Geriatrics is practiced by many types of health professionals, including physicians, nurses, nurse practitioners, physician assistants, social workers, rehabilitation therapists, pharmacists, dentists, as well as others.
A “geriatrician” is a physician who practices geriatrics Although many physicians say they are “geriatricians” because they care for a lot of older people; true geriatricians are board certified by either the American Board of Internal Medicine or the American Board of Family Practice. To become board certified, a physician must successfully complete 3 years of residency training in either Internal Medicine or Family Practice, and a one year approved Fellowship in Geriatric Medicine (some physicians became board certified without taking a Fellowship when the specialty was introduced in the 1990s, but this is no longer available).
In contrast to a geriatrician, a “gerontologist” is an individual who studies aging regardless of his or her field. Gerontologists may be economists, biologists, psychologists, architects, lawyers, ethicists, as well as professionals from many other disciplines. The shortage of geriatricians Among the more than 650,000 physicians in the U.S., fewer than 9,000 are certified in geriatric medicine. Various approaches to increase the number of geriatricians are being pursued. These range from loan re-payment programs to lobbying for better Medicare reimbursement for the medical care and care coordination of frail elderly people with multiple complex medical problems.
Find out more about these efforts at www.americangeriatrics.org In addition to aggressively recruiting students, interns, and residents into geriatrics, academic programs are attempting to teach all physicians, regardless of their specialty, basic principles of geriatrics. After all, unless a physician practices pediatrics or obstetrics, he or she will be caring for increasing numbers of elderly patients over the next several decades.
Basic principles of geriatrics
Many older people and their families, as well as a large percentage of health professionals, do not understand how geriatrics differs from other fields of health care. To better articulate the differences, the Emory Geriatrics Program developed 10 basic principles of geriatrics (see side bar below). Fundamentally, geriatricians and geriatrics health care professionals view health broadly — in what has been described as the “biopsychosocial” model of health.
Geriatricians not only focus on an individual’s medical problems, but on function and quality of life, and how the individual’s health interacts with their social and psychological situations. Health professionals, who focus on curing acute illnesses, or performing surgery to fix a specific problem, have a different mind-set. Geriatrics health professionals focus more on “caring” rather than “curing.”
When do you need a geriatrician?
Mr. and Mrs. Smith., a middle-aged couple, “empty nesters” living in Atlanta, recently visited Mrs. Smith’s mother (Mrs. B.), an 86-year-old who was widowed six months ago and who still lives alone in her Florida condominium. Mrs. Jones. has several medical problems, including hypertension, diabetes, congestive heart failure, and arthritis.
Despite these, she had seemed to be doing well based on recent phone conversations. Mr. and Mrs. Smith. were shocked at her appearance and the state of the condominium. She had lost a lot of weight, was unkempt, and smelled of urine. The door was barricaded (because “one of the neighbors is after me”), the home dirty, the refrigerator empty, and unpaid overdue bills and empty medicine bottles were scattered in the bedroom. A neighbor told the couple that she had come over to help Mrs. B. up off the floor twice in the last week.
When asked how she was doing, Mrs. B. broke down in tears. Does any of Mrs. B’s situation sound familiar?
In the practice of geriatrics, this situation is too common. Mrs. Jones. meets several criteria for needing an evaluation by a geriatrician and other geriatrics health professionals, including:
1) Multiple chronic medical problems that are not being managed well;
2) Polypharmacy (multiple medications prescribed by different physicians);
3) Apparent need for more in-home assistance or consideration of a safer, more supportive living environment;
4) Assessment and treatment for different conditions: falls, incontinence, cognitive impairment, and depression. A geriatrician can serve as a consultant to assess all of these conditions and coordinate Mrs. Jone’s health care with a multidisciplinary team of health professionals.
Two excellent sources of information on geriatrics and a wealth of public education information can be found on the website for the American Geriatrics Society www.americangeriatrics.org and the Foundation for Health in Aging website www.healthinaging.org