Most parents take their children to see a pediatrician for yearly checkups without giving it much thought. After all, the differences between children and adults are so stark that it seems only natural to choose a doctor specially trained to treat younger patients.
But as we get older, we rarely apply this same logic when choosing a physician, even though our health needs often change dramatically in our later years.
“The kind of care you deliver to an older adult is definitely not the same as the care you give to a middle-aged person,” said Rhonda Randall, D.O., a geriatrician and chief medical officer for UnitedHealthcare Retiree Solutions. “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, called geriatrics, to address the needs of older adults. Geriatricians such as Randall 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 often 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, and 68 percent have two or more.i
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 over 60 take at least one prescription medication, and more than a third take five or more prescription drugs.ii As a result the 65+ population accounts for 34 percent of all prescriptions issued even though only about 15 percent of Americans fall into that age group.iii,iv
Juggling multiple chronic conditions can introduce challenges for both doctors and patients, with one condition sometimes exacerbating the effects of another. Moreover, the 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 as 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 that are unique to older adults. Some medications can be ineffective or even dangerous for older patients.v Common over-the-counter drugs such as the allergy medication Benadryl, for example, have been linked to serious confusion in the elderly.vi Digoxin, a medication used to treat irregular heartbeat, can be toxic to older people when used at doses sometimes prescribed to younger adults.vii
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 in seniors.
“I think geriatricians are the only medical specialty more interested in taking away medications you don’t need than giving you new medications. A lot of what we do is determining which medications are more likely to cause harm than help,” said Randall. “One of the most important things for geriatricians is the concept of shared decision-making. We ask 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.
So, when should someone seek out a geriatrician for themselves or a loved one? A significant change in health status could be a trigger for a visit with a geriatrician. But anytime an older adult feels his or her care is becoming too complex or needs better coordination, a visit with a geriatrician could help.
“Geriatricians can be really good at balancing all of a person’s medical needs and different doctors in one overall care plan,” said Randall.
Think you could benefit from seeing a geriatrician?
With 10,000 Americans turning 65 every day, the demand for geriatricians continues to grow. Unfortunately, these specialists are a comparatively rare breed. While there are more than 58,000 general pediatricians practicing in the United States, there are less than 7,300 geriatricians.
For this reason, finding a board-certified geriatrician to support your ongoing health care needs may be difficult, but 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 if 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.
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare Advantage and Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare.
i Chronic Disease Management, National Council on Aging https://www.ncoa.org/healthy-aging/chronic-disease
ii Prescription Drug Use Continues to Increase: U.S. Prescription Drug Data for 2007-2008, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention http://www.cdc.gov/nchs/data/databriefs/db42.htm
iii An Aging World 2015, United States Census Bureau http://cdn.cnsnews.com/attachments/census_bureau-an_aging_world-2015.pdf
iv The Demand for Geriatric Care and The Evident Shortage of Geriatrics Healthcare Providers, The American Geriatrics Society http://www.americangeriatrics.org/files/documents/Adv_Resources/demand_for_geriatric_care.pdf
v Top Prescription Drugs Older Adults Should Avoid, Cleveland Clinic https://my.clevelandclinic.org/ccf/media/files/Geriatrics/Geriatric-Times/Geriatric-Times-Drug-Management-Fact-Sheet.pdf
vi Coggins, Mark. Antihistamine Risks, Today’s Geriatric Medicine http://www.todaysgeriatricmedicine.com/archive/0313p6.shtml
vii Gosselink, AT et al. When, and when not, to use digoxin in the elderly; Drugs Aging. 1997 Jun;10(6):411-20. https://www.ncbi.nlm.nih.gov/pubmed/9205847