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Deliberate Steps, Deliberate Medicine:

Tread Carefully When Treating the Elderly

At the age of 100, my elderly aunt was intuitively aware of her declining strength. She had neither the energy nor ability to move back and forth across her apartment purposelessly. By necessity there was an economy of movement and her steps, when taken, were cautious and deliberate.

Watching my aunt helped define my approach as a doctor who works with the elderly. Medical treatments are often reflexive to medical diagnoses, but with elderly individuals in particular, physicians should be as cautious and deliberate with their decisions as my aunt was with her steps, with an implicit recognition of their frailty. Treatments should be cautious in that as a general rule of thumb the potential benefits of treatments diminish with age, while the potential harms increase. Treatments should be deliberate in that they focus on achieving stated patient goals. There is no purpose, for example, in treating a patient who is concerned primarily with maintaining quality of life with a medication that will likely diminish quality of life but offers a chance to improve longevity.

Many individuals with dementia have depleted physical, mental and emotional reservoirs, but unlike my aunt they are not intuitively aware of that frailty. Our job, as the healthcare professionals and families caring for these individuals is to recognize that frailty, work within its constraints and make cautious and deliberate medical decisions that advance the goals of our patients and loved ones.

Mark Unger                                                                                                                                                                                                              Advisory and House Physician