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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.
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 on the topics
discussed below, see the resource list at the end of this book.
It
is important to understand that problems with memory, depression,
sexual function, and incontinence are not normal parts of aging.
If your doctor doesn't take your concerns about these topics
seriously or brushes them off as being part of normal aging,
you may want to consider looking for a new doctor.
Sexuality--Most health professionals now understand that
sexuality remains important in later life. If you are not satisfied
with your sex life, don't automatically 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 what influence medications
or surgery may have on your sexual 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 can affect my body in many ways. Will it
affect my sex life at all?"
Incontinence--About 15 to 30 percent of older people living
at home have problems controlling their bladder--this is called
urinary incontinence. Often, certain exercises or other measures
are helpful in correcting or improving the problem. If you have
trouble with control of your bladder or bowels, it is important
to let the doctor know. In many cases, incontinence is the result
of a treatable medical condition. When discussing incontinence
with your doctor, you may want to say something like, "Since
my last visit there have been several times that I couldn't
control my bladder. I'm concerned, because this has never happened
to me before."
Grief, mourning, and depression--As people grow older, they
experience losses of significant people in their lives, including
spouses and cherished friends. 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 feel grief and mourning when you have a loss,
later life does not have to be a time of ongoing sadness. If
you feel down 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 lack
of interest in life. These could be signs of medical depression.
If you feel sad and withdrawn and are having trouble sleeping,
give your doctor a call. Depression can be a side effect of
medications or a sign of a medical condition that needs attention.
It often can be treated successfully--but only if your doctor
knows about it.
Memory problems--One of the greatest fears of older people
is problems with their ability to think and remember. For most
older people, thinking and memory remain good throughout the
later years. If you seem to have problems remembering recent
events or thinking clearly, let your doctor know. Try to be
specific about the changes you have noticed; for example, "I've
always been able to balance my checkbook without any problems,
but lately I'm finding that I get very confused." The doctor
will probably want you to undergo a thorough checkup to see
what might be causing your symptoms.
In
many cases, these symptoms are caused by a passing, treatable
condition such as depression, infection, or a side effect of
medication. In other cases, the problem may be Alzheimer's disease
or a related condition that causes ongoing loss of skills such
as learning, thinking, and remembering. While there currently
is no way to determine for sure if a person has Alzheimer's
disease, a careful history, physical evaluation, and mental
status examination are still important. They help the doctor
rule out any other, perhaps treatable, causes of your symptoms
and determine the best plan of care for you.
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An
advance directive is a document that allows you
to state your preferences about your care if you were
to become too seriously ill to make your wishes known.
Examples of advance directives include living wills and
durable health care powers of attorney.
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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 durable power of attorney for health
care. Advance directives allow you to say what you'd prefer
if you were too ill to make your wishes known. In an advance
directive you can name a family member or other person
to make decisions about your care if you aren't able.
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,
you will be asked if you have any advance directives.
If the doctor doesn't raise the topic, do so yourself.
To make sure that your wishes are carried out, write them
down. You also should talk with family members so that
they understand your wishes.
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 you are being mistreated in some way, 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 you if you are being mistreated.
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Feeling unhappy with your doctor--Misunderstandings can
come up in any relationship, including between a patient and
his or her doctor. If you feel uncomfortable with something
your doctor or the doctor's 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, "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.
Summary
If you have questions or worries about a subject that your doctor
does not talk about with you, bring them up yourself. Practice
with family or friends what you will tell or ask the doctor.
If there are brochures or pamphlets about the subject in the
doctor's waiting room, use them as a way to begin to talk. Talking
with your doctor about sensitive subjects is important . Although
talking about these subjects may be awkward for both you and
your doctor, don't avoid it. If you feel the doctor doesn't
take your concerns seriously, remember that you can always change
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 friend or relative can
help you remember what you planned to tell or ask the doctor.
He or she also can help you remember what the doctor says. But
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. 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, having
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 to 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 about
the important points and help you come up with questions to
ask next time.
What's
Next?
Some
Closing Thoughts
Good health care always depends on good communication with your
doctor and other health professionals. We hope this book will
help you take an active role in your health care.
If you have suggestions to add to future editions of this book
or other ideas for making it more helpful, please write to Freddi
Karp, Editor, National Institute on Aging, Public Information
Office, Building 31, Room 5C27, 31 Center Drive MSC 2292, Bethesda,
MD 20892-2292.
Getting
More Information
You can make the best of your time with your doctor by being
informed. This often includes drawing on other sources of health
information such as home medical guides, books and articles
available at libraries, organizations such as the American Heart
Association and the Arthritis Foundation, other institutes within
the National Institutes of Health, and self-help groups.
The National Institute on Aging (NIA) has information about
a variety of issues related to aging, including menopause, incontinence,
and pneumonia. Large-print Age Pages are available on topics
such as depression, stroke, safe use of medications, and types
of doctors you may see.
To order publications or to request a publications list, call
the NIA Information Center at 1-800-222-2225; TTY 1-800-222-4225.
You also may want to encourage your doctor to order these publications
for his or her office.
For a fact sheet and other publications about Alzheimer's disease,
contact the NIA Alzheimer's Disease Education and Referral (ADEAR)
Center at 1-800-438-4380.
| Additional
Resources
Sexuality
Sexuality
Information and Education Council of the United States
Suite 2500
130 West 42nd Street
New York, NY 10036
1-212-819-9770
Incontinence
Help
for Incontinent People (HIP)
P.O. Box 544
Union, SC 29379
1-800-BLADDER
The
Simon Foundation
P.O. Box 835
Wilmette, IL 60091
1-800-237-4666
Grief,
Mourning, and Depression
NIMH
Depression Awareness, Recognition and Treatment Program
Room 10-85
5600 Fishers Lane
Rockville, MD 20857
1-800-421-4211
Memory
Problems
Alzheimer's
Association
Suite 1000
919 North Michigan Avenue
Chicago, IL 60611
1-800-272-3900
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Alzheimer's
Disease Education and Referral (ADEAR) Center
P.O. Box 8250
Silver Spring, MD 20907-8250
1-800-438-4380
National
Stroke Association
Suite 1000
8480 East Orchard Road
Englewood, CO 80111-5015
1-800-367-1990
Care
in the Event of a Terminal Illness
National
Hospice Organization
Suite 901
1901 North Moore Street
Arlington, VA 22209
1-800-658-8898
Problems
With Family
Children
of Aging Parents
Suite 302-A
1609 Woodbourne Road
Levittown, PA 19057-1511
1-215-945-6900
Eldercare
Locator Service
Suite 100
1112 16th Street NW
Washington, DC 20036
1-800-677-1116
National
Center on Elder Abuse
Suite 500
810 First Street NE
Washington, DC 20002
1-202-682-2470
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