Do All Elders Need Geriatric Care?


Who needs a Geriatrician?

Whether your parent should see a geriatrician is based more on their individual healthcare needs. Two seniors both aged 70 may have very different degrees of disability or illness: one may have no problems at all, while the other may have serious health concerns. Geriatricians frequently provide the primary care for older adults who have complicated medical and social problems.

Many elders take a dizzying array of prescription medication every day. "Polypharmacy" or over-medication is a critical problem among the elderly. Geriatricians are particularly adept at tackling this issue.

A geriatrician also will be more familiar with resources available in the community.

What exactly is geriatric care?

Geriatricians and geriatric medicine specialists may offer comprehensive geriatric care and assessments to have a better idea of your parent's needs. Assessments can take several hours. As a caregiver, bring a current list of medications, eyeglass prescription, hearing aid, dentures, and information about previous doctors with you for the assessment. Typically, the assessments begin with a detailed questionnaire, which may require answers from a family member.

A geriatric assessment usually involves:

  • A complete physical
  • A comprehensive medical history
  • A record of medications and what they are treating
  • An analysis of pain levels
  • Cognitive testing
  • A screening for osteoporosis
  • Vision and hearing tests
  • A dental exam
  • A dietary consultation
  • A social worker evaluation
  • A family conference

Do My Elderly Parents Need a Geriatrician?

As a caregiver, you may ask yourself: "Should my elderly mom or dad visit a geriatrician -- isn't their family doctor enough?"

As a caregiver to an elderly parent, you are probably juggling multiple doctors, specialists, tests, records, and prescription drugs. You may feel that adding another doctor to the mix will only complicate matters. However, the opposite is true. When many factors are involved in your aging mom or dad's care, a geriatrician, or geriatric care, can be very helpful. A geriatrician can coordinate the work of specialists and other healthcare providers such as social workers, nurses, and home health aides.

What is a Geriatrician?

A geriatrician is a physician who has completed a residency in either Internal Medicine or Family Medicine with an additional 1 to 2 years training fellowship in the medical, social, and psychological issues that concern older adults. Geriatric care is a growing field as the number of elders increase.

A geriatrician is a medical doctor who has additional training and experience in assessing, diagnosing and treating the problems that are especially common in people as they age. Elder may react to illness and disease differently than younger adults. Geriatricians are able to treat older patients, manage multiple disease symptoms, and develop care plans that address the special health care needs of older adults. In addition, an elderly person may suffer chronic, complex medical conditions, including physical, psychological and social issues. Geriatricians are adept at diagnosing and treating these types of issues..

Geriatricians may have an added sensitivity to helping an elderly person maintain high levels of functioning and quality of life.

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Absolutely seek out the help of a geriatric specialist. My mother's doctor, who had replaced her long-time family doctor when he retired, didn't seem to know or care about the needs of the elderly. When she still had pain on her coxxyx due to a fall earlier that year, instead of xray he just prescribed vicodin. I immediately changed her doctor to a geriatric specialist and she knew exactly what to do. Some of my mother's dementia was due from her lack of certain vitamins in her system, as well as other issues that were found immediately. My mother still has dementia which is now in full blown Alzheimers, but at least I know that she is seeing the right doctor to help her through. Note: Here in the Los Angeles area, it's not an easy task finding Geriatric Specialists, but I was able to find one that was recommended by her insurance company which is a medicare supplimental insurance. Good luck.
We absolutely love my husband's geriatrician. He sees a behavioral nuerologist for LBD, a sleep disorder specialist (psychiatrist) for RBD, and a cardiology clinic for his pacemaker. She is fine with all of this, and coordinates his medicines to be sure there are no conflicts. She is also my mother's pcp. She has additional training in issues facing the elderly, as the article says, but it is her attitude that I really appreciate. She doesn't see her mission as "fixing" everything, and she doesn't get bored or disinterested when presented with something that can't be fixed, such as dementia. Rather her goal is quality of life for her patients, in spite of whatever they might have.

We switched from the internist we both used at the time hubby developed dementia. Her attitude was "nothing can be done. Next patient please."

When we his wonderful geriatrician pregnant for the first time I was dismayed for us, though happy for her. Her husband decided to be the full time parent so she could continue her career. I've never met him, but I love her husband too!
Savage, what a difficult situation. How old is your friend and can she qualify for Medicaid? Is she on Medicare and which parts? What happens when you leave?

Are there any LTC facilities that she could get into in Huntsville or Birmingham either through private pay or medicaid pending?

My mom's doc is affliated with the geriatric program with a medical school. It has been very good as when she needs to get tests done or anything else, it get's reviewed by the geriatric care panel. The whole perspective on care is totally different is that it is about care and not cure for dementia.

There are tests to do to see where the patient is on their cognitive abilities and level of dementia and what type of dementia:
Folstein /Mini Mental State Exam (MMSE) 30 point test. Takes about 10 – 30 minutes & looks at math, memory and orientation. Is copyrighted, so not given as much as there is a payment required to give the test. Most MD in small practice don't give Folstein because of this plus the time it takes to give it and they don't know how to interpret the results. A large practice like one within a medical school will. When my mom did her first Folstein her score was 25, then 22 then went to 13. Once it is low it doesn't get repeated.

The fact that her score was high yet her behavior (hallucinations, shuffle walk, rigid muscles), led them to diagnose her with Lewy Body Dementia rather than Alz. LBD is very different than Alz. yet their both dementia's.

Another test is the Mini-Cog: a simple 3 part test
1) name 3 objects then repeat back, could do this 2 – 3 times;
2. draw a clock then
3) repeat the words from earlier. This should take 3 – 5 minutes. What this checks is recall of new information, orientation to time and date, and clock drawing into a single score that can accurately determine if someone has cognitive impairment and its severity. The MD doesn't have to do this, it can be done by a physician's assistant or an aide. A MiniCog every 3 mos is the usual schedule.

Having a baseline Folstein/MMSE done & repeated is really helpful to be realistic about what careplan to take. They can also order a scan on brain shrinkage & to see what part of the brain has decreased. This is repeated to see what changes have happened in a period of time.

Another test is the Rowland Universal Screening, which is used outside of the US.

One hard part about all this is that the only way to truly defintely say someone has dementia is to do a brain autopsy. My mom is viewed to have LBD because of her behavior and abilities. But the doc cannot say she 100% definitely has it because the only was to see if the Lewy Bodies are there is to cut into the brain to see the Lewy Body deposits. Good luck.