As specialists go, we have all heard of cardiologists, gastroenterologists, endocrinologists, but how many of us really consider or have even heard of geriatric specialists or geriatricians when we think about care for someone 60 and older? As we age, the health challenges we face become more complex and the list of medications quickly grows, a more holistic view of the geriatric patient may be warranted.
A geriatrician is a board-certified family or internal medicine physician with an additional 1-2 years of fellowship training in geriatric medicine for separate board certification. A geriatric care physician offers a unified framework for issues such as adult-onset diseases, incontinence, dementia, depression and changes in mobility. Their focus is on enhancing quality of life and helping older adults remain independent for as long as possible.
One of the most important benefits of a geriatrician is to coordinate care. They help the elderly patient when:
• It is necessary to coordinate too many specialists.
• The physical and mental health management of senior adults becomes too complex for a regular internist.
• The list of medications becomes complicated and implications for drug interactions become serious.
Geriatricians use a "whole-body" approach in patient care as their paradigm. During a first visit, you can expect an extremely comprehensive geriatric assessment with a number of components. These include a thorough physical examination after a full recording of the patient's medical history including a pain assessment. The workup will also include cognitive testing, osteoporosis and arthritic evaluation, a nutritional assessment as well as vision, hearing and dental screening. Additionally, inputs from a geriatric social worker and the family are often important components of the evaluation.
Geriatricians are adept at working closely with the multiple specialists who may be currently managing chronic illnesses of the elderly patient. Also, there is often a team of specialists with specific geriatric certification that the physician calls upon to help with the total care of the patient including registered nurses, physician's assistants, social workers, physical therapists, occupational therapists, nutritionists, pharmacists and psychiatrists all focused on the prevention and treatment of the diseases and unique challenges that face older adults. They all are trained to take special note of the frailty and mental capacity of the patient while managing their multiple medications. These health care providers nationally are members of the American Geriatric Society.
Geriatric physicians are selective when it comes to ordering certain tests and performing procedures weighing the costs and benefits of each as they can be physically and mentally stressful for aging patients. Routine or preventive testing done in younger people may be counterproductive or risky in certain older adults. Additionally, you will find that a geriatrician is extremely sensitive when listening to the concerns of the elderly patient and in helping them deal with end-of-life issues. They realize the importance of incorporating the unique psycho-social issues related to the elderly into their care plan. As such, geriatricians can be important resources for both the individual patient and their families.
A geriatrician pharmacologically monitors all of the patient's illnesses and evaluates the therapeutic efficacy and dosage of medications. Polypharmacy, which is managing multiple medications, can unintentionally and needlessly result in dangerous drug interactions. As we age, our metabolism changes and medications are absorbed differently than when we are young. A geriatrician is uniquely qualified to recognize and avoid the problem of over-medication even factoring in any over-the-counter meds or supplements that find their way into the mix.
Geriatric medicine is poised for growth as our population ages and the 85+ segment continues to be the fastest growing. There are only about 9,000 certified geriatricians in the U.S., thus finding one that has room on their roster might be challenging. To try and address this anticipated shortage, a greater emphasis has been placed on applying skills to the elderly population during medical residencies and training. Aside from consulting with your current primary care physician, the American Geriatric Society might be a good first stop for finding a geriatrician you can trust. Lifescript Doctor Review has an interactive portal to help you find a qualified doctor in your area with the expertise you and your family need as you transition into this new phase of life. We owe it to our elderly to make sure they are properly cared for.
Anita Kamiel, R.N, M.P.S., is the founder and owner of David York Home Healthcare Agency and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn where she is happy to share her experience and help you through your home healthcare issues.
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