Treating the Elderly

Treating elderly patients with Oriental medicine offers its own set of challenges and rewards. My office is located in an area that supports a large number of retirement facilities, and from the time I began practicing 16 years ago, elderly patients have made up a healthy percentage of my practice. I had not seen many elderly patients during my school training, so I had to learn on the job. I hope sharing some of the lessons I have learned may be of use to you.

For the sake of brevity, I am using the generic term "elderly" in this article to refer to those whose age is in the upper 60s and above, although I by no means wish to imply all elderly people can be lumped into any stereotype. Patients in this age group present both a variety of medical conditions and a wide range of personal/social traits that can influence clinical outcomes. The following is a brief list of considerations to keep in mind when treating elderly patients, and thoughts on how to address them.

Deficiencies are relative. Elderly patients often present with overall qi and vital essence deficiencies. While these conditions can greatly complicate treatment in other age groups, this is not always true for the elderly, in whom deficiencies of this type are more the norm. While tonifying (especially yin tonification) is helpful, it is not as necessary to tonify before addressing other imbalances (such as qi and blood stagnation in symptoms involving pain).

Check medications. No other age group is as routinely overmedicated as the elderly. Make sure to ask about the medications your elderly patients are taking, and encourage them to speak with their pharmacist and doctors if you suspect there may be problems from drug interactions or overmedication.

A little goes a long way. Unlike other age groups, restoring an elderly patient to vital health may be an unachievable goal. The good news is that even modest improvement in pain or functioning can make a significant difference in the patient's quality of life. Don't be discouraged by how bad off an elderly patient may seem. Any help is often appreciated.

Touch therapy. Many elderly patients, especially widows and widowers, have gone years with little or no gentle, caring touch. In addition to acupuncture and herbal therapy, spend some time employing touch therapy, regardless of the condition your patient is seeing you for. Even a few minutes of back massage can help your patients reconnect with their bodies and remind them that they are still worthy of human contact.

Don't rush. Our fast-paced society greatly contributes to the tendency of elderly people to feel frustrated at their diminished capacity and sense of being a burden to others around them. You can help offset this by making your elderly patients feel they are in no way slowing you down during their treatment time. Allow extra time in your schedule for your elderly patients. Working patients prefer early morning and late afternoon appointment times, so schedule elderly patients during the slower late morning and early afternoon. This time is also helpful in that your elderly patients won't have to deal with rush-hour traffic.

Communicate with family/caregivers. Communicating with patients who have memory loss and/or dementia can be a challenge. When treating such patients, include family members or other caregivers both when gathering history and giving recommendations. Be sure to have your patients sign a release form that gives you the authority to communicate with others about their care.

Hearing loss. Patients with hearing loss can also present challenges. This is especially true for patients who have trouble admitting to themselves that they have lost hearing capacity and refuse to wear a hearing aid. Many of these individuals have become accustomed to hearing only part of what is being said, and may not ask you to repeat yourself. Look for signs your patient may have hearing loss and, if so, speak in a louder voice and get confirmation that your patient has understood you.

Bruising. While patients of any age can experience bruising after acupuncture or acupressure, it is far more common in the elderly. It is a good idea to have some sort of informed-consent statement alluding to this and stating that it is not a cause for concern. I learned the value of explaining this only after getting some calls from elderly patients who were worried that something had gone wrong when they found a bruise the day after receiving acupuncture.

Cost. Many elderly patients live on fixed incomes and find it difficult to afford therapy. The fact that Medicare does not pay for acupuncture makes it especially difficult, as many elderly patients rely on Medicare for much of their health care needs. Consider offering a substantial discount for elderly patients, especially those who have Medicare. I offer a 35% discount for those on Medicare. When quoting your rates for elderly patients, make sure you or your staff mentions that this is a discount and explains what your normal rates are. Otherwise, confusion may result if your elderly patient refers another person to you who does not qualify for the discount.

It has been said that you can tell a lot about a society by the way its elderly are treated. While high-tech, modern medicine has made great advances in life-saving interventions, its over-reliance on drugs and increasingly impersonal, high volume approach is especially hard on the elderly. We in Oriental medicine have the ability to truly complement mainstream medicine in treating the elderly by virtue of our gentle, supportive mode of therapy. Helping our elders cope with the inevitable decline that accompanies aging is personally rewarding, and helps make our entire society a better place.