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It is easier to describe an individual’s functional status, than to ascribe this status confidently to “aging.” Gerontologists have learned to be cautious in offering such interpretations because an observed deficit or impairment can arise from a variety of sources.
The tremor in an old person’s voice, for example, could well be a symptom of neurological disorder rather than a just – to-be-expected correlate of the aging process (Case, 1993). Another elderly person’s psychomotor retardation and confusion could prove to be the result of overmedication.
For example, it was common to see significant improvement in mental status within a few days after admission to the geriatric facility in which Mr. S. resided, simply because the aged men and women were liberated from the mind-dulling medication they had been receiving in nursing care facilities.
People with limited experience in gerontology and geriatrics are more likely to assume that problems experienced by elderly people are part and parcel of old age. Unfortunately, this assumption too often eventuates in a self-fulfilling prophecy.
A medical problem that might well have responded to treatment becomes chronic and recalcitrant because of misplaced therapeutic nihilism.
An anxiety reaction that has been precipitated by potentially identifiable events and amenable to intervention may be dismissed as “senile agitation.” At its worst, this assumption becomes a justification for withholding competent assessment and treatment opportunities from elderly men and women.
Aging adults themselves often have difficulty in distinguishing between “normal” changes and acquired disorders—made all the more complicated by such lifestyle factors as repeated dieting, over or under exercising, careless use of prescription or nonprescription drugs, insomnia secondary to depression, and so forth.
A well-trained geriatric diagnostician will also have difficulty at times in distinguishing more or less expected age changes from symptoms of illness or other disorder.
The person experiencing these changes may be at risk for increased anxiety either through misinterpretation or uncertainty.
For example, Mrs. D., a woman in her late seventies, fractured her hip in a fall. Mrs. D. (uncharacteristically) became so anxious that hospital staff as well as family had difficulty in dealing with her. As it turned out, Mrs. D. had put together bits of information she had heard or read to conclude that she was suffering from bone cancer—a disease that had painfully ended her mother’s life.
The anxiety quickly subsided when Mrs. D. accepted the medical evaluation that she was free of cancer but did have a problem with osteoporosis. Other elderly men and women have brought themselves to a state of anxious exhaustion by trying to understand the nature of their problems.
From a pragmatic standpoint, it may not seem to make much difference whether an elderly person’s physical problems are related primarily to intrinsic aging or to a genetic or acquired disorder. Painful is painful; fatigue is fatigue.
However, it does make a difference if we look at the whole picture over a period of time. People tend to be less anxious when they have a coherent explanation for their difficulties and an active course of action that has some potential to provide relief.
There is a need for caution in interpreting a presenting picture of impairment and distress as “just what one might expect in a person of that age.” It was not long ago that anxiety and confusion on the part of an elderly patient was often dismissed as senile agitation.
Today, geriatricians are more likely to explore the sources of expressed anxiety with an open mind. (This writer’s father would not have enjoyed his 90th birthday had not an older physician taken “vague complaints” seriously and discovered a gall bladder on the verge of rupture.)
