Dr. Bhattacharyya agreed. “I don’t think we are going to see age-based specialization by otolaryngologists,” he said. “But I do think that within each subspecialty, within head and neck cancer, within rhinology, otology and laryngology, we’re going to see a subgroup of specialists focusing on the aging population. We have to have otolaryngologists who are well versed in the needs of older patients, medically and socially and psychologically.”–JF
Otolaryngologists who specialize in the care of older patients say that appropriate care of the older population begins with an understanding of ENT-related diseases in the elderly, as well as a sense of compassion and understanding of the challenges older people face. “The assumption is that treating older people is the same as treating someone who is younger, with a few modifications,” Dr. Kost said. “But that’s like saying that a 5-year-old patient is just a miniature adult. Older patients behave differently in terms of disease processes and have to be treated as a distinct group.”
One of the challenges involved in caring for the elderly is that certain pathologies behave differently in older people. Head and neck cancer, for instance, may be more aggressive in older patients with multiple comorbidities, Dr. Kost said. Yet, older patients frequently face a treatment bias. “There’s a tendency to undertreat aggressive disease like cancer, and then have patients come back later because they were initially undertreated on the basis of their age,” Dr. Kost said. “To deny somebody appropriate therapy based on age alone is discriminatory. So it’s very important when assessing these patients not to look at chronological age, because in a lot of cases, it’s really not relevant. It’s really their functional status that’s important. If you have an 85-year-old who has minimal comorbidities, who lives with a spouse or on their own and is functioning independently, there is an excellent chance that the patient will tolerate aggressive treatment for an aggressive disease.”
Conducting a thorough assessment not only uncovers important comorbidities and functional limitations; it also allows physicians to find underlying pathology that may be missed if the practitioner focuses too much attention on the age of the patient. “Laryngeal cancer and vocal cord paralysis are more common as we get older, but we have to do our due diligence to assess for causes beyond age,” said Seth Cohen, MD, MPH, associate professor of surgery in the department of otolaryngology-head and neck surgery at Duke University in Durham, N.C. “There may be other serious factors that are going on.” The same holds true for other otolaryngologic diagnoses.
Understanding Quality of Life
Successfully treating the geriatric patient, however, requires more than diagnostic skill and expert medical intervention. Many geriatric patients suffer from multiple comorbidities, and it is essential to understand the complex interplay between patients’ physical condition and their functional status.