I was interested in this article because I saw a geriatrician for the very first time yesterday. I'm 75 and have all the usual ailments of someone who hasn't taken care of himself at all, including smoking for 61 years. The only problem I don't have is obesity or even a little bit of extra weight.

All of my conditions are under really great control. I feel great and can do everything I want to. (Good I don't want to run a marathon -- I wouldn't be able to do that).

About a month ago I decided to look for a new primary care physician. I just didn't have the confidence in my present doctor that I should have. So as I started looking around for someone who was well-rated and my insurance would work with, I came across a physician who was also a certified geriatrician.

When I visited her for the first time yesterday I was thrilled. She gave me the most through examination that any doctor has given me in many years. She talked at length with me about many issues that other doctors just didn't seem interested or concerned about. And many of the things she touched on really had to do with my, let's say needs and requirements as an older person.

I'm not sure whether I "need" a geriatrician given the things discussed and mentioned in this article, but I am really glad I selected her. Assuming no special reason to see her after yesterday, we've set up a schedule for 6-mo. visits.

I'm a happy patient.

It's a good idea. A geriatric specialist oversees all other specialists, and may become her primary care physician, if you want to set it up that way.
Just as a pediatrician is the correct doctor for a child up to age 21, then a geriatrician should see an elderly person..........after age 70. Old people have habits that may not be understood, such as sleeping a lot, picky eating, inability to swallow, eating the wrong good food, and of course there's the mobility issue. Appliances and items such as a lift chair, bedside commode, a walker and canes all help. Looking back now, I only wish that I had had a geriatrician for my dear departed husband. While we all concentrated on cardiac issues, there he was with diagnosed A-fib, and throwing clots in the brain, which resulted in two ischemic strokes. That was the cause of his demise, not a heart-attack.

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.

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!

Contacted Geriatric Drs. I found in the area. None were available to take new patients, didn't take Humana Gold Insurance, some had voice mail instead of a live person to answer their business phones, .... so frustrating! Praying for guidance from above, Almighty God, please help me know the right choices to make :)

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.

I am just beginning the process of having my friend assessed for Dementi, which I know she has, and it's extremely severe. She is non functional mentally. Am I wasting my time visiting a Geriatric Specialist or not. Her regular Dr., is not at all helpful, says there's no test for Dementia and prescribed more meds for her. No one knows better than I, that she has become almost infintile in her thinking and her actions. Almost NOTHING she does makes sense. I sure need help here...BTW, home health is not an option as I am moving back home (to MS) and am only in AL. to tend to my dear friend. I must remain here until my friend is placed in a home where she will get the constant care she needs by professionals. Need suggestions as to how to proceed. I do have Legal Guardianship of my friend.

Igloo here, got my mom moved from IL to LTC recently.

Her gerontologist is the medical director for the facility. This has been a real plus in going through admissions and working with the nursing staff. As she was already one of his patients there is no downtime if something needs to change.
Really important when they need to see a subspecialist.

For my mom, it is a godsend as "her" doctor comes by at least twice a week to check in on her.

So finding a gerontologist that are affiliated with LTC or SNF can be a real plus. For us it was just sheer luck it worked out this way. Her MD never told us that he was the medical director either, it was working with the senior's social worker at the hospital that has a senior's wellness program that I found out.

My mother was seeing an internist who ignored my concerns regarding her memory loss. He conducted no cognitive exams, and made no speciality referrals. When I got mom to a highly regarded geriatric psychiatrist, her internist never sent the blood test results and other pertinent information requested. That's when I fired this quack.

I now take mom to a warm, caring, sensitive and thorough internist who is responsive to our needs. Even better, her office is located right across the street. This is no small matter. Transporting mom to her old physician was an ordeal. Mom's new doctor has eliminated one of her blood pressure meds and mom's blood pressure is like a baby's. This doctor believes that less is more particularly among the elderly whose bodies don't eliminate medications efficiently. In short, I am very pleased with mom's new doctor.

Love Lilliput's answer.

My mom, who in her 90's, see's a gerontologist. He is affliated with the medical school and his practice utilizes a separate senior health center & short-term stay hospital for seniors. All they see is advanced elderly and I think evaluate better because of this. Most gerontologists will not see patients unless they are 80, sometimes 85.

Family practice MD's & internists, like most physicians, care is about doing things that makes a person well, cures an illness, solves a problem. For the elderly that is not the case, their aging is the problem and there is no cure. I've found that gerontologists have a very different mind-set for medical care.

Think of it this way, if your young child got sick or broke a bone you would want to take him to a children's hospital - where the equipment is smaller and designed for the needs of infants and children and the staff has the training and experience that is
focused on children - as opposed to a general hospital.

For me, that is what a gerontologist can bring for the elderly.

For most areas of the country, you can't find a gerontologist.
So if you're fortunate to have one in your region who takes her insurance and has room in their practice for her, you should
try it.

My mom's old internist had her on about 6 med's - something new for the new complaint. Ton's of samples. She had 4 colonoscopy's in 6 years - because when she complained about not having a "daily", well that's what you order to be done. If she called with a concern, they told her to go to the ER.
It's not that they were incompetent, but their practice and training is all about dealing with healthy young people who have
a problem that can be solved.

When we went to the gerontologist, we took all the meds and a list of procedures done in the last 3 years. He got rid of all the drugs (one took 6 months to get her off of), got her down to 1 nightly medication and a lubricating eye drop, does an annual brain study & bone density and twice a year blood work. Office visits every other month with a MMSE and clock draw test at each visit; does a neck and ankle wipe - to see if she is clean & still bathing properly and a sniff test - to smell urine and if her clothes are fresh. Weight and vitals. That's it.

He views it all as pallative care - make her comfortable, keep her weight on, and make her feel secure and less anxiety.

Good luck.

I found myself in the same situation with my 83 year old Mother. She had her physician for over 30 years (a very good doctor), who retired 1 1/2 years ago. This doctor, along with me, recognized that my Mother showed signs of dementia/Alzheimers so he set up an appointment with a neurologist (the insurance company wouldn't do it and changed the appointment to a psychiatrist). That doctor diagnosed my mother with demension/early Alzheimers. Her memory and decisionmaking functions were deteriorating quickly. The replacement doctor, when her doctor retired shortly after the diagnosis, while very charming, has no interest in oldsters. I've had to practically beg him to give her pain medication for a broken tailbone that she incurred over a year ago. She was always a fast walker, now she USES a walker due to the excruciating pain. When I called his office a couple of months ago to bring her in because of the pain, I was told he was too busy, and to take her to the outpatient center which is in a different city (this is an HMO). When I need to obtain a letter from him (as her primary care doctor) indicating her dementia/Alzheimers decline, it took me months to finally get it from him. He wanted nothing to do with it. What kind of a doctor is that? I finally contacted her insurance company, and through them located a geriatric doctor in her community. It becomes effective after January 1, 2011 and I've already set up an appointment. My Mother needs a doctor who knows the needs of the elderly, doesn't "dismiss" their pains and problems associated with their age, and actually cares about their health. I'll keep this site posted on how it goes.

Unfortunately the trend of doctors has basically been to focus upon the young more than upon the old. This is particularly true in the area of mental illness.

My mother is part of that generation tended to stay with doctors forever if they felt comfortable with them. She is so picky that her neurologist is the only one she kept over time. She fired anyone who said anything she did not agree with and got that reputation in the hospital. The neurologist handles my mother like a well trained therapist and has helped me greatly to help her since I got medical POA. She's very attached to this man like she is to the family lawyer. I about think this is much of a security and emotional dependency issue as it is a generational thing.

There is only one Geriatric MD for the 45,000+ city where my mother lives which is really bad when you consider how many old people and nursing homes are in that area.

When my mother moved here, she was referred to an internist who came highly recommended. Although I thought the doctor was knowledgeagble and efficient, I also felt that her focus was on "younger" patients. When my mom was in the hospital the doc was out of town and could not be reached! Her "fill-in" person was horrific. Her stay was extended by at least two days because the attending did not fill out the release forms. Whenever Mom called, she could never speak directly to the doctor...her staff was poorly equipped to deal with the elderly. Once Mom called to address a medical issue and wanted her internist to recommend a specialist. Her nurse said that she did not want to disturb the doctor. When I called the same young woman, she told me to take her to the ER!!!! When I told her that the last time I took my Mom to the ER she waited 6 hours to be seen and 8 hours to get a room. She had absolutlely NO concern for my mom. Also, whenever my Mom was at their offices, they would never help her up onto the exam table. She has Parkinson's and is 5 feet tall! They did not want to deal with "icky old people."
So we switched to a geriatric physician who also sees patients of all ages. I love him. He is thorough, listens to Mom, listens to me, and is careful about using extreme methods on elderly patients. He even suggested a change in her medications that no one else took the time to investigate.
My parents generation tended to stay with doctors forever if they felt comfortable with them. I do not feel that way. Doctors are there to provide a service for which you and your insurance company dearly pay. Like you would with any other service person, you need to "shop around" for one who meets your needs.
On a last note: our medical community needs to turn its attention to wellness as opposed to "cure." I have worked with a naturopath for many years and she helped me tremendously with the things that doctors thought too insignificant to deal with. For seniors in particular, who are not as mobile, their day-to-day health and comfort is so very important.
Lilli

Geriatric MD's are specialists. From the research I did after reading this article, cognitive assessment is part of their specialty. They also can evaluate how they are doing on a range of levels, so you don't need specialists that can't give you continuity of care - a brain, a bladder & a foot do not a patient make. joke :-)

Geritrician sounds good, but also sounds rather generalized. I think from my own experience with my mother that older parents need neurologists who can asses how their brains are doing?

Like everything else in caregiverland nothing is ever as perfect as an article suggests. I do think that your experience says more about the individual than the practice of a geriatric md.

I am at the point where I might change my mom's doctor. They are so focused on womens health and families that I am not sure how effective they are. The relationship is priceless - having them know how she was, and how she is aging, but I might check a geriatric md out as a reality check, just to see if something is being missed.

In general, this is certainly true, but my experience was the opposite. When my MIL, who has Alzheimer's, came to live with us, I found a geriatric physician for her. On the first visit, I had two forms to fill out, one that needed only a signature (for disabled parking placard) and one that was a couple of pages for day care twice a week. The doctor stood across the room from my MIL and smiled and bobbed his head at her, asked her questions which she couldn't answer correctly, but even when I told him it was incorrect, he ignored me. I told him she had complained about her right eye. He finally almost touched her to check her LEFT eye! He listened to her heart and lungs, but didn't check anything else. He looked at her records, which I had brought with us and didn't change any of her meds, in spite of her blood pressure being quite high. As we left, he asked what pharmacy we used. He then berated me for not using a particular one, which I won't name. I explained that since I am disabled myself, using the one he liked was very difficult, having limited hours and no drive through. He explained to me that I was wrong! A week later, neither of the forms I needed had been filled out yet! I immediately switched her to my own doctor, who did an extensive exam, changed her meds, filled out the forms on the spot, and has given her exemplary care, even though he's not a geriontologist.