Successful Aging

The office of Dr. Joyce Fogel is nestled into the 12th floor of St. Vincent’s Hospital, almost impossible to notice walking down the corridor. The door greets patients and visitors with kind words: “Cherish yesterday, love tomorrow, live today.” Inside, her office is decorated with similar warmth.

A piece of paper taped to a wooden dresser displays “The Physician’s Daily Prayer,” reminding Dr. Fogel about the humanitarian qualities that make one want to go into medicine. Rosie the Riveter flexes on a poster on the opposite wall, and a row of Gary Larson cartoons speaks to Fogel’s easy smile and sense of humor. The office decorum reflects the many attributes that Dr. Fogel needs daily, as the Section Chief of the Eileen E. Anderson Geriatric Section of St. Vincent’s Hospital.

“It’s unique because you don’t do a lot of cure [with geriatric care],” Dr. Fogel said. “You do a lot of prevention, a lot of maintenance. are providing education. And people do better when they understand their illness, as well as their medications.”

And as the Baby Boom generation starts to enter the golden years, the need for education on aging is more important then ever.

“Nationally, 12 percent of the population is over 65 and by 2030, that number is projected to be 22 percent,” she said, rattling off statistics at a breakneck pace. “And only five percent of elderly people are in nursing homes. That means that they are out there in the communities and need service. Right now the fastest growing portion of our population is the 85 and over group.”

The task of educating and treating this growing senior population is a bit more challenging than a typical doctor’s in that it requires more of a holistic approach, with an emphasis on complete care, not simply treating one specific illness. There are so many problems that can arise in the aging process — arthritis, heart disease, hearing loss, vision loss, memory loss, etc. — that has to approach each patient as a unique whole.

“This is an interdisciplinary program in every way,” explained. “As patients age, there is the common idea that one provider can’t care for them alone. We try to provide preventative care as well as dealing with specific problems that arise, whether it’s dementia or falling down. There are a lot of components – physicians, social workers, community resources. We provide a link for our patients to get whatever it is they need.”

And the old way of doing things just won’t do. “The ‘well what do you want – you are old’ approach is not acceptable,” she said. “Medical providers need to be tuned in to issues of aging” and treat a senior’s ailment as seriously as they would a thirtysomething’s because even if there is no cure for a specific condition, not treating it has a good chance of make things worse.

Plain and simple, for the aging senior it’s a quality of life issue.

“As life expectancy increases, people are not only living longer but they are living longer with their chronic illnesses and functional losses. I see accommodating to those losses and the loss of independence as a great challenge,” said. “One quarter of people over the age of 65 consider their health poor or have some kind of functional disability.”

Some of the more common forms of functional disability are hearing loss, vision loss and memory loss. Hearing loss and vision loss are usually easily treatable with hearing aids and glasses. And while memory loss isn’t quite so easily treatable, she said “there have been some studies that suggest remaining mentally challenged — like doing the crossword puzzle — may keep older folks a little sharper.”

Besides staying mentally active, “it is important to remain as physically active as possible to prevent deconditioning, loss of strength and muscle mass,” she said. When a person is sedentary, muscles weaken, which introduces a whole host of problems, one of which is an increased chance of falling. “Exercise is valuable both in prevention and treatment,” Dr. Fogel said. “Regular exercise can lower blood pressure, help in weight loss, improve muscle strength. Specific programs like Tai Chi have been found to be beneficial for gait and balance.” It is also important that a person eat healthy.

“Proper diet is so important in treating so many diseases — diabetes, heart disease, high cholesterol,” she said. “It may, in fact, allow for less medication use in some people. And the intake of calcium, either as supplements or in the diet, is important in treatment and prevention of osteoporosis.”

Regular doctor visits are also important in a successful aging strategy as a doctor can help tailor a plan for a patient’s specific needs and provide education as to the best diet, exercise and medication regimen. Regular visits also help detect diseases early, as do regular cancer screenings.

Dr. Fogel says that there’s much more to healthy aging than individual tasks. Seniors must also take a look at their surroundings.

“As people age they need to develop a network in the community — day programs, meals-on-wheels-type programs, etc.,” Dr. Fogel said. Seniors need to find “medical providers who are tuned in to issues of aging and services for hearing aids, low vision and physical therapy.” Older adults need to know what assistive devices are available. Do they need a personal emergency response system? What kind of personal help is needed within the home? What’s available?

Of course, family is invaluable in making these decisions. said they can help by “being understanding and encouraging seniors to get help when needed.”

“Sometimes families are in denial about their loved one’s losses as well and the need for help,” she said. “Family involvement is crucial to keep a handle on what’s going on. They can interface with health care providers and provide additional information.”

“Families also need to encourage independence as long as it is safe,” she added. “It is sometimes hard to find the right balance.”

Families can also help in one of the more unexpected challenges of aging: loss of decision-making abilities.

“An individual may not anticipate that they may become too ill to make a medical decision and don’t appoint a health care proxy or make their wishes known for care in advanced illnesses or end of life,” Dr. Fogel said. This can create major problems when there is no clear-cut course of action and family members squabble among themselves deciding on the course to take, possibly delaying treatment or even denying it altogether.

“[A patient with] advanced Alzheimer’s, is the same as having a terminal cancer patient,” Dr. Fogel emphasized. “The difference is that maybe they cannot speak for themselves. We always want to know their wishes before they reach that point. It’s our responsibility to meet their wishes as best as possible.”

Fogel noted that one of the most challenging yet rewarding parts of geriatric care comes with these patients that are incurable, but still have the rest of their lives to live out as well as possible.

“We do a lot of work with end-of-life patients,” she said. “We are always trying to find the best environment for each person. Can they stay at home? What are their last wishes? It’s about optimizing aging. It’s very rewarding to help people fill their own goals for aging.”