Diagnosis
The National Institute of Health provides a list of general Questions to ask a Doctor.
They are below, and here is the link:
http://www.nia.nih.gov/HealthInformation/Publications/TalkingWithYourDo…
or
http://alturl.com/wyjjf
Asking More Questions: Talking to Doctors in Special Situations
Your doctor may send you to a specialist for further evaluation, or you may request to see a specialist yourself. It’s likely that your insurance plan will require you to have a referral from your primary doctor.
A visit to the specialist may be short. Often, the specialist already has seen your medical records or test results and is familiar with your case. If you are unclear about what the specialist tells you, ask questions.
For example, if the specialist says that you have a medical condition that you aren’t familiar with, you may want to say something like: “I don’t know very much about that condition. Could you explain what it is and how it might affect me?” or “I’ve heard that is a painful problem. What can be done to prevent or manage the pain?”
You also may ask for written materials to read, or you can call your primary doctor to clarify anything you haven’t understood.
Ask the specialist to send information about any further diagnosis or treatment to your primary doctor. This allows your primary doctor to keep track of your medical care. You also should let your primary doctor know at your next visit how well any treatments or medications the specialist recommended are working.
Questions to ask your specialist:
What is your diagnosis?
What treatment do you recommend? How soon do I need to begin the new treatment?
Will you discuss my care with my primary doctor?
Seeking a Second Opinion
When surgery is recommended, patients often seek a second opinion. Hearing the views of two different doctors can help you decide what’s best for you. In fact, your insurance plan may require it. Doctors are used to this practice, and most will not be insulted by your request for a second opinion. Your doctor may even be able to suggest other doctors who can review your case.
Always remember to check with your insurance provider in advance to find out whether a second opinion is covered under your policy, if there are restrictions to which doctors you can see, and if you need a referral form from your primary doctor.
If you need to have surgery — In some cases, surgery may be the best treatment for your condition. If so, your doctor will refer you to a surgeon. Knowing more about the operation will help you make an informed decision about how to proceed. It also will help you get ready for the surgery, which makes for a better recovery.
Ask the surgeon to explain what will be done during the operation and what reading material, videotapes, or websites you can look at before the operation.
Find out if you will have to stay overnight in the hospital or if the surgery can be done on an outpatient basis. Will you need someone to drive you home? Minor surgeries that don’t require an overnight stay can sometimes be done at medical centers called ambulatory surgical centers.
Questions to ask your surgeon:
What is the success rate of the operation? How many of these operations have you done successfully?
What problems occur with this surgery? What kind of pain or discomfort can I expect?
What kind of anesthesia will I have? Are there any risks associated with it for older people?
Will I have to stay in the hospital overnight? How long is recovery expected to take? What does it involve? When can I get back to my normal routine?
If you are hospitalized — If you have to go to the hospital, some extra guidelines may help you. First, most hospitals have a daily schedule. Knowing the hospital routine can make your stay more comfortable. Find out how much choice you have about your daily routine and express any preferences you have about your schedule. Doctors generally visit patients during specific times each day. Find out when the doctor is likely to visit so you can have your questions ready.
In the hospital, your primary doctor and various medical specialists, as well as nurses and other health professionals, may examine you. If you are in a teaching hospital, doctors-in-training known as medical students, interns, residents, or fellows, also may examine you. Many of these doctors-in-training already have a lot of knowledge and experience. They may be able to take more time to talk with you than other staff. Nurses also can be an important source of information, especially since you will see them often.
Questions to ask medical staff in the hospital:
How long can I expect to be in the hospital?
When will I see my doctor? What doctors and health professionals will I see?
What is the daily routine in this part of the hospital?
If you go to the emergency room — A visit to the emergency room can be stressful. It may go more smoothly if you can take along the following items:
Your health insurance card or policy number.
A list of your medications.
A list of your medical problems.
The names and phone numbers of your doctor and one or two family members or close friends.
Some people find it helpful to keep this information on a card in their wallet or purse at all times.
Depending on the problem, you may have a long wait in the emergency room. Consider taking things to make the wait more comfortable, such as something to read or a sweater in case the room is cold.
While in the emergency room, ask questions if you don’t understand tests or procedures that are being done. Before leaving, make sure you understand what the doctor told you or ask for written instructions. For example, if you have bandages that need changing, be sure you understand how and when it should be done. Tell your primary doctor as soon as possible about your visit to the emergency room.
Questions to ask medical staff in the emergency room:
Will you talk to my primary doctor about my care?
Do I need to arrange any further care?
May I get instructions for further care in writing?
Is there someone here who speaks my language and can explain the instructions?
Summary: Talking to Doctors in Special Situations
Ask questions if you are unclear.
Try to write down as much information as possible.
Tell your primary care doctor if you see a specialist, need surgery, or have gone to the emergency room.
It helps the doctor—and you—if he or she knows about the non-medical parts of your life. Where you live, how you get around, what activities are important to you: these are all things that can make a difference in decisions about your health care. The following are some examples of practical matters you might want to discuss with your doctor. For more information and resources on these topics, see the section on additional resources included at the end of this booklet.
Medicare Prescription Drug Plans
Medicare prescription drug coverage is available to people with Medicare.
For information call 1-800-MEDICARE (1-800-633-4227) or visit the website at www.medicare.gov.
Planning for care in the event of a serious illness — You may have some concerns or wishes about your care if you become seriously ill. If you have questions about what choices you have, ask your doctor. You can specify your desires through documents called advance directives, such as a living will or health care proxy. One way to bring up the subject is to say: “I’m worried about what would happen in the hospital if I were very sick and not likely to get better. Can you tell me what generally happens in that case?”
In general, the best time to talk with your doctor about these issues is when you are still relatively healthy. If you are admitted to the hospital or a nursing home, a nurse or other staff member may ask if you have any advance directives.
Driving — Driving is an important part of everyday life for many people and making the decision to stop driving can be very difficult. Tell your doctor if you or people close to you are concerned about your driving and why. He or she can go over your medical conditions and medications to see if there are treatable problems that may be contributing to driving difficulties. Vision and memory tests are important. The doctor also may be able to suggest a driver’s education refresher class designed for older drivers.
Moving to assisted living — Another hard decision that many older people face is whether or not to move to a place where they can have more help—often an assisted living facility. If you are considering such a move, your doctor can help you weigh the pros and cons based on your health and other circumstances. He or she may be able to refer you to a social worker or a local agency that can help in finding an assisted living facility.
Paying for medications — Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. If the doctor does not know the cost, ask the pharmacist before filling the prescription. Then call your doctor and ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?”
Your doctor may also be able to refer you to a medical assistance program that can help with drug costs.
Summary: Practical Matters
Don’t hesitate to bring up concerns, even if they don’t seem directly related to a medical condition.
You and your doctor can make better decisions together if the doctor knows about your troubling non-medical concerns.
If the doctor can’t help solve your non-medical problems, he or she may be able to refer you to other resources that can help.
Tips: Advance Directives
Advance directives are written instructions letting others know the type of care you want if you are seriously ill or dying. There are two main kinds:
Living wills — A living will records your end-of-life wishes for medical treatment in case you are no longer able to speak for yourself. Living wills typically refer only to life-prolonging treatment when you are close to death.
Health care proxies — A health care proxy is named through a “durable power of attorney for health care.” Sometimes this person may be referred to as a representative, surrogate, agent, or attorney-in-fact. A health care proxy is helpful if you do not want to be specific about your end-of-life treatment—you would rather let the health care proxy evaluate each situation or treatment option independently. This type of advance directive is also important if you want your health care proxy to be someone who is not a legal member of your family.
Make sure your doctor and family understand your advance directives and your views about end-of-life care. That will help them make the decisions you would want. Sometimes people change their mind as they get older or after they become ill. Review the choices in your advance care directives from time to time and make changes as needed.
Advance care directives are legally valid everywhere in the United States, but laws concerning them vary from state to state. Forms approved for the state you live in are available from many different health care organizations and institutions. Make sure that the form you choose is legal in your home state and any other state that you may live in for part of the year.
Can I Really Talk About That? Discussing Sensitive Subjects
Much of the communication between doctor and patient is personal. To have a good partnership with your doctor, it is important to talk about sensitive subjects, like sex or memory problems, even if you are embarrassed or uncomfortable. Most doctors are used to talking about personal matters and will try to ease your discomfort. Keep in mind that these topics concern many older people. For more information, see the section on additional resources at the end of this booklet. You might find that using booklets from these organizations can help you bring up sensitive subjects when talking with your doctor.
It is important to understand that problems with memory, depression, sexual function, and incontinence are not necessarily normal parts of aging. A good doctor will take your concerns about these topics seriously and not brush them off as being “normal.” If you think your doctor isn’t taking your concerns seriously, talk to him or her about your feelings or consider looking for a new doctor.
Alcohol — Anyone at any age can have a drinking problem. Alcohol can have a greater effect as a person grows older because the aging process affects how the body handles alcohol. Someone whose drinking habits haven’t changed may find over time that he or she has a problem. People can also develop a drinking problem later in life due to major life changes like the death of loved ones. In fact, depression in older adults often goes along with alcohol misuse. Talk to your doctor if you think you may be developing a drinking problem. You could say: “Lately I’ve been wanting to have a drink earlier and earlier in the afternoon and I find it’s getting harder to stop after just one or two. What kind of treatments could help with this?”
Falling and fear of falling — A fall can be a serious event, often leading to injury and loss of independence, at least for a while. For this reason, many older people develop a fear of falling.
Studies show that fear of falling can keep people from going about their normal activities, and as a result they may become frailer, which actually increases their risk of falling again. If fear of falling is affecting your day-to-day life, let your doctor know. He or she may be able to recommend some things to do to reduce your chances of falling. Exercises can help you improve your balance and strengthen your muscles, at any age.
Feeling unhappy with your doctor — Misunderstandings can come up in any relationship, including between a patient and doctor or the doctor’s staff. If you feel uncomfortable with something your doctor or his or her staff has said or done, be direct. For example, if the doctor does not return your telephone calls, you may want to say something like this: “I realize that you care for a lot of patients and are very busy, but I feel frustrated when I have to wait for days for you to return my call. Is there a way we can work together to improve this?”
Being honest is much better for your health than avoiding the doctor. If you have a long-standing relationship with your doctor, working out the problem may be more useful than looking for a new doctor.
Grief, mourning, and depression — As people grow older, they may lose significant people in their lives, including spouses and cherished friends. Or they may have to move away from home or give up favorite activities. A doctor who knows about your losses is better able to understand how you are feeling. He or she can make suggestions that may be helpful to you.
Although it is normal to mourn when you have a loss, later life does not have to be a time of ongoing sadness. If you feel sad all the time or for more than a few weeks, let your doctor know. Also tell your doctor about symptoms such as lack of energy, poor appetite, trouble sleeping, or little interest in life. These could be signs of depression, which is a medical condition.
Depression may be common, especially when people experience losses, but it is also treatable. It should not be considered “normal” at any age. Let your doctor know about your feelings and ask about treatment.
HIV/AIDS — The death of a spouse, divorce, or separation can lead some older people to find themselves dating again and possibly having sex with a new partner. It’s a good idea to talk to your doctor about how safe sex can reduce your risk of sexually transmitted diseases such as HIV/AIDS. It’s important to practice safe sex, no matter what your age.
Incontinence — Older people sometimes have problems controlling their bladder. This is called urinary incontinence and it can often be treated. Depending on the type of incontinence you have, the doctor may recommend exercises, suggest helpful ways to change your habits, prescribe useful medications, or advise surgery. If you have trouble controlling your bladder or bowels, it is important to let the doctor know. To bring up the topic, you could say something like: “Since my last visit there have been several times that I couldn’t control my bladder.”
Free Information
If you are worried about memory problems and Alzheimer’s disease you can contact the NIA-funded Alzheimer’s Disease Education and Referral Center (ADEAR)—a comprehensive source of information. ADEAR staff can:
Answer specific questions about Alzheimer’s.
Send free publications.
Refer callers to local resources.
Provide information about clinical trials.
Help you find materials about specific issues.
Call toll-free 1-800-438-4380 or visit the ADEAR website at www.nia.nih.gov/Alzheimers.
Memory problems — Many older people worry about their ability to think and remember. For most older adults, thinking and memory remain relatively intact in later years. However, if you or your family notice that you are having problems remembering recent events or thinking clearly, let your doctor know. Be specific about the changes you’ve noticed; for example, you could say: “I’ve always been able to balance my checkbook without any problems, but lately I’m very confused.” Your doctor will probably want you to have a thorough checkup to see what might be causing your symptoms. In many cases, memory problems are caused by conditions such as depression or infection, or they may be a side effect of medication. Sometimes, the problem is a type of dementia, such as Alzheimer’s disease. With a careful history, physical exam, medical tests, and tests of memory and problem solving, specialists can diagnose Alzheimer's with a high degree of accuracy. Determining the cause of memory problems is important to help the doctor, patient, and family choose the best plan of care. Although there is no cure for Alzheimer's, medicines can help for a while, especially in the early stages of the disease. Medications also can ease serious behavioral symptoms such as agitation, anxiety, and depression. Support groups and education are important and can help patients and caregivers.
Problems with family — Even strong and loving families can have problems, especially under the stress of illness. Although family problems can be painful to discuss, talking about them can help your doctor help you. Your doctor may be able to suggest steps to improve the situation for you and other family members.
If you feel that a family member or caregiver is taking advantage of you or mistreating you, let your doctor know. Some older people are subjected to abuse by family members or others. Abuse can be physical, verbal, psychological, or even financial in nature. Your doctor may be able to provide resources or referrals to other services that can help if you are being mistreated.
Sexuality — Most health professionals now understand that sexuality remains important in later life. If you are not satisfied with your sex life, don’t just assume it’s due to your age. In addition to talking about age-related changes, you can ask your doctor about the effects of an illness or a disability on sexual function. Also, ask your doctor about the influence medications or surgery may have on your sex life. If you aren’t sure how to bring the topic up, try saying: “I have a personal question I would like to ask you...” or “I understand that this condition or medication can affect my body in many ways. Will it affect my sex life at all?”
Summary: Discussing Sensitive Subjects
Don’t hesitate to discuss sensitive subjects with your doctor.
Use brochures or booklets as props to introduce topics you may feel awkward discussing.
If you feel the doctor doesn’t take your concerns seriously, it might be time to think about changing doctors.
Who Else Will Help? Involving Your Family and Friends
It can be helpful to take a family member or friend with you when you go to the doctor’s office. You may feel more confident if someone else is with you. Also, a relative or friend can help remind you about things you planned to tell or ask the doctor. He or she also can help you remember what the doctor says.
Don’t let your companion take too strong a role. The visit is between you and the doctor. You may want some time alone with the doctor to discuss personal matters. If you are alone with the doctor during or right after the physical exam, this might be a good time to raise private concerns. Or, you could ask your family member or friend to stay in the waiting room for part of the appointment. For best results, let your companion know in advance how he or she can be most helpful.
If a relative or friend helps with your care at home, bringing that person along when you visit the doctor may be useful. In addition to the questions you have, your caregiver may have concerns he or she wants to discuss with the doctor. Some things caregivers may find especially helpful to discuss are: what to expect in the future, sources of information and support, community services, and ways they can maintain their own well-being.
Even if a family member or friend can’t go with you to your appointment, he or she can still help. For example, the person can serve as your sounding board, helping you practice what you want to say to the doctor before the visit. And after the visit, talking about what the doctor said can remind you of the important points and help you come up with questions to ask next time.
They are below, and here is the link:
http://www.nia.nih.gov/HealthInformation/Publications/TalkingWithYourDo…
or
http://alturl.com/wyjjf
Asking More Questions: Talking to Doctors in Special Situations
Your doctor may send you to a specialist for further evaluation, or you may request to see a specialist yourself. It’s likely that your insurance plan will require you to have a referral from your primary doctor.
A visit to the specialist may be short. Often, the specialist already has seen your medical records or test results and is familiar with your case. If you are unclear about what the specialist tells you, ask questions.
For example, if the specialist says that you have a medical condition that you aren’t familiar with, you may want to say something like: “I don’t know very much about that condition. Could you explain what it is and how it might affect me?” or “I’ve heard that is a painful problem. What can be done to prevent or manage the pain?”
You also may ask for written materials to read, or you can call your primary doctor to clarify anything you haven’t understood.
Ask the specialist to send information about any further diagnosis or treatment to your primary doctor. This allows your primary doctor to keep track of your medical care. You also should let your primary doctor know at your next visit how well any treatments or medications the specialist recommended are working.
Questions to ask your specialist:
What is your diagnosis?
What treatment do you recommend? How soon do I need to begin the new treatment?
Will you discuss my care with my primary doctor?
Seeking a Second Opinion
When surgery is recommended, patients often seek a second opinion. Hearing the views of two different doctors can help you decide what’s best for you. In fact, your insurance plan may require it. Doctors are used to this practice, and most will not be insulted by your request for a second opinion. Your doctor may even be able to suggest other doctors who can review your case.
Always remember to check with your insurance provider in advance to find out whether a second opinion is covered under your policy, if there are restrictions to which doctors you can see, and if you need a referral form from your primary doctor.
If you need to have surgery — In some cases, surgery may be the best treatment for your condition. If so, your doctor will refer you to a surgeon. Knowing more about the operation will help you make an informed decision about how to proceed. It also will help you get ready for the surgery, which makes for a better recovery.
Ask the surgeon to explain what will be done during the operation and what reading material, videotapes, or websites you can look at before the operation.
Find out if you will have to stay overnight in the hospital or if the surgery can be done on an outpatient basis. Will you need someone to drive you home? Minor surgeries that don’t require an overnight stay can sometimes be done at medical centers called ambulatory surgical centers.
Questions to ask your surgeon:
What is the success rate of the operation? How many of these operations have you done successfully?
What problems occur with this surgery? What kind of pain or discomfort can I expect?
What kind of anesthesia will I have? Are there any risks associated with it for older people?
Will I have to stay in the hospital overnight? How long is recovery expected to take? What does it involve? When can I get back to my normal routine?
If you are hospitalized — If you have to go to the hospital, some extra guidelines may help you. First, most hospitals have a daily schedule. Knowing the hospital routine can make your stay more comfortable. Find out how much choice you have about your daily routine and express any preferences you have about your schedule. Doctors generally visit patients during specific times each day. Find out when the doctor is likely to visit so you can have your questions ready.
In the hospital, your primary doctor and various medical specialists, as well as nurses and other health professionals, may examine you. If you are in a teaching hospital, doctors-in-training known as medical students, interns, residents, or fellows, also may examine you. Many of these doctors-in-training already have a lot of knowledge and experience. They may be able to take more time to talk with you than other staff. Nurses also can be an important source of information, especially since you will see them often.
Questions to ask medical staff in the hospital:
How long can I expect to be in the hospital?
When will I see my doctor? What doctors and health professionals will I see?
What is the daily routine in this part of the hospital?
If you go to the emergency room — A visit to the emergency room can be stressful. It may go more smoothly if you can take along the following items:
Your health insurance card or policy number.
A list of your medications.
A list of your medical problems.
The names and phone numbers of your doctor and one or two family members or close friends.
Some people find it helpful to keep this information on a card in their wallet or purse at all times.
Depending on the problem, you may have a long wait in the emergency room. Consider taking things to make the wait more comfortable, such as something to read or a sweater in case the room is cold.
While in the emergency room, ask questions if you don’t understand tests or procedures that are being done. Before leaving, make sure you understand what the doctor told you or ask for written instructions. For example, if you have bandages that need changing, be sure you understand how and when it should be done. Tell your primary doctor as soon as possible about your visit to the emergency room.
Questions to ask medical staff in the emergency room:
Will you talk to my primary doctor about my care?
Do I need to arrange any further care?
May I get instructions for further care in writing?
Is there someone here who speaks my language and can explain the instructions?
Summary: Talking to Doctors in Special Situations
Ask questions if you are unclear.
Try to write down as much information as possible.
Tell your primary care doctor if you see a specialist, need surgery, or have gone to the emergency room.
It helps the doctor—and you—if he or she knows about the non-medical parts of your life. Where you live, how you get around, what activities are important to you: these are all things that can make a difference in decisions about your health care. The following are some examples of practical matters you might want to discuss with your doctor. For more information and resources on these topics, see the section on additional resources included at the end of this booklet.
Medicare Prescription Drug Plans
Medicare prescription drug coverage is available to people with Medicare.
For information call 1-800-MEDICARE (1-800-633-4227) or visit the website at www.medicare.gov.
Planning for care in the event of a serious illness — You may have some concerns or wishes about your care if you become seriously ill. If you have questions about what choices you have, ask your doctor. You can specify your desires through documents called advance directives, such as a living will or health care proxy. One way to bring up the subject is to say: “I’m worried about what would happen in the hospital if I were very sick and not likely to get better. Can you tell me what generally happens in that case?”
In general, the best time to talk with your doctor about these issues is when you are still relatively healthy. If you are admitted to the hospital or a nursing home, a nurse or other staff member may ask if you have any advance directives.
Driving — Driving is an important part of everyday life for many people and making the decision to stop driving can be very difficult. Tell your doctor if you or people close to you are concerned about your driving and why. He or she can go over your medical conditions and medications to see if there are treatable problems that may be contributing to driving difficulties. Vision and memory tests are important. The doctor also may be able to suggest a driver’s education refresher class designed for older drivers.
Moving to assisted living — Another hard decision that many older people face is whether or not to move to a place where they can have more help—often an assisted living facility. If you are considering such a move, your doctor can help you weigh the pros and cons based on your health and other circumstances. He or she may be able to refer you to a social worker or a local agency that can help in finding an assisted living facility.
Paying for medications — Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. If the doctor does not know the cost, ask the pharmacist before filling the prescription. Then call your doctor and ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?”
Your doctor may also be able to refer you to a medical assistance program that can help with drug costs.
Summary: Practical Matters
Don’t hesitate to bring up concerns, even if they don’t seem directly related to a medical condition.
You and your doctor can make better decisions together if the doctor knows about your troubling non-medical concerns.
If the doctor can’t help solve your non-medical problems, he or she may be able to refer you to other resources that can help.
Tips: Advance Directives
Advance directives are written instructions letting others know the type of care you want if you are seriously ill or dying. There are two main kinds:
Living wills — A living will records your end-of-life wishes for medical treatment in case you are no longer able to speak for yourself. Living wills typically refer only to life-prolonging treatment when you are close to death.
Health care proxies — A health care proxy is named through a “durable power of attorney for health care.” Sometimes this person may be referred to as a representative, surrogate, agent, or attorney-in-fact. A health care proxy is helpful if you do not want to be specific about your end-of-life treatment—you would rather let the health care proxy evaluate each situation or treatment option independently. This type of advance directive is also important if you want your health care proxy to be someone who is not a legal member of your family.
Make sure your doctor and family understand your advance directives and your views about end-of-life care. That will help them make the decisions you would want. Sometimes people change their mind as they get older or after they become ill. Review the choices in your advance care directives from time to time and make changes as needed.
Advance care directives are legally valid everywhere in the United States, but laws concerning them vary from state to state. Forms approved for the state you live in are available from many different health care organizations and institutions. Make sure that the form you choose is legal in your home state and any other state that you may live in for part of the year.
Can I Really Talk About That? Discussing Sensitive Subjects
Much of the communication between doctor and patient is personal. To have a good partnership with your doctor, it is important to talk about sensitive subjects, like sex or memory problems, even if you are embarrassed or uncomfortable. Most doctors are used to talking about personal matters and will try to ease your discomfort. Keep in mind that these topics concern many older people. For more information, see the section on additional resources at the end of this booklet. You might find that using booklets from these organizations can help you bring up sensitive subjects when talking with your doctor.
It is important to understand that problems with memory, depression, sexual function, and incontinence are not necessarily normal parts of aging. A good doctor will take your concerns about these topics seriously and not brush them off as being “normal.” If you think your doctor isn’t taking your concerns seriously, talk to him or her about your feelings or consider looking for a new doctor.
Alcohol — Anyone at any age can have a drinking problem. Alcohol can have a greater effect as a person grows older because the aging process affects how the body handles alcohol. Someone whose drinking habits haven’t changed may find over time that he or she has a problem. People can also develop a drinking problem later in life due to major life changes like the death of loved ones. In fact, depression in older adults often goes along with alcohol misuse. Talk to your doctor if you think you may be developing a drinking problem. You could say: “Lately I’ve been wanting to have a drink earlier and earlier in the afternoon and I find it’s getting harder to stop after just one or two. What kind of treatments could help with this?”
Falling and fear of falling — A fall can be a serious event, often leading to injury and loss of independence, at least for a while. For this reason, many older people develop a fear of falling.
Studies show that fear of falling can keep people from going about their normal activities, and as a result they may become frailer, which actually increases their risk of falling again. If fear of falling is affecting your day-to-day life, let your doctor know. He or she may be able to recommend some things to do to reduce your chances of falling. Exercises can help you improve your balance and strengthen your muscles, at any age.
Feeling unhappy with your doctor — Misunderstandings can come up in any relationship, including between a patient and doctor or the doctor’s staff. If you feel uncomfortable with something your doctor or his or her staff has said or done, be direct. For example, if the doctor does not return your telephone calls, you may want to say something like this: “I realize that you care for a lot of patients and are very busy, but I feel frustrated when I have to wait for days for you to return my call. Is there a way we can work together to improve this?”
Being honest is much better for your health than avoiding the doctor. If you have a long-standing relationship with your doctor, working out the problem may be more useful than looking for a new doctor.
Grief, mourning, and depression — As people grow older, they may lose significant people in their lives, including spouses and cherished friends. Or they may have to move away from home or give up favorite activities. A doctor who knows about your losses is better able to understand how you are feeling. He or she can make suggestions that may be helpful to you.
Although it is normal to mourn when you have a loss, later life does not have to be a time of ongoing sadness. If you feel sad all the time or for more than a few weeks, let your doctor know. Also tell your doctor about symptoms such as lack of energy, poor appetite, trouble sleeping, or little interest in life. These could be signs of depression, which is a medical condition.
Depression may be common, especially when people experience losses, but it is also treatable. It should not be considered “normal” at any age. Let your doctor know about your feelings and ask about treatment.
HIV/AIDS — The death of a spouse, divorce, or separation can lead some older people to find themselves dating again and possibly having sex with a new partner. It’s a good idea to talk to your doctor about how safe sex can reduce your risk of sexually transmitted diseases such as HIV/AIDS. It’s important to practice safe sex, no matter what your age.
Incontinence — Older people sometimes have problems controlling their bladder. This is called urinary incontinence and it can often be treated. Depending on the type of incontinence you have, the doctor may recommend exercises, suggest helpful ways to change your habits, prescribe useful medications, or advise surgery. If you have trouble controlling your bladder or bowels, it is important to let the doctor know. To bring up the topic, you could say something like: “Since my last visit there have been several times that I couldn’t control my bladder.”
Free Information
If you are worried about memory problems and Alzheimer’s disease you can contact the NIA-funded Alzheimer’s Disease Education and Referral Center (ADEAR)—a comprehensive source of information. ADEAR staff can:
Answer specific questions about Alzheimer’s.
Send free publications.
Refer callers to local resources.
Provide information about clinical trials.
Help you find materials about specific issues.
Call toll-free 1-800-438-4380 or visit the ADEAR website at www.nia.nih.gov/Alzheimers.
Memory problems — Many older people worry about their ability to think and remember. For most older adults, thinking and memory remain relatively intact in later years. However, if you or your family notice that you are having problems remembering recent events or thinking clearly, let your doctor know. Be specific about the changes you’ve noticed; for example, you could say: “I’ve always been able to balance my checkbook without any problems, but lately I’m very confused.” Your doctor will probably want you to have a thorough checkup to see what might be causing your symptoms. In many cases, memory problems are caused by conditions such as depression or infection, or they may be a side effect of medication. Sometimes, the problem is a type of dementia, such as Alzheimer’s disease. With a careful history, physical exam, medical tests, and tests of memory and problem solving, specialists can diagnose Alzheimer's with a high degree of accuracy. Determining the cause of memory problems is important to help the doctor, patient, and family choose the best plan of care. Although there is no cure for Alzheimer's, medicines can help for a while, especially in the early stages of the disease. Medications also can ease serious behavioral symptoms such as agitation, anxiety, and depression. Support groups and education are important and can help patients and caregivers.
Problems with family — Even strong and loving families can have problems, especially under the stress of illness. Although family problems can be painful to discuss, talking about them can help your doctor help you. Your doctor may be able to suggest steps to improve the situation for you and other family members.
If you feel that a family member or caregiver is taking advantage of you or mistreating you, let your doctor know. Some older people are subjected to abuse by family members or others. Abuse can be physical, verbal, psychological, or even financial in nature. Your doctor may be able to provide resources or referrals to other services that can help if you are being mistreated.
Sexuality — Most health professionals now understand that sexuality remains important in later life. If you are not satisfied with your sex life, don’t just assume it’s due to your age. In addition to talking about age-related changes, you can ask your doctor about the effects of an illness or a disability on sexual function. Also, ask your doctor about the influence medications or surgery may have on your sex life. If you aren’t sure how to bring the topic up, try saying: “I have a personal question I would like to ask you...” or “I understand that this condition or medication can affect my body in many ways. Will it affect my sex life at all?”
Summary: Discussing Sensitive Subjects
Don’t hesitate to discuss sensitive subjects with your doctor.
Use brochures or booklets as props to introduce topics you may feel awkward discussing.
If you feel the doctor doesn’t take your concerns seriously, it might be time to think about changing doctors.
Who Else Will Help? Involving Your Family and Friends
It can be helpful to take a family member or friend with you when you go to the doctor’s office. You may feel more confident if someone else is with you. Also, a relative or friend can help remind you about things you planned to tell or ask the doctor. He or she also can help you remember what the doctor says.
Don’t let your companion take too strong a role. The visit is between you and the doctor. You may want some time alone with the doctor to discuss personal matters. If you are alone with the doctor during or right after the physical exam, this might be a good time to raise private concerns. Or, you could ask your family member or friend to stay in the waiting room for part of the appointment. For best results, let your companion know in advance how he or she can be most helpful.
If a relative or friend helps with your care at home, bringing that person along when you visit the doctor may be useful. In addition to the questions you have, your caregiver may have concerns he or she wants to discuss with the doctor. Some things caregivers may find especially helpful to discuss are: what to expect in the future, sources of information and support, community services, and ways they can maintain their own well-being.
Even if a family member or friend can’t go with you to your appointment, he or she can still help. For example, the person can serve as your sounding board, helping you practice what you want to say to the doctor before the visit. And after the visit, talking about what the doctor said can remind you of the important points and help you come up with questions to ask next time.