What Defines a Geriatric Practice?
A geriatric practice is defined by its patient-centered, holistic approach to caring for older adults, typically those aged 65 and over. Rather than focusing on a single disease, a geriatric practice considers how all of a patient's conditions interact, along with their mental, emotional, and social needs. This specialty training is what sets a geriatrician apart from a standard primary care physician when it comes to managing the complexities of aging.
Geriatric care is not just about treating illness but also about maintaining and improving a senior's independence and quality of life. A geriatric care team often involves a range of professionals, including geriatricians, nurses, social workers, and therapists, all working together to coordinate a comprehensive care plan.
Key Components of a Geriatric Practice
A geriatric practice focuses on several interconnected areas of an older adult's health to provide truly comprehensive care. These are often referred to as the "5Ms" of Geriatrics:
- Mobility: This includes assessing balance, gait, and risk of falls, a significant concern for older adults. Geriatric practices develop strategies to maintain or improve mobility, such as physical therapy referrals or home safety evaluations.
- Medications: Older adults often take multiple medications for various conditions, a phenomenon known as polypharmacy. A geriatric practice will review all medications, including prescriptions and over-the-counter drugs, to minimize side effects and dangerous interactions.
- Mentation (Mind): This involves assessing cognitive function and screening for memory issues, such as dementia, as well as mental health conditions like depression and anxiety. Early detection and management are key components of geriatric care.
- Multicomplexity: Geriatricians are trained to manage patients with multiple chronic conditions simultaneously, understanding how each one affects the others. This holistic view ensures that treatment for one issue doesn't negatively impact another.
- What Matters Most: This emphasizes patient-centered care, putting the individual's personal values and preferences at the core of all care decisions. Discussions about end-of-life care, health goals, and overall well-being are central to this philosophy.
Geriatric Practice vs. General Adult Primary Care
While a general primary care physician (PCP) can provide excellent health services throughout an adult's life, a geriatric practice offers specialized expertise that addresses the unique complexities of aging.
| Feature | Geriatric Practice | General Primary Care |
|---|---|---|
| Primary Focus | Holistic, patient-centered care for older adults with complex health needs. | General wellness and disease management for adults of all ages. |
| Specialized Training | Extensive additional training in geriatrics, focusing on age-related diseases, syndromes, and treatment interactions. | General medical training, with broad knowledge across all age groups. |
| Medication Management | Expert in polypharmacy, reviewing all medications to simplify regimens and minimize side effects. | Monitors medications but may not have the same level of specialized insight into drug interactions in older adults. |
| Care Coordination | Often acts as a "quarterback" for care, working closely with an interdisciplinary team (nurses, pharmacists, social workers, etc.). | Refers patients to specialists but may not have the same level of hands-on coordination across different providers. |
| Appointment Length | Typically schedules longer appointments to allow for thorough discussion of all medical, social, and emotional issues. | Appointments are generally shorter, focusing on a more limited set of concerns per visit. |
| Key Conditions | Focuses on age-related issues like dementia, falls, osteoporosis, incontinence, and frailty. | Addresses a wider range of acute and chronic conditions common across the adult lifespan. |
When is a Geriatric Practice Needed?
Deciding when to transition to or consult a geriatric practice is not tied to a specific age but rather to the presence of complex health needs. Some people remain healthy and active well into their 80s and can continue with a general PCP. However, the American Geriatrics Society suggests considering a geriatric specialist when:
- An older adult is managing multiple chronic health conditions that make care complicated.
- There is significant frailty, impaired physical function, or difficulty with daily activities.
- The patient is taking numerous medications, increasing the risk of adverse drug reactions or interactions.
- There are notable changes in memory, mood, or cognitive function.
- Family caregivers are experiencing considerable stress related to the patient's care.
In many cases, a patient can continue seeing their general PCP for some needs while consulting with a geriatrician for specialized advice. This allows for the best of both worlds, leveraging the geriatrician's focused expertise on complex, age-related issues while maintaining a long-standing relationship with a trusted primary care provider.
The Geriatric Assessment: A Holistic View
A cornerstone of a geriatric practice is the comprehensive geriatric assessment (CGA), a detailed evaluation that goes far beyond a standard physical exam. The CGA is a multi-dimensional, multi-disciplinary process designed to evaluate an older person’s overall health, functional ability, cognitive status, and socio-environmental circumstances.
Components of a Comprehensive Geriatric Assessment include:
- Functional Ability: A review of basic activities of daily living (ADLs) like dressing and bathing, as well as instrumental activities of daily living (IADLs) such as managing finances and preparing meals.
- Physical Health: A comprehensive review of all medical history, chronic conditions, vision, hearing, and nutritional status.
- Cognition and Mental Health: Screenings for memory problems, mood disorders, depression, and other psychological issues.
- Socio-Environmental Factors: An evaluation of the patient's living situation, social support network, and caregiver needs.
- Medication Review: An in-depth analysis of all medications and supplements to identify and address polypharmacy.
This thorough assessment allows the geriatric team to develop a personalized care plan that is tailored to the individual's specific goals and challenges. The plan is a collaborative effort involving the patient, family members, and the entire care team.
Conclusion
A geriatric practice is a highly specialized, patient-centered approach to healthcare that addresses the complex and interconnected needs of older adults. By moving beyond a focus on single conditions, geriatric teams work to maintain and improve a senior's independence and overall quality of life. The comprehensive geriatric assessment is the key tool used to create a holistic and personalized care plan. For older adults with multiple chronic conditions, complex medication regimens, or declining function, consulting a geriatric practice can offer a level of coordinated and compassionate care that may not be available through general primary care.
Find a Geriatrics Healthcare Professional
For more information on geriatrics and to find a specialist in your area, consult the resources provided by the American Geriatrics Society.
