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The Geriatric Care Team: A Patient-Centered Approach

Interviewer: You've just been told that you need a geriatrician but you like your primary care physician just fine. Why do you need a new doctor?

Dr. Mark Supiano is the Executive Director of the University of Utah Center on Aging. Why? Why do I need to change?

Dr. Supiano: A couple of points first, geriatrics is a team sport and in our patient-centered medical home that we've just launched here as part of University Health System, the other members of that team are equipped to provide services and resources to patients who have functional needs to maintain their independents. In addition to me or my colleagues as geriatricians, that team includes geriatric nurse practitioners, a pharmacist, a Pharm.D prepared geriatric pharmacist, a geriatric social worker, and a case manager to help navigate the needs that our patients have.

More than age, it is a change in function or cognition, the accumulation of multiple chronic conditions, so it's not just your age 65 but your now age 65 and heart disease and diabetes and depression and osteoporosis, and a number of other issues that may prompt you to be on a number of medications, and the challenge is who is coordinating all of that individual's care, particularly if their function and other needs are becoming apparent, and that's really where geriatrics comes into play.

Age vs Function: When Geriatric Care Becomes Necessary

Interviewer: Couldn't somebody much younger have those same issues, and why wouldn't they need a geriatrician, then?

Dr. Supiano: Good point, and so it works in both directions. It's not, as I said, not just driven by age. There are many younger people with those multiple chronic conditions who, if they have functional and/or cognitive declines, would likewise benefit from this geriatric approach.

Interviewer: Okay, understood. Are there different health care needs for somebody who's older that has these conditions, though? Different considerations?

Geriatrics Is Critical After Age 85

Dr. Supiano: Yes. The real bang for the buck, frankly, is above the age of 85. That's where the geriatric's expertise is most likely to make an impact in terms of improving someone's health and function, because of the deficits that are often evident in that population. For example, perhaps as many as half of people over the age of 85 have some evidence of cognitive impairment. If that becomes limiting in terms of their function, if they're having difficulty managing their ability to live independently, that's the time when a geriatric assessment to evaluate what the causes and consequences of that cognitive decline might be, and that's where a geriatric evaluation would come to play.

Maintaining Independence and Quality of Life

Interviewer: Yeah. So don't think about it as, "Oh, my gosh, I've got to go to a geriatrician. I'm getting older." Think about it as, "How can I maintain my independence, my health, and my quality of life as long as possible?"

Dr. Supiano: Exactly. So the skills that our team can provide is to perform that assessment, identify not just what the medical problems are but what the functional issues are, where someone might have limitations in their activities of daily living, their ability to live independently, where they may have limitations in managing their own medications, using the telephone, maintaining their finances, using transportation, shopping, preparing meals. If there are problems in those areas that's something that we are trained to evaluate and to try to remedy to the extent that we can, identify reversible conditions that have a positive influence on someone's function.

Geriatric Care vs Nursing Homes

Interviewer: So it sounds like perhaps it's a new way of thinking, because it used to be as soon as the function would start to decline then perhaps maybe as you get older you would have to go to an assisted living home or nursing home. Now it's go to a geriatrician and let's see how we can continue to keep you independent as long as possible, maybe even beyond what somebody might normally go to a nursing home.

Dr. Supiano: That certainly is a goal, and while that goal cannot always be achieved, our team is equipped to help patients and their family members, their caregivers, navigate that landscape to identify the living environment that would be most appropriate for their functional needs.

Interviewer: And something else I understand a geriatrician can do is really align the care given with the patient's wishes, almost like personalized medicine, which is an old concept for geriatricians but kind of a new concept for the rest of medicine.

Dr. Supiano: It's critically important as people develop frailty and become more vulnerable to complications of their multiple chronic conditions that we identify what's really important to them and their care, and it may not be simply getting their numbers under control or managing their given disease, but it's a focus on function.

_{updated: October 15, 2024
originally published: September 22, 2015}