Geriatricians provide primary care for older folks

Older adults coping with multiple medical conditions often need help coordinating their care and medications. That's where geriatric specialists enter the picture.

Geriatrics, a subspecialty of internal medicine, requires advanced training in conditions specific to aging and issues that affect an older population. Geriatric specialists, or geriatricians, focus on the health and well-being of older adults and the changes that sometimes occur with aging, such as falls, incontinence and dementia, according to the American College of Physicians.

Consider, say, a 66-year-old widow with diabetes and dementia who's never driven a car and has two adult children - a daughter who's busy with her own family and a son who's estranged from his mother. The woman might require a breadth of services: physical, cognitive and psychosocial, explained Dr. Irving Gomolin, chief of geriatric medicine at Winthrop-University Hospital in Mineola. But, he says, "If you're 85 years old and running a marathon and you have hypertension, you don't need to see a geriatrician."

SCOPE OF CARE

Geriatricians are often affiliated with multi-specialty groups or large health systems. They provide a range of services in a multitude of settings.

Winthrop geriatricians, for example, have an active outpatient practice providing primary care to older adults, Gomolin said. The division also consults on cases involving older hospitalized patients and makes visits to people in nursing homes and subacute-care rehabilitation facilities and, occasionally, at home, he said.

"The focus is often not the cure of a problem but the care of the problem, ensuring maintenance of functionality and mobility," said Dr. Gisele Wolf-Klein, director of geriatric education at North Shore-Long Island Jewish Health System in New Hyde Park and a professor of clinical medicine at Hofstra University School of Medicine, set to open in August 2011.

A geriatrician's expertise may be brought to bear, for instance, in dealing with a heart attack patient who has been hospitalized and has become extremely agitated, she said. Often, geriatricians make recommendations to reduce an older person's risk for adverse side effects and unwanted drug interactions caused by the use of multiple medications.

"That is something that we geriatricians are very, very attuned to," Wolf-Klein said.

SUPPLY AND DEMAND

With the aging of the baby boom generation, the demand for geriatric specialists continues to escalate. But the nation's supply of geriatric specialists remains woefully inadequate.

As of March, there were slightly more than 7,000 board-certified geriatricians in the United States. That's one geriatrician for every 5,000 people age 65 and older, according to the American Geriatrics Society, based in Manhattan. By 2030, the ratio will drop to one geriatrician for every 7,665 older adults, it says.

"The challenging reimbursement environment does not incentivize as many physicians as society needs to enter geriatrics," Gomolin said.

Federal health-care reform might bolster geriatricians' ranks. The Patient Protection and Affordable Care Act, enacted in March, establishes a national commission to study health-care workforce needs. The law also provides training opportunities and fellowships for health-care providers in short supply, including geriatricians.

THE LONG ISLAND SCENE

More than 370,000 seniors live in Nassau and Suffolk counties, including increasing numbers with multiple chronic conditions or diseases that impair their ability to perform activities of daily living, reports the Long Island Geriatric Education Center, a consortium of health-care institutions led by Stony Brook University Medical Center.

Since its inception in 2001, the consortium has trained more than 5,700 health-care professionals in the proper care of geriatric patients.