As a geriatrics doctor, I am often asked, “When does old age begin anyway?” My usual answer is, “Old age begins 10 years older than whatever age you are now.” That’s usually good for a laugh.
Is it people 65 and older? But as I will soon be 64, am I one year away from being my own patient, a “geriatric?” OMG, as they say. So, who should see a geriatrician?
As a practitioner and teacher of geriatric medicine, I do my best to give a concise, useful answer to the question. But the answer is not as simple as it is for other fields of medicine. Ask most people, “Who should see a cardiologist?” and they will answer, “People with heart problems.” The pediatrician’s population is neatly defined by age, commonly 18 or younger. So, if it’s not an organ or a number, then what defines my specialty?
As of the 2020 census, there are 55.8 million persons 65 or over in the U.S., making up 16.5% of the population. Currently, there are 6,129 certified and actively practicing geriatricians across the country. So, if everyone > 65 years old should see a geriatrician, then each one needs to care for an impossible 9,104 patients, if my math is right. Therefore, given the limited supply of geriatricians, can we determine who benefits most from seeing a geriatrics doc?
Well, there are 80-year-olds who look 60, with few medical problems on few medicines and still working, and 60-year-olds who look 80, with multiple medical problems on multiple medications who need help for the day-to-day. As someone somewhere once said, “It’s not the years, it’s the miles.” And that’s it in a nutshell. The older adults I can help most are people 65 and over with a lot of miles on the odometer. This person typically suffers from multiple medical conditions, or is experiencing rapidly declining physical function or frailty, is taking a bag full of medications, or has an age-associated diagnosis like dementia, osteoporosis, or incontinence. Often, it’s all of the above, and there may be challenging social situations as well, like driving or home safety.
Leaders in the geriatric medicine field have come up with a pithy answer to the question, “When can geriatric medicine best help older adults?” It’s a memory aid called the 5 M’s: Mind, Mobility, Medications, Multi-Complexity, and Matters Most. This mnemonic is a common-sense, practical, reminder about the health issues with which geriatric medicine physicians–and others with special training in geriatrics—can be most helpful. Of course, there may be a lot to unpack when dealing with any of those “M’s”, not only the biology of disease but the accompanying psychological or social issues as well.
Consequently, there are two other indispensable aspects of being a geriatrician. Let’s call them the two “C’s”: communication and coordination. A geriatrician needs to be an expert and empathic communicator who can answer questions and help patients and families sort things out. I need to be able to help my patients prioritize their conditions, and medications and maximize their physical functioning and well-being. That’s the final of the 5 M’s which is “Matters Most.”
So, like a pediatrician, I am a hybrid. I am a physician who takes a holistic, whole-patient, primary-care perspective and also a specialist with expert knowledge of the diagnosis and treatment of the common diseases of older age. This knowledge includes not only biology but also psychosocial issues that may accompany the challenges of getting older. The goal is to help maintain the health and maximize the function and independence of my patients–help as best I can to add life to years. And that’s geriatrics.
Dr. Scott is UGA associate professor of medicine, director of geriatric medicine education at the AU/UGA Medical Partnership, and medical director of the C.A.R.E. Clinic. He will be happy to hear from readers with comments and questions. Feel free to email him at athensgeriatrician@gmail.com. His column will appear in these pages quarterly.
