Slow Medicine and Difficult Choices

By Suzanne Modigliani, LICSW, CMC
Certified Geriatric Care Manager
Brookline, Ma.

Elders and their family members often find themselves overwhelmed by options and choices for their medical care. It can feel as though there is always another test, medication or procedure to cure the ills of aging. Many do improve things, but some can feel as though they are making life worse. Families may be grateful to hear of the concept of “Slow Medicine,” developed by Dr. Dennis McCullough of Dartmouth Medical School.

Slow Medicine takes into account that elders in their later years have a different set of issues and vulnerabilities than the young old. The philosophy involves really slowing down the decision making and keeping in mind the unique circumstances of a particular elder. Professional Geriatric Care Managers get to know their clients very well and often act as a bridge in such decision making, ensuring that the elder, the larger family system and professionals are communicating well. Honoring the elder’s value system is important and understanding the consequences of each decision means asking the right questions. At this time of life many value quality of life above all.

Every medical event is not a crisis and a wait and see approach can work well. Trips to the emergency room are overwhelming, disorienting and frightening for many. The cumulative effect of multiple medications, surgeries and tests can impact quality of life for those over 80.

Relationships developed between family and elder, elder and geriatric care manager, client system and medical provider will serve everyone well in the long run so people know values and expectations to make decision making easier.

A modern elder may see many specialists. Geriatric Care Managers try to ensure there is communication among them, that each is aware of the medications prescribed and that these are regularly reviewed. Sometimes medications are prescribed which are to treat side effects of others. Having an advocate in the medical maze is vital.

Slow Medicine does not mean forsaking treatment, it means carefully considering treatment and its full implications. Comfort means different things for each elder. Small problems should be caught early. Geriatric Care Managers can discuss normal aging and what expectations for managing symptoms can look like. They are partners with elders and families for the long haul, understanding that there is indeed an irreversible decline in the very old.

For a more complete discussion of Slow Medicine, read Dr. McCullough’s book, My Mother, Your Mother.