experience drastic reductions in both income and health insurance coverage when they enter retirement (Tian et al 2005; Hinrichsen et al 2006). Older adults may be perceived as economically secure because of Social Security and Medicare in the US, and social insurance programs in other countries, but older age can be accompanied by signiﬁcant economic limitations. In the US, for example, more than 10% of those older than 65 were living at or below federal poverty level, and 28% were considered to be low income, according to 2003 statistics (Chen and Landefeld 2007). Americans over 65 years of age account for 17% of those deﬁned as poor (Rao et al 2004). In the realm of health care, it is often the case that social programs such as Medicare fall short of covering the numerous medical care needs of this population of patients, and some patients may even face choices between obtaining necessary medications and purchasing other life necessities. Access to optimal care may be limited by many factors, including economics and geo- graphic location. In the US, compared with those reporting incomes over $50,000/year, low income older adults report signiﬁcant limitations in access to affordable medical care (Chen and Landefeld 2007). Disparities in health care availability and access can contribute to poor chronic disease management and adverse health outcomes. Following acute myocardial infarction, for example, low income Medicare patients present to the hospital later than those with higher incomes, have been found to be less likely to be treated at hospitals with catheterization facilities and medical school afﬁliation, receive lower rates of evidence-based medical therapy, and have lower rates of survival at 30 days and 1 year (Rao et al 2004). Low income, and difﬁculties meeting basic needs such as paying for food and medical bills, have been shown to be most consistently associated with increased mortality (Chen and Landefeld 2007). Even among patients of later middle-age (51–61 years old), those who lacked health insurance were found to have higher risk adjusted rates of decline in overall health and physical functioning and higher risk-adjusted mortality compared to individuals with private insurance (Sudano and Baker 2006). Data from the Health and Retirement Study show that near-elderly adults who are uninsured as they approach 65 years of age are a particularly vulnerable population (McWilliams et al 2003). Many have out-of-pocket expenses and restricted access to medical care, and as a result can experience serious health consequences from limitations in preventive services, delayed diagnosis, and poor monitoring and control of chronic disease (Sudano and Baker 2006). Indeed, limitations in health insurance Clinical Interventions in Aging 2007:2(3) Physician-patient communication coverage are associated with less availability of preventive services, particularly for minority patients and those with lower levels of education. For these patients, a late-stage cancer diagnosis, untimely care for acute medical problems, and poor management of chronic conditions can compromise health outcomes and even survival (McWilliams et al 2003; Baker and Sudano 2005). In fact, in the US, a quarter of adults in late middle age are at increased risk of health decline because they are uninsured in the years before retirement and Medicare eligibility (Baker and Sudano 2005). The physician-patient relationship as a therapeutic agent Overview As patients navigate the physical, psychological, social, economic, and lifestyle changes associated with aging, one relationship that may remain an important source of support and encouragement is the relationship with their physician. Regular visits may occur to address a variety of health con- cerns including medication follow-up, health behavior and lifestyle counseling, blood tests and screening, and many aspects of chronic disease management. In the US, patients 65 and older who suffered from comorbid disease ranked as an intermediate health liability were found to visit their primary care physician 3.9 times per year and their specialist 4.3 times per year on average (Starﬁeld et al 2005). Frequent medical visits give physicians the opportunity to be therapeutic agents in the provision of health care to the aging patient. Their role can go far beyond offering biomedical care. Communication between physician and patient can have far-reaching implications for the physical and mental health of elder patients. Effective physician- patient communication involves the exchange of both biomedical and psychosocial information as well as the emotional and affective care that is so important to older patients’ health outcomes. The development of a trusting therapeutic relationship can be central to the health care of elder patients. The communication of information to patients Offering information to patients and successfully conveying it in a clear and comprehensible format is a central component of the medical visit. Physicians typically give their patients information in the form of explanations or instructions. They communicate a diagnosis, describe options for treatment, and explain the strengths and weaknesses of those options. 455