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Geriatrician vs Gerontologist: Whose Help Do You Need?


Whether serving as a caregiver for an elderly relative or planning for future health care needs, you may be wondering what medical professionals specialize in healthy aging.

The elderly often have one or more medical conditions that require medications and specialized management, testing and follow-up. According to the National Council on Aging, 80% of older adults have at least one medical condition and two-thirds have two or more. Managing these conditions and their treatment plans requires broad training and a solid knowledge of the scientific literature. Two sets of experts help coordinate this team effort:

  1. Geriatricians are medical doctors who are board-certified in internal or family medicine then receive an additional 1-2 years of training in a geriatric fellowship. They specialize in challenges that affect the quality of life with age: falls, mobility, incontinence, delirium and fatigue.
  2. Gerontologists are primarily researchers (who may also be healthcare professionals). They have experience and expertise in the impact of aging on mental, physical and socio-emotional health. They spend time thinking about and researching theories of aging and lifespan development from a social, psychological, physical, and biochemical perspective.

Gerontologists do important work as researchers and scholars who often provide important basic knowledge for the medical professionals (geriatricians and otherwise) who work with older adults.

Where do geriatricians work?

Geriatricians work in primary care as well as in hospitals.

Geriatricians often have clinical privileges at long term care (skilled nursing facilities) along with their outpatient duties. They oversee the medical care of many older adults at skilled nursing facilities, managing their medications, and coordinating the care of the geriatrics professionals who work there (like occupational therapists, geriatric psychologists, and physical therapists).

Similarly, geriatricians play a crucial role in outpatient care teams by providing care coordination and medication management. Because most seniors have several medical conditions to manage, geriatricians know that additional time is often required to provide the right care and coordination with other clinical experts. Indeed, geriatricians often book longer appointments to ensure all questions are answered and involve caregivers in developing the treatment plan.

Like-minded geriatricians may choose to form a practice which models innovations in care, such as integrated / co-located care (for example, being able to seamlessly offer geriatric mental health care services within the context of a medical care visit), help with transitions in care, and linking families to community services. Some of these programs may arrange home-based visits, coordination with mental health professionals and social workers. Programs which bring seniors together to learn about aging well provide a great benefit to participants, allowing them to make new connections and gain the motivation to stay current with appointments, exercise, and medications.

Should I switch to a geriatrician?

Internists tend to treat adults between the ages of 20 and 60, but if you or a loved one are starting to feel poorly and taking too many medications, it might be time to switch to a specialist who understands the specific issues associated with aging.

Geriatricians are skilled at looking at the whole medical picture and often focus on the “less is more” approach with medications. Physician specialists may add medications without perhaps truly appreciating what is already on a patient’s medication list, while skilled geriatricians often scour the patient’s chart looking for medications and pills that can either be consolidated or dropped completely. Overuse of over-the-counter medications, or even vitamins or supplements, can lead to frailty or cognitive impairment.

Given the complexity of managing multiple chronic conditions, any time you or a loved one visits their doctor, it is important to bring all daily medications, vitamins, and supplements to the visit for review. Because geriatricians can also help with palliative care and end of life planning, people who have a terminal illness or are receiving treatment for cancer may wish to consult a geriatrician.

A geriatric assessment may help improve the quality of life and reduce side effects during this time, making each day as comfortable as possible. A recent study found that people who received a geriatric assessment had fewer falls in the home and fewer medication side effects. This is important because we all age differently. A 70-year-old may be physiologically more similar to a 50-year-old whereas another patient the same age might have the frailty more typical of a 90-year-old. Medications affect the body differently and a geriatric assessment can inform treatment plans to ensure patients are neither under- nor over-treated.

What might I expect from a geriatrician?

Geriatricians serve elderly patients with kindness, empathy, and a desire to see the person in a holistic way rather than focusing on one organ system. They may choose to enter the profession immediately after medical school following an early exposure via an elective course or with the encouragement of a mentor. Others may start out as family practitioners or internists then decide to specialize in elder care. They are your first line of defense in handling medical problems and can refer you to specialists as well as help coordinate the care you receive from specialists. Although your medical record should list all your current medications, the geriatrician might be the one to notice dangerous drug interactions and work with the prescribing doctor as well as a pharmacist to recommend an alternative treatment plan. Many doctors, including geriatricians, also use telemedicine and remote monitoring for health conditions like diabetes, high blood pressure and irregular heart rhythms.

Is this a growing field in healthcare?

As the population ages—in the U.S. more than 1 in 5 people will be over age 65 by 2040—demand for both professions is growing. Approximately 30% of these seniors will need the services of a geriatrician on their health care team, but worldwide projected shortages of internists, family practitioners and geriatricians make this a high-demand field. Nurses, doctors, including geriatricians, therapists and aides provide vital services, such as routine blood pressure checks, medication management, and support carrying out activities of daily living (ADLs). Gerontologists conduct research specific to the aging process, such as disease prevention and the interactions between mental and physical health. Both geriatricians and gerontologists provide essential support to both patients and their caregivers, allowing them to enjoy independent living as long as possible.

Geriatricians serve a vital role in aging well and maintaining independence as long as possible. Gerontologists support the geriatricians with research on aging, health services and quality of life. While geriatricians practice clinical medicine, they are backed by their research colleagues who are exploring new paths to healthy aging. Although many of us prefer to remain in deep denial of the aging process, seeking out a trusted guide may help identify problems earlier, allow for the right treatment at the right time, and ultimately make the experience of aging gracefully more enjoyable.

Resources:

Model programs developed by leading geriatricians: https://www.todaysgeriatricmedicine.com/archive/0313p10.shtml

Johns Hopkins Medicine - Geriatric Medicine and Gerontology: https://www.hopkinsmedicine.org/geriatric_medicine_gerontology/aging_research/

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