Over the course of your lifetime, you’ll probably see many different doctors. From the OB-GYN who helps deliver you to your pediatrician, dentist, family doctor and disease-specific specialists you may encounter, even healthy people will likely have a lot of doctor appointments along the way. And for those who’ve reached a certain age, it may be time to add a new doctor to the roster: the geriatrician.
“A geriatrician is a medical doctor whose field of expertise is caring for older adults,” says Dr. Susann Varano, a geriatrician at Maplewood Senior Living, a Westport, Connecticut–based senior living residence company. In order to become a geriatrician, the physician must complete residency training in internal medicine or family practice (each a three-year course of study) and then complete a geriatrics fellowship, which can take one to three years. “It takes a total of 12 to 15 years before you can call yourself a geriatrician,” when undergraduate education and medical school are factored in, Varano says, and this means the geriatrician is well-versed in most any health issues older adults may be facing.
[See: 11 Health Habits That Will Help You Live to 100.]
And there are quite a few common conditions older adults deal with, says Dr. Tanya Gure, section chief of geriatrics and associate professor in internal medicine at the Ohio State University Wexner Medical Center. “Some geriatricians focus on more advanced age patients where there tend to be issues related to mobility and trying to live independently. I focus on [patients aged] 65 and up so I can do a broader spectrum of geriatrics,” which may include health issues related to falling, gait impairment, balance problems, difficulty walking, memory and cognitive issues and “other syndromes and conditions related to advanced age,” such as changes to how the internal organs function. “We also deal with medication-related concerns and focus on polypharmacy,” or managing the use of several different medications in patients who have multiple chronic diseases. In short, the geriatrician can help you manage nearly any health condition you may be dealing with or refer you to a specialist for more intensive care as needed.
Making the decision to seek the assistance of a geriatrician should be based on a number of factors. When you do visit with a geriatrician for the first time, consider asking the following questions to ensure the right concerns are being addressed.
1. Should I even be seeing you?
As with many aspects of health care, the answer to this question is going to vary greatly from one patient to another. Generally speaking, though, a geriatrician sees patients who are over the age of 55. Many geriatricians focus on treating patients who are a good bit older than that, with some specializing in caring for adults over age 80.
“Geriatric medicine is very individual because older adults are heterogeneous in nature,” Varano says. Whereas younger adults and children are fairly predictable in reaching certain milestones — “for example, in young children, you expect them to walk and talk by a certain age — older adults are more heterogeneous. You can have an 80-year-old with the body of a 50- or 60-year-old, or a 50-year-old with end stage renal disease who manifests as much older. There’s tremendous differences,” she says, and it’s important for the geriatrician to be sensitive to these variations and tailor care to the individual.
“Our greatest value is in caring for patients who are medically complex and who have a significant number of issues going on related to their comorbidities and chronic health issues,” Gure says.
[See: 7 Surprising Things That Age You.]
2. Will you replace my primary care physician?
Varano says most geriatricians practice in one of two ways — either by replacing a person’s primary care physician and taking over the role of managing all aspects of the person’s health, or by consulting on an as-needed basis to resolve particular problems. She says some older adults prefer to make the switch to a geriatrician before they develop any health crises “so that when they become a more frail, complicated, older adult, they can manage their medical conditions appropriately.” Other patients seek help only when needed, and this approach to care is often initiated by the adult child of the patient. With these patients, “I typically see the adult child coming to seek a geriatric consultation because their mom or dad is having memory loss or depression or behavioral issues and they just want that one issue addressed or resolved in a consultation setting while maintaining their own primary care physician. Once that’s done then they no longer seek help from the geriatrician,” Varano says.
Both approaches can work just fine, and if you have a well-established and comfortable relationship with your primary care doctor, you may not want or need to transfer all your care to the geriatrician. But if your health needs are complicated, switching to a geriatrician to manage everything through the age-dimension lens might offer benefits. This is an individual choice that may also be decided in part by whether you can get an appointment with a geriatrician locally: The American Geriatrics Society reports there are currently fewer than 7,300 geriatricians practicing in the United States and that by 2030, the country will need more than 30,000 of these specialty doctors to meet demand.
3. Which medical concern should take priority?
For patients who have multiple medical problems, it’s often helpful to actually write them down before your meeting and then ask your geriatrician to prioritize the issues, Varano says. This will help your doctor get a full understanding of the scope of the medical concerns you have so he or she can focus on getting the most dangerous issue under control first before moving on to addressing other matters that may be less problematic. Listing out your concerns can also help ensure you won’t forget to bring anything up. “When your geriatrician acknowledges these problems and you work through the concerns or issues together, your voice has been heard and valued,” giving you back some control over the situation, Varano says. Together, you can build a management plan for the variety of issues you may be dealing with.
And many geriatricians advise patients to bring a caregiver, such as a spouse or adult child to their meetings to make sure nothing is missed and to help round out their understanding of how age-related conditions and changes are impacting the patient and their family on a daily basis.
4. Am I on the right medications?
Polypharmacy, or the taking of several different medications for different conditions and diseases simultaneously, is an increasingly common phenomenon among older adults. According to a 2015 study in The Journal of Gerontology, Series A: Biological Sciences and Medical Sciences, “prescription medication use among older adults in the United States has increased dramatically from 1988 to 2010, and use of 5 or more medications has tripled to nearly 40 percent.” Drugs to treat heart disease, metabolic diseases such as diabetes and mental health issues have increased in prevalence, and many people take several of these medications to manage multiple conditions. Keeping track of all these different medications, their potential adverse interactions with each other and any side effects is an important part of what a geriatrician can do for you.
Gure says geriatricians assess the various medications a senior is taking with regard to their health goals “and streamline the list to fit with what they need to accomplish with their health. We try to eliminate things that tend to be harmful or inappropriate.” She recommends you bring the bottles of everything you’re taking — both prescription drugs as well as nonprescription drugs such as vitamins and supplements — to your meeting so your doctor can go through them all and determine if anything needs to change.
[Read: Aging Parents at a Distance Who Aren’t Really ‘Just Fine’.]
5. What do I need to do for next time?
There are many other questions you may want to ask your geriatrician during your first meeting with them, but for many patients, this won’t be your only chance to work with the doctor. Therefore, it’s a good idea to ask your geriatrician how you can best prepare for your next meeting to make it even more productive than the first. Your doctor might suggest you keep a log of what you eat and drink or to start keeping a journal about how you’re sleeping or mood changes. All of this information may be helpful at the next session in further refining which treatment priorities and approaches are best for you.
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5 Questions to Ask During Your First Visit With a Geriatrician originally appeared on usnews.com
