By Dr. Kate Gregorevic, February 6th 2017
A geriatrician is a doctor who has completed specialist training in the care of older adults. But why do older adults need their own specialist? And why do doctors choose this area of medicine? Older adults often have more complex health care needs than younger adults, and there are also some medical conditions that occur more commonly in older adults, like frailty, dementia and falls. In addition, many older adults have multiple medical conditions requiring multiple medications, and unlike many other specialties, which are organ specific, like cardiology (Heart) or renal (Kidney), geriatricians take a whole person approach.
Frailty is a loss of physiological reserve leading an individual vulnerable to a significant decline in health status from a seemingly minor insult. Assessment of frailty requires comprehensive geriatric assessment. This means geriatricians look at the whole person across medical, functional, cognitive, nutritional and social domains. This holistic assessment allows development of a management plan based on that person’s values and goals. This is also important because no two 80 year olds have had identical life experiences – due to life events and some lifestyle choices, people can have a vastly different health status at the same age.
What training do geriatricians undertake?
Geriatricians in Australia are trained under the Royal Australasian College of Physicians. Following graduation from university, we undertake four years of basic physician training in hospitals, working in a variety of areas like general internal medicine, intensive care, emergency, perioperative medicine and cardiology. Following this we undertake three years of subspecialty training in geriatric medicine. During this time, trainees (registrars) are supervised and assessed, as well as undertaking a formal training program. After a minimum of seven years of postgraduate training, a doctor can call themselves a geriatrician. This process does differ slightly in different countries, but in most countries for someone to call themselves a geriatrician, they need to have undertaken specialist training.
Where do geriatricians work?
Geriatricians work across a variety of settings such as residential aged care, acute hospital, rehabilitation wards and outpatient clinics. Geriatricians are often responsible for looking after older adults who are admitted to hospital with an illness like pneumonia, or working with surgeons who repair broken bones. Studies have shown that having a geriatrician involved in care of frail older adults actually improves survival.
Many geriatricians visit people in their own homes or in residential care. This is particularly important for people who are having some difficulty at home. For many people staying independent in their home is a major goal, so by visiting there, a geriatrician can get a valuable insight to help people develop evidence based strategies to maintain their independence.
Geriatricians also operate specialised clinics to diagnose and manage specific conditions. Attending a specialist falls and balance, memory or continence clinic involves a multi-disciplinary assessment and evidence-based advice.
As the population ages, we see increasing numbers of older adults interacting with the healthcare system, but there are not enough geriatricians to see everybody. Geriatricians therefore have an increasingly important role in educating other health care professionals and optimising hospital processes and environments. As clinician researchers, we are able to use our experience and perspective to do further research into ways we can help our patients.
From a personal perspective, with the rapidly growing number of studies on healthy ageing, there has never been a more exciting time to be a geriatrician. I feel greatly privileged to meet people who have lived far longer than to learn from their unique perspective and great resilience.
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