Geriatric specialist treats the 'whole person'

Q&A

April 12, 1994|By Ed Brandt | Ed Brandt,Sun Staff Writer

Dr. Gary Applebaum says he decided to go into geriatrics, which deals with the problems and diseases of the aged, for a simple reason:

"There's so much more to treating older people than just illness. You have to treat the whole person, and it's a joy to me to see patients recover from a serious illness and maintain their independence."

Dr. Applebaum, 35, went to medical school at the University of Pennsylvania in his native Philadelphia, getting his degree in 1985. He served his internship and residency at Francis Scott Key Medical Center and studied for more than a year at the Johns Hopkins School of Medicine on a geriatrics fellowship before joining the Hopkins faculty in 1989.

He has been medical director of the Charlestown Retirement Community in Catonsville, which has more than 2,200 residents, since 1989. He was recently named 1994's Clinician of the Year by the American Geriatrics Society.

Q: Have you seen a change in the way geriatrics is being approached since you joined the profession?

A: There's a lot more interest in geriatrics, and the field is growing rapidly. There were 31 million Americans 65 or older in the 1990 census, and it's projected there will be 40 million, or 20 percent of the population, by 2010.

The problem is, there aren't nearly enough doctors in geriatrics, and our medical system is producing only about 100 geriatricians a year. The deficit is in the thousands -- and growing.

Q: Is there a solution to this shortage?

A: Definitely yes. It can be handled by broadening the exposure of medical students and residents to geriatric medicine in an outpatient setting.

Q: What kinds of health concerns do older citizens have, in broad terms?

A: What senior citizens really fear most is any kind of chronic illness that causes them to lose their independence, their mental capacity or compromises their ability to get around. They fear having to inconvenience others, having daily pain or discomfort or something that would require kinds of therapy that affect their dignity.

Quality of life issues are more important to them than the onset of serious, life-threatening diseases, such as cancer or heart disease, for example, that younger adults worry more about. Everyone realizes they're eventually going to die of something and that they'll have to deal with that.

Q: To many, "loss of mental capacity" translates into fears of Alzheimer's disease. What are the latest developments in the treatment of Alzheimer's?

A: I can't think of many things more frightening to an elderly person than the thought of getting Alzheimer's.

Alzheimer's is responsible for half the 1.7 million people in nursing homes.

We know what the brain cells look like in a patient with Alzheimer's, and we know there is a deficit in a certain chemical -- acetylcholine -- and there are genetic markers that indicate a tendency toward the disease but don't guarantee that you'll get it.

But, we are uncertain as to what

causes Alzheimer's, and there is no specific treatment for it.

We can give patients the chemical they're deficient in and make them a little better, but it only delays the process. There are a lot of clues, and a there is a lot of research being done.

Q: How about arthritis, which is another disease from which the elderly suffer?

A: Yes, 50 percent of those 65 and older have some arthritis, and here, joint replacement with metal joints has been the major advance in this area.

The disease also can be treated with anti-inflammatory drugs, but the cure and prevention of arthritis has not advanced very far.

Q: Have you any basic health advice for an elderly person?

A: Yes. Take medications as prescribed, and make sure your primary doctor knows what they are. Don't be so eager to start on different medicines.

Many patients are over-medicated. My belief on dosage is start low and go slow.

The trouble is, the patient expects to get a prescription and sometimes gets more medicine than he or she needs. This is a special problem, and many drugs have not been tested adequately in older people.

Q: Do you tell patients they have a terminal disease?

A: I never lie to a patient. It's insulting to keep information from them, and it's sometimes necessary to go against the family's wishes.

Of course, that can cause a lot of trouble, but you can't have a relationship with patients if you lie to them.

I might soften it a bit by saying I have a blurry crystal ball, or something like that, but I want to deal in likelihood and options, not deception.

Anyway, the family usually takes it much harder than the patient. Most elderly people are more concerned with the quality of their life, their independence and their dignity than they are with the notion of death.

Q: What do you think of the Clinton medical plan as it relates to the elderly?

A: There's not a lot of interest by the administration in changing Medicare, except for a couple positives -- some kind of coverage to pay for medicines and long-term care.

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