Changes in ambulatory care with patient age: is geriatric care qualitatively different?

Approximately 25,000 recorded visits between primary care physicians and adults aged 25 and older in the 1985 National Ambulatory Medical Care Survey were analyzed to study the relationship between patient age and selected process measures of the physician-patient encounter. Multiple presenting complaints and visit diagnoses both rose with age. In spite of this evidence of increased complexity of elderly patients, mean visit length for cough, dizziness, diabetes, and general medical examinations failed to rise, with longest visits tending to be among middle-aged patients. Performance of blood pressure examinations, rectal examinations, breast examinations, pelvic examinations, and Papanicolaou (Pap) smears on patients presenting for general medical examinations tended to decline beyond age 65. These results suggest that individual office visits for older patients may be less comprehensive than those for younger adults.