Currently, there are approximately 76 million Americans past the age of 50 – a number equal to the entire U.S. population of 1900 – and this segment of the population continues to grow.

How well any of us age depends to some extent on how we live – a confirmation of the old adage, "As a twig is bent, so grows the tree." Once we become old, how well we function depends on many factors, including the type of care we receive from professionals.

While all older adults are similar to the younger persons they once were, each is also different, and that difference shows in both individuals’ emotional needs and their vulnerability to specific mental illness. As an office patient profile reflects an increase in providing care for an older population, the doctor’s knowledge and skills need to include a deeper understanding of the unique emotional needs of this population.

Showing Respect: Subtle Differences

A client, who was seeking my help to cope with the emotional impact of Parkinson’s disease, fell and hurt her arm and shoulder. Her daughter rushed her to the emergency room, where the attending physician addressed her throughout the exam as "Grandma."

"If he had been my regular doctor," she told me, "I would never have gone back. I hate to be patronized."

I would guess the attending doctor thought he was being friendly and creating rapport with her. However, she regarded his attempts as demeaning and inappropriately familiar.

Another woman told me she was looking for a new chiropractor. When I asked why, she said, "He introduced himself as Dr. Smith, but called me by my first name. At my age, I’ve earned a little respect."

Manners, politeness and respect are important issues for everyone. They become more important with age. Older adults are attempting to deal with many kinds of loss: loss of relationships, loss of mobility, loss of independence, privacy and competency, and finally the approaching loss of life. For many, this creates a sensitivity to anything that crosses the boundaries into a familiarity that hasn’t been invited.

Putting The Aging Process Into Perspective

There is the old story of the man who went to the doctor to ask about a sore leg.

"It’s just because you’re getting old," the doctor said. To which, the man replied, "But Doc, my other leg doesn’t hurt, and it’s the same age."

Even the most health-conscious people change as they grow older, and aches and pains are often symptomatic of those changes. It’s surprising how many people are unprepared. The patient who comes in due to a car accident or suffering some other identifiable injury understands a cause-effect relationship. The process of aging, though, creates a more subtle relationship with a much greater variation from person to person and is a connection most people want to deny.

"I feel guilty," a patient said. "It seems as if there is always an ache or pain somewhere. I want to be able to go in and say that my back is fine and my joint pain is gone, but I can’t. If I were Dr. Jones, I’d give up on me."

Another patient told me of a different reaction: "I’m not sure Dr. Wilson is doing me any good. I feel better when I leave the office, but before long, something else begins to hurt. Maybe I should try someone else."

Of course, most people want to feel good, and for many, perhaps even most, older adults, this is an achievable goal. Often, however, it is a goal that is not quickly or easily reached, and many are unprepared for either the effort or time achieving health may take with an older body. Education, reassurance and support become more crucial with older patients.

Talking To Patients, Not Relatives

When a parent brings in a young child, the doctor explains and recommends directly to the parent. We all know this is appropriate, because a young child’s ability to understand and follow through is limited. Parents are designated as the ones responsible for the child’s welfare.

When this dynamic of talking to someone else about the patient is duplicated with an elderly person, the clear, if unspoken, message is that the elderly person is not able to understand or assume responsibility for themselves. Unless we are positive this is an accurate assessment, this form of communication promotes stress and/or dependence, both of which work against healing.

In one of our group sessions, a woman said, "Do you know what I like about that chiropractor I’ve started to see? Well, do you know how my daughter and I are struggling because she wants to take over? She went in with me last week when she drove me to the appointment, and the next thing I knew, it was, ‘Mother feels this,’ and ‘Mother is wondering if …’ as if I wasn’t even there. I said, ‘Marsha, I can talk for myself,’ but she kept going. The doctor just smiled at her and then began talking directly to me."

Families are both helpful and fearful, and it isn’t always easy to sort out what family dynamics are present in your office. Unless the person has dementia or has requested that someone else be given the information, the rule of thumb is to talk to the patient, not the relative.

Taking Time To Listen

Today’s older patients were born into a world without either the Internet or instant mashed potatoes. At the same time, as the person’s thought processes and the ability to retrieve appropriate words begins to slow down with age, the pace of modern life has accelerated. This is a stressful bind that can cause some people to withdraw and sink into either dependence or depression.

"My chiropractor is always in a hurry. My internist is always in a hurry. The only person I see who isn’t in a hurry is my dentist, and I can’t talk to him because I have a mouth full of gauze and drills and who knows what else. I get nervous trying to explain what I’ve been feeling when everyone is in such a rush. Sometimes I just end up saying I feel fine."

If we are to get accurate information from those patients who are finding it more difficult to organize their thoughts and remember details, we need to slow down. At times, picking up on those symptoms of nervousness and forgetfulness, we may also discover a problem in addition to the subluxation, such as the beginning of a dementia, depression, anxiety or panic disorder. The chiropractor is often the professional seen most often and may therefore be in the best position to do an initial evaluation and make a referral. With early detection and care, lives will be saved and the final, and to date inevitable, outcome of illnesses such as Alzheimer’s disease may be postponed for years.

The mind/body connection is well known. As a mental health professional, I am aware of how psychological stress, fear and trauma are placed in the body, causing discord. Without appropriate work with the body, my patients will not regain emotional equilibrium.

The reverse is also true. Those patients who seek chiropractic care while showing signs of psychological distress will continue to suffer until their mental health needs are addressed.

Fortunately, we are entering into a time in the history of health care where collaboration is becoming possible. Mental health professionals and chiropractors make good partners in providing care for older adults.

About the author: Ann G. Thomas, Ed.D., is a psychotherapist in private practice in California. An internationally noted lecturer, workshop leader and educator in the areas of mental health and aging, she is the author of numerous magazine articles and the recent book, The Women We Become, which describes the psychological considerations of aging. She is currently working on a book on grandparenting. Inquiries may be addressed to her at 724 Danville Blvd, Danville, CA 94526; call (925) 820-7921; or E-mail athomas724@mac.com.