The Socioemotional Needs of Elderly Family Practice Patients: Can Social Workers Help?

This study investigates the psychosocial characteristics of a group of suburban elderly people who were believed to use the relationship with their family physician for reassurance, support, and other socioemotional needs. These patients presented minor complaints, demanded time and attention, and were somewhat frustrating to their doctors. Thirty-four physicians in five New Jersey practice settings assessed elderly patients who visited their offices during a two-year period. Background data were collected on the physicians, and 193 elderly patients were interviewed. Based on pretested criteria, patients were divided into a study and comparison group. When t tests were used to analyze the data, the patients with socioemotional concerns were found to be significantly more anxious, more depressed, and more introspective, and they perceived themselves to be sicker than other elderly patients. These findings have implications for the use of social workers in the service of emotionally distressed family practice patients.Illness behavior is a concept first used by Mechanic (1963) to describe the manner in which a person experiences symptoms of illness and takes action to alleviate those symptoms. At both policy and practice levels, illness behavior of elderly family practice patients should concern health care social workers. Using the family physician to deal with the psychosocial symptoms of elderly patients is an inefficient use of Medicare and Medicaid dollars. Medicalization of the problems of the elderly patient is a policy dilemma that, if properly addressed, would distinguish medical from psychosocial problems in the senior population and would use social workers to deal with the nonmedical aspects of senior care (Azzarto, 1986). How does medicalization manifest itself in the family doctor's office? What and how severe are the psychosocial problems of elderly patients who come to the family doctor's office? Can social workers help? This research offers possible answers to these questions.THEORETICAL ISSUESVarious models have been used to guide the conceptualization of physician utilization in large epidemiological studies. Andersen (1968) stressed three types of patient variables: predisposing characteristics, enabling factors, and need variables. Antonovsky (1972) suggested a model that expanded the scope of research beyond the patient and included host characteristics, characteristics of the medical system, and characteristics of the social environment. Mechanic (1979) considered these and other prediction models to be too limiting for the study of physician utilization and proposed a process model. Despite its limitations, however, Antonovsky's focus on the social functions of medical practice blended well with the notion of medicalization and, because of its classification of variables, seemed to lend itself more conceptually to a smaller study.Instead of physician utilization, however, the independent variable used in this study was physician socioemotional utilization, defined as the patient's presentation of minor complaints with a relatively low need for medical attention but high demand for time, attention, and reassurance. The study's population of elderly patients were upper-middle-class suburban New Jersey residents who received their medical care in private practice settings. A few of the patients, however, did pay sliding scale fees and used Medicaid. The host characteristics, using Antonovsky's (1972) classification, were the psychosocial problems that the suburban senior citizen might somaticize and bring to the doctor's office.One such psychosocial problem is depression. Somatization and depression have been found to correlate positively in many geriatric studies (Hall, 1980; Katon, Kleinman, & Rosen, 1982; Raskin & Sathananthan, 1979; Salzman & Shader, 1979; Swab, Holzer, & Warkeit, 1973). In the general population and in a setting similar to the study's, Rosenthal, Goldfarb, Carlson, Sagi, and Balaban (1987) found that depressed patients were seen more often for office visits than their nondepressed counterparts. …