Are you 65 or older? While your primary care doctor may be an internist or general practitioner, have you thought about adding a geriatrician to your health care team?
A geriatrician can act as your health care “quarterback,” helping to ensure you get the specific care you need, as well as coordinating care with specialists.
“Our health needs often change dramatically in our later years,” said Dr. Efrem Castillo, chief medical officer for UnitedHealthcare Medicare & Retirement. “The kind of care you deliver to an older adult is not the same as for a middle-aged person. The physiology of older people is very different from people in other stages of life.”
Those differences are significant enough that the medical community developed a specialty — geriatrics — to address the needs of older adults. Geriatricians are licensed physicians who have completed additional training in managing the care of older people. That training makes geriatricians uniquely suited to help older adults manage the complex demands of their health care needs.
One source of that complexity is chronic conditions. Older adults are significantly more likely than their younger counterparts to have a chronic condition such as hypertension, diabetes and heart disease. In fact, about 80 percent have at least one chronic condition, and 68 percent have two or more.
Given the prevalence of chronic conditions in older adults, they’re also heavier users of prescription medications than younger adults. About 90 percent of adults 65 and older take at least one prescription medication, and 40 percent take five or more prescription drugs.
Juggling multiple chronic conditions can introduce challenges for doctors and patients, with one condition sometimes exacerbating the effects of another. Moreover, treatments for illnesses can sometimes interfere with each other. That means the recommended course of treatment could look different in a patient with one chronic condition when compared to a patient with several.
Establishing the ideal treatment regimen for older adults with multiple chronic conditions can be further complicated by side effects unique to older adults. Some medications can be ineffective or even dangerous for older patients. Common over-the-counter drugs such as the allergy medication Benadryl, for example, have been linked to serious confusion in the elderly. Digoxin, a medication used to treat irregular heartbeat, can be toxic to older people when used at doses sometimes prescribed to younger adults.
Geriatricians are trained to understand how drugs uniquely impact older adults so they can appropriately customize their drug regimen to mitigate the risk of complications.
Decisions about how to customize a patient’s treatment aren’t necessarily black and white, requiring a doctor and patient to carefully balance risks and benefits. For example, some diabetes medicines can cause dizziness, meaning the doctor needs to focus not just on regulating the patient’s blood sugar but also on minimizing the risk of a fall, which is the most common cause of injury for seniors.
“A lot of what geriatricians do is determining which medications are more likely to cause harm than help,” said Castillo. “And the concept of shared decision-making is integral here — asking patients, ‘What trade-offs are you willing to take?’”
Sometimes, the trade-offs are purely medical in nature — weighing the pros and cons of taking a certain medication or undergoing a specific screening, for example. But more often than not, they also involve a person’s overall life goals. How important is it to maximize longevity? Comfort? How about independence? Each person answers those questions differently, and geriatricians are trained to use the answers to guide their treatment recommendations and care plan.
When should you seek out a geriatrician for yourself or a loved one? A significant change in health status could be a trigger for a visit with a geriatrician. But any time an older adult feels his or her care is becoming too complex or needs better coordination, a visit with a geriatrician could help.
Finding a geriatrician
With 10,000 Americans turning 65 every day, the demand for geriatricians continues to grow. And despite a shortage of certified geriatricians as the demand increases, many geriatricians will see a patient on a one-time or as-needed basis and then make recommendations to the patient’s primary care physician.
The American Geriatrics Society offers information about how to find a geriatrician on its website, and many larger hospitals and university medical centers have geriatricians on staff that will see new patients. If you’re enrolled in a Medicare Advantage plan, be sure to confirm whether a geriatrician you want to see is in your plan’s network and if your plan requires you to first get a referral from your primary care physician before a visit with a geriatrician will be covered.
UnitedHealthcare members can get help with those questions. From scheduling your next checkup appointment to helping you find a specialist to getting the treatment you need, it’s easier to get the right care at the right time.
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