When Do You Need a Geriatrician?

by Richard O’Boyle, Publisher
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As an individual’s health status declines, their need for care by a doctor and other healthcare professionals increases. As you find yourself confronted with numerous medical problems, you are probably juggling multiple specialists, tests, records, and prescription drugs. That’s when a geriatrician can be helpful. A geriatrician can coordinate the work of specialists and other healthcare providers such as social workers, nurses, and home health aides.

As people age, they tend to deal with multiple medical conditions. According to the Alliance for Aging Research, the average 75-year old person has three chronic medical conditions and uses five prescription drugs, as well as multiple over-the-counter remedies. For many older people, the incidence of depression, incontinence, and memory loss are a direct threat to their ability to live independently. “Careful management of these conditions by a multi-disciplinary team becomes paramount to maintaining long-term health, vigor, and the capacity for personal growth and independence,” the AAR said in a report critical of current medical staffing ratios.

A geriatrician is a medical doctor who is specially trained to prevent and manage the unique and multiple health concerns of older adults. According to the American Geriatrics Society, geriatricians are able to treat older patients, manage multiple disease symptoms, and develop care plans that address the special healthcare needs of older adults. Generally, geriatricians are primary care physicians who are board-certified in either Family Practice or Internal Medicine and have also acquired the additional training necessary to obtain the Certificate of Added Qualifications in Geriatric Medicine.

There are approximately 9,000 geriatricians in the U.S. In addition, there are several hundred osteopathic physicians (DO) certified in geriatrics, as well as about 2,400 board-certified geropsychiatrists (a psychiatrist trained to deal with the mental health needs and specific syndromes faced by older adults), according to the AGS. Other healthcare professionals who work on a geriatrics team, such as nurses, pharmacists, and physical therapists, may have advanced training and hold special certifications in geriatrics.

Who Needs to See a Geriatrician?

For the most part, the elderly are cared for by general internists and family physicians. Whether you should see a geriatrician is based more on your particular healthcare needs than on your chronological age. Two individuals both aged 65 may have very different degrees of disability or illness: one may have no problems at all, while the other may have serious health concerns. Geriatricians frequently provide the primary care for older adults who have complicated medical and social problems.

Regardless of an older person’s age, a geriatrician should be consulted when:

  • Their condition causes considerable impairment and frailty. For example, they may be over the age of 75 and coping with a number of diseases and disabilities, including cognitive problems such as dementia;
  • Proliferating prescription drugs make it unclear which drugs are appropriate; or
  • Family members and friends are feeling considerable stress and strain as caregivers.

If you’re basically healthy and happy with your internist or primary-care physician, you need not switch to a geriatrician, says Richard Bennett, M.D., a geriatrician and professor of geriatric medicine at Johns Hopkins University. But he adds, “If your medical picture is a complicated one or if you’re contending with a disability” you may consider consulting with a geriatrician.

Robert S. Stall, M.D., a geriatrician in Buffalo, N.Y. notes that “polypharmacy,” or over-medication is a critical problem among the elderly, and one that geriatricians are particularly adept at tackling. “Many older people see several doctors, each of whom may prescribe different medications. These same people may also use over-the-counter medication regularly. They may even get their medications from more than one pharmacy, or from friends,” Stall notes. “It’s not hard to see how medications may pile up and how difficult they may be to track. Even one drug that’s not right for a person can impair function and decrease enjoyment of life. Imagine what five, or ten, or fifteen can do.”

Geriatricians’ holistic approach to healthcare is also appealing to aging adults who find it more and more difficult to live independently due to dementia, incontinence, or increasing frailty.  As part of a ‘whole-picture’ approach, geriatricians frequently consult with a healthcare team to intervene when a bad situation threatens an older person’s independence. For example, a team of nurses, social workers, and home health aides under the leadership of a geriatrician may assist a person with dementia to stay safely at home by arranging for home improvements, shifts of aides, adult day care, or other healthcare services.

Finally, geriatricians may have an added sensitivity to helping an elderly person maintain high levels of functioning and quality of life. Stall says that generalizations and statements that assume all older adults naturally become weak, sick, and forgetful are unjust and prejudicial. “Older people get sick from disease, not ‘old age,’” he says.

Sources:

 - “When You Should Switch From Your Primary Care Physician to a Geriatrician,” Tufts University Health & Nutrition Letter, August 2002.
 - American Geriatrics Society Referral Line 1-800-247-4779 http://www.americangeriatrics.org
 - “What is Geriatrics? An Introduction to Health Care for Older Adults,” American Geriatrics Society Foundation for Health in Aging http://www.healthinaging.org/public_education/what_is_geriatrics.php
 - “Talking With Your Doctor: A Guide for Older People,” National Institute on Aging http://www.nia.nih.gov/health/pubs/talking/p2.htm
 - “You and Your Doctor: It Takes Two to Tango” by Pauline Salvucci, MA http://www.ec-online.net/Knowledge/Articles/twototango.html
 - “Medical Never-Never Land: Ten Reasons Why America Is Not Ready for the Coming Age Boom,” Alliance for Aging Research, Feb. 2002 http://www.agingresearch.org/advocacy/geriatrics/02016_aar_geriatrics_text.pdf
 - “Seven Principles of Geriatrics,” by Robert S. Stall, M.D. http://www.acsu.buffalo.edu/~drstall/

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