Dr. Denis Grillo, Ear, Nose & Throat, 03/05/13

In the past, I have done several articles on the differences between a pediatric patient, an adult patient, and an older more senior adult patient.

There are some major differences in treatment and strategies for care, and it is important we be aware of these different points. In this particular article I am addressing the needs of the senior, or the geriatric patient.

As I have written about in the past, senior patients are much more complex, and sometimes have several things going on that can affect their quality of life.

As medicine improves and becomes more sophisticated, we are able to address these issues, and geriatric care and specialties are starting to become more common as the baby boomers age. Just like pediatric specialties and pediatric hospitals have come to be, this might very well be the case for the geriatric patient.

Besides recognizing the need for specialized care for these patients, doctors, nurses, and family members need to coordinate and collaborate for the most effective way to treat and heal these patients. Simple things make a big difference.

The vast majority of younger patients are literate, and some of our older patients came through a period of time in the United States when they quit school and went into the workforce to help the family through difficult periods in our country, including the Great Depression and World War II.

We need to make sure the patient is able to read, because prescription bottles have very small print and can be confusing. Medicine taken the wrong way can be a problem, just to name one of many possible scenarios.

Older patients have problems, including age-related vision issues as well as cataracts that cloud vision, and glaucoma, which can affect the eyesight, so you want to make sure a patient is able to read published materials such as postoperative instructions. The use of illustrations, or pictures, and diagrams will help when the patient may not be so literate.

Hearing loss is another problem that can interfere with care, as well as treatment of medical problems, and even understanding the need of post-operative care. At least one-fourth of our senior patients, if not more, have problems with hearing. We know from history that hearing loss can cause some social isolationism and depression, and even seem to interfere with cognitive impairment, and make the patient seem like he may have a touch of dementia. Make sure the hearing is OK, and if not, address that problem.

Depression is a big issue with older patients. There may be situations where the patient is retired, inactive, has lost a spouse, and does not get out socially. Depression is not a life-threatening issue per se, but it definitely affects how the patient responds, performs tasks of daily living and willingness to take care of him or herself. Depression can complicate medical and surgical issues.

Further physical injuries after a surgery, especially if the patient is having some dizziness or balance problems, is very common with the older patient. Make sure their living environment is safe. Reducing the risk of fall and injury is very important. I frequently tell my balance patients that dizziness can be an annoyance, but a fall secondary to dizziness, which could cause a hip fracture, is a life-changing situation. There are fall prevention measures available in the literature and online that can be implemented.

Medications can cause problems including sedation, confusion, agitation, a change in the patient’s personality, and sometimes, in extreme cases, auditory or visual hallucinations. This type of situation can occur from a hospitalization for an acute exacerbation of congestive heart failure, or pneumonia, or could occur from a hospitalization for a fall and hip fracture in which the patient’s medications may change.

So when they are back home, things are not as they were before the event, and this can be very disconcerting for the patient, and attention to these matters is very important. Family members, health care givers including visiting nurses, are very helpful in this situation.

Phone contact is also very helpful in managing the geriatric patient’s care. Sometimes patients are hesitant to contact the doctor or the nurse. They don’t want to bother them, or they might think their question is too simple or foolish. A simple follow-up phone call, even from a family member who can “break the ice” so to speak, to make sure the patient is understanding their instructions, is helpful in a speedy and full recovery. Nowadays we have the availability of visiting nurses, but for patients who do not have that benefit, a phone call might work very well.

Family members and friends who participate in the patient’s care are very helpful. The doctors and nurses do their best, but cannot be everywhere for everybody, so having a good support system is helpful. Teamwork between all of these parties will likely result in a more successful outcome for the older patient, who, as we know, has a greater chance of having medical, surgical, and general health problems.

Denis Grillo, D.O., FOCOO, is an ear, nose and throat specialist in Crystal River. Call him at 352-795-0011 or visit
CrystalCommunityENT.com.