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Planning Retirement Online


What if I need a geriatrician in later life

By Jeanne Davis

Why and when would I need a geriatrician? 

Joan’s mother is in a nursing home. She is 84 and there are quite a lot of things wrong, says Joan.  “Asthma, which she has had all her life, bowels not functioning properly, can’t see very well, a thyroid condition, confusion.” There is a doctor who attends the home’s residents. Instead of sending Joan’s mother to individual specialists, he refers Joan and her mother to a consultant geriatrician. 

 

 

What does a geriatrician do? 

A geriatrician is a general physician who specialises in the medical needs of older people. In many aspects, these may differ from those of midlife adults. Older people often have multiple medical problems. The geriatrician is trained to look at the problems as a whole and determine how they interact.

“Our geriatrician provided an excellent overview,” Joan said, “and a course of treatment.  I was most impressed, too, with her ability to explain what was happening in a way that both of us could understand. And she had the time to give us.” 

The geriatrician  knows about the syndromes of ageing that are not in any particular speciality, like mental confusion, urinary incontinence, instability and gait disorders, failure to thrive, depression.  

Too often, a doctor might dismiss these conditions, remarking, “Well, what do you expect.  She’s 80 years old! This is just normal ageing.”  A geriatrician will try to find an answer to the problem.

 

A geriatrician also coordinates care

 

Joan is now involved in her husband’s medical needs. After being taken to the A&E of their local hospital when he suffered a heart attack, he was cross referred to the consultant in adult medicine and put in the care of his team. (NB The geriatric department might be called the department for adult health or adult medicine. Staff and patients alike are reluctant to use the word geriatric, which unfortunately evokes an image of a worn out and decrepit elder.)

 

With multiple medical problems, you need someone to keep an eye on the total picture. Joan’s husband is taking eight different medicines (he has asthma, a hiatus hernia and arthritis in addition to heart problems). The team reviewed all his pills, to make sure they didn’t compete with each other and add up to a cocktail that one person shouldn’t be taking. The team, Joan says, also know more about the latest drugs in adult medicine, that other doctors may not be aware of.

 

Rehabilitation  

 

The job of the geriatrician is also to improve the quality of life, to keep older people functional and independent as long as possible. Sometimes with very simple advice, such as exercise, a patient can be made more functional and independent. 

“An important part of our training,” says Jonathan Treml, specialist registrar in geriatric medicine, “is in rehabilitation. Geriatricians understand that older people have less physical and mental reserves to be able to cope with the insults that life throws up.  A younger person can tolerate  quite a serious illness without other problems. An older person requires quite a lot of time and patience to get better, as well as medicine.

“Also in our training we work closely with other disciplines: nurses, physical therapists, occupational therapists. A patient getting better is not just  what the doctor does, but what the whole team does and the patient does.”    

 

What attracts medical students to train as geriatricians?  

 “Originally,” Jonathan says, “I was attracted to it because it was the last speciality where you could be a good generalist and because you could treat the whole person. Once into my training, I recognised other aspects. The particular problems of ageing  are fascinating and they aren’t as well researched as other medical conditions. There’s lots more scope for research.“Another reason is the fact that relatively minor conditions can cause major problems to patients also means that minor adjustments  or relatively simple treatments can give major rewards. That can be very satisfying to a doctor.

“Older patients can be more satisfying to look after. They have a better attitude towards health care than many younger people. On a personal level, I prefer talking to older people. Lots more of interest to say, lots more of life and experience to share.

 

“There is another personal reason which is to do with dignity in death. The nature of our profession is that unfortunately a proportion of our patients don’t survive. People are entitled to a good death with dignity and attention to detail. One of the most important things when a person is unwell is to listen to them and to talk. We make sure they are given the time. Our tools are our brains and ears. We don’t need to deal with lots of equipment .”

 

Ask to see a geriatrician if you think you need one

Some people find it difficult to ask their doctor for other opinions. Do ask to see a geriatrican when you think they can be of help to you or those close to you. You’re not being geriatric. Just thinking clearly and seeking what you need. 

To view previous articles  - see the laterlife-interest index page

 


 

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The above article is part of the features section of laterlife.com called laterlife interest. laterlife interest contains a variety of articles of interest for visitors to laterlife.com written by a number of experienced and new journalists.

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