Empowering Older Adults: How to Advocate for Yourself at the Doctor's Office

As we get older, health conditions related to aging can result in more frequent doctor’s appointments. In fact, a recent study found that older adults spend an average of three weeks each year receiving health care outside of the home.

But whether you or someone you care for has an appointment every week or just once a year, there are ways you can prepare to advocate for yourself at the doctor’s office.

“The fact that older adults can have the most complex medical problems and need individualized care means they need to be prepared to advocate for themselves so they aren’t prescribed or suggested a treatment that could cause more harm than good — or they aren’t actually denied a potential treatment due to their age that could still be appropriate for them,” says Ernest Mandel, MD, SM, executive vice president of health care and chief medical officer at Hebrew SeniorLife and director of nephrology and dialysis at Hebrew Rehabilitation Center.

As a geriatrician, I always appreciate when patients are ready to advocate for what matters to them. In my experience, here are a few additional things to keep in mind: 

Essential tips for older adults to prepare for a doctor’s appointment  

Prioritize a few concerns to discuss 

If it’s hard to get an appointment with your doctor or you haven’t seen them in a while, you may want to speak with them about everything worrying you in one visit. But if your list of concerns is long, covering everything thoroughly in one appointment may be unrealistic. Instead, think about what your top two or three concerns are.

Come prepared to discuss those in more detail. This approach isn’t to dismiss you but to give you and your doctor enough time to address your main worries without rushing through your appointment. If you have more you'd like to talk about, you can always make a follow-up appointment on your way out.  

Invite a loved one to your appointment

If you have a condition such as hearing loss or cognitive impairment or get anxious about speaking up during doctor’s appointments, it’s always a good idea to bring a health care proxy or trusted loved one to your appointment. Your loved one can put you at ease and help you communicate your concerns so your physician fully understands and addresses them.

Bring any medications and mobility aids 

Always bring an up-to-date list of all your medications so your physician knows what you’re taking and when. You can even bring the medications themselves, particularly if you’re seeing a new physician or your medications have changed. Also consider bringing any cane, walker, wheelchair, or other mobility aid to your appointment — even if you don’t use it often. Geriatricians can assess how well you get up from your chair and walk with and without your mobility aid, which is essential to determining your fall risk. Bringing devices that you use to manage chronic conditions at home, such as blood glucose monitors, can also help your physician manage your care. 

Don’t forget important medical documents 

Here at Hebrew SeniorLife, residents have all their essential health documents in one all-encompassing envelope. Depending on your community, this envelope may be called the “file for life” or the “red envelope.” It contains critical documents such as your health care proxy, advance directives, medication lists, and health history. If you don’t live in a Hebrew SeniorLife community, consider using a folder or binder to organize your medical documents. Having everything in one place is especially helpful when you see a new doctor who doesn’t already have your medical information on file, as you can bring it along to help them get up to speed.

Maximize the value of your Medicare annual wellness visit 

In 2011, Medicare launched yearly wellness visits specifically designed for older adults. The annual wellness visit is for preventive care rather than treating or diagnosing specific conditions. It’s an opportunity for older adults to understand their current health and risk factors.

To make the most of your annual wellness exam and advocate for your health needs, consider the 4Ms of age-friendly care. By understanding what they are and how they tie into your life, you can better advocate for your needs: 

The 4Ms of age-friendly care 

Hebrew SeniorLife is designated an “age-friendly health system” by the Institute for Healthcare Improvement. Age-friendly health systems offer care centered around the 4Ms to support your health and well-being: What Matters, Medication, Mentation, and Mobility.

Before you walk into your next appointment, reflect on the 4Ms: 

• Medication: Are your medications working well for you? Do you think you’re taking too many medications? Are they affordable? 
• Mobility: Have you experienced any falls or balance issues?
• Mentation: Do you have any concerns about cognitive decline or mood changes?  
• What matters: What are your personal health goals? What matters most to you? 

Considering these questions before your appointment can guide your conversation with your physician. You may not have considered what matters most to you before, and that can take some time to reflect on. Even if what matters most to you isn’t health-related, it can still provide clinical value to your doctor.  

“For example, if since their last appointment, a patient has had a grandchild born and now what matters most to them is the ability to travel out of state regularly to visit that grandchild, it’s important for the physician to know that. That could inform whether a medication is prescribed that requires the patient to come in for an infusion versus one that can be taken orally at their convenience,” says Dr. Mandel. 

How caregivers can advocate for their loved ones

You may wonder how to best advocate for your loved one if you're a caregiver. Try to understand and honor what matters most to them. That can feel challenging, especially in cases of cognitive decline. You may need to reflect on what mattered most to them when they could express it to guide your decision-making.

It’s also important to allow your loved one to advocate for themselves if they’re able and interested in doing so. “Thinking in the context of patients who have memory impairments, they’re often coming in with a caregiver. They often cannot articulate what’s of concern to the same extent that the caregiver can. There is a balance. You need the information from the caregiver, but you don’t want the patient to feel disenfranchised or irrelevant to the conversation about them,” explains Dr. Mandel. Striking a balance between relaying crucial information to physicians and letting your loved one speak ensures they remain part of the conversation.

Advance care planning is the process of thinking, discussing, and recording health care wishes to ensure they are known, understood, and respected. If you haven’t sat down with a loved one to discuss their health care wishes and can still do so, don’t wait! It may feel challenging to initiate this conversation as a caregiver, but it’s essential. Advance planning conversations can guide future decisions you make as a caregiver when your loved one can no longer advocate for themselves. 

An age-friendly approach to better health 

While physicians typically strive to provide the best care, older adults sometimes experience age-related biases when receiving treatment. This can include receiving standardized treatment that overlooks age-related health needs or comorbidities or hesitancy from doctors in recommending aggressive treatments due to age. “In both situations, there’s room for self-advocacy,” notes Dr. Mandel. If you don’t feel like you’re on the same page as your physician, it’s okay to explore care with someone whose approach feels more in line with your preferences.

Hebrew SeniorLife exclusively serves older adults, ensuring ageism has no place in our approach to health care. Our dedication to evidence-based, person-centered care is why Hebrew Rehabilitation Center in Boston and Hebrew Rehabilitation Center at NewBridge on the Charles in Dedham, MA, are designated age-friendly health systems. In addition, our Hebrew SeniorLife outpatient clinics at NewBridge on the Charles in Dedham, MA, and Orchard Cove in Canton, MA, are also participants in this program.

That dedication shines through in services ranging from long-term chronic care, post-acute rehabilitative care, outpatient memory care at the Deanna and Sidney Wolk Center for Memory Health, a comprehensive range of outpatient care clinics, and more.

Interested in discovering what age-friendly care could look like for you? Find a service or community online today to learn more.  

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