A friend recently asked if I thought his parents should see a geriatrician. Both in their 90s, they have multiple medical ailments and have had difficulty managing these conditions, as treatment for one affects another. They are treated by a number of medical specialists but no one physician is “captaining the ship,” and as a result, there have been numerous visits to the emergency department due to symptoms that could have been prevented.
Most primary care practices are seeing an increase in the number of older persons that they treat. The main problem internists see in caring for older patients include the time that it takes to address multiple medical and social problems with both the patient and their family member or caregiver. There is a lot to talk about and these visits can take twice as long as a visit with a younger patient. And, as much as we are loathe to admit it, there can be ageism in medicine – which can result in some complaints being dismissed and potentially avoidable issues become major problems.
Hospitals are recognizing that the care of older individuals requires special expertise. Many have developed distinct emergency departments for the care of the elderly and have designed inpatient units (often called ACE or Acute Care for the Elderly) specifically geared to the needs of an older population.
There are many reasons that an older person might seek the care of a geriatrician. Here are a few:
Geriatricians recognize that many diseases that come with aging may not be amenable to cures. So, many geriatricians focus on preventing issues from becoming more complex and on how older people can function better (have a good quality of life) notwithstanding their medical situation. This may eliminate putting an older person through expensive and potentially dangerous tests that may not change any care regimen.
The physical exam given by a geriatrician may also include tests for mental status, balance issues and others not usually included in a visit to the internist. Geriatricians can pick up on “cues” given by older patients that may be indicative of a larger problem – and they are more sensitized to these cues than general physicians. Often geriatricians will be involved in getting a patient meals at home to assure proper nutrition, treat loneliness issues and mitigate complex family dynamics since medical and social problems often become interrelated as we age.
Geriatricians have specific knowledge about which medications might be fine in a younger person but could cause a problem in the elderly. For example, some antihistamines like Benadryl can make an older person so drowsy and dizzy that they may fall and possibly break a hip. Medications can also interact differently in older people and the dosage might be different than those for a younger person.
Often, I receive calls from children of clients whose parent was brought to the emergency department after a fall and is confused and delirious. While they are undergoing an extensive workup, I ask if anyone checked for symptoms of a urinary track infection and/or dehydration as these can often present as confusion in the elderly and it is the confusion that leads to the fall....and so on. (I know I am not a physician but I have seen this happen far too often.)
Choosing a physician is a personal decision. Regardless of whether you seek the care of an internist or geriatrician, make sure that you see someone who takes the time to really listen to what you are telling them, understands how our bodies and the world we live in can work and should work together as we age and who is able to communicate with you, your family and other members in the system.
