Find the Right Specialist to Manage Long-Term Care - dummies

Find the Right Specialist to Manage Long-Term Care

By Carol Levine

Copyright © 2014 AARP. All rights reserved.

Aging is a normal process, not a disease. But older people are more likely to have conditions that affect their ability to manage day-to-day life on their own and that require frequent checkups, often with several different doctors. They take many medications and over-the-counter preparations. They may also experience episodes of acute illness requiring a hospital stay.

What is geriatric care?

The term geriatric care covers a wide spectrum of necessary services, but, most often, it refers to managing the medical side of aging — from doctors to hospitals to medications. Geriatricians and gerontologists are both specialists in aging. What is the difference?

  • Geriatrics is a medical subspecialty. Geriatricians are physicians, primarily internal medicine doctors, who have taken additional training that focuses on the diseases of aging and their treatments. They have been certified by the American Board of Internal Medicine to practice geriatric medicine.

  • Gerontology is a multidisciplinary study of the mental, physical, environmental, and social aspects of aging. Gerontologists do research, teach aging in universities, participate in organizational planning and policy, and contribute to the broad knowledge about the impact of aging on individuals and society.

Perhaps the simplest distinction is this: While both geriatricians and gerontologists are called doctor, a geriatrician is an M.D. or a D.O. (doctor of osteopathy) and a gerontologist is usually a Ph.D. An M.D. can prescribe medications; a gerontologist can’t. Geriatricians see patients individually, while gerontologists generally do not, although they may work in settings like nursing homes or government agencies to advise on practice and policies.

Within geriatric medicine, there are even more specialists: geriatric psychiatrists, cardiologists, pulmonologists, and others. Some nurses and social workers also become specialists in this field.

Consider the need for a geriatrician

Is it essential for an older adult to be treated by a geriatrician? No. many internists (internal medicine doctors) and family physicians provide excellent primary care for older adults. Although they may not have advanced training, they have the benefit of experience.

Among their patients are undoubtedly many older adults, and experienced doctors have learned that older adults need more time during office visits and react differently to medications than their younger patients.

The American Geriatric Society recommends that a geriatrician should be consulted in the following circumstances:

  • An older person’s condition causes considerable impairment and frailty. These patients tend to be over the age of 75 and coping with a number of diseases and disabilities, including cognitive (mental) problems.

  • Family members and friends are feeling considerable stress and strain as caregivers.

Many older people want to stick with a doctor they have known for years. (But the doctor, of course, is aging too, which may be something to consider.) If you or your parent or other relative have a good relationship with a doctor and the care needed is not highly specialized, then you have no reason to make a change.

However, be sure to be particularly observant about symptoms that may indicate a change in your or your relative’s condition, or a medication side effect that may be related to a person’s age. If your regular doctor doesn’t take questions or observations about memory or behavior changes seriously, this may be a sign that it’s time for a change.

Family members and sometimes older persons themselves are often the best reporters of changes that may indicate something serious. Maybe it’s a side effect of a medication (even one that has been taken for a long time) or even a urinary tract infection. Maybe it’s a sign of depression. Maybe it’s a sign of early dementia.

Geriatricians are able to do comprehensive evaluations of these worrisome but often nonspecific reports and can recommend further testing if necessary.

If your regular doctor refers you to a specialist, ask specifically about that person’s experience and qualifications for treating older adults.