M05.03.05 Aging

The human body undergoes significant changes throughout life, and understanding these changes is crucial for providing optimal medical care to elderly patients. This guide will explore the medical, psychological, social, and financial aspects of aging, along with end-of-life considerations.

Leading Causes of Death in Elderly Patients (>65 years old):

• Heart Disease
• Malignancy (Cancer)
• Cerebrovascular Disease (Stroke)
• Chronic Lower Respiratory Disease

Preventive Care and Geriatrics:

• Preventive care becomes increasingly important with age to improve quality of life and survival.
• Geriatrics is a medical specialty focused on elderly patients.
• As a physician, regardless of specialty, you will likely encounter and treat elderly patients.

Medical Care of Geriatric Patients:

• Preventive care may include:
  • Aspirin therapy
  • Lipid management for cholesterol control
• Vaccinations: Due to higher morbidity and mortality risks in older adults, vaccinations are crucial for:
  • Tetanus
  • Diphtheria
  • Pneumococcus (prevents pneumonia)
  • Influenza (Flu shot)
• Screening:
  • Evaluate comorbidities, functionality, and life expectancy before recommending screening tests.
  • Generally, screening benefits are maximized when life expectancy is greater than 5 years.
  • Common screenings include:
    • Cancer screening (ages for starting may vary):
      • Breast cancer: Women > 40 years old
      • Colorectal cancer: Men and women > 50 years old
    • Abdominal aortic aneurysm screening: Men 65-75 years old

Psychiatric Considerations:

• Depression screening: Age is a risk factor for suicide, so screening is crucial, especially for patients with terminal or debilitating illnesses.
• Adjustment disorder: Life changes like retirement or illness can cause adjustment disorders.

Physiological Changes with Aging (Not Pathological):

• Sexuality:
  • Sexual interest and activity do decline somewhat with age, but a partner is the biggest predictor of continued sexual activity.
  • Changes in men: Slower erections, longer refractory period (time to recover after orgasm)
  • Changes in women: Vaginal dryness and thinning
• Sleep:
  • Early morning wakefulness is common.
  • Less deep sleep occurs, but REM sleep remains relatively stable until very old age (>85 years old).

Financial Considerations:

• Several factors can contribute to financial instability in the elderly:
  • Inadequate fixed income (e.g., Social Security, pensions)
  • High medical costs
  • Low financial literacy (vulnerability to scams)

End-of-Life Care:

• Discussing life expectancy, treatment options, and end-of-life wishes is important.
• Do Not Resuscitate (DNR) status should be documented.
• Patients may have a living will or health care power of attorney to guide care decisions.
• Physicians have an obligation to be truthful with patients, but avoid false hope while acknowledging their wishes (e.g., pain management, quality of life).
• Encourage open communication about feelings and social connections to avoid isolation.

The Kübler-Ross Stages of Death and Dying:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

These stages are not linear and may not be experienced by everyone.

Hospice Care:

• Hospice care provides comfort and support for terminally ill patients (life expectancy ≤ 6 months) and their families.
• The goals are to promote peace, comfort, and dignity during the end-of-life journey.
• Care includes medical care, psychological support, and spiritual support.
• Hospice can be delivered at home or in specialized facilities.
• Payment options include Medicare hospice benefits, Medicaid hospice benefits, and private insurance.

Bibliography:

• National Institute on Aging: https://www.nia.nih.gov/
• American Geriatrics Society: https://www.americangeriatrics.org/
• Kübler-Ross, E. (1969). On death and dying. Routledge.