Why see a geriatrician? A geriatrician is trained to treat older patients, understands chronic conditions, knows about drugs interactions in older patients, and is more selective in medical testing. They also genuinely like older people!
You have been going to the same doctor for 30 years but you just celebrated your 82nd birthday and your family feels that you should look for a doctor who specializes in older people. Do you really need to switch? Is a geriatrician, a doctor that only sees older people really necessary? Isn’t your family doctor good enough? What can a geriatrician do that your family doctor doesn’t?
The answer actually depends on your health. There are good reasons to stay with the same doctor if your health remains stable. You have a relationship. He/she knows all about you and your medical history. He/she is already monitoring your high blood pressure and renewing your cholesterol medication. If you’re lifestyle remains unchanged, you may have no reason to see a geriatrician.
I spoke with Dr. Jomarie Zeleznik, a geriatrician who has been visiting homebound seniors in Manhattan, the Bronx, and Brooklyn. “Age is not the sole reason that an older person should change doctors. Older people tend to have a wider range of healthiness than younger people. Some older people age faster than others. So two seniors both aged 70 may have very different degrees of health: one may have no problems at all, while the other may have serious health concerns.”
Patients with several medical problems would probably benefit from see a geriatrician. Here are five reasons why:
- Geriatricians are specially trained to work with older patients. They receive the same training in medical school and residency programs as general practitioners or family practice doctors. But then they must complete an additional one to two year fellowship training in the medical, social, and psychological issues that concern older adults. The majority of physicians and health care practitioners caring for older patients have not been adequately trained to understand the complexity of these conditions like a geriatrician does.
- Geriatrician offers a more holistic approach to medicine than most general practitioners. Dr. Zeleznik, explains, “Older people tend to have more chronic conditions than younger people—they are more likely to have problems with balance, aches and pains, vision and hearing problems, memory loss, or incontinence. When I treat an older person I help them find ways to maneuver their environment better. That might be by ordering a walker or suggesting how to make their home easier to maneuver.”
- A geriatrician understands that older patients react differently to prescription and over-the counter-drugs than younger people. As people age, the body metabolize drugs at a slower rate. There are complex changes in the way the intestine absorbs medications into the blood stream. The greater the number of medications a person takes, the greater the likelihood that the drugs will interfere with each other in the body. A geriatrician can choose or avoid medications to avoid overmedication.
- A geriatrician is more selective about the number and types of medical tests that an older patient requires. An annual physical exam might include a complete physical, cognitive testing, pain level, balance, osteoporosis, vision, and hearing and signs of depression. However the doctor might decide to forego screens for breast or colorectal cancer, or prostate cancer depending on the life expectancy and the risks of testing. Another consideration is what the patient would want to do with the results. For example: if cancer is found, will the patient want treatment? If the answer is “no”’, then there is no sense in doing the test.
- A geriatrician evaluates all the medications that a patient takes before prescribing more. Many seniors take an average four or more medication, a situation referred to as polypharmacy. This situation often results in the use of too many drugs or drugs that interact adversely with each other. A geriatrician usually asks every patient bring in all his medication both prescription and over-the-counter remedies for review.
All five reasons place an emphasis on the older patient and place an emphasis on quality of life rather than simply treating the disease.
There is another less tangible reason why an older person might consider seeing a geriatrician. Most geriatrics genuinely like older people and prefer treating them. Dr. Zelenik sums up their attitude. “ I love the wealth of knowledge that an older patient offers. They have rich life experiences. They are more willing to listen and are more grateful for any help you can offer them.”
Doctors, like everyone else, are becoming “specialists”. Orthopedics, Allergists, Cardiologists, Pulmonologists, Endocrinologists, Urologists. The list seems endless. When you have multiple medical problems, it just makes sense to have a doctor that understands how all your problems and medications affect your body as it ages. You can think of geriatricians as “specialists in problems of the aging body”. The geriatrician is a doctor who knows how to diagnose you as your health needs change. These are some things to think about when deciding if you are ready for a geriatrician.
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