Aging is about change. Some changes are happy—grandchildren, retirement, new wisdom—and others are challenging. Your risk for chronic disease rises and movement doesn’t come as easily as it once did. You may struggle with emotions you haven’t encountered before.
Who can help you navigate these changes?
A board-certified geriatrician is a doctor who has completed a specialized fellowship in geriatric medicine and passed an exam about issues related to aging and the care of older adults. They specialize in the primary care of people age 65 and older who are independent and live at home as well as the complex medical needs of older adults in nursing facilities or hospitals.
We asked UNC Health geriatrician Meredith Gilliam, MD, MPH, about the benefits of seeing a geriatrician as you age.
Do I need a geriatrician, a primary care provider or both?
You may have a family medicine or internal medicine doctor you’ve received primary care from for years. That doctor may be the only one you need as you age.
“Many doctors who see older adults as part of their general internal medicine or family medicine practices have this interest and real-world experience with the issues of aging,” Dr. Gilliam says.
Ask your primary care provider about their level of comfort with continuing your care. They may refer you to a geriatrician for occasional concerns but remain your primary care provider.
“Many geriatricians act as consultants, and a primary care provider may refer a patient if there are concerns about cognitive health or issues with medications,” Dr. Gilliam says. “Other times, the geriatrician might become the primary care doctor, particularly when there are multiple medical issues that need regular management.”
Do I need to be a certain age or have chronic health conditions to see a geriatrician?
Some geriatricians have an age minimum, often 65 or 70, to start seeing them. The most important factor is whether you’re experiencing health issues related to aging and need help managing them.
“Sometimes people start dealing with multiple mediations and diagnoses as well as functional and cognitive impairment when they’re fairly young; other times those are issues in the 80s, 90s and 100s,” Dr. Gilliam says. “If there are multiple chronic conditions, we can coordinate with specialists and assess which are most threatening to overall health.”
That said, anyone of the right age can see a geriatrician.
“We enjoy seeing people who are thriving in older age, who are still very healthy and independent,” Dr. Gilliam says. “I have patients who are 75 and still enjoy working, who are traveling, playing sports, keeping up with grandkids. With them, the question is, ‘How can we help you keep it this way, so you can do the things that are important to you for as long as possible?’”
A geriatrician can help you determine whether a new symptom is part of aging or a sign of something more concerning.
“The question I’m asked quite a bit is, ‘Is this a normal part of old age?’” Dr. Gilliam says. “When people have more fatigue, a new ache or pain, if they’re peeing three times in the night—it’s hard to know if that’s just getting old because you’ve never been old before. We can help people understand what’s expected or not expected.”
What kind of care can I expect from a geriatrician?
If your geriatrician is also your primary care provider, your visit may be what you’ve come to expect from other primary care providers: There will be vaccines and disease screenings you need, as well as discussion of healthy habits related to diet, exercise and sleep that will keep you feeling your best and lower your risk for future disease.
A geriatrician will also focus on issues related to aging, summarized by the 5 M’s of geriatrics:
- Mobility: how you’re walking, your risk for falls, any movement issues
- Medications: how many you’re taking and whether all of them benefit you
- Mind: your overall mental health, as well as any signs of cognitive impairment
- Multicomplexity: how multiple health issues may be interacting and affecting you
- (What) Matters Most: your priorities as you age and your wishes for end-of-life care
The 5 M’s mean there may be slightly different exams or conversations during an appointment with a geriatrician.
“We do functional assessments, which involve looking at a day in the life and whether you need help doing different activities of daily living—driving, paying bills, getting to the toilet or bathing,” Dr. Gilliam says. “We also do cognitive assessments to look for dementia or other issues, a gait assessment to see how you’re walking, and a detailed review of the medications you’re taking. As you age, the risks associated with some medications goes up, while the benefits of taking them may go down.”
A geriatrician can help with advance care planning so that your wishes around end-of-life treatments are known and respected.
“We talk about how you’re doing in the moment but also look at the next five, 10, 20 years,” Dr. Gilliam says.
Geriatricians can also help you find local resources or programs that could help you, and they provide support for caregivers of older adults as well.
“In our clinic, our biggest asset is our care management team, which has social workers who are experts in finding programs a person qualifies for—if someone is struggling to pay bills, for example—and in providing resources for caregivers to help them navigate what’s needed and how to get help,” Dr. Gilliam says.
What if I can’t see a geriatrician?
Right now, there are more people aging than there are geriatricians. The American Geriatrics Society noted that in 2020, the older adult population in the United States was 52.4 million, but there were only 8,220 full-time geriatricians.
“Geriatricians can provide big picture thinking on aging, but there are other specialties that can be a big help,” Dr. Gilliam says. “We have so many fabulous colleagues in family medicine and internal medicine. Neurologists can do cognitive health assessments and psychiatry helps with mental health concerns. Palliative care can help with those conversations about what matters most when there are symptoms that affect quality of life—it’s not just about your last months or hospice.”
Your primary care provider may also have a care manager or social worker available to help you navigate resources and programs, or they may have programs in place for aging adults with multiple health concerns.
No matter which provider you’re seeing, remember to advocate for yourself or your loved one when it comes to your concerns about aging.
“It’s important to bring the questions you care about to your visits so you can be sure they’re discussed,” Dr. Gilliam says. “Then, if there are concerns your primary care provider can’t address, ask for referrals.”
Questions about aging? Talk to your doctor or find one near you.