Depression an obstacle in treating older patients

Ethics Forum. April 4, 2005.

How can you best treat an aging patient with quality-of-life issues?

Millions of aging men and women with chronic medical conditions complicated by social and psychological problems resist elective treatments, even those that could significantly improve their quality of life. What can, and should, primary care physicians do?

Reply:

The reasons for this are multifaceted, but there are ways that primary care physicians can properly assess psychosocial barriers to treatment and, more importantly, begin to help patients overcome them.

Marty Smith's situation is representative of this phenomenon.

Smith (not his real name) is 73; he has hypertension, hyperlipidemia and arthritis.

When his wife of 50 years died two years ago, Smith began losing weight. His physician discovered that the weight loss was due to Smith's lack of appetite and to the fact that he had never prepared meals for himself while his wife was alive.

Smith's son convinced his dad to move to Texas to live with his wife and him but, once there, Smith stayed in his room, watching TV most of the day.

Smith needed encouragement to eat. His son convinced him to visit a doctor in his new home after Smith complained of being tired all the time.

The new physician noted Smith's antalgic gait, and a subsequent workup revealed severe left hip degeneration.