HEALTH CARE FOR THE ELDERLY - Full extract 

With a falling birth-rate and people living longer, it is inevitable that our community is ageing. It is no surprise that geriatric medicine, the medical care of the elderly, has quickly evolved into a major specialty. 

In recent years, general practitioners have been more exposed to health problems in the elderly, and better trained in their management. The medical journals carry a large volume of articles on looking after elderly patients, and regular seminars are available for doctors to keep up to date. 

Governments are also increasingly in tune with the needs of the elderly. They have established a national network of Aged Care Assessment Teams (ACAT), comprising medical and nursing specialists, as well as social workers, occupational therapists and physiotherapists. The ACATs liase with local doctors and other health professionals and assist with specific health problems. They also perform home visits and advise on how to help patients remain at home for as long as possible. This might require arranging various support services like respite care, day centre attendance, district nurse visits, meals-on-wheels, and home-help. Installation of hand rails in areas like the bathroom and toilet might also be necessary. ACATs will also assess patients' levels of independence and advise whether hostel care or nursing home care would be more suited to their needs. 

It is important for the elderly person to have a regular family doctor, someone who can detect changes in the person's health, treat the more common medical problems, and coordinate the person's overall health care. 

Some of the conditions that occur more commonly in elderly people are: 

Confusion. There are numerous causes. It might be due to an infection, such as pneumonia or perhaps a urinary tract infection. It could also be due to a slight stroke or perhaps a side-effect from medication. 

Memory loss. Although memory loss does occur with increasing age, it still affects only a minority of elderly people. Alzheimer's disease progresses gradually, usually over several years. The memory loss for recent events is more evident initially. A similar picture can occur after strokes. Any patient with memory loss requires a full assessment to make sure there are no reversible causes for the problem, for instance an underactive thyroid gland or a vitamin deficiency. It is also important to recognize depression in the elderly; severe depression can appear like Alzheimer's disease and yet be readily treatable if diagnosed. 

Loss of mobility. This might be due to disability from a previous stroke or perhaps arthritis. A major concern with mobility problems is the tendency to falls; injuries like fractured hips and wrists may result. Conditions like Parkinsons disease can also cause severe mobility problems. 

Continence problems. The various causes of incontinence are much better understood these days, due largely to the work of the Continence Foundation of Australia. Excellent brochures to assist patients with pelvic floor exercises are available, as well as some useful bladder training programs. For more difficult problems a specialist assessment can be arranged. 

Medication difficulties can be another major concern in elderly patients. There should be a clear hand-written list explaining exactly what medications are being taken, at what times, and for what reason. This should be kept with the medications. Day-by-day medication dispensers like dosett boxes can also be helpful. Whenever any elderly patient becomes unwell, medications should always be considered as a possible cause. 

Several new health initiatives have recently been introduced by the Federal government. One of these is a comprehensive health assessment with the treating GP for people over 75 years of age. It is an excellent idea because it allows time to check many areas that might not get covered in a routine consultation. Remember to book an extra long consultation and also bring along a urine specimen to the appointment.

Looking after an elderly person who is ill does put extra stresses on the family; the important role of carers should not be forgotten. 

I have had the privilege of looking after many elderly people over the years and they have taught me a great deal. I am sure we would all benefit if we found ways to help our older people direct more of their skills and knowledge back into the community. 

Health Tips:
* There are a number of specific medical problems that occur in the elderly. Sometimes a geriatric assessment will help to define these problems more clearly. 

* Continuity of care is very important for the elderly person. It is a good idea to develop rapport with a particular GP, someone who is able to continue the person's care indefinitely.

* If you are 75 years of age or older ask your doctor about having an extended health assessment.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: December 11, 2004