Does Your Loved One Need a Geriatrician?

Patients often enter appointments with the idea that their visits will focus on placing them in a nursing home — the most intensive care found in senior living — but the goal of the appointment should be the opposite. “I am part of a team that wants to keep you away from that, actually,” says Cleveland Clinic Center for Geriatric Medicine Section Chief Dr. Ardeshir Hashmi.

Instead, appointments focus on safely maximizing independence in many areas of daily life. “We want you to age successfully,” Hashmi says. “At the core of it is what matters most to you — your life goals, preferences, care preferences, and everything under that umbrella.”

Keep reading for Hashmi’s insights on what geriatricians do, what to expect during a visit, and when it’s time to see a geriatrician.

Hashmi describes a geriatrician’s role as one that goes beyond age-related medical expertise: a coordinator between the patient, caregivers, and a variety of medical and social resources to help senior patients achieve their goals. “My job is to be sort of the quarterback in trying to bring all this together and be the connector,” he says.

When speaking to the senior’s role in these consultations, Hashmi says, “They are the content experts on their lives and on their preferences. They will tell you exactly what matters most to them. And what matters to most of us is not an obscure number from a lab.” He then lists classic examples of what patients aim for when consulting a successful aging specialist:

• “I want to feel well enough so I can attend my granddaughter’s wedding, which is three months away.”
• “My shortness of breath is not good, and I want it to be better so I can walk my grandson to school.”
• “I don’t like checking my finger stick three times a day. How can we make that easier?”

Geriatricians can take these functional, ability-focused goals and help patients achieve them by working with a wide-ranging network of resources. This can include physical therapists, nutritionists, occupational therapists, pharmacists, social workers, and more.

Supplementing health care with a geriatrician

Through age-related health expertise, geriatricians supplement — rather than replace — the medical care from your loved one’s primary care physician, Hashmi says.

He explains that successful aging specialists can supplement a patient’s medical care through screenings and treatments for age-linked conditions, including:

• Hearing loss
• Vision impairment
• Cognitive health changes
• Frailty
• Voice and swallowing changes

“There are specific screenings that other people might not think about, like bone health. For example, osteoporosis is very neglected,” Hashmi notes. In many situations, he says geriatricians can work with physicians and provide individualized health assessments that look beyond the patient’s age as a raw number.

A primary care physician may be hesitant to pursue various treatment options when using the patient’s age as a guideline. But Hashmi explains that more personalized information from geriatricians can better inform the senior patient’s diagnoses and treatments.

He says it’s important that frailer patients aren’t over-treated and that more robust patients aren’t under-treated based on age alone. “This person may be 87, but look at what kind of 87-year-old they are,” Hashmi says, illustrating how elderly patients can have family histories of strong health and other traits that can make them more robust than another patient of the same age. Adding this age-related expertise can result in a number of changes to your loved one’s care, from reducing or deprescribing medications to pursuing noninvasive treatments.

Let our care assessment guide you

Hashmi explains that when you and your loved one sit down for your first consultation with a successful aging specialist, you can expect it to differ from a typical doctor visit in four main ways:

1. Longer appointments. Hashmi says that consultations can reach an hour and a half. The average time spent with a primary care physician during a routine visit is around 17 minutes, according to a study published by the National Center for Biotechnology Information.
2. Team-based approaches. “You will spend time with a team of people, not just one clinician or physician,” says Hashmi.
3. Connections to resources. “You’ll leave with practical resources in terms of connections — even to not-for-profit organizations — tailored to your own individual situation clinically, but also from the social-determinants standpoint,” Hashmi says.
4. A focus on age-related changes and tailored care plans. Hashmi explains that over 50 physiological changes take place starting around 50 years old. Successful aging specialists will evaluate the patient’s progression through these changes, and they can help coordinate care plans between patients and caregivers based on the patient’s evolving needs.

Here are some common things you and your loved one may cover in an appointment with a geriatrician and their team:

• Discussing the care goals
• Conducting a cognitive health screening
• Connecting with community resources
• Finding the appropriate level of care
• Evaluating medication regimens
• Assessing fall risk
• Treating incontinence
• Performing mood assessments
• Performing mobility assessments

With the many physiological changes that take place starting around age 50, Hashmi explains that geriatricians are there to help you and your loved one address these changes, but that it’s best to be proactive and plan for them.

If patients don’t proactively plan for these changes, “all it takes is one bad incident, and it’s one incident too late,” he says, noting how dangerous it can be to neglect seemingly normal changes that pop up with age, like difficulties with driving or moving around the home. Because of this, he says people as young as 50 years old could benefit from consulting a successful aging specialist.

Hashmi says it might be time to start seeing a geriatrician if you or your loved one experience changes or difficulties in daily life related to these four M’s:

1. Mentation (brain health)

Hashmi says that small changes in cognition can be an early signal of aging. “If I’m seeing changes with driving on a very familiar road and have to stop and think — it may be only a moment — but the fact that it is happening is an early warning,” he says. He also notes that abandoning or getting frustrated during multi-step projects, like cooking or installing new technology, could signal that it’s time to see a geriatrician.

2. Medication

It’s common for older patients to have developed lengthier lists of medications that they take on a regular basis. Hashmi says that many patients overlook the difficulty of managing numerous medications because they expect to have more difficulty with this task as they age. However, he says difficulty with medication management is serious, notable challenges with the task aren’t normal, and seeing a geriatrician can help to address it.

“A lot of people say, ‘Well, of course. I’m getting older, so I shouldn’t be able to manage this,’” Hashmi says. “But it’s a change.”

Years’ worth of visits with primary care physicians and specialists can tack on prescriptions from each doctor, and taking numerous medications can cause negative side effects from drug interactions, according to Hashmi.

He says that patients should be able to explain the purpose of each medication they take — including over-the-counter meds and supplements — even if they can’t remember the pharmaceutical names. Since health conditions change with age, Hashmi notes that every visit presents the possibility for altering medication regimens based on the patient’s condition, and that geriatricians can guide patients to updated regimens that fulfill their health needs and minimize adverse drug interactions.

3. Mobility

Limited mobility from aging can add difficulty to a number of activities of daily living (ADLs), like bathing, dressing, and various tasks around the home. Hashmi says that changes or challenges with you or your loved one’s ADLs can be an indication that it’s time to see a successful aging specialist.

Talk with a Senior Living Advisor

4. What matters most

When you discuss care goals with a geriatrician and their team, your interests, life wishes, and medical care preferences are all key focal points. To ensure that you or your loved one’s wishes and preferences are fulfilled, successful aging specialists can work directly with families, or coordinate with elder law attorneys, to create advance directives and living wills or trusts. Working through these complex legal documents yourself can eat away the time for doing what you love.

If you or your loved one are stretched for time or are facing difficulties compiling the legal documents tied to aging, Hashmi says it’s beneficial to consult a geriatrician and their team, adding that patients can gain more freedoms as a result. “Use your team. We’re all here to support you and your independence, so leave the mundane stuff to us. You just go and enjoy whatever it is that is your area of interest.”

A Place for Mom and Cleveland Clinic: Supporting seniors and their families

This article was developed in conversation with Dr. Ardeshir Hashmi, section chief of the Cleveland Clinic’s Center for Geriatric Medicine, as part of a series of articles featuring expert advice from Cleveland Clinic geriatricians.

Sources:

American Family Physician. “Deprescribing Is an Essential Part of Good Prescribing.”

American Family Physician. “The Geriatric Assessment.”

Cleveland Clinic. “What is a Geriatrician?”

Interview conducted with Hashmi, A. Cleveland Clinic. July 26, 2021

Interview conducted with Hashmi, A. Cleveland Clinic. November 5, 2021

The National Center for Biotechnology Information. “Time Allocation in Primary Care Office Visits.”

UpToDate. “Comprehensive geriatric assessment.”