From arthritis to diabetes, hearing loss to cancer, seniors are treated for a wide range of medical conditions, and they and their caregivers can face a sometimes bewildering array of doctors. Deciphering all the different specialties in medicine sometimes seems to require an advanced degree itself, but your health can depend on making the right choice.
So we’d like to help you with this guide to the types of geriatric care specialists that seniors are most likely to need for their health care. Some of the specialists may have advanced training and be specially certified in geriatrics, the care of seniors.
A geriatrician is a medical doctor trained in providing clinical care for adults 65 years and older. She or he can be either a family practice or internal medicine physician, but has additional training in geriatric care.
But, because the United States is facing a critical shortage of geriatricians, seniors are more likely to get the bulk of their medical care from their Primary Care Physician, who may focus on either family medicine or internal medicine. While seniors may be dealing with several medical problems at once, it’s best to start with a PCP rather than assuming they need to see a number of specialists.
“Seniors see, on average, 12 different physicians a year. But, that can be a recipe for disaster. They really need a medical home to help them coordinate the care they need,” explains Dr. Patricia Borman, Director of Advanced Training in Geriatrics at Swedish Medical Center in Seattle. “Only about 5% truly need specialty care.”
Seniors may see an audiologist to diagnose and treat hearing loss. It is estimated that hearing loss affects about 30% of people over age 65 and half of people in their 80s. The University of Florida reports it is the third most common chronic condition in seniors. Left untreated, hearing loss can contribute to depression and social isolation.
A physician that a senior is likely to see at some point is a cardiologist. A cardiologist is an internal medicine physician who specializes in the diagnosis and treatment of disorders of the heart and blood vessels. A senior may be referred to a cardiologist if they have coronary artery disease, heart failure, valvular heart disease or a congenital heart defect. A cardiologist may recommend a patient receive medication or a pacemaker or defibrillator to maintain their heart’s normal electrical rhythm.
If your parent has adult onset diabetes, chances are they will see an endocrinologist to help manage it. Endocrinologists specialize in the diagnosis and treatment of disorders of the endocrine system, which includes various hormones and glands such as the thyroid, pancreas, and adrenal glands. Type 2 diabetes can worsen the symptoms of other health problems occurring in seniors, so it’s important that diabetes is managed well.
FAMILY PRACTICE PHYSICIAN
If your doctor isn’t a geriatrician, she or he may be a family practice physician,who provides broad-based medical care for all ages, from youth to seniors. Many families prefer to have one family practice doctor familiar with the whole family’s needs. Family practice physicians can handle most of a patient’s routine medical care without referring out to specialists. For example, they could take care of minor dermatological problems without having to refer patients to a dermatologist.
Geriatricians take an interdisciplinary approach to health care. A geriatrician is trained to ask comprehensive questions about a senior’s overall quality of life-not just about their particular medical issue-to develop a personalized plan of geriatric care. For example, if a senior is complaining of back problems, a geriatrician will ask how that is impacting their life. Often, rather than just seeing a specialist to deal with the pain, what the senior really needs is help around the house, cleaning, or grocery shopping.
A geriatrician will then work with a team of nurse practitioners, psychiatrists, surgical specialists, pharmacists, social workers, and physical and occupational therapists to make sure their patient gets exactly the right kind of help.
A geropsychiatrist, also known as a geriatric psychiatrist is a medical doctor trained to evaluate, diagnose, and treat the mental health needs and specific syndromes faced by older adults. While many psychiatrists can provide help to seniors, geropsychiatrists have specialized training in senior care. They may prescribe medications and can also provide counseling.
A gerontologist may be a part of this team. Gerontologists study aging, but provide non-clinical geriatric care, such as social work. Gerontologists study the mental, physical, and social changes in people as they age, and how that affects society as a whole. They then use that knowledge to affect programs and policies.
Instead of a family practice physician, patients may prefer an internist. An internist is a medical doctor trained in the diagnosis and non-surgical treatment of diseases in adults (internal medicine). Internists may have subspecialties in allergy and immunology, cardiology (heart), endocrinology (hormone disorders), hematology (blood disorders), infectious diseases, gastroenterology (diseases of the gut), nephrology (kidney diseases), oncology (cancer), pulmonology (lung disorders), and rheumatology (arthritis and musculoskeletal disorders).
A nephrologist is a medical doctor specializing in kidney diseases, transplantation, and dialysis therapy. They may treat patients for short-term problems such as inflammation of the kidneys, or long-term problems such as chronic kidney disease or cancer. Some specialize in treating certain age groups.
A neurologist is a medical doctor or osteopath trained in the diagnosis and treatment of nervous system disorders, including diseases of the brain, spinal cord, nerves, and muscles. Neurologists will examine a patient’s muscle strength, movement, balance, reflexes, memory, speech, language, and other cognitive abilities. If your elderly parent has had a stroke or has dementia or Parkinson’s disease, a neurologist may handle their care. Neurologists may perform diagnostic tests such as CAT scans, MRIs, or spinal taps.
A Nutritionist or Registered Dietitian can assess how well a senior’s nutritional needs are being met. They may provide specific recommendations about which foods to choose and how to prepare them, and will work with seniors who experience appetite problems, weight loss, or difficulty chewing.
With a man’s lifetime risk of developing some kind of cancer at about 50%, and a woman’s risk at about 30%, one doctor a senior may see is an oncologist. Oncologists may specialize in certain types of cancer, as well as types of treatment. For example, a radiation oncologist will specialize in using radiation to treat tumors, while a medical oncologist will specialize in using drugs to treat the tumors, also called lesions.
Ophthalmologists are medical doctors who can diagnose and treat several vision conditions affecting the elderly, including age-related macular degeneration (AMD), which creates a loss of sharp, central vision needed for driving, reading and recognizing faces. AMD is the leading cause of visual impairment and blindness in Americans over 65. Ophthalmologist can also treat cataracts, which cloud the eye’s lens and are the leading cause of blindness in the world, and glaucoma, which causes the loss of peripheral vision.
Seniors interested in an alternative approach to medicine may want to choose an Osteopath. An osteopath is a doctor with training similar to a medical doctor, but she or he manipulates the muscular and skeletal systems to help the body heal itself. Osteopaths may prescribe medication, perform surgery, and often use manipulation techniques similar to chiropractic or physical therapy.
Next to their doctors, one of the most important health care professionals for seniors is their pharmacist. Seniors should pick one pharmacy and be on a first-name basis with their pharmacist. Dr. Borman explains that about 50% of all U.S. prescription medicines are for seniors, even though they make up only about 13% of the population. It’s important that seniors not only tell their doctor every type of medication they’re taking, it’s important that their pharmacist also know, to help them avoid dangerous drug interactions. Some pharmacists-called Consultant Pharmacists-specialize in geriatric care, and often work in nursing homes.
Physical therapists and occupational therapists are not medical doctors, but have specialized training in improving quality of life in people of all ages. For example, a physical therapist will help a senior recover mobility and strength after a fall, stroke, or surgery, and help them learn to use a wheelchair or transfer themselves from chair to bed. An occupational therapist will help seniors who have difficulty caring for themselves learn a different way to tie their shoes, dress, or bathe, so they can remain as independent as possible.
Another type of doctor frequently seen by the elderly is a Ppulmonologist. This physician practices a subspecialty of internal medicine: the diagnosis and treatment of pulmonary (lung) conditions and diseases. Emphysema, asthma, bronchitis, and pneumonia all require special care in seniors. Diseases of the pulmonary system affect the amount of oxygen-rich blood in the body, which could lead to heart problems such as pulmonary hypertension, arrhythmias, or heart failure.
A rheumatologistis an internal medicine physician who specializes in diagnosing and treating arthritis and other diseases of the joints, muscles and bones, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, fibromyalgia, and tendonitis.
SPEECH LANGUAGE PATHOLOGIST
A speech therapist may be needed after a stroke or injury that affects the voice or impacts a senior’s ability to swallow food.
A urologist is a surgical specialist in problems of the urinary system in both males and females, as well as the male reproductive organs. Seniors may see a urologist for conditions such as urinary infections, bladder cancer, incontinence, or sexual dysfunctions.
Finding the right geriatric care specialist who can treat you or your loved one appropriately is only part of the challenge. Because today’s doctor-patient relationships are more collaborative than ever, seniors need to find someone who truly listens to them. It’s not always easy to do, but you or your loved one’s good health depends on it.
Update: January 2018