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Aging Well
Is This Medical Specialist Right for You?A geriatrician focuses on the health concerns of older people.The elderly woman is rushed to the emergency room with a broken hip. The professionals there do what they’re trained to do—expertly treat the fracture. But beyond the immediate problem lies another: the question of why the woman fell and broke her hip.Does she have osteoporosis? Poor vision? Weakness from malnutrition? Badly lit stairs? Exploring questions like these, says Francis Salerno, M.D., is the work of a different kind of medical professional—the geriatrician, specialist in the health concerns of older people. Salerno is chief of geriatrics at Lehigh Valley Hospital and Health Network. If the woman with the broken hip is fortunate, she and her doctor will consult with a geriatrician and get to the root of the problem before she has another fall. Is it time for you or someone you love to call a geriatrician? “There is no set age at which a person needs geriatric care,” says family physician and geriatrician Brooks Betts, D.O. Most of his patients are over 65. “But a frail 60-year-old might benefit from a geriatric assessment—and a vigorous 80-year-old might do fine without one.” When daily functioning begins to declineThe time to call a geriatrician, Betts says, is when someone is declining to the point where it’s starting to affect daily functioning. As we age, we’re all prey to natural body changes as well as the effects of the illnesses and injuries we’ve had over the years. These can add up to a tendency to fall, mental con-fusion, loss of appetite, incontinence, back pain—each of which can put our lives into a tailspin.“We call such conditions ‘geriatric syndromes,’” Salerno says. “They’re not diagnoses in themselves, but symptoms that can have many different causes. For example, urinary incontinence can stem from infection, muscle weakness, overuse of medications and other factors—most often, in combination.” Geriatricians have special training in these syndromes and how to treat them. “Many people don’t realize that their problem can be fixed,” Salerno says. He recalls a patient who was too embarrassed to tell her doctor about her incontinence and stopped going out. She grew anxious and depressed, gained weight, lost strength—in short, went into physical, emotional and social decline. A thorough evaluation is called forThe kind of thorough evaluation needed for someone like this demands time the primary care physician doesn’t have today, says internist Thomas Lakata, D.O., of Lehigh Valley Hospital and Health Network. He often refers families to a geriatrician. “Most commonly, the family wonders if a loved one is getting too forgetful or weak to live on her own,” he says.The patient, family and geriatrician sit down together and review the patient’s whole history. “Involving the family is vital because problems with aging don’t affect just the patient,” Lakata says. The geriatrician can help make decisions like whether it’s time for assisted living. The geriatric specialty came into being decades ago. “Internists, family physicians and now, psychiatrists can do the added training and research to qualify as a geriatrician,” Salerno says. “But in spite of the growing need as our population ages, there is a national shortage of geriatricians.” The geriatrician is an educatorPartly because of the shortage in their numbers, geriatricians most often function as educators and consultants rather than day-to-day caregivers. “I don’t recommend switching to a geriatrician just because you reach a certain age,” Betts says. “If you need an assessment or a second opinion, have the geriatrician work in partnership with your family doctor. Older patients often have a longstanding, caring relationship with their doctor, and walking away from it would be a mistake.”That said, if you’re concerned that you or someone you love is declining, don’t hesitate to reach out to a geriatrician, Lakata says. “There are resources and new medications out there that can help prevent further decline. I encourage people to take this step as early as possible.”
Want to Know More? Lehigh Valley Hospital has 26 geriatricians on staff. For a referral for a geriatric assessment, call 610-402-CARE. This page last updated 2/12/08 04:08 PM
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