1. AGEISM “A process of systematic stereotyping of and
discrimination against people because they are
old, just as racism and sexism accomplish
with skin color and gender.”
Robert Butler, MD (1975): Why Survive? Being Old in America

2. AGENDA: LARGE GROUP Skit 1: Emergency Room Skit 2: Internist’s Office
Discussion: Doctor-Older Patient Communication
Geriatrics Pearls

3. AGENDA: SMALL GROUP Review Break into groups
Enhanced Social History
Geriatrics Screen
Communication Checklist
Break into groups
Interview/Assess older patient
Discussion
Evaluate morning

4. GERIATRICS PEARLS Effective communication can improve health outcomes.
Ageism is prevalent and can interfere with effective communication.
A thorough psychosocial history is essential in geriatric medicine.
Assessing and maintaining function and independence is a major goal of geriatric medicine.

5. COMMUNICATION and the MEDICAL INTERVIEW
Age-heterogeneous patient populations recall about 50% of what their doctors say.
Prevalence of low health literacy in > 60 age group is > 80%.1
Physicians who communicate better will have patients who understand more about their illness and will be more likely to adhere to regimens.2
1 Weiss B et al.(1995); 2Grueninger U et al

6. THE THIRD PERSON in the MEDICAL INTERVIEW
Older patients often referred to as “he” or “she.”
Older patients raise fewer topics in triads than dyads.
Older patients less assertive in triads than dyads.
Less shared laughter in triads.
Adelman R, Greene M, Ory M ( 2000)

7. IMPORTANCE of a COMPLETE HISTORY
About 75% of diagnoses can be made by the history alone.
In 70% of interviews, physicians interrupt patient history after 18 seconds.
In 77% of interviews, patient’s problems not fully elicited.

8. ENHANCED PSYCHOSOCIAL HISTORY
Thoroughly assessing psychosocial issues can improve accuracy of diagnosis.
Thoroughly assessing psychosocial issues may lead to interventions that can affect morbidity and mortality.

9. IMPORTANCE OF ASSESSING FUNCTION
Predicts outcomes
Allows physician to monitor response to treatment
Helps in making diagnoses
Communicates about the patient
Helps to determine level of care needed