It comes as second nature for most parents to take their children to a pediatrician at least once a year. The differences between children and adults are so stark that it makes sense to choose a doctor specially trained to treat younger patients.
Yet as we age, far too few of us apply this same logic when choosing a physician, even though our health needs often change dramatically in our later years. And we know from recent experience with the COVID-19 pandemic that the health complexities for older adults can make them particularly vulnerable to certain illnesses, demonstrating the need for a care approach as tailored as the individuals themselves.
“The kind of care you deliver to an older adult is definitely not the same as the care you give to a middle-aged person,” said Michael Stockman, M.D., a geriatrician and medical director with UnitedHealthcare Medicare & Retirement. “The physiology of older people is very different from people in other stages of life.”
Those differences are significant enough that the medical community developed a specialty called geriatrics, to address the needs of older adults. Geriatricians, like Dr. Stockman, are licensed physicians who have completed additional training in managing the care of older adults. That training makes geriatricians uniquely suited to help seniors manage the demands of their often-complex health issues.
One of those complex issues is the care of chronic conditions, such as high blood pressure, diabetes and heart disease, which are much more prevalent in older people than the rest of the population. More than half of older adults have at least two chronic conditions. This group is also at higher risk for developing chronic diseases, along with other complex conditions such as cancer and Alzheimer’s disease.
Additionally, nearly 90% of adults 65 and older take at least one prescription medication, and more than half report that they take four or more, compared to one-third for those in the 50 to 64 age bracket.
Juggling multiple chronic conditions can be a challenge for the doctor and the patient. One condition can sometimes make the effects of another condition worse, and the treatments or medications for different illnesses sometimes interfere with each other.
Decisions about how to customize a patient’s treatment aren’t necessarily black and white, requiring a doctor and patient to carefully balance risks and benefits. For example, some diabetes medicines can cause dizziness, meaning the doctor needs to focus not just on regulating the patient’s blood sugar but also on minimizing the risk of a fall, which is the most common cause of injury in seniors.
“I think geriatricians are the only medical specialty more interested in taking away medications you don’t need than giving you new medications. A lot of what we do is determining which medications are more likely to cause harm than help,” Stockman said. “One of the most important things for geriatricians is the concept of shared decision-making. We ask patients, ‘What trade-offs are you willing to make?'”
Sometimes, the trade-offs are fairly simple – weighing the pros and cons of taking a certain medication or undergoing a specific screening, for example. But more often than not, they also incorporate a person’s overall quality-of-life goals. How important is it to maximize longevity? Comfort? How about independence? Each person answers those questions differently, and geriatricians are trained to use the answers to guide their treatment recommendations and care plan.
In addition to the clinical aspects of an individual’s care are the complexities of variables commonly referred to as “social determinants of health” – things like access to healthy food, financial burdens, racial disparities, transportation limitations and more. Many older adults are dealing with these potential barriers to health and, as Stockman noted, a geriatrician can help support his/her patients in identifying and addressing these challenges alongside their regular care plan.
So, when should someone seek out a geriatrician for themselves or a loved one? A significant change in health status could be a trigger for a geriatrician visit. But anytime an older adult feels his or her care is becoming too complex or needs better coordination, a visit with a geriatrician could help.
“Geriatricians can be really good at balancing all of a person’s medical needs and different doctors in one overall care plan,” Stockman said.
Think you could benefit from seeing a geriatrician?
With 10,000 Americans turning 65 every day, the demand for geriatricians continues to grow. Unfortunately, these specialists are a comparatively rare breed. While there are more than 58,000 general pediatricians practicing in the United States, there are fewer than 5,600 geriatricians.
For this reason, finding a board-certified geriatrician to support your ongoing health care needs may be difficult, but many geriatricians will see a patient on a one-time or as-needed basis and then make recommendations to the patient’s primary care physician.
The American Geriatrics Society offers information about how to find a geriatrician on its website, healthinaging.org, and many larger hospitals and university medical centers have geriatricians on staff who will see new patients. If you’re enrolled in a Medicare Advantage plan, be sure to confirm if a geriatrician you want to see is in your plan’s network and whether your plan requires you to first get a referral from your primary care physician before a visit with a geriatrician will be covered.