For months, Teresa Christensen鈥檚 87-year-old mother, Genevieve, complained of pain from a nasty sore on her right foot. She stopped going to church. She couldn鈥檛 sleep at night. Eventually, she stopped walking except when absolutely necessary.
Her primary care doctor prescribed three antibiotics, one after another. None worked.
鈥淒octor, can鈥檛 we do some further tests?鈥� Teresa Christensen remembered asking. 鈥淚 felt that he was looking through my mother instead of looking at her.鈥�
Referred to a wound clinic, Genevieve was diagnosed with a venous ulcer, resulting from poor circulation in her legs. A few weeks ago, she had a successful procedure to correct the problem and returned home to the house where she鈥檚 lived for more than 50 years in Cottage Grove, Minn., a suburb of St. Paul.
Would her mother benefit from seeing a geriatrician going forward, wondered Christensen, her mother鈥檚 primary caregiver, in an email to me? And, if so, how would she go about finding one?
I reached out to several medical experts, and they agreed that a specialist in geriatrics could help a patient like Genevieve, with a history of breast cancer and heart failure, who鈥檇 had open heart surgery at age 84 and whose mobility was now compromised.
Geriatricians are 鈥渆xperts in complexity,鈥� said Dr. Eric Widera, director of the geriatrics medicine fellowship at the University of California, San Francisco.
No one better understands how multiple medical problems interact in older people and affect their quality of life than these specialists on aging. But their role in the health care system remains poorly understood and their expertise underused.
Interviews with geriatricians offer insights useful to older adults and their families:
Basic knowledge. Geriatricians are typically internists or family physicians who have spent an extra year becoming trained in the unique health care needs of older adults.
They鈥檙e among the rarest of medical specialties. In 2016, there were 鈥� fewer than two years before, according to the American Geriatrics Society.
Geriatricians can serve as primary care doctors, mostly to people in their 70s, 80s and older who have multiple medical conditions. They also provide consultations and work in interdisciplinary medical teams caring for older patients.
Recognizing that training programs can鈥檛 meet expected demand as the population ages, the specialty has launched programs to educate other physicians in the principles of geriatric medicine.
鈥淲e鈥檝e been trying to get all clinicians trained in what we call the 鈥�101 level鈥� of geriatrics,鈥� said Dr. Rosanne Leipzig, a professor of geriatrics at the Icahn School of Medicine at Mount Sinai in New York City.
Essential competencies. Researchers have spent considerable time over the past several years examining what, exactly, geriatricians do.
A by Leipzig and multiple co-authors defined 12 essential competencies, including optimizing older adults鈥� functioning and well-being; helping seniors and their families clarify their goals for care and shaping care plans accordingly; comprehensive medication management; extensive care coordination; and providing palliative and end-of-life care, among others skills.
Underlying these skills is an expert understanding how聽older adults鈥� bodies, minds and lives differ from middle-age adults.
鈥淲e take a much broader history that looks at what our patients can and can鈥檛 do, how they鈥檙e getting along in their environment, how they see their future, their support systems, and their integration in the community,鈥� said Dr. Kathryn Eubank, medical director of the Acute Care for Elders unit at the San Francisco Veterans Affairs Medical Center. 鈥淎nd when a problem arises with a patient, we tend to ask 鈥楬ow do we put this in the context of other concerns that might be contributing?鈥� 鈥�
Geriatric syndromes. Another essential competency is a focus on issues that other primary care doctors often neglect 鈥� notably falls, incontinence, muscle weakness, frailty, fatigue, cognitive impairment and delirium. In medicine, these are known as 鈥済eriatric syndromes.鈥�
鈥淚f you鈥檙e losing weight, you鈥檙e falling, you can鈥檛 climb a flight of stairs, you鈥檙e tired all the time, you鈥檙e unhappy and you鈥檙e on 10 or more medications, go see a geriatrician,鈥� said Dr. John Morley, professor of geriatrics at Saint Louis University.
鈥淢uch of what we do is get rid of treatments prescribed by other physicians that aren鈥檛 working,鈥� Morley continued.
Recently, of an 88-year-old patient with metastasized prostate cancer who was on 26 medications. The older man was troubled by profound fatigue, which dissipated after Morley took him off all but one medication. (Most of the drugs had minimal expected benefit for someone at the end of life.) The patient died peacefully eight months later.
Eubank tells of an 80-year-old combative and confused patient whom her team saw in the hospital after one of his legs had been amputated. Although physicians recognized the patient was delirious, they had prescribed medications that worsened that condition, given him insufficient pain relief and overlooked his constipation.
鈥淢edications contributing to the patient鈥檚 delirium were stopped. We made his room quieter so he was disturbed less and stopped staff from interrupting his sleep between 10 p.m. and 6 a.m.,鈥� Eubank said. 鈥淲e worked to get him up out of bed, normalized his life as much as possible and made sure he got a pocket talker [hearing device] so he could hear what was going on.鈥�
Over the next four days, the patient improved every day and was successfully discharged to rehabilitation.
Finding help.聽A geriatric consultation typically involves two appointments: one to conduct a comprehensive assessment of your physical, psychological, cognitive and social functioning, and another to go over a proposed plan of care.
The American Geriatrics Society has a 鈥� a useful resource. Also, you can check whether a nearby medical school or academic medical center has a department of geriatrics.
Many doctors claim competency in caring for older adults. Be concerned if they fail to go over your medications carefully, if they don鈥檛 ask about geriatric syndromes or if they don鈥檛 inquire about the goals you have for your care, advised Dr. Mindy Fain, chief of geriatrics and co-director of the Arizona Center on Aging at the University of Arizona.
Also, don鈥檛 hesitate to ask pointed questions: Has this doctor had any additional training in geriatric care? Does she approach the care of older adults differently 鈥� if so, how? Are there certain medications she doesn鈥檛 use?
鈥淵ou鈥檒l be able to see in the physician鈥檚 mannerisms and response if she takes you seriously,鈥� Leipzig said.
If not, keep looking for one who does.
KHN鈥檚 coverage related to aging & improving care of older adults is supported by .
We鈥檙e eager to hear from readers about questions you鈥檇 like answered, problems you鈥檝e been having with your care and advice you need in dealing with the health care system. Visit to submit your requests or tips.