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Medicine coming of age.

It's not easy growing old. Despite medicine's dramatic success in recent decades, the impact of these familiar words remains undiminished. With the number of elderly growing rapidly, many are asking that medicine pay more attention to the elderly's unique needs. The challenge, however, is that aging itself is not a disease, and the success of medical treatments may involve factors beyond usual medical care.

Progress has been made regarding diseases that most often affect the elderly. Conditions that used to be dismissed merely as old age and senility are now being identified and treated as diseases. But treatment of disease becomes more complicated and multifaceted when the patient is elderly. There's often not one best solution to a medical problem; indeed, treatment may require more than a straightforward medical answer.

One example of this involves malnutrition. Dr. Howard Fillit of the Mount Sinai Medical Center in New York City estimates that up to 40 percent of the sick elderly he sees are malnourished, even though they often don't realize it (New York Times, 10 October 1992). "If they were objective, they would see themselves as skeletons," Fillit claims, "but they just see themselves as old." The problem is compounded by the fact that malnutrition for the elderly is difficult to define or even to recognize, according to geriatrician Dr. James Cooper of the National Institute on Aging. Proper diagnosis and treatment of the elderly may thus be hindered by malnutrition. Asks Dr. Fillit, "What good is it going to do to give them the right antibiotic for pneumonia and send them back home?"

Indeed, home itself may also be an important factor in fostering medical well-being for the elderly. Traditionally, nursing homes and other medical institutions have been seen as responses to aging as a medical problem.

An article in the Wall Street Journal (4 December 1992) reports that "assisted living" homes can provide real benefits to elderly who aren't diseased so much as merely old. By providing private and personalized apartments, such homes assist the elderly without overly medicalizing their environment--often with measurable health improvements.

As the number of the elderly swells, attention to their medical problems is sure to grow. Although only 11 percent of medical schools require courses in geriatrics (The New Physician, September 1992), the issue is receiving attention. The American Geriatrics Society has issued new curriculum guidelines on care of the elderly that recognize the "special importance of differences that need to be considered when caring for older patients." Medicine is learning that while aging itself cannot be cured, its unique problems should also not be ignored.
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Title Annotation:caring for the aged
Author:Hanson, Mark J.
Publication:The Hastings Center Report
Date:May 1, 1993
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