A Fifth Key Principle of Geriatric Care

by Robert S. Stall, M.D.

It is very important that older adults, their families, friends and health care providers understand several key concepts to ensure that older adults receive timely & appropriate health care services and advice. I add a fifth "key principle" to the "four key prinicples" that everyone should remember when caring for older people.

Seek and treat DIS-EASE, not just disease.

The practice of geriatric medicine--care of older adults--is truly holistic. With modern medicine's focus on curing specific ailments, it is easy to forget the broader definition of the word "disease". Put a simple hyphen between the first 's' and 'e' in "disease"and a whole new world of possibilities emerges. By focusing on DIS-EASE--not just disease--everyone, including older people themselves, can broaden their scope of investigation, treatment options and perhaps most importantly, their expectations.

Break the word disease into "DIS-" (the "opposite or absence of"*) and "EASE" (the state of being comfortable: as a : freedom from pain or discomfort b : freedom from care c : freedom from labor or difficulty d : freedom from embarrassment or constraint"*) and you have a word that goes far beyond just treating pneumonia, broken hips and heart attacks.

I never learned the real meaning of "disease" in medical school, and neither did the students of the varied health care disciplines that I've taught over the years. Discomforts, cares, difficulties, constraints and embarrassments are now included in the DIS-EASES that can be addressed--and must be addressed-- in order to optimize the quality of life and functional ability of older people. With this expanded set of "DIS-EASES" to be identified and treated, the therapeutic arsenal likewise grows, limited only by our interest, effort and ingenuity. Mere curing turns into true CARING, the most fulfilling outcome of all for everyone.

(* from the Merriam-Webster On-line Dictionary http://www.m-w.com/)

A Story to Remember

I once saw a patient who was about to turn 100 years old. She had pain in her right knee. I asked what she thought was wrong.

What do you expect at my age? she asked, shrugging her shoulders. How is your left knee? I replied. Just fine, thank you she answered. Then why doesn't your left knee hurt? Isn't it the same age as your right knee? I shot back, with a smile. She smiled too and understood what I meant.

Think about it. Often. I do. It helps to keep me on the right track when I try to help my older patients.
Don't sell older people short. There is always something that can be done to help an older person lead a happier, more functional life, even in extreme old age.

Sincerely,