According to a doctor of "old people", geriatrics should treat different ages and phases

Dr. Louise Aronson said that the United States has almost no geriatricians – doctors dedicated to the health and care of the elderly: "There could be six or seven thousand geriatricians," she says. "Compare that to the members of the pediatric society, which has about 70,000 people."

Aronson is a geriatrician and professor of medicine at the University of California at San Francisco. She notes that older adults represent a much higher percentage of hospital stays than their pediatric counterparts. The result, she says, is that many geriatricians end up focusing on "the oldest and most fragile" – rather than on healthy aging.

Aronson considers geriatrics as a specialty that should adapt and change with each patient. "My youngest patient is 60 years old and my oldest, 111 years old, so we are really talking about half a century," she says. "I need to be a different type of doctor for people of different ages and different phases of their old age."

She writes in her new book on innovative approaches to health care for seniors and end-of-life care Old age: Redefining aging, transforming medicine, reinventing life.

Interview highlights

On how people's health needs become more complicated as they get older

Although old age is not a disease in itself, it increases vulnerability to the disease. It is therefore the very rare person over 60 years old … and certainly over 80, this does not already tend to have several health problems. So when something new comes up, it's not just the new symptoms of a potentially new disease, but also an older body made up of other diseases, treatments for other diseases.

If a person has symptoms and is an elderly person, we sometimes find this diagnosis unique and unifying, but it is actually the exception. If we pay attention, we are more likely to find something new and maybe some other things. We add to a list [and], we end up with a longer list, not a smaller list, if we are really attentive to everything going on in this person's life and health.

On how the immune system changes with age

Our immune system has multiple layers of protection for us. And there are biological changes in all these layers, and sometimes it's the number of cells that can defend us, if we have any infection. Sometimes it is literally the immune response. For example, we know that vaccine responses tend to decline with age and that people's immunity is sometimes less strong. It also tends to last less. And that's about the strength of the immune response, which changes in various ways. But our immune system is an integral part of every other organ system in our body, which increases our vulnerability as we age in all bodily systems.

On the importance of vaccines for the elderly

Older people … are among the populations (including very young children) to be hospitalized or die as a result of influenza. The flu shot, especially a good year, but even if the correspondence is not perfect in a given year, [protects] the elderly get sick and end up in the hospital and die. … That said, we have not optimized vaccines for seniors as we do for other age groups. So, if you look at, for example, the Centers for Disease Control recommendations regarding immunization, you will see that there are, I believe, 17 categories for children, different sub-stages of childhood for which they have different recommendations and five steps for adulthood. . But people over 65 are grouped into one category. … We are all different throughout our lives and we need to focus our interventions on all of us, not just on certain segments of the population, namely children and adults, leaving the elders on the outside.

On how medications can change their effect on the patient over time

Researchers have traditionally stated, "We will not include the elderly in our studies because their bodies are different and / or because they have other conditions that could interfere with their response to it. drug." But then they give the drug to those same old people … and so often with a new drug, we will see all kinds of reactions to the drug that are not in the warnings. So the number one message is simply because it's not listed does not mean it's not the culprit. Another important point is that any medicine can do it. And he can do it even if the person is on it for a long time. … We think drugs are kind of fixed entities, but what really matters is the interaction between the drug and the person. So even if the medication stays the same, the person can change.

On the importance of making home visits in his work

What brought me to medicine and what keeps me there is people. And when you make a home call, you see the person in his environment, so she must be a person before being a patient, which I like a lot. I can also see their living conditions, and more and more, we realize and pay attention to the real influence of these social factors on health and the risk of positive or negative results for people.

Roberta Shorrock and Seth Kelley produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for coups.