Do You Need a Geriatrician?

By Dr. Jacqueline Lloyd

Geriatrics is the medical field that focuses on the problems and diseases of the older generation. What makes a clinician (doctor, nurse practitioner, or physician assistant) specially qualified to care for older people? When is it time to begin seeing such a health care provider?

First, seniors need a “geriatrically-prepared” clinician. These professionals study the knowledge, skills and approaches of the care of older persons — the breadth of which increases daily. Be aware that many medical professionals who see a lot of older patients believe themselves to be geriatrically-prepared. Without being geriatrically prepared, their approach toward seniors may not have the same attention to overall wellbeing.

Whether they’re “healthy” or not, the aging adult is complex — for a number of reasons. While specialists focus mainly on one piece of the puzzle each, a geriatrically-prepared clinician knows they need to consider the complete puzzle when making any decisions.

How do you know if a clinician is geriatrically-prepared? Here are two quick clues:

1. If (s)he does not seem concerned about subtle changes in your loved one’s everyday function, and
2. If the only thing (s)he does after your loved one describes their problem is to pull out a prescription pad without reviewing all regular prescriptions, over-the-counter meds (OTC), vitamins, and herbal medications, (s)he is probably not geriatrically-prepared — especially if the patient is seeing multiple clinicians.

In contrast, geriatrically-prepared clinicians do the following:

1. They review all medications with an eye to identifying meds that may no longer be needed or are no longer helpful. They are willing and able to safely discontinue a medication no longer believed to be necessary. They will also work to simplify the number of meds and/or alter dosages.
2. They use every opportunity during the visit to observe the patient, such as walking with them to the exam room, and/or asking them to remove clothing in order to see if there are any apparent difficulties. They can also observe any adaptive behaviors your loved one may have adopted.
3. They ask about things they may not be able to observe. They will normalize things that may be embarrassing or off-putting to the patient. For example, “How many times have you fallen in the past six months?” instead of “Have you had any falls?”

When treating an older patient, a geriatrically-prepared clinician focuses not only on finding one correct diagnosis, but also on finding all issues contributing to functional issues or loss. It takes a major shift in thinking.

This shift will lead the medical professional to consider risk versus benefit much more seriously. In an older person, it is far more important to weigh the benefits and consequences of any course of treatment. A geriatrically-prepared clinician will likely make treatment decisions primarily based on the patient’s values, goals of care, and desired quality of life.

Is the medical intervention based not only on indication, but also on justification in this older person? Will the benefit the patient experiences be worth the risk to them and their functioning? If the clinician doesn’t discover the patient’s goals, how can he or she determine whether an intervention will be a benefit?

So, how do you know when it’s time to start seeing a geriatrically-prepared medical professional? Unfortunately, there is no easy answer. It’s not based on age alone. Every older adult perhaps ought to see one occasionally — certainly in the event of a major illness, and especially in the event of a functional decline of any kind; for example, if you are no longer able to get around because your leg hurts. Anyone who suffers from chronic diseases should see a geriatrically-prepared clinician, regardless of age.

Even if your health care provider is not geriatrically-prepared, you can be. Spend time with them during appointments, ask questions, and make sure you understand the answers. Ultimately, it’s your life and your body, and it’s your choice how it’s treated.

About the author: Dr. Jacqueline Lloyd has a long and distinguished career in medical education — all dealing with geriatrics. She is now retired and living at Advent Christian Village, where she still serves on the Board of Directors. Most recently, Jacki was professor and education director of geriatrics at Florida State University. She has a national reputation in geriatrics and rehabilitation in the elderly, and has served on state and national forums addressing problems of aging. Above all, she says she is “a child of the KING, and a God-fearing daughter, wife, mother, grandmother, physician, teacher, caregiver, and servant/leader.”