Specialty Area: Geriatrics

Description of Specialty: Geriatrics is the care of the older adult patient, in particular diagnosis and treatment of problems associated with aging. The doctor acts as a primary care coordinator, but occasionally assists with complicated patients.

1. Diagnosis: Dementia (memory loss)

Questions that should be asked:

  1. What causes memory loss?
  2. What medicines are available, are over-the-counter medicines effective or what homeopathic vitamin medication are helpful?
  3. What can be done for anxiety and agitation associated with memory loss?
  4. Are there organizations or others that can help with social/family issues or provide support?

2. Diagnosis: Urinary Incontinence

Questions that should be asked:

  1. What tests would be helpful in determining the cause of incontinence?
  2. What are the side effects of medication used to treat this condition?
  3. How can I tell if I have an infection?
  4. What is the goal of my therapy to control or to cure?

3. Diagnosis: Age-associated memory impairment ("normal" memory loss)

Questions that should be asked:

  1. What makes you believe my memory loss is normal?
  2. What should my family look for to alert me that my memory loss is becoming abnormal?
  3. Are there any medicines which can help protect me from serious memory loss and how effective are they?

4. Diagnosis: Constipation

Questions that should be asked:

  1. What food should I eat to help promote normal bowel movements?
  2. What foods should I avoid?
  3. Are there dangers in over-the-counter remedies?
  4. What is a normal bowel movement and what are normal bowel habits

5. Diagnosis: Pressure Sore (decubitus ulcer)

Questions that should be asked:

  1. How did I get this and is my circulation involved?
  2. Are any of my other diseases involved?
  3. What should I put or not put on the sore?
  4. How can I keep from getting more sores or from having a recurrence?

6. Diagnosis: Vertebral Compression Fracture

Questions that should be asked:

  1. Why did I get this and what risk factor do I have?
  2. What can I do to prevent more fractures from happening?
  3. Do I have osteoporosis?
  4. Should I take calcium and how much?
  5. What physical tasks can I do and should I restrict certain activities and for how long?
  6. What medications are available and are they appropriate for me?

7. Diagnosis: Shingles (herpes zoster)

Questions that should be asked:

  1. How did I get this?
  2. What can I put on it and what should I avoid?
  3. How long will it last?
  4. What can I do to help the pain and itching?
  5. Can shingles recur and with what frequency?

8. Diagnosis: Weight Loss (unexplained)

Questions that should be asked:

  1. What foods can I eat to improve my weight and should I see a dietician?
  2. Are my other diseases making me lose weight?
  3. Can weight loss be normal with aging and can it help me?
  4. What should I look for in the future to help determine what may be making me lose weight?
  5. How often should I weigh myself?

9. Diagnosis: Depression

Questions that should be asked:

  1. Should I see a psychiatrist or can you help me?
  2. What side effects of medication prescribed should I look for and should I stop taking any of them?
  3. What can I do to help myself besides taking medication?
  4. How long will it be before I can expect to feel better?

10. Diagnosis: Agitation/Anxiety associated with Dementia

Questions that should be asked:

  1. What provokes these symptoms?
  2. What changes in symptoms can there possibly be some control over?
  3. What types of medicines help these symptoms?
  4. What side effects should be monitored?

11. Diagnosis: Dysphagia

Questions that should be asked:

  1. What can cause trouble swallowing?
  2. What types of foods can be eaten?
  3. Would a speech therapist help me and are there tests that would help me?
  4. Will I need a feeding tube or some other way to get nutrition?

12. Diagnosis: Failure to thrive/generalized decline in health without apparent cause

Questions that should be asked:

  1. What symptoms should I look for to make certain we can't find a more specific diagnosis?
  2. Is it worth trying medicines to improve appetite or to treat atypical presentation of depression?
  3. What should our goals be for diagnosis and pursuit of patient comfort?

13. Diagnosis: TIA (Transient Ischemic Attack)

Questions that should be asked:

  1. What risk factors do I have and why did this happen?
  2. What medicines are available to keep this from happening again?
  3. Should I take aspirin?
  4. What are my chances of having another ministroke or full-blown stroke?
  5. What exercise or diet would help me?
  6. What can I do to prevent a recurrence?

14. Diagnosis: Old Age

Questions that should be asked:

  1. How much longer do you expect I'll live?
  2. How come other people my age don't have the same problems?
  3. What can I do to prevent age-related problems of diet?
  4. Should we discuss advance directions or code states in case I get very ill?

15. Diagnosis: Gait Disorders and Falls

Questions that should be asked:

  1. What specifically causes me to fall?
  2. Are there tests we can do to tell us why I fall?
  3. Should I see a neurologist or a physical therapist?
  4. Should I use a cane or walker?
  5. What can I do around the house to help prevent falls?
  6. Are there exercises I can do to help prevent falls?

Charles Crecelius, M.D. Clinical Instructor, Department of Medicine Washington University School of Medicine St. Louis, MO

                                                                                       

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