Essential principles in the care of the elderly

The world is aging. Already in 2003, the US Census Bureau reported that 35.9 million persons in the United States were 65 years or older, 12% of the population. The first baby boomers turn 65 years old in 2011, and the next 25 years will witness the most rapid increase in the number of older adults. The oldest of the old, those aged 85 years and older, are the fastestgrowing segment of the American population. This, coupled with further advances in chronic disease management, diffusion of “best practices, ” increased attention to maintaining physical, cognitive, and psychological function, and availability of improved treatments for the most common causes of death and disability, is likely to continue to extend both the average life expectancy and years of active life. Increasing awareness of persistent inequalities in our health care system, a decreasing ratio of working adults to support dependent children and retirees, and an increasing burden on family caregivers are just some of the countervailing forces that continue to limit the promise of healthy, productive aging. We certainly want good health care waiting for us in our golden years, but what is good care? In the care of the elderly patient, there are 11 essential principles that should be considered: 1) the role of the physician as the integrator of the biopsychosocial–spiritual model; 2) continuity of care; 3) bolstering the family and home; 4) good communication skills; 5) building a sound doctor–patient relationship; 6) the need for appropriate evaluation and assessment; 7) prevention and health maintenance; 8) intelligent treatment with attention to ethical decision making; 9) interprofessional collaboration; 10) respect for the usefulness and value of the aged individual; and 11) compassionate care.