What type of doctor should an 80 year old see?

By age 85, a significant number of seniors experience multimorbidity, making specialized care essential. Deciding what type of doctor should an 80 year old see depends on the complexity of their health needs, and understanding the different options can lead to better health outcomes.

Quick Summary

Deciding on the best physician involves weighing a general primary care physician (PCP) against a specialist in geriatric medicine, known as a geriatrician. A geriatrician is ideal for managing multiple chronic conditions and complex medication schedules, while a trusted PCP can be the right choice for healthier seniors.

Key Points

• Geriatrician Specialization: Geriatricians are primary care doctors with extra training focused on the complex health needs and chronic conditions common in older adults.

• PCP Can Still Be Right: A long-standing primary care physician (PCP) is often the best choice for an 80-year-old in good overall health with a simple medical history.

• Complex Health Needs Determine Choice: If an 80-year-old has multiple chronic conditions, takes many medications, or experiences cognitive/mobility issues, a geriatrician is typically recommended.

• Holistic and Coordinated Care: Geriatricians specialize in coordinating care across multiple specialists, helping to manage competing treatments and medication side effects.

• Communicate Your Priorities: When choosing a doctor, prioritize communication style, accessibility, and a shared philosophy on health goals to ensure the best fit.

Geriatrician vs. Primary Care Physician: What's the difference?

For an 80-year-old, the choice between a general primary care physician (PCP) and a geriatrician can seem confusing, but it hinges on the complexity of their health profile. While both provide essential primary care, their training and approach differ significantly. A PCP treats patients of all ages and is a familiar point of contact for preventive care and acute issues. A geriatrician, however, completes additional fellowship training focused specifically on the unique health needs of older adults.

What is a geriatrician?

A geriatrician is a primary care doctor who specializes in the unique healthcare needs of people aged 65 and older. Their expertise is particularly valuable for seniors navigating several complex or chronic health problems simultaneously. For an 80-year-old, this specialized knowledge can be critical. Geriatricians are trained to manage conditions common in older age, such as dementia, frailty, incontinence, osteoporosis, and mobility issues. They are also experts in addressing polypharmacy, which involves managing multiple medications to reduce side effects and dangerous interactions. Geriatric practices often offer longer appointments to allow for comprehensive assessments and thorough discussions of complex medical issues.

The role of a primary care physician (PCP)

Many 80-year-olds can, and do, continue to receive excellent care from their existing PCP, especially if they are in good overall health and have a strong, long-standing relationship with their doctor. A PCP who is familiar with a patient's medical history over many years is an invaluable asset. They can effectively manage routine health concerns, screen for common diseases, and make referrals to specialists as needed. For an 80-year-old with few chronic conditions and a relatively simple medication regimen, remaining with a trusted PCP can be the best option.

How to choose: Factors for an 80-year-old

Making the right choice depends on a careful evaluation of the individual's specific circumstances. Several factors should be considered when determining what type of doctor an 80 year old should see.

Health complexity

• Multiple chronic conditions: If the individual has multiple conditions like heart disease, diabetes, arthritis, and kidney disease, a geriatrician's expertise in managing these overlapping issues can be highly beneficial.
• Complex medication management: Taking five or more medications, as many seniors do, increases the risk of side effects and interactions. A geriatrician's focus on medication optimization (deprescribing) is a major advantage.

Functional and cognitive changes

• Cognitive concerns: Memory lapses or cognitive decline are not a normal part of aging. A geriatrician is specially trained to screen for and manage early signs of dementia and other cognitive impairments.
• Mobility issues and fall risk: With falls being a leading cause of injury in older adults, a geriatrician's emphasis on balance, gait assessment, and fall prevention is a critical part of their care.

Practical considerations

• Family and caregiver support: Geriatricians are accustomed to working with family members and caregivers to coordinate care and provide support. This team-based approach can be very helpful for navigating the complexities of elder care.
• Availability: The number of geriatricians is limited, so accessibility in your area may influence the decision. Sometimes, a highly experienced PCP is a more accessible and equally effective option.

Questions to ask a potential doctor

Here are some questions to guide your decision:

1. What is your experience working with older adults, and what is your approach to managing multiple chronic conditions?
2. How do you manage complex medication schedules to minimize side effects?
3. Do you have specific programs or resources for fall prevention and cognitive health?
4. How do you coordinate care with other specialists?
5. How long are typical appointments for older patients?
6. What is your philosophy on end-of-life care discussions and advanced care planning?
7. Do you have a support team, such as social workers or pharmacists, to assist with care management?

A comparison of geriatrician vs. PCP

Feature	Geriatrician	Primary Care Physician (PCP)
Specialization	Additional fellowship training in geriatrics, focusing on older adults.	General medical training for patients of all ages.
Expertise Focus	Complex, multi-system issues, cognitive decline, frailty, and polypharmacy.	Wide range of acute and chronic health issues for all ages.
Appointment Length	Often schedules longer appointments to address complex issues.	Standard appointment times, which may be shorter.
Care Coordination	Highly experienced in coordinating care with multiple specialists and caregivers.	Refers patients to specialists as needed, but may not specialize in complex coordination.
Ideal Patient	Best for those with multiple chronic illnesses, significant functional decline, or cognitive concerns.	Suitable for generally healthy seniors or those with stable, well-managed conditions.

Preparing for your appointment

Regardless of the doctor you choose, preparing for appointments can maximize their effectiveness. Here are some tips:

• Create a detailed and up-to-date list of all medications, including prescriptions, over-the-counter drugs, and supplements. Note dosages and frequency.
• Write down your main health concerns and questions in advance to ensure you cover everything.
• Consider bringing a family member or caregiver to help with note-taking and to provide additional information.
• Maintain a diary of symptoms, changes in mobility, or memory concerns to share with the doctor.
• Have all recent medical records and test results available for review.

The importance of coordinated care

Whether your 80-year-old opts for a geriatrician or a PCP, the most important aspect of their care is coordination. As health needs become more intricate, there's a higher likelihood of seeing multiple specialists, such as a cardiologist or neurologist. A strong primary care provider, especially a geriatrician, acts as the central hub, ensuring all aspects of care are aligned and that prescriptions don't conflict. This holistic view helps prevent complications and promotes the best possible quality of life.

For more information on senior health topics, the National Institute on Aging provides valuable resources: National Institute on Aging.

Conclusion

Choosing the right doctor for an 80-year-old is a highly personal decision. For those with complex, multifaceted health issues, a geriatrician provides specialized expertise that can significantly improve care quality. For healthier seniors, a long-standing relationship with a trusted PCP may be more than sufficient. The key is to evaluate the individual's needs, consider the pros and cons of each option, and prioritize a doctor who is an effective partner in navigating the unique challenges of aging. Ultimately, the best doctor is the one who listens, communicates effectively, and helps the individual achieve their highest quality of life.

Frequently Asked Questions

When should an 80 year old switch from a PCP to a geriatrician?

An 80-year-old should consider switching when their health needs become more complex, such as managing multiple chronic diseases, dealing with multiple medications, experiencing cognitive decline, or frequent hospitalizations. A good time to discuss this is during a regular checkup with their current PCP.

What kind of specific issues does a geriatrician address for an 80 year old?

Geriatricians are trained to handle issues like managing multiple medications (polypharmacy), assessing risk for falls, evaluating memory problems, managing frailty, and discussing end-of-life care options. They take a comprehensive and holistic approach to an 80-year-old's well-being.

Are geriatricians covered by Medicare?

Yes, geriatric care is generally covered by Medicare, just like care from other primary care physicians. However, it is always wise to confirm with your specific Medicare plan or supplement to understand your coverage details and any potential costs.

How can I find a qualified geriatrician for an 80 year old?

You can start by asking your current primary care doctor for a referral. You can also search online through directories provided by organizations like the American Geriatrics Society or use tools on websites like Health in Aging or WebMD. Patient reviews and testimonials can also provide valuable insight.

What should an 80 year old bring to their first appointment with a new doctor?

It is crucial to bring a complete list of all medications (prescription and over-the-counter), a list of any supplements, recent lab results or medical records, a list of health concerns and questions, and potentially a family member to assist with the conversation and note-taking.

What is the biggest advantage of seeing a geriatrician for an 80 year old?

The biggest advantage is their specialized expertise in complex medical care for older adults. They understand how different conditions and medications interact in aging bodies, allowing for more personalized and coordinated care that focuses on maximizing function and quality of life.

Can an 80 year old have both a PCP and a geriatrician?

While it's generally best to have one primary care provider, in some cases, an 80-year-old might keep their PCP for general care and consult a geriatrician for specific, complex issues. You should check with your insurance provider to ensure coverage and avoid duplicate services.