Understanding Your Well-Being Screening: What Questions Doctors Ask Those Over the Age of 65 and Why
Americans live longer today than ever before. More than one in every seven adults in the U.S. is 65 or older—and the average person can now expect to celebrate their 78th birthday.
Prevention is the key to enjoying your golden years. In May, during Older Americans Month, we highlight important health and wellness topics that specifically affect our older population.
A yearly preventive/wellness visit or Annual Wellness Visit (AWV) with your primary care provider lays the foundation for a lifetime of well-being, even if you are visiting your doctor throughout the year for other reasons. This check-up is an opportunity for you and your doctor to discuss ways you can stay healthy and prevent disease. Patients who have annual preventive/wellness visits are in better overall health and have more control of their chronic conditions.
If you came in recently for an AWV, you may have noticed our well-being screening postcards. These postcards serve as a reminder of important topics to discuss during your visit such as mental health, medication costs, fall risk, bladder control, and activities of daily living – topics that you may not have been thinking about, or maybe have been but feel a bit uncomfortable bringing up. Our doctors have seen and heard the full spectrum of issues, but they can only help you with what you tell them about. Therefore, it’s important to have an open, ongoing dialogue.
While we like to remind you to bring up your concerns, your doctor will be asking you some specific questions. Learn why we ask these questions, how this knowledge can improve your overall wellness and quality of life, and the various ways our teams can help.
Questions Doctors Ask and Why
Topic 1: Improving Bladder Control
Expert advice from Philip J. Dorsey, MD, a urologist at New Jersey Urology, a Summit Health Company.
Questions we ask: Do you experience leaking urine? Does it interfere with your daily life?
Why we ask them: Dr. Dorsey: Urinary incontinence, or leaking urine, affects between 15 and 33 percent of older adults in the community. Urinary symptoms like leaking and increased frequency or urgency negatively affect both physical and mental health. Unfortunately, many urinary conditions are undiagnosed and undertreated. It is common for patients to be ashamed of these symptoms, become isolated at home, and believe there is nothing that can be done to help them.
Patients typically will not volunteer that they have bothersome urinary symptoms. We hope these questions will jumpstart conversations about a very common condition that has a profound impact on quality of life.
How we can help: Dr. Dorsey: Fortunately, there are many ways we can help patients with urinary leakage. Some patients experience improvement with changes to their diet or routine and simple pelvic exercises, while others may benefit from medications or minor surgical procedures.
In any case, the only way we can help is if all information is disclosed to us. So, the first step in improving symptoms is to bring them to the attention of the provider.
Topic 2: Mental Health
Expert advice from James Korman, PsyD, Service Line Chief of Behavioral Health at Summit Health and Dr. John Wang, Psychiatrist at Westmed Medical Group.
Questions we ask: Do you have concerns about your emotional health? Does anxiety or depression interfere with your daily life?
Why we ask them: Dr. Korman: A significant number of patients sitting in the primary care waiting room suffer from anxiety and depression. Many may not even realize it. Physical symptoms like aches and pains can be caused by underlying stress, anxiety, and depression.
Anxiety and depression can impact many areas of life, including work and occupational functioning, socialization, the ability to enjoy activities, sleep patterns, as well as diet and nutrition.
Dr. John Wang: Patients are often unaware or reluctant to bring up behavioral health issues and symptoms. Our goal is to identify these individuals and make appropriate interventions so they can function normally and enjoy their lives.
How we can help: Dr. Korman: There are many ways we can relieve some of this personal distress. When appropriate, we integrate mental, behavioral, and physical care during patients visits to their physicians. But not everyone needs therapy or medication. Minor adjustments, such as not being socially isolated or re-engaging in activities, can make a big difference.
We have numerous specialists who can help, including psychologists, psychiatrists, social workers, nutritionists, and physical therapists. We encourage the patient to continue working with their primary care provider to identify the proper course of treatment.
Dr. John Wang: With our older patients, often they and their families struggle with access to services and how to get assistance. Connecting them with resources can be an important first step. Additionally, encouraging them to address end of life issues with their primary care provider is a critical part of helping them achieve orderly care. With the transition away from nursing home placement, family members are often acting as home health aides and utilizing visiting nurse services and/or hospice. With proper planning, senior aging can be a smoother transition than facing the unpredictable unprepared.
Topic 3: Physical Health/Activity
Expert advice from Bankim Shah, MD, an internal medicine physician at Summit Health.
Question we ask: Does your physical health interfere with your daily activities like bathing, getting dressed, and completing household tasks?
Why we ask it: Dr. Shah: Discussing activities of daily living with a patient allows us to understand their limitations. They may bring up issues like pain, limited range of motion, balance concerns, or organizational and cognitive problems. Gathering information about their home environment, such as access to caregivers, helps us understand their living situation and evaluate their safety and independence.
How we can help: Dr. Shah: We connect patients with occupational, physical, and speech therapy, as needed. In addition, we offer resources for patients who need assistance in or out of the home such as outpatient nursing, home health aides, or social work management. Caregivers are included in the conversation to ensure the patient has the proper social support.
Topic 4: Reducing Risk of Falling
Expert advice from Ian Stein, MD, a neurologist at Summit Health and Cordelia Schwarz, MD, Chair of Neurology at Westmed Medical Group.
Question we ask: Have you fallen or had trouble with balance or walking?
Why we ask it: Dr. Stein: If a patient has fallen once, it is likely they will fall again in the future. We ask this question to help identify the reason why they fall and help reduce future risk of falls and injuries. It could be an issue affecting their strength, balance, or sleep, as well as a problem with the home environment such as having too many stairs or rugs in the house.
Dr. Schwarz: More than one in four people aged 65 and older have had at least one documented fall. Some of these falls cause injuries, loss of independence, and in some cases, death. Many falls can be prevented by identifying and modifying risk factors.
How we can help: Dr. Stein: If we identify risks for falls such as medication, vision issues, or dizziness, we can work to eliminate the risk. If imbalance is the issue, the most important way we can intervene is to get a physical therapist to see the patient. These specialists play a critical role in fall prevention by helping to improve their gait, or how they walk. We can also suggest modifications to the patient’s home, such as grab bars and hand railings, or removing tripping hazards to help prevent slips and falls.
Dr. Schwarz: We can reduce falls by reviewing medications and suggesting ways to make a person’s home safer. Installation of grab bars and removal of tripping hazards is a great way to start. But oftentimes, we’ll prescribe physical therapy or suggest various balance exercises. We may also recommend having the eyes and feet checked and have a discussion on proper footwear.
Topic 5: Medication Cost
Expert advice from Gwen Egloff-Du, PharmD, BCPS, a pharmacist at Summit Health.
Question we ask: Do you have any concerns about the costs of your medications?
Why we ask it: Dr. Egloff-Du: When patients are unable to afford their medication, they often skip doses or fail to fill their medication altogether. By encouraging patients to discuss the cost of medications, we can address their concerns, increase adherence to their course of treatment, and improve overall health outcomes.
How we can help: Dr. Egloff-Du: The best way to lower costs is to prescribe a generic medication that is equally as effective as a more expensive brand medication. Your provider can help you investigate if there is an alternative that would be more cost-friendly.
Don’t be shy when it comes to your well-being. While your providers may ask specific questions related to these issues, you should certainly bring them up at your visit. Don’t be embarrassed. Your provider is happy to discuss these concerns and help you stay well and feel good.