BOX 2-1

Typical Profiles of the Older Adult Population

Mrs. S is a 75-year-old divorced woman who is retired from her job as an executive secretary and now lives in a retirement community where she plays golf three times a week. She lives without assistance and frequently drives 45 minutes to babysit for her daughter’s children. Mrs. S had breast cancer 20 years ago, which was treated with a mastectomy, and now has hypertension, which is treated with a diuretic. She sees her primary care physician twice a year and her oncologist once a year.

Mr. Y is an 82-year old man who lives in an apartment with his wife. He has diabetes with peripheral neuropathy, hypertension, coronary artery disease, and chronic obstructive pulmonary disease. He continues to drive and has been assuming many of the instrumental activities of daily living because of his wife’s failing health; she has moderate dementia. Mr. Y sees a primary care physician every three months, a pulmonary specialist twice a year, a cardiologist once a year, and a diabetes educator once a year. He participated in pulmonary rehabilitation following a hospitalization for pneumonia 3 months ago. His primary care physician recently gave him the name of a social worker to consult with about possibilities for getting additional support in the home (e.g., a homemaker and an attendant to help bathe and dress his wife) and community-based resources (e.g., adult day health programs, caregiver support).

Mrs. M is a 97-year-old woman who has had severe Alzheimer’s disease for 8 years. She recognizes her son and speaks to him, but her speech has no meaningful content other than to indicate when she is uncomfortable. Over the past decade she has gotten progressively more immobile, and she stopped walking 3 years ago. She has been cared for at home by her son, who retired to be able to care for his mother. Mrs. M takes no medications. Her course has been punctuated by recurrent complications of immobility including pressure sores, contractures, and recurrent pneumonias. She sees her primary care physician every 2 months but also has several emergency department visits per year, occasional hospitalizations, and periodic care from home health for wound care.

Mr. R is an 88-year-old man who is widowed. His medical problems include heart failure, hypertension, polymyalgia rheumatica, and prostate cancer. He has been living in a nursing home since falling and sustaining a hip fracture 1 year ago. Although he can ambulate with a walker, he is dependent in several activities of daily living. He has a niece who visits approximately once a month. Prior to his relocation to the nursing home, he saw several specialists, but none of them make nursing home visits. His primary care physician sees him every 3 months as well as in between these routine visits when an acute problem arises. None of his specialist physicians sees him in the nursing home.

NOTE: These are hypothetical examples developed for illustrative purposes and are not actual patient summaries.

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