Geriatric medicine in a nutshell

For the past month, I spent Thursday afternoons at the VA Geriatrics clinic as part of my sub-specialty requirement for Adult Ambulatory Care. My mentor was fantastic. About half of the patients I saw at some point during the interview said of him, "That man walks on water!" For his part, my geriatrics preceptor brushed that off and laid all the credit at his patients' feet for doing the hard work.

From my perspective, there's some truth to both my mentor's story and his patients' claims. He has a special way with his patients, and I tried to glean as much wisdom as possible in my 16 hours with him. The following are some nuggets of wisdom that come either from my observations of his practice or directly from him. They summarize fairly well the practice of geriatric medicine:

• There are three diseases that you need to avoid in order to make it to your 90's: 1) Heart disease, 2) Cancer, and 3) Dementia.


• Likewise, there are three diseases that you will almost certainly have if you are lucky enough to make it to your 90's: 1) Arthritis, 2) Vision loss, and 3) Hearing loss. If you had a practice purely of 90-year-olds, you would likely be focused on those issues.


• In an elderly patient, prevention measures may be less useful in long-term processes such as high blood pressure or cholesterol. When a patient's life expectancy is short (recognizing that we are not very good at predicting it), the benefits of getting their blood pressure or lipids at goal might be outweighed by harmful side effects of medications.


• Avoiding polypharmacy is a big challenge. Always consider whether a drug is truly needed, how it will interact with drugs that the patient is already taking, and the impact of its side-effects on the patient's overall health. This should be true for all patients but particularly so for the elderly who are more vulnerable.


• Improving the quality of life is sometimes more important than extending life.


• Speak loudly and slowly to your elderly patients, smile a lot, ask them about their lives, and listen to their stories with genuine interest.