Understanding Geriatric Medicine
Edward Schneider (MD, Senior Advisor, Los Angeles Jewish Home for the Aging) gives expert video advice on: What is 'geriatric medicine'?; What is 'gerontology'?; What kind of training does it take to become a geriatrician? and more...
What is 'geriatric medicine'?
Geriatrics is a subspecialty of medicine that deals with the treatment and care of older people.
What is 'gerontology'?
Gerontology is the study of aging, the biology of aging, the sociology of aging, the psychology of aging, the economics of aging, and basically all aspects of the aging process. So it's the study of aging.
What kind of training does it take to become a geriatrician?
Usually, someone is trained either in family medicine, or internal medicine; perhaps psychiatry and then does a two year fellowship, perhaps even a three year fellowship in geriatric medicine or geriatric psychiatry.
What are the origins of geriatric medicine?
It goes back about a hundred years. Geriatrics really started in Great Britain, actually in Scotland. There were several doctors who were pioneers in geriatrics, going back to 1910, 1920. There were also pioneers in America dating back to the 1920's, 1930's, and 1940's. There was Doctor Lord at Johns Hopkins here in America. In 1950 and 1960 the first geriatric program was officially established at the Long Island Jewish Hospital.
At what age should I see a geriatrician?
It's an interesting question: when does geriatrics begin? If you ask an internist, they'll say I can take care of an older patient and that there is no real age that I should give the patient up. But we find in geriatrics that when the internists find that their patient has too many diseases, are taking too many medicines, having too many complications, at almost any age, they then become a geriatric patient. For example, in my clinic I see patients who are 58, I see patients who are 99. That's the span. It's really up to the doctor to refer someone who they think may have problems related to aging that they don't want to deal with. We are the experts in problems of aging.
How can a geriatrician help me?
There are many reasons that an older person would seek out the care of a geriatrician. Let me give you an example. Geriatricians have the specific knowledge of what medications should not be taken by older people. There are about sixty medicines which young people could take without a problem but are dangerous in older individuals. I'll give you an example. Most over the counter medicines contain the active ingredient in Benadryl, diphenhydramine. This can be very detrimental to an older person, make them so drowsy and so dizzy that they'll fall and perhaps even break a hip the next day. So, diphenhydramine and these strong antihistamines should not be taken by older people. But the average doctor may not know that information. So a geriatrician has that knowledge base in what medicines should and should not be given to older people. Secondly, they know which medicines interact and don't do well in an older patient. They also know the dosing for older individuals which is different many times than the dosing for younger people. Also, geriatricians focus on the issue of function. Internists often focus on; you have a disease, let's treat the disease and cure it and make you better. Many diseases of aging are not amenable to cures. Arthritis, dementia, incontinence; these are things which you have to make people function better with. They're not going to be cured right now. But we need to help people to function better with these conditions. So, geriatricians focus on function, on rehabilitation. That's a very different focus. The next very important area is that we also are concerned about specific geriatric issues. When our patients come to our clinic, they get a geriatric depression test. Now when you see your internist, they often don't look into depression but geriatricians do because depression is a common problem as you get older. They look at cognitive or mental function. A lot of, again, internists don't look at this. We as geriatricians are concerned. Is this the first stages of Alzheimer's disease? Do people have what we call mild cognitive impairment? Do you have Parkinson's disease? Do you have early Parkinson's disease? These are important issues because the earlier we treat, the higher the success with it. The third area is issues like balance. As you get older, your balance is impaired. So, we want to see how is your balance, what we can do to help you with your balance. So once again, to summarize everything, geriatricians have that specific knowledge base about older patients, to help them function at the maximum, possible level.
Why are the medical needs of senior citizens different?
Well, there are two things that happen with aging. One of the normal aging processes, so as you get older, your immune system doesn't respond as well as if you're younger. So, for example, if you get pneumonia, and you're 20, the odds are like 99.9% you're going to do fine and there will be no problems. But, when you get to be 80 or 85, you have a risk of dying from that pneumonia. Your immune system is impaired. So, we have to worry about treating you rapidly, efficiently, effectively, right away. So the normal changes in aging affect your ability to deal with a variety of illnesses. Ok? So we have to be concerned about that. For example, as you age, the sun exposure you've had for 40 years adds up. So, we've got to be looking for skin cancers, much more than someone looking at a 25 year old where the odds are very little of finding a skin cancer. So, as a geriatrician we're concerned with the normal changes of aging. Then, there are main diseases that become much more frequent as you age and we're also interested in looking at those, going down the list of what could be affecting you, for example, arthritis. The odds are if you're 65, 75, 85, you have osteoarthritis. How are you doing with it? What can we do to help you out? These are critical issues. Another critical area is looking at health maintenance. Exercise is important when you're young. It's much more important as you get older. You almost exercise by accident when you're young. You go out dancing for the night. You're running after a bus. You're jogging. You're having fun. You get older, it's much more important that you get out there, much less likely that you're exercising by accident. So, again, we have to direct seniors toward exercise programs. For example, for every one senior who starts exercising, another is quitting. Secondly is nutrition. Nutrition is important when you're young, even more important later in life. Watch that intake of polysaturated fats, for example. Make sure people are eating lots of fruits and vegetables. Make sure they're having one or two portions of fish a week. These are critical things. Sleep. Sleep when you're younger is not a problem. Sleep when you're older is a big issue and we have to deal with it.
What is the projected need for geriatric care in the future?
The needs for geriatrics are enormous! We have today four million individuals, for example, over age 85. We may have in the next upcoming decades, thirty or forty million people in this age group. Why is 85 so important? Because the average 85 year old is either in a nursing or assisted living facility, or lives at home with assistance. So again, think about thirty million people and their needs for transportation, their needs for medical care, their needs for social care, housekeeping and shopping, etc. These needs within geriatrics are going to be enormous.
What is an 'osteopathic physician' or a 'DO'?
A doctor of osteopathy trains almost identically to an M.D. . The only difference is they receive another 100 to 200 hours of education on spinal manipulation. So they receive the same training as an M.D., but have the extra boost of spinal manipulation. Osteopathic physicians are accredited just as medical schools are, and they become interns or residents, and they become specialists, just like physicians.
What is a 'geropsychiatrist'?
A "geropsychiatrist" is someone that specializes in the area of psychiatry, as it relates to older patients. And again a special knowledge base is really required, because the problems of older people maybe very different. Let me give you an example. Schizophrenia, is very common in young people, but you don't usually see it start in old age. Geriatric depression is very different from depression at age twenty. Therapy's are very different. Are you going to send someone to a psychologist at age 75 or 85? Probably not. You're looking for short term directive therapy such as cognitive therapy or drug therapy.
What kinds of health care professionals make up a geriatric medical team?
A geriatric medical team is a very important concept; the geriatrics. We do things as a team, not as an individual. It's not just the doctor. It's the doctor, the nurse or the nurse practitioner. It's the dentist, it's the pharmacist, it's the occupational therapist, it's the physical therapist, it's the speech therapist, it's the social worker, and there are many other members of the team as well. But that's just the core of this huge team of people that really provides geriatric care.
When should a caregiver send an older person to see a geriatrician?
When an older person starts having multiple problems, is taking many drugs, and has many medical issues, that's the time for them to see someone who has specialized training in geriatrics.
What does it mean to 'die of old age'?
You really don't die of old age, you die of a specific disease or condition. But as you get older, you get much more susceptible to things that are going to kill you, so your odds of dying actually increases exponentially with aging. If you are 25 or 35 or 45, the odds are that you are not going to die that year, but if you are 95 or 100 the odds are pretty good that you may die that year.
What is the best source of information on geriatric medicine?
A great source is the American Geriatric Society. This is an organization comprised of Geriatricians from across the country, and lead by people who head up Geriatric programs at major universities.
Are the diseases geriatrics treat changing?
What will happen in the future to geriatrics, what will happen to older people, 10, 20, 30, 40 ago? I hope, and I think there's a reasonable amount of evidence behind this, that we'll eliminate Alzheimer's disease. That would be wonderful for a place like the Jewish Home, where half our patients have dementia, have Alzheimer's disease. It would be great for older Americans to be freed of that possibility in their old age. I think that's going to occur. I think we'll help to eliminate Parkinson's disease as well. I think we'll help reduce the burden of arthritis. I think we're going to have a lot healthier older people in the future. And I think the diseases that will wind up killing people will be accidents and homicides and things like that. The current killers, heart disease and cancer will be conquered. Heart disease by good diet and exercise and perhaps by new therapies, cancer by specific therapies, and the devastating one, Alzheimer's disease, by specific therapies.