Unfortunately, in spite of this new focus on geriatrics, there is unhappy evidence that many doctors today still may be giving their older patients less attention. In a 1987 study, when researchers videotaped the doctor/patient interviews of five typical private-practice physicians, they discovered that with older people doctors tended to focus on physical symptoms alone. Conversations about the effects of the illness – whether the patient was having trouble getting around and was worried or depressed – were much more likely to take place with younger adults.

However, the patients seemed as much at fault as the doctors. During their visits, elderly people brought up only their dizziness, or pain, or blood pressure. Younger patients tended to raise a broader set of questions, focusing both on their symptoms and on how their illness was affecting their lives.

So when older people are given less attention, they themselves may be partly to blame. Being trained in the idea that the doctor is an authority figure, they may be less aggressive in bringing up their concerns. Because they demand less from their doctors, they get less.

Sociologist Marie Haug of Case Western Reserve University, who has done extensive research on elderly patient/physician relationships, finds older people are also guilty of therapeutic pessimism and are just as prone to self-diagnose treatable conditions as old age. Because not feeling well is supposed to be “normal” at age seventy or eighty, many people are reluctant to call their doctors when a symptom appears. Their attitude is, “At my age what can any doctor do?”

My hand has begun shaking uncontrollably, and my wife tells me I should give the doctor a call. I’m reluctant. After all, I’m seventy-eight. It’s not like the shaking is so bad. I can walk. I can play golf. My life is not in danger. When I look around, I see how bad things could be. I don’t need to be in a nursing home. I don’t have heart trouble. I’m better off than most men my age. Why should a person in the pink of health waste the doctor’s time?

This reasoning condemns people to live with what they have; they lose the race by default, neglecting to put in a bet. When this man was badgered into making an appointment, his doctor prescribed a far from painful remedy – a drink of Scotch a day. He now takes his “medicine” each evening, and his shaking is gone.

Many symptoms that seem to be old age are treatable. Even real age-related disabilities – such as problems in walking or dressing – often can improve. When gerontologists at Ohio State University traced the course of disabilities like these in several thousand older men over a fifteen-year period from 1966 to 1981, they found that more of us do develop infirmities as the years advance, but disabilities also go away. Many men who had trouble reaching, lifting, or walking in 1976 did not have the same problems five years later in 1981. What looks like the permanent physical ravages of aging can be surprisingly temporary.

Furthermore, a 1986 report shows that rehabilitation can work wonders. When 190 severely disabled older people were treated at a special geriatric rehabilitation center, the changes were dramatic. The number who could function on their own (at least partially) increased from 87 to 173. Those able to walk independently rose from 42 to 127.

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Doctors are becoming aware of their attitudes. They are now being trained that we are not powerless in dealing with disabling chronic disease. Within the past fifteen years the number of medical schools offering courses in geriatrics has grown from a handful to a majority. By 1995 experts estimate that every medical school will offer at least some training in this exciting new field. Here is some of the information that geriatrics courses provide.

Diseases can produce different symptoms in older people than they do in the young.

An interesting example is a heart attack. In younger people its wrenching pain is impossible to miss. But by our seventies the only sign of a heart attack may be mental confusion or indigestion. Earlier, doctors might often have sent an elderly heart attack victim home with antacids. Today’s more geriatrically aware physicians are less likely to make this fatal mistake.

Age does not equal illness.

In geriatrics courses doctors learn that not all older people are sick. In fact, as we grow older we differ more and more from one another physically. Students are taught to view their older patients as individuals, not as bodies aged eighty or ninety-five.

What physical changes are normal and what are pathological.

Geriatric training makes doctors sensitive about labeling the many things that can be helped as just “old age.” They are less likely to over-treat too, reading illness into normal changes or pushing drugs excessively. By learning about studies such as the Baltimore study sponsored by the National Institute on Aging, they get a better sense of when to treat their patients and when not to intervene.

To restore function.

They are also trained in the orientation toward disability I just described: improving eighty-year-old Mrs. Jones’s ability to get around can be as worthwhile a goal as curing her disease. If she can get to the store, she may not have to move. She can continue to live with her husband and will not have the heartbreak of going to a nursing home. Reaching these goals may mean arranging for a physical therapist to come to her home to increase her mobility and strength; knowing about the many gadgets that can make life easier for the disabled; treating the depression that is compounding her physical problems; working with her family; knowing what community services are available to keep people out of nursing homes.

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GENERAL HEALTH