As a third-year medical student in my mid-20s, there are many privileges associated with youth that I take for granted. In the winter of 2021, however, I elected to spend several weeks pursuing a rotation in geriatric psychiatry. I spent hours talking to older patients — in clinic, over the phone, in the inpatient unit at The Johns Hopkins Hospital. We spoke at length about their medical problems, which were often complex and debilitating, but also about their lives. What is it like to grow old? I asked them. Here is what I learned.
Aging is loss — loss of function, health, independence, cognition — replaced by fear of what the future holds. For some, aging happens gradually, but others remember the exact moment they first felt old. For one patient, it was the day she experienced a devastating fall after insisting to her husband that she was not too old to rake leaves.
Aging can be lonely, especially for those who have lost loved ones, or those who do not see their loved ones often. For them, holidays, birthdays and other special occasions are often not the joyful experiences they remember from their youth.
Aging is expensive. Those with fewer resources in the way of money, social support or health literacy are struggling. I spoke with a patient who waited in a freezing cold lobby for two hours to receive a box of free groceries, which she then struggled to carry up to her apartment. For these patients, daily life focuses more on surviving than on thriving.
To care for an aging patient means to treat the patient from an interdisciplinary perspective, to understand the patient’s history, living situation, support network, available resources, values and goals. It also means to care for their family, understanding that they, too, might be frustrated, fearful and tired. In clinic, I saw a patient with severe dementia who had become joined at the hip with her husband, acting agitated and tearful when left alone in the house. Neither the patient nor her noncognitively impaired husband could remember the last time they were apart for more than an hour.
To care for an aging patient and their family means to temper expectations while instilling hope. Sometimes, it means to be realistic about a patient’s functional capacity and to tell patients and families what they are most afraid to hear. Sometimes, it means telling the patient that he or she no longer can live independently or sit behind the wheel. The line between autonomy and paternalism can be a difficult one to navigate.
Finally, and I believe this to be especially true for those such as myself who are just starting out in medicine, to care for an aging patient means to adopt a mindset of humility, to view each patient as a beacon of lived experience and wisdom. It means to acknowledge that just as a clinician may possess medical expertise, a patient, especially a geriatric patient, is an expert at life itself. Each has something to teach the other.
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