Geriatricians are the gold standard for high-quality health care for older adults. Unfortunately, when compared to other medical specialists, they’re often hard to find—a shortage that creates ramifications for older adults nationwide.
However, it’s important that caregivers understand why the geriatric approach is so important, as well as how to find a geriatrician—and what to do if you can’t.
What’s the difference between a geriatrician and a gerontologist?
While both gerontologists and geriatricians address the unique health concerns associated with aging, there are distinct differences between the two.
A gerontologist is a catch-all term for any professional who studies the science of aging and its effects on medical treatment and well-being. A gerontologist can operate in any field, including psychology, nursing and social work. Some gerontologists have clients, but some do not.
A geriatrician on the other hand is a professional with a medical degree and additional training and certifications associated with specifically caring for the medical conditions unique to older adults. In addition to completing medical school and residency, a geriatrician is board-certified in internal or family medicine and has also completed a geriatric medicine fellowship and has passed the Geriatric Medicine Certification Examination.
Why should my loved one see a geriatrician?
Geriatricians see the big picture of your loved one’s entire health landscape. Think of the artistic technique pointillism where artists carefully paint thousands of dots of pure, unmixed color. When viewed up close, these dots are nonsensical; when viewed from afar, in the context of the other dots, a beautiful art piece emerges.
The concept is similar in medicine, especially geriatrics.
For example, if your loved one develops symptoms of memory impairment and visits a standard primary care doctor, the primary care doctor may only see their memory impairment from a narrow viewpoint, often because they are limited to a brief 15-minute window carved out for the appointment.
By nature of their position, a hospital internist may have more context, and may see an expanded view of your loved one’s memory impairment. They’ll have the added context that includes information such as the medications your loved one is taking and in-depth knowledge of their current acute condition.
They still can’t see the whole picture, however. Their view is just a tad broader than that of the primary care doctor:
On the other hand, a geriatrician can view your loved one’s memory impairment in the context of the landscape of their entire life. Here’s why:
- They understand polypharmacy and thus can identify how various medications interact to create symptoms.
- They’ll have access to information on all your loved one’s chronic illnesses, and how these conditions interplay not only with each other but also with the medications your loved one takes.
- They have studied the psychosocial effects of aging, and their impacts on physical health and well-being.
- They also devote extensive time to your loved one; most geriatrician appointments are at least an hour in length.
- They streamline care by picking the most important battles and prioritize the treatments most likely to enhance physical functioning and well-being.
- Geriatricians are prepared emotionally to absorb the mental and physical struggles with which older patients struggle.
- Geriatricians also work closely with their patients’ family members to help create adequate support in the home and social environments for recovery.
- They can practice in locations with a high volume of elderly patients, such as outpatient settings, nursing facilities or hospitals.
Geriatricians view your loved one’s memory impairment in context of the entire landscape of your loved one’s life:
“Those who are trained in geriatric medicine are superb primary care providers, focusing on wellness and preventive health as well as managing chronic medical conditions,” says Johns Hopkins geriatrician Michele Bellantoni, MD.
The geriatrician shortage
While geriatricians are the optimal choice for your loved one, the catch is there simply aren’t enough of them!
The size of our oldest and sickest population is ballooning, yet according to AGS, the U.S. needs approximately 20,000 geriatricians to meet the needs of Baby Boomers today, but less than 7,300 certified geriatricians are practicing nationwide.
The prediction that the U.S. will need even more geriatricians – as many as 30,000 by 2030 – means that older adults could soon be in even more dire straits.
Filling in the gaps
The field of geriatrics adopts a team-based approach to caring for older people and supporting families and caregivers. A typical geriatrics team may include:
- Geriatrician
- Geriatric pharmacist
- Geriatric psychiatrist
- Geriatric staff nurse
- Nutritionist
- Occupational therapist
- Speech and hearing specialist
- Physician assistant
- Podiatrist
- Social worker
This comprehensive team-based approach to geriatrics offers plenty of opportunities for creative solutions. For example, many geriatric teams are using nurse practitioners or physician assistants who have specialized in geriatrics.
How to know if your loved one needs to see a geriatrician
If your loved one is aging, it’s very likely they need to see a geriatrician. This is because, as we age, certain age-related scenarios become more salient:
- Injuries, illnesses and medication side effects impact the body more as we age.
- Older adults are more prone to the negative impacts of stress.
- Chronic illnesses become more common, and most older adults have three or more chronic health conditions.
- Polypharmacy – the use of numerous medications – is more common as we age.
- Chronic impairments of the body and mind require lifestyle changes that may place stress on the older adult.
These scenarios combine to create geriatric syndromes, which include incontinence, pain, falls and declines in independence.
How to find a geriatrician
The American Geriatrics Society offers a geriatrician finder, or you can also search by certification at the CertificationMatters.org website to search for board-certified doctors by specialty (e.g., geriatrics) and location. (Keep in mind that geriatrics is a subspecialty of internal medicine and of family medicine. This means geriatricians are initially certified by either the American Board of Internal Medicine or the American Board of Family Medicine).
What to do if you don’t have access to a geriatrician
Don’t be surprised or discouraged if you can’t find a geriatrician in your area. The next best option is a doctor with ample experience in caring for older adults. To determine this, ask questions such as:
- What additional geriatric training have they received?
- Does their care approach for seniors differ from their approach to middle-aged patients? If so, how?
- Do they practice the geriatric team approach at their clinic? If so, who is included on the team?
A Plan B is to get a medication review and fall risk assessment. If you can’t get an immediate appointment, there are several things you can do:
- Consider checking at an academic medical center near you. These often have geriatrics divisions that usually offer consultation services.
- Some medical centers also have fall clinics, which will include a comprehensive medication review along with an assessment of other fall risk factors.
- Some pharmacies offer medication reviews. You can also consider a local school of pharmacy for such a review.
In addition, finding a PACE (Program of All-Inclusive Care for the Elderly) center in your area is an excellent replacement for a geriatrician. PACE uses an all-inclusive model of care that includes medical care, supportive services, and day center services. This is a particularly good choice for frailer older adults or adults with memory impairment. PACE is also covered by Medicare.
Your loved one deserves the best care they can get, and the geriatric-team approach may be the best option for excellent health care for older adults. Remember to keep the preferences and opinions of your loved one in mind while collecting your care team.
It’s also important to remember this care team will be a great resource for you as a caregiver, so be sure to keep that in mind as well.
