If you’re a boomer, I am guessing you haven’t yet thought much about how geriatrics can help you. But it can.
Contrary to popular opinion, geriatrics is not just for people who are very old or very frail or have Alzheimer’s disease or live in nursing homes.
It is for anyone who would benefit from having health care suitably modified to be a better fit for what happens as people get older. And if you’re aged 60 or older, that almost certainly means you.
Best of all, you don’t need to see a geriatrician in person, in order to benefit from geriatrics. But you do need to understand what geriatrics is, what a geriatrician is and what gerontology is.
What is Geriatrics?
Geriatrics is the branch of health care and medicine specialized in aging and in the care of older adults.
(Geriatricians) got better at considering the big picture of a person’s health and life before diving into a specific medical problem.
I like to explain it to people by comparing it to pediatrics. The specialty of pediatrics developed because doctors realized that children do better when health care is modified to better fit the ways in which kids and their health differ from that of fully grown people.
Similarly, the specialty of geriatrics developed because doctors noticed that getting older tends to bring on certain health challenges and can change the way common conditions need to be managed.
Those doctors interested in older adults developed a specialized medical knowledge base. They studied how health problems develop and progress in older adults, along with how these problems could be better evaluated and managed.
But health care and the practice of medicine isn’t just about understanding the science of the body and how to tune it up. It’s also about how to talk to patients and how to help them feel better and be healthier.
Pediatrics had to develop an approach, along with a scientific knowledge base. As a doctor, you can’t ask kids questions the same way you interview adults. You have to work with their “kid-ness” (which varies depending on the age and temperament of the child). And you especially have to work with their parents.
Similarly, in the specialty of geriatrics, doctors developed an approach to better work with aging adults. They got better at considering the big picture of a person’s health and life before diving into a specific medical problem. They got better at using a holistic and integrated approach for people with multiple chronic illnesses, rather than trying to treat every disease separately. They got better at talking to people who might have problems with their thinking or hearing.
They also got much better at working with families, who were often heavily involved in the day-to-day health and life care of their older patients. And since so many things in the lives and health of older adults are interconnected, they got better at collaborating with other disciplines, such as social work, physical and occupational therapy and pharmacy.
In short, geriatrics means the art and science of better health and health care for older adults.
As a medical knowledge base, it covers the best information on health and illness in older adults. And as a clinical approach, it covers more successfully delivering health care to older adults and their family caregivers.
What Is a Geriatrician?
A geriatrician is a health professional who has completed extra training and certification in geriatrics. The term usually refers to a medical doctor (who has a MD or DO degree), but I have seen it very occasionally used to refer to professionals who are not physicians.
To be board-certified in geriatric medicine, you have to first do a residency in internal medicine or family medicine. This is followed by an additional year of clinical geriatrics fellowship.
The medical specialty of psychiatry also offers a geriatric subspecialty, so some psychiatrists are certified as geriatric psychiatrists.
What Is Gerontology?
Gerontology is the study of aging and of older adults.
It’s a broad field and covers aging from a variety of angles, including social science, psychology, public health and policy. Some gerontologists are even specialized in physiology and biological processes, so this aspect of gerontology can overlap quite a bit with geriatrics.
Many academic institutions offer degree and certificate programs in gerontology, as is described here. Care managers for older adults often have some type of certification in gerontology.
In short, both gerontology and geriatrics involve developing expertise related to aging adults.
But as a medical specialty, geriatrics is more narrowly focused on health and medical care for seniors.
You Don’t Need a Geriatrician. You Do Need Geriatrics.
People ask me all the time: “At what age does one need a geriatrician?”
This is a tough question to answer, in part because the United States has a serious shortage of geriatricians. So those of us in this field end up tending to people who most urgently need a doctor specialized in geriatrics, which means the oldest and the frailest.
But really, the question should be: “At what point would you start to benefit from what we know and do in geriatrics?
For most people, the answer is at some point in their 60s. That’s because by then, most people have become physiologically less resilient in their mind and body, although only a minority have developed chronic impairments.
Medication side-effects start to become more of an issue. Falls are also often related to age-associated changes in strength, vision and balance. And people in their 60s are certainly more susceptible to develop delirium during hospitalization, compared to people who are younger.
Do you need a geriatrician to help avoid these problems or to address advance care planning? Nope. Since most older adults will have to get health care from non-geriatricians, there’s currently a big push afoot to make sure that all people in health care — other than the pediatricians, of course — get better at applying what we know in geriatrics.
But here’s the thing. The most important member of a health care team is the patient, followed by the family caregiver.
So if you’re young-old, or even “old-old,” that means YOU.
And if you are helping care for an aging relative, that also means YOU.
The art and science of geriatrics shouldn’t just be practiced by geriatricians. In an aging America, everyone should be equipped with the knowledge and resources to help optimize the health of seniors.
So for better health in aging, don’t forget to think geriatrics. Our field is here for all seniors, not just for the very old.
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