Dr. Carlson with a senior patient in her practice. Dr. Carlson and her partners have thought carefully about how to make the visits of senior patients comfortable for them while maintaining office efficiency.
Caring for elderly patients in optometry
By Dori M. Carlson, OD, FAAO
Feb. 12, 2025
Approximately 33 percent of my practice consists of patients aged 65 and older, with about one-third of our services billed to Medicare.
This demographic is not just a statistic; they represent a vital part of our community, and their care is both a privilege and a responsibility.
Here is how we care for our elderly patients while growing a profitable practice.
Managing Chronic Conditions
Many of these elderly patients have chronic conditions that necessitate multiple visits throughout the year.
While I can only estimate, I would say a significant percentage of them—especially those with glaucoma, macular degeneration and diabetes—require regular follow-ups.
Our practice is heavily focused on medical eyecare, and we often see glaucoma patients multiple times a year, with other chronic conditions dictating the frequency of visits based on their severity.
Navigating Complex Cases
One of the most challenging aspects of caring for these patients is managing the complexities of multiple diseases.
I recently had a patient with both macular degeneration and cataracts. Her vision has declined since August, and it’s difficult to determine whether the decline is due to the cataracts or the macular degeneration.
These cases require careful analysis of previous scans and a thorough understanding of the patient’s overall health. Ultimately, it’s about involving the patient in their care decisions.
I frequently ask them how they’re functioning, whether they feel their lifestyle has changed and how their quality of life is impacted. These discussions are essential, and I strive to engage my patients in every step of their care.
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Effective Scheduling Strategies
To address the challenges of providing care to elderly patients without disrupting the experience of others or overwhelming my staff, I rely on my seasoned team.
They’ve been with me for a long time and have a keen sense of how much time each exam requires. We typically schedule our older patients in the morning or early afternoon, avoiding late-day appointments for those who need extra time.
This scheduling strategy allows us to catch up during lunch if we run behind. We allocate 30-minute slots for comprehensive exams, which helps reduce stress for both my staff and me.
While I could see more patients in an hour, the complexity of cases often requires additional time, and I’ve found that this approach keeps the day flowing smoothly.
Connecting with Patients Who Have Dementia
When working with patients who have dementia, I learned that humor can be a powerful tool. Treating these individuals with respect and dignity is paramount, and humor often helps bridge the gap.
Many elderly patients enjoy reminiscing about their past, and engaging them in conversations about their siblings or fond memories can create a meaningful connection with both the patient and their caregiver.
Investing in Technology for Better Care
Investing in the right technology has also been crucial in enhancing the care we provide to elderly patients.
We recently purchased a slide for our exam chairs, allowing us to easily accommodate wheelchairs. Our exam rooms are designed to lower the biomicroscope for better access, and we utilize handheld instruments like tonometers and bluminators when necessary.
This technology not only makes our lives easier, but also ensures that we can provide the best possible care to our elderly patients.
Training Support Staff for Success
For our support staff, it’s essential to understand that caring for elderly patients isn’t fundamentally different from caring for younger ones; it just requires a bit more time and patience.
Empathy is key, and training staff to be attentive and understanding can significantly enhance the patient experience.
Maximizing Medicare Reimbursements
Maximizing reimbursements from Medicare is an ongoing challenge. Staying educated on reimbursement rules and service levels is crucial.
Recently, CMS released a new code for treating patients with chronic conditions, and our goal for 2025 is to embrace this change and learn how to use it effectively.
The Joy of Caring for Elderly Patients
In conclusion, there is immense joy in caring for elderly patients. Their life experiences are fascinating, and I believe that treating them with patience, empathy and a touch of humor is essential.
If we’re fortunate, we may find ourselves in their position one day. Allowing for adequate time, and finding what works for our schedules, is key to providing the best care possible.
Dori M. Carlson, OD, FAAO, is a partner with Heartland Eye Care, P.C. , a Vision Source practice with two locations in North Dakota. To contact her: dori.carlson@gmail.com
