Behavior Boost

By Robert F. Bornstein, PhD and Mary A. Languirand, PhD

Sad, but true: Our bodies eventually wear out. Many factors contribute to the speed and severity of that deterioration, including genetics, environment, and behavior. Some we can control, and--good news-these "controllable" factors help prevent or mitigate a number of different medical problems. This is particularly important when you consider the fact that many older people have several significant health conditions. Attend any dinner party of those over 50, and at least part of the evening will almost certainly be spent discussing health issues and medications, doctor visits and insurance woes. Occasionally you'll meet someone who only has hypertension, or diabetes, or COPD, but often folks are actually dealing with all these conditions and then some.

Once upon a time, your primary physician dealt with all your medical needs all by him or herself. When your problems progressed past a certain point, specialists were consulted, and you could find yourself meeting with a half-dozen different doctors. As long as everybody communicated well and often, this teamwork was often extremely beneficial. However, even in the best-case scenario you could spend a lot of time and effort getting to different offices, filling out essentially the same paperwork multiple times, and then trying to figure out how to coordinate a veritable blizzard of instructions, medications, and suggestions on your own. Mistakes and miscommunications were fairly common. Some folks just found the whole experience too overwhelming, and simply opted out of treatment altogether-sometimes with disastrous consequences.

Efforts to re-think this pattern are increasingly moving toward a new care model that blends the best features of the old system with the truism that making a few beneficial behavioral changes can make big health differences. "Medical homes" and "patient-centered care models" focus on treating the whole person to maximize overall quality of life, eliminating barriers to specialty care, streamlining paperwork, and enhancing communication. Some models quite literally house primary care doctors and specialists in the same physical space, while others keep separate spaces, but go the extra mile to ensure that everyone communicates clearly to help the patient achieve the health goals that he or she sets. Almost all of these models emphasize the fact that the patient's choices and behaviors are among the most important factors in whether or not his or her problems can be treated successfully, and try to ensure success by including behavioral health experts on treatment teams. Need to quit smoking, exercise more, eat better, drink less, sleep more deeply, manage a complex medication schedule? You're going to achieve those goals more readily if you fine-tune your behavior with the help of a psychologist.

Many people see the intrinsic logic of including mental health professionals on medical treatment teams-who better to help assess and solve problems, motivate, and encourage? Others resist the notion that they need mental health care; "I'm not crazy, I just have high blood pressure!"

To this the psychologist would agree completely, as the focus is on helping the patient learn and implement some research-based methods for improving his or her health quickly. Sessions are brief, problem-focused, and goal-oriented-it's all about outcome. The cost to the patient is a fraction that of traditional psychotherapies, and is increasingly covered in whole or in part by "chronic care management" funds specially allocated to address the needs of those dealing with multiple medical problems.

For many of us, multiple medical problems cannot be avoided or escaped entirely, but how we respond to the challenges can make the difference between good and poor quality of life. You can work to be a "healthy" diabetic or asthma patient, or you can choose to be a "sick" one. Letting a psychologist help you navigate the course could well make all the difference.


Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, which is available at, or may be purchased directly from HarperCollins Publishers.

Our latest book is entitled How to Age in Place: Planning for a Happy, Independent, and Financially Secure Retirement, published by Ten Speed Press, a division of Random House.