What’s Age Got to Do With it?

 

By Michelle Brubaker   |   December 19, 2017

​When 84-year-old Richard Brehm wakes up every morning, he does a stretching program and walks for 30 minutes. He is active, eats well and listens to his wife.

Richard Brehm

“She is the one who makes me see a doctor,” laughs Brehm.

Brehm and his wife receive care through senior medicine at UC San Diego Health.

“So few doctors are trained specifically to address the kinds of problems senior citizens have,” said Brehm. “There is a real benefit of seeing someone who appreciates what the body goes through while aging.”

A lot of people are going through it. Roughly 10,000 Americans turn 65 each day. The population of those over age 65 is expected to nearly triple by 2030 as a result of aging Baby Boomers. According to the American Hospital Association, by 2030:

  • 14 million Boomers — one in every four — will be living with diabetes
  • Almost half of Boomers will have arthritis, the number peaking at more than 26 million in 2020
  • More than 21 million Boomers will be considered obese

“Now more than ever, we need our aging community to understand the specialized care available to them,” said Khai Nguyen, MD, primary care/geriatrics physician at UC San Diego Health.

Part of primary care, senior medicine at UC San Diego Health provides diagnostic evaluations, care for acute and chronic conditions and medical consultations. It’s ranked among the nation’s top 50 programs for geriatrics care by U.S. News & World Report.

Khai Nguyen

“As you get older, your health care needs change. Our doctors see through a special lens,” said Nguyen. “We take care of patients at higher risk of conditions accumulated over a life span, such as arthritis, heart disease and lung disease. A lot is happening in our bodies as we age.”

Brehm visits Nguyen every three to six months, mostly for issues related to aging. He is monitored for complications due to a number of back, prostate and other surgeries. 

“I particularly appreciate that Dr. Nguyen keeps close tabs on me, his friendly bedside manner and his thoroughness in discussing my medical issues in terms I understand,” said Brehm. “Every visit I am asked to list three things that I want to him to address. As an example, I was worried about a growth on my neck that turned out to be a benign skin tag that develops with age. That diagnosis saved me from having to make an appointment with a dermatologist.”

Nguyen said senior medicine should always be a multidisciplinary effort. “It took a village to raise us and it takes a village to take care of us when we age.”

Brehm says he always feels reassured and confident after leaving Nguyen’s clinic.

“I know my health is in the best hands,” said Brehm. “The team of doctors and nurses makes you feel like you are their only patient. And what I really love is that when I’ve needed a specialist, Dr. Nguyen has usually been able to recommend one through his personal knowledge.”

Patients age 65 and older, like Brehm, are the main demographic to receive care through senior medicine, but Nguyen says in some cases, age is just a number.

“You have to take the biological, chronological and health age of a patient into consideration. A 50-year-old patient may have the health of a 70-year-old and vice versa,” said Nguyen. “Deciding when to receive care from a geriatrician is very individualized.”

Nguyen said the main questions a patient should ask themselves are:

  • Has there been a decrease in my daily activities?
  • Do I have complex medical issues?
  • Did my primary care physician make a recommendation?

“The transition to receive my primary care through senior medicine was definitely a smooth one,” said Brehm.

The senior medicine team works closely with patients and their families for shared decision making.

“If we don’t make it a family conversation, it may be assumed the patient wants more aggressive care than they really do,” said Nguyen. “Also, most health problems are more than one thing — a cough could be related to multiple issues. We need to see the forest through the trees.”

Common concerns among older patients include chronic pain, memory loss, fatigue, anxiety and depression.

“Some of these issues may be related to age, but as a society we are sometimes quick to blame age on certain behaviors,” said Nguyen. “As geriatricians, we are trained to determine when something is normal and when something needs medical attention and intervention,” said Nguyen.

However, if a patient notices a decline in function, it’s important to discuss this with a primary care physician who can refer that individual to Nguyen’s team.

“Eating, bathing, dressing and walking are all things we take for granted when we are young, but if these functions are disrupted due to age, it can take a big toll on a patient’s overall health and well-being,” said Nguyen. “We may not be able to cure the medical condition, but we can work to manage it so patients can enjoy doing things, like being active with their grandkids or continuing to do a hobby they are passionate about.” 

The senior medicine team also takes a close look at the medications older patients are taking to see if all are necessary.

“The more medication a patient is taking, the greater the risk of adverse effects combined with the fact that an aging body has a different metabolism. We look at a patient’s medications and safely reduce them if needed so they can continue to meet life’s challenges but have improved outcomes,” said Nguyen.  “Our goal is to always manage the health conditions of our patients so they can have the best quality of life.” 

A life Brehm plans on living to the fullest with his wife.

“I feel really well and want to continue to walk and enjoy the outdoors with my wife for years to come,” said Brehm.


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