Do You Really Need a Geriatrician?

Pediatric patients “graduate” to adult primary care at age 18. Should people who turn 65 look for a geriatrician?

By Deborah Jeanne Sergeant

Podiatrists specialize in foot issues, dermatologists in skin issues and cardiologists in heart issues.

But do you really need a doctor specializing in, well, oldness?

And if you do, when should you begin seeking the care of a geriatrician?

“Most geriatricians would say that a healthy person in their 70s or older with no medical conditions probably doesn’t need a geriatrician,” said Daniel King, a geriatrician with Highland Hospital.

Many of these types of patients receive sufficient care from their long-term internist or general practitioner. King explained that their continuity of care is well served by these providers. But for people with more complex medical issues, a geriatrician’s care may help. This could include chronic diseases like advanced diabetes or health issues that significantly hamper many activities of daily living such as dementia and stroke recovery.

“These benefit the most from seeing a geriatrician,” King said. “I try to limit the people I see to those who are older than 80. If you’re younger than 80, I accept those who have complex medical comorbidities. That makes them frailer.”

He views geriatricians as specialists in life transitions such as providing guidance in getting more help and improving mobility.

“It’s not a blanket statement that when you turn 75, you need a geriatrician,” he added. “More and more of what I do is a consultation.

You’d remain in the care of your internist or general practitioner and consult in areas of things like transition and memory.”

Because of the lack of geriatricians, many primary care physicians are filling the role of a geriatrician for those just beginning to need this type of care, according to Sarah Howd, assistant professor of medicine and geriatrics at the University of Rochester. She is board-certified in both internal medicine and geriatric medicine, is a certified medical director, and serves as the associate medical director of the Senior Living Practice of UR Medicine Geriatrics Group.

“The American Geriatrics Society cites that there are 54.1 million Americans older than 65 with only 6,800 certified geriatricians, and this gap continues to grow,” Howd said.

“Primary care providers can do a wonderful job with the complex medical needs of a geriatric patient, but they may lack the time to be able to do in-depth assessments for things like falls and memory complaints.

‘Geriatricians are trained to care for complicated medical issues as well as common geriatric syndromes. [They] coordinate care among many different care team members, like home nursing, physical and occupational therapy, dieticians, pharmacists and different medical specialists.’

Physician Sarah Howd is board certified in both internal medicine and geriatric medicine. She serves as the associate medical director of the Senior Living Practice of UR Medicine Geriatrics Group.

“They may also lack the resources to determine how much care a person needs to stay safe in their home as well as the ability to guide the patient and family to access these services. Geriatricians are trained to care for complicated medical issues as well as common geriatric syndromes like frailty, falls, poor nutrition, and cognitive decline. Geriatricians are also trained to coordinate care among many different care team members, like home nursing, physical and occupational therapy, dieticians, pharmacists, and different medical specialists,” added Howd.

For many patients with complex care, a geriatrician in a primary care office will take over as the patient’s primary care provider.

Pediatric patients “graduate” to adult primary care at age 18. As to when this should happen, providers offer no concrete age. Although 65 is a round number and kicks off the Medicare years, “there is no set answer,” Howd said. “There are some 60-year-olds with significant health issues and some 90-year-olds who are very healthy and fit.”

Agreeing with King, Howd said that the medical complexity of a patient’s healthcare needs is typically a bigger determinant of whether a geriatrician provides care.