Q. I am 79 years old and recently widowed. Since my regular primary care physician moved, I had to find a new one. Given my age, I decided to see a geriatrician. My initial visit was professional and thorough; the doctor was cordial, attentive and quite nice. Yet I just did not feel he was right for me. Note: I am healthy, walk several miles a day, volunteer at a hospital, care for my two grandchildren one week per month and have a very full life. Should I have seen a geriatrician?M.L.
A. Dear M.L.
There is a good reason you did not feel there was a right fit.
A geriatrician is a medical doctor specializing in the diagnosis, treatment and the prevention of disease and disability of older adults. Board certified in family or internal medicine, they receive additional training and certification in geriatric medicine. This extra training gives them added experience with conditions like heart disease, arthritis, osteoporosis, Parkinson’s disease, mobility concerns and Alzheimer’s disease. They also address issues of pain, falls, incontinence and side effects from medication, often dealing with multiple chronic conditions. Geriatricians as primary care providers are trained to look at not only physical symptoms but all aspects that can affect an older patient’s condition including lifestyle, community, family and a full medical history. Health promotion and disease prevention are integrated in their care.
Here is the mismatch. Although you qualify by age, you did not visit the geriatrician with an age-related problem. But let’s talk about how you came to your conclusion for that visit.
You essentially relied on your chronological age which is understandable. Typically, geriatricians see patients who are at least 70 years old so your chronological age qualifies you. Here’s the rub. Your functional age is likely much younger than your chronological age, a measurement of how well you function in daily life. And you did not present a problem.
Functional age has a lot to do with physiological, psychological and social aspects.
For our discussion, we’ll focus just on the physical aspects or one’s fitness that can determine what you can do and how well you can do it. The Mayo Clinic identified five areas to measure: Muscle strength, aerobic fitness, endurance, flexibility and body composition. Their web site suggests a person can determine their level of functioning with a self-assessment protocol. See https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/fitness/art-20046433. Several of the suggested tools that you will need include a stop watch, yardstick, scale and someone to record your scores and repetitions and more. Note when fitness and function are a concern, a professional should be consulted.
So when should someone see a geriatrician? According to the American Geriatrics Society, a geriatrician should be consulted when an older person’s condition causes significant impairment and frailty. A second reason is when caregivers such as family and friends feel the increased stresses and strains in caring for a loved one.
Older adults without significant age-related diseases, disabilities or problems usually can safely see a primary-care physician who specializes in internal or family medicine. Many have taken additional relevant courses and have experience in treating older adults.
Your question draws attention to a larger issue. That is the shortage of geriatricians in our country. According to the American Geriatrics Society, the United States will need more than 23,000 new geriatricians by 2030. That’s the year when the youngest baby boomer turns 65.
Why the shortage? Perhaps several reasons. Geriatricians are the lowest-paid among medical specialties. Consequently, students graduating with large amounts of debt may seek more lucrative specialties. Additionally, many new doctors lean towards a field that focuses on cure while many older adults suffer from chronic conditions where the goal is management rather than cure. Others prefer specialties that highlight the newest technology. Although geriatricians are few compared to other medical specialties, their reported level of satisfaction is high.
The number of medical specialties in the U.S. is illuminating: 50,000 psychiatrists, 47,000 emergency medicine physicians, 17,000 oncologists and only about 7,500 board certified geriatricians. That’s a problem given we have about 21 million adults 70 and older — many with chronic age-related problems.
Seeing a geriatrician was just step one in finding the right doctor for you. It seems timely to find an internist or family practice physician with some experience with older adults.
M.L., Thank you for your important question. Hopefully, when we need a geriatrician, we will be able to find one. Best wishes in continued good health.