The Value of Choosing a Geriatrician

It's not unusual for someone to see the same doctor for decades. But as a person grows older, it's wise to consider switching to a geriatrician or consulting one.

Geriatricians have expertise in dealing with many chronic conditions — heart ailments, high blood pressure, diabetes, disabilities — common in older patients. They are trained to consider the needs of the whole person and focus on function and quality of life. Some geriatricians routinely make home visits to see how a patient lives and what changes could improve safety, nutrition, enjoyment, and mobility. Usually, they recognize the importance of allowing family members to attend appointments and can be counted on to coordinate care with specialists.

Geriatricians are also well aware of deleterious effects that medications can have on older people. According to a 2002 study published in the Journal of the American Geriatrics Society, it's common for the elderly to receive prescriptions for inappropriate medications. It's essential to keep tabs on possible drug interactions and to calibrate pain medications carefully. Unfortunately, signs of trouble may be dismissed as dementia or depression by doctors not as well versed in working with older patients.

A comprehensive geriatric evaluation can offer wide-ranging advice that vastly improves a person's quality of life and ability to live independently. That might include recommendations to change or discard medications, consult with a physical therapist or occupational therapist, adapt the home, pursue neurological testing, or add home care services. Medicare or Medicaid will pay for the evaluation. Some private insurance also provides coverage if the primary care physician makes a referral.

Care in an Emergency
In a medical emergency, such as a stroke or heart attack, the best hospital is often the closest one. But after the initial crisis is resolved, what steps should come next? For example, should you consider a move to a "better" hospital? If care is attentive and effective and the medical team is responsive and communicates well, stay put, advises Dr. Anne Fabiny, a geriatrician and assistant professor of medicine at Harvard Medical School. A more prestigious hospital does not automatically ensure better care.

If you are concerned about the quality of care your loved one is receiving, always speak to the physician first. Treat a move to another hospital as a last resort. If communication is poor or vague, press hard for answers and more responsive care. Certainly, get the patient's primary care doctor involved. Call upon the hospital's patient advocate for assistance, too, and request a second medical opinion if necessary.

Source: from Caregiver’s Handbook, Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.  Use of Content | Medical Disclaimer