Geriatrics is a medical subspecialty focused on the practice of medicine for people over the age of 65. Geriatricians have the unique opportunity to accompany people as they approach the ends of their lives.
In this field, you will deal with patients that tend to have multiple medical problems and cognitive issues. The goal of a geriatrician is to provide optimal care for older people. If you wish to assist people aging gracefully, consider pursuing a medical career in geriatrics.
Geriatricians train in internal medicine or family medicine after medical school and then complete a geriatrics fellowship. Geriatricians work in a variety of settings including academic medical centers, nursing homes, private offices, research institutions and health centers.
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Geriatric patients are living examples of history and resiliency. I love asking patients who are over 80 years old how they lived so long. The answers are as varied as the people and include everything from exercise, to a drink every evening, to love or a spiritual connection.
As we age, our ability to do things like walk, talk, think, taste and hear changes degenerates. Many elderly people experience losses resulting in implications for their daily activities.
For example, loss of taste buds reduces appetite because food no longer tastes good. Consequently, patients lose weight or fail to ingest proper nutrients due to poor intake of wholesome food or an increase in sugary or salty foods, which can have implications for blood pressure and diabetes. Gum disease, ill-fitting dentures or tooth decay can also affect how a patient eats.
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The geriatrician must be fully cognizant of nonverbal flags at all times. For example, pay attention when the patient walks into the exam room and moves from chair to exam table. Gait and mobility are critical factors in telling how an elderly patient interacts with the world. Instability may point to a diagnosis such as Parkinson’s disease or vitamin deficiency.
By listening to a patient’s speech, a geriatrician becomes especially attuned to cadence, fluency and the ability to identify items of concern.
Physical appearance is a clue to how the patient is doing at home. Signs of dishevelment or poor hygiene may point to the patient needing assistance. Geriatricians must consider the patient’s recent life changes, mental capacity and other factors in addition to physical condition.
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For example, perhaps the patient lives alone, has a home with stairs or has recently experienced the loss of a loved one and lacks social support on a daily basis.
In some cases, the geriatrician may have to engage social services to asses home care possibilities and occupational health fixes. Identifying family members who may be able to provide assistance or engage in home health will help ensure the patient is safe at home and able to perform activities of daily living. It requires a multidisciplinary team to fully assess a patient’s situation.
Patients may feel pressured to ask the physician to fix what ails them. While some patients prioritize living longer , many just want their ailments to be identified and then shift their focus to quality of life. Either way, the geriatrician must open a dialogue to identify the patient’s priorities.
While it depends on the cognitive ability of the patient, offering to talk to a family member is always good practice. Oftentimes a family member accompanies the patient to the geriatrician, making it easier to talk to the family. Calling a family member to discuss important aspects of care is also a good idea, especially when there is a change in medication or a new diagnosis.
Since geriatric patients die rather frequently given their age, taking care of this population requires a team of health care professionals and most often involves having a relationship with a patient’s family members.
As a medical student interested in geriatrics, focus on a broad-based clinical experience in preparation for an internal medicine residency. Seek out a mentor in the department of geriatrics and consider clinical research in geriatrics or a medicine related area like nephrology, cardiology, endocrinology, neurology or pharmacology. Identify residency programs with a strong geriatrics focus, especially those in areas with large geriatric populations.
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Consider Pursuing a Medical Career as a Geriatric Specialist originally appeared on usnews.com
