Geriatrician, huh...what's that?  When should I consider one for my loved ones or...(gasp, cough, sputter)...ME?!?!

A geriatrician is a physician who specializes in the care of older adults.  By older adults, the field has traditionally used Medicare eligibility (i.e. 65 years old) as the time to start considering a geriatrician as part of your health care team.  However, there is a wide spectrum of older adults above 65, and many geriatricians feel that their expertise is most beneficial once a person is 75 or even 80 years old and beyond.  

Over the span of my career, I have treated robust, active, & independent 95 year olds who run marathons as well as debilitated, frail, & complex 72 year olds who cannot escape the revolving door of hospitals, skilled nursing facilities, and other medical care venues.  So, I usually tell patients and families that we shouldn't use age as a cut-off, but look more holistically at a person and their goals of care.

That being said, I offer some snippets for your consideration as to when to consult with a geriatrician-

A) Health Planning & "Forecasting"

This applies to many adults over 65- healthy or frail.  A geriatrician knows how to put the pieces of a puzzle together to help you with the big picture- to make sense of medical complexity.  We understand how chronic medical conditions can progress over time and what that means to you, what you should be on the lookout for.  We also know how to tie the medical aspect of your care with the cognitive, functional (ability to care for yourself and exist in the community), social, & psychological.  A geriatrician will assess these in the context of your goals for care- that is, what are your priorities at this point, and how to we construct plans of care for you that allow you to meet these goals.  

B) Frailty, Multi-morbidity, Complexity

Geriatricians are great to help with the older adult who is facing frailty- the decline in physiologic resilience.  Huh?!?  Basically, the decline in the different systems in your body to efficiently respond to a stress so that you recover back to your baseline quickly.  This is why it takes an older adult, especially one with many medical problems (multi-morbidity) longer to get over illness, surgery, or other setbacks from their routine.  Because a geriatrician is trained to put all the pieces of a puzzle together, s/he can help you make sense of the complex situations that are going on and pave a clear path to figure out what's coming down the pike or what choices are available for your health and wellness.  

C) Cognitive Concerns

One of the most common questions I get asked as a geriatrician is, "Doc, what's the difference between normal memory loss and dementia?!  Could this be depression?  When should I be concerned?"  Assessing memory and other domains of cognition is something that is a geriatrician's bread & butter- it takes more than a quick screen test in the office, and again (see the theme here?), requires integrating the medical, psychological, social, functional, and cognitive realms of health.  

Patients having memory loss, driving concerns (more often the family/loved ones), vulnerability to financial management troubles, changes in behavior, or exhibiting trouble managing their day to day functioning because of cognitive issues should consider seeing a geriatrician for a more thorough evaluation.  

D) Frequent Falls

Gait can change as we get older and be affected by numerous issues including hearing, vision, medical conditions, medications, and overall physical fitness.  As gait changes, it can put an older adult at risk of falls.  An isolated one-time fall can usually be assessed by a general practitioner, but when there is a pattern or recurrent falls or progressively worsening gait, it helps to have a geriatrician weigh in to sort through all the possible issues.  Related to this could be concerns for how to improve safety in the home or environment, when to consider using an assistive device, or when physical or occupational therapies might be helpful.  

E) Outlining Goals of Care

Conversations regarding what's important to a patient- his/her priorities, are at the heart of what geriatricians enjoy.  This is because it provides a deeper understanding of the patient and how we can work together to adjust plans of care to fit their priorities- a lot of "thinking out of the box."  Related to this, a geriatrician can help you navigate completing advance care directives, healthcare power of attorney forms, POLST (Physician Orders for Life-Sustaining Treatment) forms, and understanding what DNR/DNI/full codes mean in the context of the specific patient.  

F) Decision Making Capacity

Sometimes, especially as cognitive decline and/or dementia progress, a patient starts having trouble making decisions for themselves- regarding medical, financial, and/or dispositional matters.  A geriatrician can do a thorough assessment to help teams working with the patient understand what his/her decisional capacity may be.  This often is applicable to patients who, unfortunately, may need to undergo guardianship hearings.  

G) End-of-Life Care 

As we get older, and perhaps more medically complex or frail, it's important to start considering what's important to us as we approach end of life.  What are the options for care and treatment? What are my preferences?  What is hospice vs. palliative care?  How can I communicate this to my family/loved ones and other providers?  These are all questions that geriatricians are adept at answering.  They can gently guide you and your loved ones through these difficult conversations and outline a plan for care that makes sense to you.  

This is just a high level overview of what a geriatrician can offer you.  If any of these questions are on your mind or the minds of a loved one, consider reaching out to a geriatrician and getting a comprehensive geriatrics assessment to start getting answers.

At Geriatrics Planning & Solutions, Inc., I am available to help with these matters and can do this in the comfort of your home on your time so that you get the answers you need.  Reach out today to find out more about how I can help.

Arun S. Rao, MD

Geriatrics Planning & Solutions, Inc.

https://www.geriatricsplanningandsolutions.com