help them, not demonize or marginalize them. I can see why the public may not have much sympathy for helping substance abusers (that's not to say I agree or disagree w the public, just that I get it). But why be hostile to aging adults, when so many of us have aging adults in our lives. They are people just like us, only older.

      In truth I've assumed people ignore geriatric issues because they aren't "sexy", the associated marketing to consumers is challenging, and the challenges of getting it right are dizzying. (Medically tough, reimbursement is tough, regulation issues tough.)

      Thanks once again for your comments.

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