Hearing loss and dizziness, for instance, are extremely common in the geriatric population and can have a dramatic effect on patients’ quality of life. “Younger patients who have dizziness can often compensate pretty well, because their muscles, joints and vision are good,” said Neil Bhattacharyya, MD, associate chief of otolaryngology at Brigham and Women’s Hospital in Boston. “But an 85-year-old with dizziness who also has arthritis of the knees, poor balance and cataracts has a triple hit against them.”
Explore this issue:October 2012
Similarly, hearing loss and age-related vocal changes can impact every part of a patient’s life. “Elderly people who have hearing loss and dysphonia are more likely to have higher depression scores and quality of life issues than people who don’t have hearing loss or vocal changes,” Dr. Cohen said. Otolaryngologists who work with older patients must consider patients’ living environments, communication burden, cognitive ability, values and comorbidities when designing treatment plans.
—Karen Kost, MD, American Society of Geriatric Otolaryngology
Of course, developing a thorough understanding of the patient’s quality of life takes time. Conducting a full history and physical of an older patient takes longer than it does for younger patients, in part because older patients typically have more extensive medical histories. “An 80-year-old almost always has a more complicated history than a 35-year-old,” said Jerry Goldstein, MD, a founding member of ASGO. Older patients may also have communication difficulties, including hearing loss, weak voices and possible memory loss, which make it difficult to quickly and easily obtain information.
Busy otolaryngologists may feel hard pressed to come up with the extra time to spend with elderly patients, but physicians who work with the geriatric population on a regular basis say the time spent is a worthy investment.
The Importance of Collaboration
For otolaryngologists who are used to treating pathology only, skillfully managing the care of geriatric patients may require a shift in focus. “We have to go beyond the diagnosis and look into patients’ quality of life,” Dr. Bhattacharyya said. “Are they safe at home? Or do they need some assistance? We have to advocate for our patients, too.”
Few, if any, otolaryngologists have time to act as patient case managers, so it’s essential for otolaryngologists to collaborate with other health care personnel. “We have to remember that we are not treating these patients in isolation,” Dr. Cohen said. “We may have to work with neurologists, pulmonologists and primary care physicians. Geriatric patients have lots of needs, and a lot of these problems are interrelated.” Tools such as electronic health records can help physicians communicate across disciplines; so can old-fashioned phone calls.