Co-morbidity, a term that means multiple medical problems, is generating a lot of interest in geriatric research, Friedman noted. An example would be how to treat a diabetic who also has Alzheimer’s. “All these people who have diabetes are now living into their eighties and nineties, where in the past they would have died,” she said. “We worry about over-treating them. Someone who is ninety and has Alzheimer’s and gets cancer would be treated differently than a younger person.”
Regarding a 95-year-old who is diagnosed with high cholesterol, “are you really going to treat them for preventing heart disease? People need to take charge of their own health care and make their own medical decisions.”
Many people who come to the center are experiencing some change in functioning, such as memory loss, confusion, loss of appetite or sleep, or problems with balance. These problems may be related to their taking multiple medications. For example, “one woman had symptoms similar to Parkinson’s disease, such as shaking and falling. I adjusted her multiple medications, and the symptoms went away,” Friedman said. Another woman who was experiencing a lot of pain and insomnia also turned out be over-medicated; she had visited a succession of doctors, each of which prescribed another medication.
“I took her off all the pain and sleep medications and the symptoms went away,” said Friedman. “We spend a lot of time with patients and have expertise in breaking down all those medications. I go through everything with a fine-tooth comb.” Sometimes she’ll meet with her patients multiple times before sending the person back to his or her doctor with recommendations.
In contrast, younger seniors — people in their sixties and seventies — might want to go on medication to prevent illness, Friedman said.
Dementia is a particular concern, given that it affects a quarter of people who are 85. The center offers a computer test that younger people who think they have symptoms can take to determine whether they are getting it. In many cases “the test reveals they don’t have dementia. The test is really difficult.” Friedman said medication isn’t necessary in cases of normal memory loss.
Gould’s role is psychologically oriented. “I treat patients suffering from depression or anxiety, from general mental-health issues to very aging-specific issues,” such as death of a spouse.
“One trend is a general sense of loss as the aging process takes away a person’s independence,” she said. “There’s a lot of depression around stopping driving or a partner not doing well, which means the person is more socially isolated. They can’t participate in activities they enjoy or see friends or family as much. Or their friends are not around anymore, or their family has moved away and doesn’t come to see them as often. They need support to adjust to these changes.”
Gould will suggest ways people could be more socially connected. Some churches offer transportation for seniors, while many libraries and county agencies for the aging sponsor senior programs.