AGEISM. “A process of systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish with skin color and gender.” Robert Butler, MD (1975): Why Survive? Being Old in America. AGENDA: LARGE GROUP. Skit 1: Emergency Room
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AGEISM “A process of systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish with skin color and gender.” Robert Butler, MD (1975): Why Survive? Being Old in America
AGENDA: LARGE GROUP • Skit 1: Emergency Room • Skit 2: Internist’s Office • Discussion: Doctor-Older Patient Communication • Geriatrics Pearls
AGENDA: SMALL GROUP • Review • Enhanced Social History • Geriatrics Screen • Communication Checklist • Break into groups • Interview/Assess older patient • Discussion • Evaluate morning
GERIATRICS PEARLS • Effective communication can improve health outcomes. • Ageism is prevalent and can interfere with effective communication. • A thorough psychosocial history is essential in geriatric medicine. • Assessing and maintaining function and independence is a major goal of geriatric medicine.
COMMUNICATION and the MEDICAL INTERVIEW • Age-heterogeneous patient populations recall about 50% of what their doctors say. • Prevalence of low health literacy in > 60 age group is > 80%.1 • Physicians who communicate better will have patients who understand more about their illness and will be more likely to adhere to regimens.2 1 Weiss B et al.(1995); 2Grueninger U et al
THE THIRD PERSON in the MEDICAL INTERVIEW • Older patients often referred to as “he” or “she.” • Older patients raise fewer topics in triads than dyads. • Older patients less assertive in triads than dyads. • Less shared laughter in triads. Adelman R, Greene M, Ory M ( 2000)
IMPORTANCE of a COMPLETE HISTORY • About 75% of diagnoses can be made by the history alone. • In 70% of interviews, physicians interrupt patient history after 18 seconds. • In 77% of interviews, patient’s problems not fully elicited.
ENHANCED PSYCHOSOCIAL HISTORY • Thoroughly assessing psychosocial issues can improve accuracy of diagnosis. • Thoroughly assessing psychosocial issues may lead to interventions that can affect morbidity and mortality.
IMPORTANCE OF ASSESSING FUNCTION • Predicts outcomes • Allows physician to monitor response to treatment • Helps in making diagnoses • Communicates about the patient • Helps to determine level of care needed