What Is Geriatric Care?
Geriatric care at its core is medical care for older patients that centers around preventing and treating conditions, diseases, and disabilities that are commonly encountered by older adults. Still, it is a broad term that often goes beyond traditional medical treatment. Geriatric care can encompass a variety of health-related services for elderly adults, including care management, specialized medical care, independence, and social or psychological needs. Because aging is inevitable and the health care needs of the elderly are not the same as for younger populations, geriatric care plays an important role in optimizing both the health and quality of life for older adults in their later years.
Is Geriatrics Considered Primary Care?
Yes, primary care physicians who specialize in medical care for the elderly are referred to as geriatricians. Geriatricians diagnose, treat, and help older patients manage a range of conditions and diseases as they age. Because geriatricians focus solely on the elderly population, they are able to develop true expertise around the unique health issues that may arise as patients get older. This may include balance issues, hearing and vision loss, osteoporosis, osteoarthritis, dementia, frailty, incontinence, and more. Geriatricians commonly have advanced knowledge regarding drug therapy for seniors, health maintenance, the impact of aging on illness patterns, and rehabilitation for older demographics.Geriatricians in the United States are primary-care physicians who are board-certified in either family medicine or internal medicine. They will have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. Geriatricians' model of care typically emphasizes collaboration with nurses, pharmacists, therapists, and social workers as well as other disciplines to provide patients with a holistic approach to health care.
Does a Senior Need Both a Geriatrician and a Primary Care Physician?
Ultimately, it is up to the patient to determine where they receive their primary care from. This decision may be influenced by the patient's history and rapport with their current primary care physician. There is certainly value to having mutual trust that is built up over years, and if the primary care physician is still providing attentive and satisfactory care as the patient ages it may be worth it to continue the relationship.
Another factor for a patient to consider is if their unique or prevalent health issues are primarily age related, progressive, and/or chronic. If so, they may be better suited to be primarily managed by a geriatrician. In some cases, a patient may maintain their primary care physician while also meeting with a geriatrician.
It is common for older adults to see more than one doctor depending on what health care needs they have. Other specialists may be involved, such as a neurologist, urologist, psychiatrist, and more. However, geriatricians can certainly serve as the sole primary care physician for general health care in older adults, and they can provide referrals when the patient needs to visit a specialist.
Geriatricians also commonly work with other integral members of a patient's care team, including family members and caregivers, occupational and physical therapists, social workers, and other medical physicians. While not all care teams need to be this robust, it is good to know that geriatric medicine can serve as the core piece of older adults' long-term health management strategy.
What Is Included in a Geriatric Assessment?
A geriatric care assessment is used by geriatricians to clearly define the care needs for an elderly individual. The assessment provides insights into the patient's mental, physical, emotional, and psychological well-being. It may also take their living conditions, family involvement, socioeconomic factors, functional ability, and any other factor that may influence the patient's overall quality of life into account.
An assessment may be initiated when a new patient meets with a geriatrician, or if a physician wants more information and context about a patient after an event occurs or a health condition is identified. This could include: incontinence, confusion, falls, or general immobility. In some cases, physicians from a variety of expertises may be called upon to be involved in the assessment, such as a nutritionist, social worker, or physical therapists. This can provide a more comprehensive analysis of a patient's condition and potential issues to be aware of. In general, a geriatic assessment will take the following areas into consideration:
- Functional Ability: Two overarching types of functional ability should be assessed, and they both look at tasks that are essential for living. The first, activities of daily living (ADL), should assess primary self-care activities such as getting dressed, eating, grooming and bathing, using the bathroom, and ability to effectively control bowel and bladder functions. The second, instrumental activities of daily living (IADL), includes activities that are slightly more involved and are integral to living independently, such as managing finances, operating a phone, food preparation, medication management, and ability to take care of household tasks as needed.
- Physical Health: All aspects of a patient's medical history and current medical issues should be thoroughly reviewed. Additionally, the assessment may include data from family medical history or demographic data if helpful. Beyond a standard physical examination, the physical health assessment will be specifically geared toward conditions that tend to deteriorate naturally or reduce in functionality with advancing age. This includes focus points such as balance and fall prevention, vision, hearing, continence, osteoporosis, and polypharmacy (the simultaneous use of multiple drugs to treat a single ailment or condition) alongside a full physical assessment. In addition, there may be screenings for diseases if there are functional deficits outside of the standard aging process.
- Cognition and Mental Health: During this process, older patients usually receive a cognitive assessment as well as screening tests to determine the presence of any potential mental issues that may require additional attention or treatment. Common mental issues with older adults include dementia and depression. Identifying these conditions as early as possible allows the geriatrician to help the patient receive the care and support they need to help improve and cope with their mental state.
- Socio-Environmental Circumstances: An important facet of the geriatric assessment is understanding the patient's current living situation, and helping to determine what the ideal living arrangement would be for them. The patient's in-person social network, support resources, and safety should all be considered during this process. If the patient is not able to live independently, with a partner, or with family members, it may be recommended that the patient pursues a more suitable setting to live in. This may include assisted living residences or skilled nursing homes.
Once the geriatric assessment has been completed, it should clearly define how prepared the older adult is to be self sufficient, and outline the assistance that they may need to maintain their health and overall quality of life. All information should be compiled and be accessible for each member of the patient's health care team. It should also include a comprehensive action plan with specific instructions for managing or treating conditions identified during the assessment. Additionally, the geriatrician should provide follow-up instructions including caregiver and family responsibilities, ongoing medical needs, and potential rehabilitative services if needed.
Does Medicare Cover Geriatric Assessments?
The coverage a patient may receive from Medicare may vary depending on which plan they are enrolled in, but it is possible for Medicare to cover office visits to a geriatrician. According to medicare.com, with Original Medicare (Part A and Part B), allowable charges for visits to a geriatrician may be covered under the patient's Part B benefits. The geriatrician must accept Medicare assignment, and a copayment and deductible may apply. If the patient is enrolled in a Medicare Advantage plan with a Health Maintenance Organization (HMO), their plan may require a referral from a primary care doctor in order to see a geriatrician.
At What Age Should You Switch to a Geriatric Physician?
According to the American Geriatrics Society, about 30 percent of people over the age of 65 need to utilize geriatric medicine services. Still, there is no specific age that automatically qualifies a patient for geriatric care. Instead, overall health of the patient, the patient's needs, and the availability of geriatric resources will serve as determining factors for when a patient should look to receive care from a geriatric physician. In some cases, a primary care physician may refer a patient to a geriatrician, or some patients may opt to independently set up a consultation with a geriatrician who will then schedule follow-up appointments if necessary.
Signs That You May Need Geriatric Care
It can be difficult for patients and their families to determine the right time to transition from a primary care physician to a geriatrician, or to begin including a geriatrician as part of an overall care team. Oftentimes, it is not a clear-cut decision. Here are some indicators that a patient may be at the stage of life where geriatric care may be more beneficial:
- Managing multiple medical conditions: For older adults who have more than one chronic medical condition that they must manage on a regular basis, they may be facing challenges that can impact their lives on a daily basis. If these conditions interfere with regular physical activity or impair cognitive function, a visit to an office of geriatric medicine could give them the necessary resources to more effectively manage their long-term medical issues.
- Multiple medications with adverse side effects: For older patients who must take multiple medications to manage a variety of health conditions, it is not uncommon for a mix of medicines to trigger negative issues as a result. As the number of different medicines being used increases, the higher the likelihood that there could be adverse side effects. A geriatrician may be able to help older patients streamline their medical intake or find combinations that would be suitable to take together without worry of problems arising.
- Noticeable memory or cognitive impairment: When memory issues and forgetfulness seem to become a more regular occurrence, it may be worthwhile to see a geriatrician. One of the key mental concerns for aging adults is the onset of dementia, which frequently goes undiagnosed or unnoticed. A geriatrician can conduct a screening to test for mild cognitive impairment (MCI) which is considered to be a precursor to dementia.
- Reduced mobility: Mobility is of the utmost importance for older adults and their ability to stay independent and healthy. When patients begin to experience instability, lack of balance, physical frailty, or general functional decline, it is highly recommended to meet with a geriatrician. Falls are a significant danger in advanced age. According to the CDC, at least 300,000 older people are hospitalized for hip fractures annually, and three million older people are treated in emergency departments each year. A geriatrician can help ensure that medications are not the cause of dizziness, provide exercises to improve strength and balance, or refer a patient to a physical therapist. A geriatrician can also coordinate with an occupational therapist to ensure that the patient's home is optimized to be as safe (in the context of falls) as possible.
- Have an age-related disease: If the patient has already been diagnosed with an age-related disease or condition, it may be best to seek out geriatric care for assistance moving forward. This includes issues such as incontinence, dementia, or osteoporosis. Since this is more common among patients that a geriatrician sees on a regular basis, they should be well informed on the issues and able to provide more comprehensive support and resources to help the patient.
- During hospitalizations: Studies have shown that patients who receive coordinated care (including geriatric care) while in the hospital had shorter stays and lower readmission rates. Consultations from a geriatrician while a patient is hospitalized can provide meaningful advice and instructions to help a patient recover more effectively and return to everyday activities faster.
How to Choose a Geriatrician
Choosing the right physician for geriatrics is crucial for a positive patient experience. Unfortunately, the demand for geriatric physicians far outweighs the supply. The American Geriatric's Society estimates that there are nearly 6,800 certified geriatricians in the country, with approximately 53% of those practicing geriatric medicine full-time. Couple this with the fact that Americans are steadily living longer lives and it is easy to see that the availability of geriatric physicians will likely remain a pressing issue. Still, there are some key considerations to keep in mind when selecting a geriatrician to work with.
- Referrals: One of the best things for patients to do when looking for a geriatrician is to seek out referrals. A primary care physician should be able to provide patients with one or more potential options, but personal referrals from family and friends should also be considered. Once a short list is established, patients can set up consultations to get to know the geriatrician and determine which one is the best fit for them.
- Experience: A geriatrician's credentials should be taken into consideration with factors such as formal education and training, years of experience with geriatrics, and any areas of specialization. Patients may also inquire about the geriatrician's certifications and affiliations with medical organizations that specialize in caring for older patients.
- Philosophy: An in-person meeting with a geriatrician should help patients get a sense of the physician's approach to geriatrics and their treatment principles. It is important that the patient and physician share a similar outlook when it comes to medical care and addressing overall goals related to health.
- Communication: Each physician will have their own communication style, and it is important that their patients are able to align with it. Some geriatricians may operate primarily online, while others may primarily meet with patients face-to-face. Regardless of the medium, the geriatrician should be easy to understand, deliver clear instructions, and (ideally) be able to develop a level of chemistry with their patients. It is also important to determine how frequently the physician utilizes email, online portals, phone calls, or text messages to communicate with their patients. The patients should consider how easily they can navigate these primary communication methods.
Conclusion
Geriatricians are an excellent resource for patients who are advancing in age and are looking for a doctor who has expertise in the unique issues that they are facing. While geriatricians can serve as primary care physicians, they can also work in tandem with a patient's current physician as well as a broader team of medical specialists. A geriatrician should help simplify the patient's health care and often takes extra time and care to ensure that the patient fully understands the situation, the plan moving forward, and that their concerns are fully addressed.
At Keystone Health we provide a holistic focus on the patient's quality of life and do our best to eliminate the stress associated with medical care during a patient's golden years. We have an interdisciplinary team of medical professionals and specialists to ensure that our patients needs are fully addressed. If you or a loved one would benefit from receiving geriatric care and you are in the greater Boise area, please reach out to us at Keystone Health for a free consultation.
