Older People: Talking to Doctors : Practical Matters

by National Institute on Aging

(Page 8 of 9)

It helps the doctor - and you - if he or she knows about the non-medical parts of your life. Where you live, how you get around, what activities are important to you: these are all things that can make a difference in decisions about your health care. The following are some examples of practical matters you might want to discuss with your doctor. For more information and resources on these topics, see the section on additional resources included at the end of this booklet.

Planning for care in the event of a serious illness - You may have some concerns or wishes about your care if you become seriously ill. If you have questions about what choices you have, ask your doctor. You can specify your desires through documents called advance directives, such as a living will or healthcare proxy. One way to bring up the subject is to say: "I'm worried about what would happen in the hospital if I were very sick and not likely to get better. Can you tell me what generally happens in that case?"

In general, the best time to talk with your doctor about these issues is when you are still relatively healthy. If you are admitted to the hospital or a nursing home, a nurse or other staff member may ask if you have any advance directives.

Driving - Driving is an important part of everyday life for many people and making the decision to stop driving can be very difficult. Tell your doctor if you or people close to you are concerned about your driving and why. He or she can go over your medical conditions and medications to see if there are treatable problems that may be contributing to driving difficulties. Vision and memory tests are important. The doctor also may be able to suggest a driver's education refresher class designed for older drivers.

Moving to assisted living - Another hard decision that many older people face is whether or not to move to a place where they can have more help - often an assisted living facility. If you are considering such a move, your doctor can help you weigh the pros and cons based on your health and other circumstances. He or she may be able to refer you to a social worker or a local agency that can help in finding an assisted living facility.

Paying for medications - Don't hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. If the doctor does not know the cost, ask the pharmacist before fi lling the prescription. Then call your doctor and ask if there is a generic or other less expensive choice. You could say, for instance: "It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?"

Your doctor may also be able to refer you to a medical assistance program that can help with drug costs.

Tips: Advance Directives

Advance directives allow you to say what you'd prefer if you are too ill to make your wishes known. There are two main kinds:

Living wills - A living will describes your decisions for medical treatment at the end of life. Living wills typically refer to life-prolonging treatment when death is imminent.

Healthcare proxies - Also known as a medical or health care power of attorney, a healthcare proxy is more detailed than a living will. It allows you to appoint the person or persons you trust to make health decisions for you if you cannot. It also allows for more detailed advance care planning, letting you state your wishes about resuscitation, feeding tubes, antibiotics, hospital transfers, respirators, and more.

Because the healthcare proxy involves more decisions, you may want to talk to your doctor about various options for care. For instance, many people would be willing to try a feeding tube or a ventilator for a while, but then would want it to be stopped if their condition did not improve. Also talk to family members and the person you have appointed as your proxy to be sure they understand your wishes.

Advance care directives are legally valid everywhere in the United States, but laws concerning them vary from State to State. Forms approved for the State you live in are available from many different health care organizations and institutions.

Discussing Sensitive Subjects

Much of the communication between doctor and patient is personal. To have a good partnership with your doctor, it is important to talk about sensitive subjects, like sex or memory problems, even if you are embarrassed or uncomfortable. Most doctors are used to talking about personal matters and will try to ease your discomfort. Keep in mind that these topics concern many older people. For more information, see the section on additional resources at the end of this booklet. You might find that using booklets from these organizations can help you bring up sensitive subjects when talking with your doctor.

It is important to understand that problems with memory, depression, sexual function, and incontinence are not necessarily normal parts of aging. A good doctor will take your concerns about these topics seriously and not brush them off as being "normal." If you think your doctor isn't taking your concerns seriously, talk to him or her about your feelings or consider looking for a new doctor.

Alcohol - Anyone at any age can have a drinking problem. Alcohol can have a greater effect as a person grows older because the aging process affects how the body handles alcohol. Someone whose drinking habits haven't changed may fi nd over time that he or she has a problem. People can also develop a drinking problem later in life due to major life changes like the death of loved ones. In fact, depression in older adults often goes along with alcohol misuse. Talk to your doctor if you think you may be developing a drinking problem. You could say: "Lately I've been wanting to have a drink earlier and earlier in the afternoon and I fi nd it's getting harder to stop after just one or two. What kind of treatments could help with this?"

Falling and fear of falling - A fall can be a serious event, often leading to injury and loss of independence, at least for a while. For this reason, many older people develop a fear of falling.

Studies show that fear of falling can keep people from going about their normal activities, and as a result they may become frailer, which actually increases their risk of falling again. If fear of falling is affecting your day-to-day life, let your doctor know. He or she may be able to recommend some things to do to reduce your chances of falling. Exercises can help you improve your balance and strengthen your muscles, at any age.

About the Author

www.nia.nih.gov
NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.