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Robert Langridge’s cardiologist told him he needed an operation for an aortic valve aneurism. 但是在87岁的时候, 其他现金足球网哪个好状况也使情况复杂化, 他不确定这是不是最好的主意.

的 doctor “was really adamant” about the need for surgery even as he acknowledged that Langridge would probably function at a lower level after the procedure, 朗里奇的妻子说, 露丝. Other medical professionals the Langridges consulted also said a nursing home would almost certainly be in Langridge’s future. 当那对夫妇说他们不想那样的时候, 一位医生的反应是, “养老院怎么了??”

“的se kinds of decisions are really difficult, and it’s not easy to navigate,” 露丝 Langridge said. She went on a search for a doctor who was more on the couple’s “wavelength” and ended up finding Dr. 卡拉Perissinotto, 他是加州大学的老年病学专家和医学教授, 旧金山. 和佩里西诺托商量后, 朗里奇夫妇决定推迟手术，让罗伯特恢复体力.

鲁思·兰格里奇说，佩里西诺托“把他当作一个完整的人看待”. 她指出，在咨询之前，“没有人说，‘让我们看看你有多虚弱.“那些医生从来没有说过，‘让我们看看你在房间里走动.'”

老年病学家表示，像朗脊夫妇这样的经历并不罕见. 美国.S. 医疗保健系统一直没有关注老年患者的具体和多样化的需求, 这应该从医学院开始, 他们说.

近年来，老年医生的数量增长缓慢, even as the number of Americans over 65 has been growing at a faster rate than the overall population. 到2034年，老年人的数量将超过儿童, 到2060年, 几乎四分之一的美国人将超过65岁, 根据Seniorliving的说法.org. 的 美国老年病学会预计对老年病医生的需求将增加45% 2013年至2025年.

Perissinotto说 she started thinking about the age-related health care gap in med school, where she was “floored” at how little the professors discussed the difference in illness trajectories between older adults and the general population.

“在我训练的早期, I realized that I had more training in pediatrics and sub-specialty care than I did in geriatrics. 然而在你从事的任何领域, 除了儿科, 老年人很可能在你服务的人群中占很大比例,”她说。.

佩里西诺托在实习期间也发现了同样的问题. “我们为40岁的人做的和为80岁的人做的是一样的, 我们对待所有八十岁的老人都是一样的，不管他们是依赖还是独立, 预期寿命有限还是完全预期寿命, 这让我很不舒服,”她说。.

Dr. 韦斯伊利, 范德比尔特大学医学教授，危重症联合主任, 大脑功能障碍, 和幸存者(CIBS)中心, 在他职业生涯的早期有过类似的认识吗.

“作为一名年轻的ICU医生, 我竭尽全力只为了拯救生命,伊利在他最近的书中写道, “每一次深呼吸，” which details his experiences and his mission to restore what he calls the “covenant” between physician and patient that depends on communication.

人, 尤其是老年人, who are heavily sedated for long periods can suffer long-lasting or even permanent physical and mental problems, 说伊利, now head of a team that works with patients who have suffered from delirium and other problems post-ICU.

医生通常在拯救老年病人方面做得很好, ，但有时却没有注意到他们所遭受的痛苦,伊利说. 老年人特别容易患上重症监护后综合症(PICS)。, 包括抑郁症在内的一系列身体和精神障碍, 记忆问题和疲劳, 他说.

“这种对老年人的非人化和年龄歧视正在发生, 我认为, 这是目前社会上非常危险的趋势，我们必须克服,伊利说. “我们在医学中发现了它，但在医学之外，在整个世界中也发现了它.”

Vanderbilt is developing a program to give medical students “a more consistent dose” of geriatrics in the curriculum and more emphasis on what matters to the patient, 伊利说.

这对像Michael Gulliford这样的人来说是一个可喜的变化. 当他的父亲, 一位受欢迎的兽医，85岁还在执业, 降落在医院, “他只是被当作一个老人对待,格利福德说. “I spent most of the time I was there trying to remind people only a number of weeks ago he was an eighty-five-year-old working five days a week” as hospital staffers made comments like, “嗯, 他是八十五年. 他老了”或者“他有过美好的生活.”

“当你到了那个年纪, 缺少一个人来监管整个机构，这是一个大问题, Michael Gulliford说. 病人会看心脏专科医生，看大脑专科医生, 但没有人把一个问题对另一个问题的影响放在一起, 他说.

“作为病人或护理人员，很难把所有这些拼凑起来，”他补充说.

在生命之初，事情是非常不同的.

“In pediatrics, we actually dose 药物 by weight, and it’s very clear,佩里西诺托说. “我们没有对老年人做类似的研究，可能是因为还没有研究过.”

Yet understanding the effects of certain drugs on different physiologies is “huge,”她说。. 过度用药的危险包括身体虚弱、认知障碍甚至死亡. 佩里西诺托说:“令人难以置信的是，这在没有经过更多审查的情况下被允许。.

的 pandemic “brought to the forefront how ageist and how discriminatory our health care system is,佩里西诺托说.

当疾病控制和预防中心发布其最初的COVID-19指南时, 它没有考虑到老年人经历的不同症状, 她说. 它也很容易错过失去味觉或嗅觉的信号, 尤其是对患有痴呆症的人, Perissinotto补充道.

Colleagues working in assisted-living situations said residents often exhibited signs of weakness or loss of appetite, 但没有人将其与COVID-19症状联系起来，比如失去味觉或嗅觉, 她说.

“We missed those symptoms early on because we did not include them in our definition of symptoms,”她说。. “我想知道, 如果我们是一个承认老年人的社会，就会有所不同, 我们会拯救生命吗?”

在很多情况下, it was an “uphill battle” to get hospitals to include geriatricians on COVID-19 expert panels, 这不仅限于COVID, 她说.

“我们从文献中知道，心脏病发作经常被遗漏, 因为人们的表现可能不同,佩里西诺托说. 老年病学家对此并不陌生，但为什么这一点却被忽视了? 的 amount of harm we potentially do every day to older adults is really just unacceptable.”

老年医学专家说，他们的专业收入相对较低, 即使是临床医生也不怎么尊重它. 尽管数据显示，当老年医生参与病人护理时, 住院时间更短, 谵妄不太常见，患者有更好的体验, Perissinotto说.

然而，一些医学院正在响应人们对老年医学的关注.

医学的每一个专业都在某种程度上与老年人相互作用. 艾莉森麦切纳, assistant professor of clinical medicine in the Perelman School of Medicine at the University of Pennsylvania and medical director of Penn’s Center for Continuing Care. “Educating the workforce to be able to meet the needs of this population is really critical.”

“我们都要照顾老年人，”米切纳说. “老年病学不需要局限于一个专业. It should span medical training, and these concepts should be woven into everything that we’re doing.”

宾夕法尼亚大学医学院的一年级学生学习老年病学的“5m”——心智, 流动性, 药物, multicomplexity, 最重要的是——以及对老年人友好的卫生系统的概念, 这些概念在他们的整个训练过程中都得到强调, 她指出.

“It’s puzzling that we’re in the midst of this demographic transition where ten thousand people a day are turning sixty-five, 然而，我们生活在一个充斥着强烈年龄歧视主题的社会,约翰·G说. 舒马赫, associate professor at the University of Maryland-Baltimore County (UMBC) and co-director of the school’s doctoral program in gerontology.

“由于年龄歧视的问题，招聘人员进入该领域是一个挑战,也因为人们认为老年病学“只关注老年人”,舒马赫说. 在UMBC, 他说, “我们试图将其视为一个生命历程的问题,“从青年到老年.

“我确实认为情况正在改变，”佩里西诺托说. 她指出，世界卫生组织开展了一项反对年龄歧视的运动. “关于它的讨论开始增多了. 我不知道如何转化为实践，”她补充道.

急诊科通常是老年病人进入医院的地方, and they may face long waits in uncomfortable surroundings without any nourishment or attention. 他们也可能接受不必要甚至有害的治疗. 老年病学家说，这是导致不良后果的一个原因. One solution gaining traction is the idea of separate emergency departments for geriatric patients.

Training everyone who comes in contact with an older patient — from first responders to front-desk staffers to doctors and nurses — to recognize needs and symptoms specific to older people, 能避免很多问题吗, 舒马赫说.

“我们现在没有能力培训足够的老年病医生, 因此，我们必须将“医学”老年化, 在急诊科的领导下,舒马赫说。, 谁是作者之一 指南 医院如何建立老年急诊科.

That doesn’t have to mean building a new facility or even retrofitting an existing emergency department, 舒马赫说. Relatively simple changes like making food available to older patients can ensure they have the “functional reserve” to answer questions, 他说.

Hospitals also might want to revisit emergency-room policies on common procedures such as catheter insertion — catheters are often overused or left in too long, which can lead to infection — and fall assessment protocols to determine the reason behind a fall, 舒马赫说.

舒马赫说，从长远来看，这样的措施将使所有患者受益. 他说:“对老年患者的良好护理将是对每个人的良好护理。. “这是一个跨学科的过程.”

诺拉时 是费城的自由撰稿人. 阅读更多