JustCare

Tag: Geriatrician

  • Why see a geriatrician?

    Why see a geriatrician?

    Today, more than 55 million Americans are over 65. The US has an older population than it has ever had. Sadly, the physician population has not grown to meet the needs of older Americans reports Pamela Paul for The New York Times.

    How many board-certified geriatricians are there in the US? Just over 7,000. Only one for every 10,000 older adults. The number has shrunk more than 25 percent in the last 25 years.

    Older adults with multiple chronic conditions can fare much better with treatment from a geriatrician. Much like with children, taking care of older adults is different from taking care of working people. As we age, our brains and bodies change.

    While there are a range of doctors who treat older adults, many of them have never received appropriate training to do so. That training can be invaluable. We have less muscle mass, smaller kidneys and weaker immunological systems by the time we are 65.

    When it comes to geriatric care, physicians should be looking at both the prescription drugs and over-the-counter drugs you take, your cognition, your movement and what you most care about. Geriatricians must consider which of a patient’s medical needs are most important. Patients’ life desires should rank high, be it going on vacation or having better balance. Physicians need to keep in mind that patients might not be able to follow a treatment plan.

    Geriatricians work to help promote as good health as possible. For example, my dad’s geriatrician got my dad off of a few of the prescription drugs he was taking after testing their efficacy over a several month period and finding that they were not benefiting him. His geriatrician also kept a doctor who saw my dad in the emergency room from prescribing him a new and costly medication he did not need. And, that’s not all.

    My dad’s geriatrician arranged for a nurse to visit him every two weeks to check his blood because he was on a blood thinner. She prescribed physical therapy for him because he was shuffling his feet when he walked and she worried about his risk of falling. After talking to him and me about his social network, she thought it would be helpful if he had more social interactions. So, she arranged for the hospital social worker to see him and help him find a program that engaged him socially.

    Why aren’t more physicians becoming geriatricians? It’s a fulfilling profession. But, it’s not glamorous. It requires spending more time with patients. It’s challenging because patients are ultimately not going to improve a lot. It requires an extra year of training over primary care. And, the pay is relatively low, averaging about $258,000 a year.

    Here’s more from Just Care:

  • Roundup: Your doctors and your health

    Roundup: Your doctors and your health

    Some doctors are a lot better than other doctors. As you get older, it’s especially important that you and your loved ones have doctors who listen to you, who do not undertreat or overtreat you, and who work with you to think through your health care wishes and your treatment options. These days, many doctors are looking at their computers and their watches during the patient’s visit, and those doctors should be avoided at all costs. Here’s a bunch of things to think about as a caregiver and as a patient:

    Take care of your health:

    Choose your doctors carefully:

    Make the most of your doctor’s visit:

    Speeding your recovery:

  • Do you need a geriatrician?

    Do you need a geriatrician?

    As you get older, it is extremely helpful to have a geriatrician as your primary care doctor. If at all possible, you want a doctor who well understands the health issues particular to older adults. Do you need a geriatrician?

    Paula Span reports for The New York Times on the shortage of doctors who are expert at treating older adults. With the population of older adults booming, these doctors are needed more than ever. Older adults sometimes struggle with sleeping, with balance, with side effects from prescription drugs, among other things. Geriatricians are skilled at identifying and addressing these and other issues.

    Geriatricians also oversee care for older persons to help promote as good health as possible. For example, my 97-year old dad’s geriatrician got my dad off of a few of the prescription drugs he was taking after testing their efficacy over a several month period and finding that they were not benefiting him. His geriatrician also kept a doctor who saw my dad in the emergency room from prescribing him a new and costly medication he did not need. And, that’s not all.

    My dad’s geriatrician arranged for a nurse to visit him every two weeks to check his blood because he is on warfarin, a blood thinner. She prescribed physical therapy for him because he was shuffling his feet when he walked and she worried about his risk of falling. After talking to him and me about his social network, she thought it would be helpful if he had more social interactions. So, she arranged for the hospital social worker to see him and help him find a program that now engages him socially.

    Through these services, my dad’s geriatrician has improved his quality of life immeasurably. But, most people are not so lucky as my dad. It can be hard to find a geriatrician today.

    There are just 7,000 geriatricians in the US, and not even 3,500 of them practice full-time according to the American Geriatrics Society. A full-time geriatrician can see about 700 patients a year. And, it’s estimated that about 15 million older adults–one in three–need one.

    If you do not suffer from multiple chronic conditions, you do not need to see a geriatrician. If you think you or someone you love would benefit from seeing a geriatrician, contact your local hospital about geriatricians in your community. Or, if you’re enrolled in a Medicare Advantage plan, contact your plan. You might have a wait a bit for an appointment, but it’s likely worth the wait.

    While there’s a shortage of geriatricians, doctors and other health care providers are increasingly aware of their need to understand medical issues of older adults, even if they are specializing in other fields. Today, older adults represent nearly four in ten patients of internists and general surgeons. With the population aging, a large portion of patients are older.

    In order to compensate in part for the scarcity of geriatricians, geriatricians are training other doctors, as well as nurses, physician assistants, therapists and pharmacists, about the needs of older adults. And, hospitals are adapting to better meet the needs of older patients through, for example, geriatric emergency rooms. You can read about them on Just Care here.

    Recognizing the need for more health care professionals with expertise in the care needs of older adults, the Democratic majority in the House of Representatives has voted to reauthorize a $41 million educational program to address shortages in the workforce. But, the Republican Senate has not voted to pass it as of yet.

    Here’s more from Just Care:

  • Watch your feet: Foot care is critical and pain is treatable

    Watch your feet: Foot care is critical and pain is treatable

    You’ve heard the expression, “watch your back.” When it comes to older adults, you might say “watch your feet.” Caring for an older adult means checking vision, gait, hearing and balance on a regular basis.  It also should mean checking feet.  Feet are a window into whether an older adult is able to care for himself or herself.

    When it comes to feet, older people have lots of issues. Your primary care doctor or geriatrician should be sure to check your feet regularly. Here are seven things to watch out for and talk to your doctor about:

    1. Foot pain: People are more likely to have foot pain in later life as the skin becomes thinner and less elastic. Painful feet can usually be treated.
    2. Fungal infections between the toes causing redness, blisters or itching: Use an over-the- counter fungal spray or cream. And, talk to your doctor. Make sure your feet, including the area between the toes, are dry to prevent infections.
    3. Corns and calluses: Make sure your shoes fit well, and your feet are not rubbing up against them. Use a pumice stone or foot file to remove hard or calloused skin. You also can rub the corns or calluses gently with a washcloth but do not shave them. Moisturize dry and rough skin on your feet to prevent cracks.
    4. Ingrown toenails: Cut toenails regularly to avoid ingrown toenails caused by the nail growing too long and cutting into the skin. Keep in mind that many older adults can’t bend down to cut their own toenails.
    5. Tissue build up in the ball of the foot or toes causing pain. This could make it harder to balance. Make sure your shoes are wide enough.
    6. Toes that are pulled back: This can affect balance. Make sure shoes have enough space in them.
    7. Swelling.  See a doctor if your feet are swollen.

    If you have diabetes, you may have poor blood flow in your feet. And, you are more prone to scrapes, bruises and infections. You should check your feet every day for red patches. If you have sores or blisters or cracks in your skin, see a foot doctor. You want to avoid getting infections.

    And, regardless of your health status, exercise your feet to increase blood flow and improve the health of your feet. You can also do foot exercises.  For more information, check out this pamphlet from the National Institute on Aging.