Geriatrician offers holistic approach to health care

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Dear Doctors: What is a geriatrician, and how do you know if you need one? My mom is 78 and is starting to be frail. She feels like her regular doctor doesn't listen to her and rushes through her appointments. I wonder if switching to a specialist might be better for her.

Dear Reader: A geriatrician is a physician who has undergone specialized training in the field of geriatric medicine. This is a branch of medicine that focuses on the health and well-being of older adults.

It is an important specialty because reaching older age is often accompanied by the onset of a diverse range of complex medical conditions and health issues. These include changes to strength, flexibility and mobility; a decrease in bone density; hearing loss; cataracts; changes in heart function; the onset of neck, back and nerve pain; incontinence; a decrease in good-quality sleep; and alterations in cognitive function. As we age, the risk of developing certain chronic conditions and diseases -- such as arthritis, high blood pressure, Type 2 diabetes, cardiovascular disease and certain cancers -- also increases.

If your mother begins to see a geriatrician, they will pay attention to more than just her physical health. The doctor will focus on her mental health and her emotional well-being as well. An important part of the specialty is to monitor medications. This includes any that the patient is already taking and drugs that may be prescribed in the future. The doctor will watch for any duplications, as well as potential drug interactions.

If a patient is seeing other specialists, such as a rheumatologist or cardiologist, the geriatrician may reach out to those doctors and ask for updates about those visits. The practice of geriatric medicine is a holistic approach that touches on multiple aspects of a patient's daily life. As a result, these appointments tend to be longer and more in-depth than a typical doctor visit -- and sometimes more frequent.

Mobility, which is crucial to safety, can change significantly in a short period of time in older adults. Geriatricians are trained to watch for these changes, and to counsel their patient on how to manage them. This can include urging the use of a cane or a walker, as well as specific advice about how to reduce the risk of falls in the home environment. This specialty also includes training in helping a patient to deal with palliative care, as well as end-of-life care.

It is sometimes suggested that someone begin to see a geriatrician when they reach 65. However, the timing of when -- or even whether -- to make the change also depends on each person's specific situation. Someone who is in good health and is happy with the medical care they are receiving may choose not to switch.

In your mother's case, the interactions with her current doctor have begun to fall short of her needs. That, along with her increasing frailty, suggest that a physician with a specialty in aging may indeed improve her quality of life. Her doctor, or your own doctor, should be able to provide you with a recommendation.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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