When It’s Time to See A Geriatrician?

When It’s Time to See A Geriatrician…And how they may keep you out of the hospitalIf you’re in your 60s or 70s, you may have wondered if you should start seeing a geriatrician instead of, or in addition to, your primary care provider. These are family doctors or internists with special training in the health needs of older adults. About 30 percent of people over age 65 need one, according to the American Geriatrics Society.But you might not need to book an appointment at the same time you sign up for Medicare. “Geriatricians specialize in the care of people with multiple chronic medical conditions that cause challenges with their day-to-day physical and mental functioning,” explains Michael Steinman, a geriatrician at the University of California San Francisco. And so the reason for using this specialist is not determined by just age. “A 65-year-old with high blood pressure, high cholesterol and type 2 diabetes may benefit, but an 80-year-old who walks five miles a day and is only on one or two medications doesn’t need one.”Research shows that it’s best to make an appointment sooner rather than later. Adults who see a geriatrician are less likely to end up in the hospital, possibly because these physicians are more likely to be on the lookout for warning signs such as frailty and appetite loss, and also are more likely to avoid prescribing potentially risky medications.Here are four signs that you may need a geriatrician.

• You’re on multiple medications. More than a third of adults over age 62 are taking at least five prescription drugs. Over 60 percent use some type of herbal or dietary supplement. But the more meds you’re on, the more likely you are to experience side effects, have cognitive problems or even end up in the hospital. “The older you get, the harder it is to metabolize and clear medicines from your body,” says Steinman. “And the more drugs you’re on, the more likely you are to experience drug-drug interaction.” A geriatrician can review all your meds and determine which ones you really need and which you can shelve.

• You’re having trouble with your memory. Almost 60 percent of people over age 65 with probable dementia are undiagnosed or unaware that they have it, according to a Johns Hopkins University School of Medicine study published last year in the Journal of General Internal Medicine. A geriatrician can screen you for mild cognitive impairment (MCI), which is a precursor to dementia, as well as for depression, which can be more subtle in older adults, says Veronica Rivera, a geriatrician at the Icahn School of Medicine at Mount Sinai in New York City.

• You’re less mobile. If you don’t feel as steady on your feet as you used to or are having trouble getting around, it’s a good idea to see a geriatrician who can assess your balance and gait, says Tinetti. (Falls are the leading cause of injuries and death from injuries among adults over age 65, according to the Centers for Disease Control and Prevention). A geriatrician can also give you balance-strengthening exercises to do at home and/or prescribe a course of physical therapy, as well as send a physical therapist or occupational therapist to your home to do a fall-risk assessment. All these steps can help keep you independent — and in your home — longer.

• You’re hospitalized. Research shows that older adults who get care from a geriatrician in the hospital do better once they’re discharged. People over age 65 who got a geriatric consult while hospitalized for a traumatic injury such as a broken rib, head injury or fracture were able to resume about two-thirds more of their daily activities (like shopping, walking across a room, managing finances and self-care) than those who didn’t, according to a University of Michigan study published in JAMA Surgery. 

By Hallie Levine, AARP, February 11, 2019