What is geriatric care? All the details

Aging comes with many changes, especially when it comes to health. As adults get older, the best way to ensure you’re on the lookout for potential health risks and poised for prevention is to find yourself a geriatric care provider.

“The same way that a child goes to a pediatrician, as you age, you want someone who specializes in gerontology,” says Jeanne Mihalik, an advanced practical nurse and nurse practitioner who treats patients at Atlantic Health System’s Center for Healthy Aging. “There are certain diseases and illnesses that are more common among the aging population that the professionals at a gerontology practice are going to be more attuned to.” 

The more efficiently and aggressively you can prevent or slow the progress of these various illnesses, the longer you — or an aging loved one in your care — will be able to stay active and independent. Read on for expert insight on what to expect from geriatric care and how to find a great provider. 

What is geriatric care?

Geriatric care is specialized medical care designed to meet the needs of older adults. This includes physical health needs, as well as mental, emotional and social well-being.

One big reason you may want to switch from a family practice to a geriatric specialist is the amount of time they can provide during appointments to assess changes that might end up being simple or complicated to manage. 

For example, changes in gait (how you walk) and balance could signal a complicated issue, like dementia, or something easy to handle, like low blood pressure. But it’s more difficult for a family doctor to assess this in a standard 10 to 15-minute visit, which many of these practices are limited to, explains Dr. Kathryn Brandt, chair of primary care at the University of New England College of Osteopathic Medicine. A specialist such as a gerontologist will likely have 25- to 30-minute appointments, so they can spend more time per patient versus a general practitioner.

“People are much more youthful now — you don’t see 65-year-olds who look like the ‘Golden Girls’ anymore. But you start at that young age so your provider has time to get to know you and understand your medical history well in advance of anything actually going awry.”

— Jeanne Mihalik, advanced practical nurse and nurse practitioner

In addition to having more time and recognizing common symptoms of aging, a gerontologist is well-versed in the conditions that become more pronounced in the aging population. For instance, a geriatrician is trained to recognize and treat the following conditions in tandem with one another:

• Heart disease.
• Hypertension.
• Osteoporosis.
• Hearing and vision loss.
• Diabetes.
• Certain cancers.

Who needs geriatric care?

Everyone over age 65 should be looking for a geriatric practice. 

“It may feel early,” says Mihalik. “People are much more youthful now — you don’t see 65-year-olds who look like the ‘Golden Girls’ anymore. But you start at that young age so your provider has time to get to know you and understand your medical history well in advance of anything actually going awry.” 

Look at it like this: Pediatricians are doctors who get extra training in order to understand the usual phases of a child’s development, common childhood illnesses (like pink eye), safe medications and vaccination schedules. Same with gerontology: Gerontologists are doctors with extra training on what happens to an aging body, common conditions (like hypertension and diabetes) and safe medications.

In addition to preempting and addressing serious health concerns, geriatric care can bolster your own or your loved one’s wellness. Per the American Geriatrics Society, the goal of geriatric care is “to improve the health, independence and quality of life for all older people.” 

The four pillars of geriatric care

“The standard of care for the geriatric population is known as ‘the Four Ms,'” says Brandt. This stands for “mobility, medication, matters and the mind.”

These are the priorities for a doctor treating the aging population, so let’s talk about what they mean.

Mobility 

By looking at how someone moves, the doctor can determine whether they are at a fall risk and act quickly — by ordering physical therapy, for instance — to strengthen anything that’s starting to wear down.

Medication 

“A lot of geriatric care is actually subtracting medicine,” says Brandt. “With age come changes in how your body handles side effects, for instance. I had a patient with insomnia, and we figured out it was because she was taking her diuretic at night, so she was getting up to pee.” 

A geriatrician can look at your medications with a critical eye and see which may no longer be a good fit. 

What matters to you 

If a physician takes a one-size-fits-all approach, it rarely benefits the patient. “A physician’s priorities aren’t always the same as a patient,” says Brandt, who gives the example of someone who wants to have an indulgent Sunday dinner with their family but who needs to watch their blood sugar. “[Doctors] should be treating you with that in mind.” 

Geriatric care practitioners are especially able to take their patient’s unique lifestyle, age-related needs and health history into consideration.

Mind 

Catching cognitive decline early is key; you can get your ducks in a row, figure out who will get Power of Attorney if you can’t make decisions for yourself, complete a living will and start eating better and exercising to stave off the progression of the disease.

These are scary things to think about, but the more we challenge the stigma of age-related diseases and prioritize preventive care and early planning, more people will be able to take steps to make their later years less onerous for themselves and their loved ones.

What to expect when you see a geriatric care doctor

When you first see a new geriatrician, you’ll get a Comprehensive Geriatric Assessment (a CGA). This is for your doctor to take stock of your health at its baseline so they’ll know what your chart looks like when all is well. 

The gerontologist will look through your medical history and evaluate your health up to this point. From there, you will likely receive the tests listed below. Some will involve your geriatrician, and some may be done with other professionals connected to the practice.

“Your team will come up with suggestions, and you’ll make the decisions based on their blueprint, what it says about what’s up with you now and what to watch for going forward.”

— Jeanne Mihalik

Geriatric practices typically offer a multidisciplinary approach to care (meaning that they have specialized nurses, occupational therapists, physical therapists, social workers and other practitioners who can address specific health concerns). Together, they make up a team of professionals working together to monitor every aspect of your care.

Geriatric care basics: The functional assessment

A functional assessment, usually conducted by an occupational therapist (OT) and/or a physical therapist (PT), evaluates your ability to perform basic tasks. It will tell you if you need extra support to avoid falls or perform your Activities of Daily Living (ADLs), such as bathing or dressing.

If needed, the medical experts can then recommend supports like shower railings and/or suggest strategies or alternatives for how to do things as your body changes. For instance, if you’re becoming a little less steady, your PT might have you do balance-training exercises to strengthen the muscles that help keep you from falling. If your eyesight is growing less sharp, an OT might recommend lights for you to install in hallways and entryways so you don’t miss a step. 

Geriatric care basics: The cognitive assessment 

A cognitive assessment will most likely be done by your doctor, but it might also be conducted by a speech-language therapist (SLP). Either way, the test is meant to assess neurologic functioning. While cognitive decline is a terrifying possibility that nobody wants to think about, it is important to catch early. The fact of the matter is that, with early detection, it is possible to implement strategies to slow down the progression of cognitive loss and create a plan to manage future care needs.

A social worker doing a cognitive assessment will ask you about your family, friends and other support systems. They might also be able to collaborate on paperwork related to your health care needs, such as Medicare and supplemental insurance documentation or a living will. They might also be able to tell you about specific programs or resources, like Meals on Wheels, transportation services, or where the local bridge club meets.

Geriatric care basics: Your care plan

Finally, your team will come together and come up with a care plan for you. This means they’ll each share their findings and identify particular challenges, then map out interventions and suggest which should take priority.

“You’re not married to this plan,” Mihalik adds. “Your team will come up with suggestions, and you’ll make the decisions based on their blueprint and what it says about what’s up with you now and what to watch for going forward.”

What does geriatric care help with?

There’s a never-ending list of ways your geriatrician’s office can look out for you. Here are just some of the things they’ll be able to help you with:    

• Medical management: Everything about each patient is overseen by one office, offering a holistic (whole-body) continuum of care and coordination of services, not different pieces viewed by individual specialists who don’t look beyond their field.
• Rehab: If you are injured in a fall or if you have a scheduled surgery and need time to recover, the geriatric care office can be the point-person between the hospital, rehab and in-home care services.
• Mental health: It’s very common for older adults to deal with “the blues” or even fall into a depression. Geriatric practices know how critical mind health and mood management are, and they are a vital resource for someone experiencing life changes due to aging.
• Palliative care or hospice: It can be very hard to gauge exactly when to turn to comfort or end-of-life services. People are often afraid of them or may think of them as “giving up.” A geriatric practice can bring in experts to explain and invoke these services if and when you think they’re needed.

Where to find geriatric care

If you’re looking for a geriatric care practice of your very own (and by this point, we really hope you are!), consider using search tools on the following sites:

• The American Geriatrics Association. 
• Health in Aging.
• Aging Life Care Association. 
• Medicare directory or your supplemental insurance directory for geriatric medicine.

“The best thing you can do to ensure a happy and healthy aging process for yourself or your loved one is to find a geriatric care provider as soon as possible,” says Trish Colucci Barbosa, a board-certified registered nurse and the president and principal care manager at Peace Aging Care Experts in New Jersey.

By being proactive, you can ensure you or an aging loved one have the best possible health care, head off a potential health crisis and stay strong. 

Original article written by Amy Keyishian.