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Tailored care tips for our older patients
By Pamela Miller, OD, FAAO, JD, FNAP
Oct. 29, 2025
Several years ago, a senior patient came into my office from a care facility. Let’s call her Mrs. Jones. We chatted as I would with any other patient, until all of a sudden, she paused and said, “My sister told me they’re clearing out my room at the facility.” I looked around my exam room, expecting her sister to reveal herself. No one did.
I took a beat and decided to call the care facility. I said that Mrs. Jones was with me, which they knew, and she was worried because her sister told her they were emptying her room. I was met with silence, until the person on the other line asked, “What’s going on?” I explained that Mrs. Jones’ sister is visiting from Pasadena, and she told Mrs. Jones that the facility staff are cleaning out her room. “Well, Dr. Miller, her sister isn’t visiting. She’s dead.”
I politely hung up, returned to the exam room and told Mrs. Jones, “Don’t worry about it. I just talked to someone at the facility, and they know you’re returning. Nobody is clearing out your room.” Mrs. Jones smiled, reassured. She was competent and engaged, but her sudden confusion changed how I managed the visit.
As optometrists, how we care for our patients—particularly seniors—defines our work. It’s our responsibility to meet patients where they are to deliver personalized and exceptional care.
MEET PATIENTS WHERE THEY ARE
I could have dismissed what Mrs. Jones said as a transient lapse, or even argued with her, but listening and acting spared her anxiety and prevented a downstream issue. Acceptance of your patients, wherever they are, is essential. This means combining observation with clear, respectful communication and tailoring care to function, not just test results.
“Mature” doesn’t necessarily mean “old.” Some seniors still work and spend hours on video calls. Others live in facilities and rely on caregivers. The standard of care should differ because functional needs differ. Be willing to deviate from a standard exam script, spend extra time on history and tailor recommendations to how patients actually use their vision. If you don’t assess real-world living, you risk prescribing lenses or treatments that look good on paper but fail in real life.
START WITH OBSERVATION
How an older patient walks in your office is one of the richest clinical clues you can get. Limping, leaning, stooping or always tilting the head can indicate arthritis, cranial nerve dysfunction, vestibular deficits and more. If staff seat patients before you see them, you risk losing those clues. Make a practice of meeting patients at the front door or asking staff to note gait and posture in the chart so you start the encounter with those observations in mind. Why does this matter? Because these observations directly affect vision care management. For instance, a markedly stooped patient may find standard bifocals intolerable.
Another crucial observation is hearing level. Less visible than a limp or head tilt, hearing loss strongly affects how patients receive information. Many mature patients rely on lip reading, facial expression and reduced background noise to understand you. always face the patient throughout the exam, especially when explaining findings and clinical recommendations. Speak clearly at a measured pace and do your best not to ramble. Women’s voices are often higher than men’s, so speaking at a slightly lower pitch may help.
THE PATIENT IS PRINCIPLE, NOT THE CAREGIVER
If a senior patient arrives with a caregiver, the situation should not change. The caregiver’s presence should not override the patient’s autonomy. Caregivers are invaluable for history, medication reconciliation and follow-up, but the patient is principle.
Always ask the patient’s permission before inviting a caregiver into the exam room. If they decline, you must respect their privacy and HIPAA rights. Address the patient directly and avoid speaking only to the caregiver unless the patient asks you to. Small accommodations—facing the patient during conversation, removing face masks when safe and ensuring good lighting—help them follow the conversation and feel respected.
EVALUATE RESPECTFULLY
If competency is a concern, probe with targeted and respectful questions. Don’t ask “What floor are we on?” or “Who’s the president?” Instead, you should ask functional questions: “Do you manage your medications?” or “Who helps at home?” or “Do you handle your own finances?” You can even ask them to describe a typical day in their life rather than subjecting them to confrontational tests. These questions will reveal real-world ability and needs—pill organizers, home-safety evaluations or referrals—without shaming or ostracizing the patient.
Even when competency isn’t a concern, a senior patient’s functional history should guide clinical decisions. Ask whether they’re still working or retired, how many hours per day they spend on screens, whether they read small print and what their hobbies are. A gardener who needs sharp near vision has different needs than a retired librarian who reads on a computer or in print all day.
Mature patients often require longer visits and more nuanced counseling, which affects scheduling, staff and revenue. Use intake templates to capture functional history, train staff to note gait and hearing and allow flexible appointment slots for complex visits. Spending a few extra minutes up front reduces callbacks, improves adherence and increases patient satisfaction. In my experience, the extra investment yields trust and long-term loyalty.
Another quick note on respect. This applies to everyone, not just seniors. If a patient has a professional title, use it. Let them tell you if they prefer a first name. As an optometrist, would you want your patients to call you by yours?
DON’T FORGET THE HUMAN TOUCH—LITERALLY AND FIGURATIVELY
Touch can be comforting, but consent matters. Never assume it’s welcome. Cultural norms vary, so always ask before physical contact. A gentle hand on a patient’s forearm or a reassuring palm on their knee can communicate empathy and calm, but not for everyone. When appropriate, I often place both of my hands on either side of a patient’s hand when we greet, which protects arthritic joints and feels supportive. A rough handshake can be painful.
Resist the reflex to say, “I know how you feel.” You don’t. Ask open-ended questions and let the patient tell you what’s really going on. Remember that the human touch isn’t only physical. It’s also the tone of your voice, steady eye contact and the small silences that invite a response. Those gestures convey respect and presence just as powerfully, if not more, as a gentle touch.
Treat your senior patients with the respect, patience and curiosity you’d expect for yourself and loved ones. Observe how they move and speak, then tailor care to how they live. Clinically, it improves outcomes. From a business perspective, it strengthens retention, reduces complications and builds a reputation that keeps patients returning—and sending their friends and family to you.
Read another article by Dr. Miller here.
Read more patient experience articles on ROB here.
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After 51 years in her solo Highland, Calif. practice, Pamela Miller, OD, FAAO, JD, FNAP, is now a member of the Faculty Medical Group of the Loma Linda University School of Medicine Department of Ophthalmology, working as an Instructor and Optometrist. To contact her: drpam@omnivision.com |
