Sounding Board. The illness as the focus of geriatric medicine

Understanding the difference between illness and disease is a prerequisite to the care of patients affected by incurable disorders. Educated palliation in the absence of substantive information regarding this discrepancy is the art of medicine. Because elderly patients often present with several chronic diseases, many of which are irreversible, cure-oriented physicians caring for the elderly are especially vulnerable to frequent disappointments. Multiple influences, such as psychological, social, environmental, and iatrogenous factors, may also substantially limit the possibilities for "total cure." More important, even though many chronic conditions are incurable, the discomfort or disability they produce may be substantially modified. If this concept is not realized and addressed, patients (many of them elderly) with irreversible chronic diseases may receive less than optimal care from physicians seeking cures. Studies need to be directed at defining and quantifying specific interactions between illness and disease and discovering risk factors for chronic disability in the elderly. The degree to which we as physicians can assist the chronically ill may reflect our understanding of human discomfort and our sensitivity to personal distress. If we maintain a purely disease-specific focus, we may have difficulty thinking about strategies to serve the patient. Defining pathologic entities may be less complicated than intervening in the illness of the patient, but the latter constitutes healing.