“There’s a beauty in the aging process,” reflected Dr. Serhat Tunc, a psychiatrist in the geriatric psychiatry fellowship program at Saint Louis University (SLU) School of Medicine. Like most physicians who choose the geriatrics pathway and working in elder care, he speaks with a tremendous amount of respect and compassion for people over the age of 65. 

Across the country, gerontologists are reframing what it means to treat and support America’s most vulnerable population. It starts with changing how people see the elderly and includes normalizing conversations around the medical and behavioral healthcare of older people.  

The beauty in working with older patients

“Old people need special attention,” Dr. Tunc explained. “And I’m happy to give it to them. They deserve respect and to live in dignity. For what they have done for us, we have to pay them back.” Originally from Istanbul, Turkey, Dr. Tunc said he decided to go into geriatrics in February 2023 after witnessing the extensive, disproportionate suffering older people went through in the aftermath of the worst earthquake in Turkey’s history. “I thought about how much harder it would be for them to recover compared to younger adults. Then I thought about how I wanted to help and what I could do.”

“Why are we so scared of age?” asked Dr. Angela Sanford, interim director of the Geriatrics Fellowship program at SLU. “It is a natural part of the life cycle. For geriatrics, I think you have to have a special compassion, and I have that. It’s my vocation. 

“Some physicians don’t work with older people. You can offer whatever salary you offer. You can throw in whatever funding to do whatever work. They simply prefer to put old people away because they think old people are problematic. That they’re burdens. As a society, we just have this negative view of older people, and therefore that trickles down. 

“I mean, it starts when kids are little. Think about the fairy tales our kids watch. Think about every villain in every Disney movie. It’s an old woman. In Snow White, the witch is an old woman. With Rapunzel, again, the wicked witch is an old woman. There’s Cruella Deville in 101 Dalmatians. She’s fashionable, but still an old woman who steals Dalmatian puppies. Ursula, the villainous sea witch in the Little Mermaid schemes to rip out Ariel’s voice because she wants to have a youthful singing voice. 

“It starts from when we’re little and it just goes on. We’re taught to have this negative view of age, aging and the aging process. Therefore, when people grow up we have a negative view. No one wants to get old. Why? Because it’s been portrayed in such a negative view.”

Dr. Sanford developed a fondness for older people at a young age, which influenced her choosing geriatrics. “Why did I go into geriatrics? Probably because of my grandma. I loved my grandma. Granny was my favorite. She took me to the beauty shop every weekend, and I hung out with this old woman and her old woman friends, and I was like, I don’t really know how to hang out with kids my age. I like these old people. But if you don’t have those positive role models, then maybe aging is scary and it’s seen as something you don’t want to happen.”

As healthcare professionals, every physician and nurse and tech can play a part to help normalize the conversation with and about older people. Those efforts should also include building an awareness of ageism in the workforce and healthcare. 

“When we talk about normalizing the education gap,” explained Dr. Sanford, “it’s not about the process, but the conversation around it. Even just burden, the caregiver burden. Why is it a burden and not a normal part of the relationship? Just a normal relationship. This person took care of you as kids and you take care of them as an adult. That shouldn’t be a burden. It’s just part of give and take. You know, we don’t call it childcare burden. I mean, it’s tough, but we’re not supposed to feel burdened with our children.

“The question is, how do you get people to intrinsically want to take care of older people? Until the culture changes around aging and the aging process, you’re not going to have more geriatricians, because it’s going to continue to be seen as a negative specialty to go into.”

The goal of improving older patients’ day-to-day lives

Dr. Julie Gammack, a geriatrician and head of Saint Louis University School of Medicine’s Graduate Medical Education program, said, “One of the things we keep hearing as we look into the declining numbers of geriatrics specialists, is that med students cite that they feel older adults just aren’t curable, like you can’t cure them. They have a desire to focus on curative medicine and that’s not necessarily what geriatric medicine is about.”

Because of that, Dr. Gammack said, “A lot of patients just get brushed off just because they’re getting old. Whereas we take our time and really look at the whole person, we hear them out about all their issues, and we take into consideration every aspect. We consider if something is just because of their age, or is it something we would consider pathologic, or something I can treat but need to look more into?

“We tend to focus on patients who have reached a cognitive, functional or behavioral challenge point in their lives. It’s not always about age. We have 80-year-olds who are playing tennis every day. And there are 50-year-olds who are maybe wheelchair bound and chronically debilitated. So, it’s less the age than where the patient is functionally. 

“So, it’s really about care complexity and functionality impairment that makes a geriatrician different. As geriatricians, we provide a layer of expertise and can really take a very focused look at some of the syndromes and the challenges that are present in older adults that are functionally and cognitively challenged.”

The joy of enhancing cognitive abilities of older patients

Effective communication and being able to interact with others is as important to quality of life for people of 65 as it is for anyone else. Dr. Parnika Saxena, program director of Stanford Medicine’s Geriatrics Psychiatry program, helps ensure future geriatric psychiatrists have the tools they need to help as best they can. Methods can be through medication, group discussions, private therapy, cognitive behavioral therapy or a combination of these.

“The decision for treatment has to be based on guidelines, not the psychiatrist’s preference. We look at the entire patient, their comorbidities, their lifestyle, their age and cognitive diagnosis, then base treatment on clear, scientific rationale. First and foremost, it is always do no harm. Sometimes it might be a matter of choosing the option that will be the least harmful. 

“We also have to consider what is the patient’s preference. Medically speaking, sometimes, not treating the problem can be less harmful. We might ask the patient; what do you think you would feel better with?  We make sure they are making an informed decision. We discuss the issue and give them the options. 

“Older adults have a greater propensity of side effects to medication. Often, psychiatric conditions manifest in patients who do not have a primary psychiatric disorder. Meaning, a patient with a urinary tract infection could present with symptoms that look like schizophrenia. Another example is with Parkinson’s disease. Five to ten years beforeParkinson’s presents, people can show strong signs of depression. Sometimes those with Parkinson’s disease  can also have hallucinations. 

“A big component in geriatric psychiatry is liaising with caregivers, geriatricians and other healthcare professionals.”