My mother, 75, has seen the same family doctor for 20 years. I’ve heard of doctors who specialize in treating the elderly. Should I look into this for her?

Dr. John Connolly

Your friend was referring to geriatricians, physicians specially trained to care for the elderly. To be certified in geriatrics, a physician must first become an internist or family practitioner by completing three years of postgraduate training after medical school (referred to as a residency program) and passing a certifying exam, followed by a one or two-year fellowship in geriatric medicine. The physician must then pass a rigorous exam jointly sponsored by the American Board of Internal Medicine and the American Board of Family Practice, which must be taken every ten years.

Treating older adults is very different from treating younger patients. The elderly are more prone to disease and decreased physiological function. Aging cells are more susceptible to the accumulation of calcium, cholesterol, and other substances responsible for the deterioration of tissue. The deterioration of the circulatory system is also common in the elderly. A geriatrician is trained to diagnose, treat, and manage the unique medical problems of the elderly. Older people are more susceptible to diseases found in people of all ages. They may also suffer from progressive diseases that tend to become more severe as they age. And, they are at greater risk of the side effects and toxic reactions caused by drug interactions because of the large number of medications they take (thirteen a year, on average).

Geriatricians often use teams of health care providers to assess a patient’s condition. The team may include a geriatric nurse, social worker, nutritionist, physical therapist, pharmacist, and/or psychiatrist. For example, they look for medical problems common to the elderly such as incontinence, frequent falls, confusion, sexual dysfunction, and side effects caused by multiple medications. They also look at the patient’s quality of life, such as the ability to perform simple activities of daily living, the type and level of support available, living arrangements, and financial resources.

Based on your mother’s recent experience, you might very well consider seeing a geriatrician. If you are reluctant to switch physicians at this time — and that is certainly understandable given your mother’s twenty year relationship with her doctor — you can first ask for a consultation with a geriatrician. Geriatric assessments are generally covered by Medicare (with the exception of social assessments).

The only problem may be the availability of geriatricians in your area. There are only about 9,500 certified geriatricians in the country which is less than half the number necessary to treat the more than 34 million adults over age 65. You can ask your mother’s current physician for a referral to a geriatrician (which he should be willing to do), or you can contact the local hospital or medical society for the names of geriatricians. In the event one is not conveniently located, you might want to consult with an internist or family doctor that has been trained (but not necessarily certified) in geriatric medicine, or one who has a large elderly patient population. Regardless of which physician you use, it is important that you and your mother make your concerns known.

Dr. John Connolly is President & CEO of Castle Connolly Medical Ltd., America's "trusted" source for identifying top doctors. He has an extensive background in management and healthcare. For more than a decade, he was President of New York Medical College where he successfully revitalized the school while insuring its financial security. Dr. Connolly is extensively involved in healthcare activities including serving as a director of the New York Business Group on Health, as founder, a director and past chair of the American Lyme Disease Foundation, as a member of the Presidents Advisory Council of the United Hospital Fund of New York, and as a Fellow of the New York Academy of Medicine. He has also served on the boards of two hospitals and as chairman of the board of one, and is currently Chairman of Professional Examination Service, Inc. He also is a frequent guest on regional and national TV and radio shows, including 20/20, CNN and Good Morning America.