Excerpt: 'Treat Me, Not My Age'


Invariably, after I give my geriatrician-versus-gerontologist spiel and folks understand that I'm a "real" doctor, they ask a series of predictable questions. "How old do I have to be to see you?" or "How old is geriatric?" usually comes first. This is, in fact, the central metaphysical question in geriatrics, and since metaphysics contends that the universe is relative, I'll provide a relative answer: It depends.

Let me explain. Needing a geriatrician is partially about age but mostly about function. In my practice I have ninety-year-olds who are going to work on a daily basis, and providing care for them is very much like doctoring a fifty-year-old. But visit just about any nursing home in America and you'll find fifty- and sixty-year-olds who have been rendered impaired by diseases like multiple sclerosis or stroke, and caring for them is very similar to caring for frail ninety-year-olds. So there's really no age at which you become geriatric. If you're young or old and have many chronic diseases and functional problems, geriatricians are probably for you, but we're also delighted to see older patients who are doing well and are trying to avoid frailty. As one of my patients in her early sixties likes to say, "How old is geriatric? The older I get, the older it gets!"

Another question I'm frequently asked is whether I'm a primary care physician (like the doctor you see for your annual physical or when you have a cold) or a consultant (like the doc you see for a one- or two-shot deal when you have a specific problem, like an orthopedist for a broken bone or a bad shoulder). Answer: both. Most geriatricians provide primary care to older adults and see them annually or more frequently as the need arises, but we're also called on by patients, families, and other doctors to help with specific problems and questions like the following:

Is my memory loss normal for my age?

Am I taking too many medicines?

Why is my mom falling?

Is my hospitalized patient confused from medications, or is it another problem?

Can Dad really live alone safely without help, or am I just being overprotective?

And finally, while we're dispensing with questions I'm most frequently asked, let me also deal with the ever-present, morbid end-of-life question: "Doc, it must be tough dealing with only dying patients. How do you do it?"

Well, first of all, the only people I know who are not dying, at whatever speed, are already dead.

Do I deal with end-of-life issues in my practice? Sure. But I prefer to frame it another way: While I certainly have expertise in hospice and palliative care, I am much more interested in how people live during the last years of their life on this planet, however long or short those years are. I have absolutely no interest in extending life expectancy to the extent that people are living and breathing but unable to do the things that mean the most to them. Those nursing homes with a smattering of prematurely disabled fifty-year-olds that I just told you about? Far more common are tenants aged eighty, ninety, and beyond, who have very limited quality of life. I would argue that the "life extension" these people have experienced -- a good deal of it a result of technology -- is as big a failure of medicine as any forty-year-old dying of breast cancer or fifty-year-old perishing from a heart attack.

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