Specialty focuses on seniors

<p>In medical school, I learned that one of my jobs as a family physician would be to help my patients live long and die young. Although it may sound confusing, this is not a contradiction. It meant that I was going to learn to help my patients feel healthy and young until the day they died — at a very ripe old age. </p><p>So how do young doctors, years away from their own elder years, prepare to care for older patients? Although any family physician or internal medicine doctor can excel in the care of elders, geriatrics is also its own medical subspecialty. Geriatricians, already board certified in family practice or internal medicine, have earned a Certificate of Added Qualifications (CAQ) in the subspecialty of geriatrics.</p><p>Geriatricians have all completed at least four years of medical school, one year of internship, and two more years of residency to get their board certification. After completing those seven years of school and training, they complete a minimum of a one-year fellowship in geriatric medicine. Finally, after completing the fellowship, they must past a rigorous daylong exam to qualify for the CAQ.</p><p>Human physiology changes as we age; mental and social needs change, and our efforts to stay well become more challenging in a myriad of ways. The habits of a lifetime combined with our genetic inheritance come home to roost. The training in a geriatric fellowship recognizes these special needs and covers specific clinical knowledge and skills necessary for the comprehensive care of the elderly. </p><p>Geriatricians study the expected physiologic changes that occur as we age. With changing metabolisms, our response to medication is different than when we were younger. There is also a tendency to give a new pill for every new complaint and the dangers of “polypharmacy” can be especially dangerous. Medication management, done well, can save lives.</p><p>Geriatricians learn that certain diseases in the elderly present with symptoms unlike those of younger patients. They learn to tell the difference between the normal and abnormal signs of aging. They study a long list of physical problems that are characteristic of older patients, in addition to problems that are managed differently in older adults. They learn to provide hospital care, rehab care, nursing-home care, long-term care, home care and assisted-living care. They treat dizziness, incontinence and depression. </p><p>Elders have their own set of risks. A specialist who is trained to evaluate a patient's ability to safely function in his daily life can put medical problems into perspective. Geriatricians' physical diagnosis skills include evaluation of gait and balance. They learn that those who are immobilized, either by physical limitations or other lifestyle factors, are at risk for more health problems.</p><p>Geriatricians know their community's resources, facilities and rehabilitation services. They learn which diagnostic procedures are appropriate, select only those that might be helpful or necessary, and know how to interpret the results. Overtreatment is a recognized risk in geriatric care, leading to an increased incidence of iatrogenic illness — illness actually caused by a medical treatment or procedure. </p><p>They are taught to evaluate a patient's mental status, learning to tell the difference between dementia and a normally aging brain. This diagnostic ability can sometimes provide the opportunity for early treatment and can help the family prepare for inevitable changes.</p><p>Geriatricians are taught to deal with ethical issues, including advanced directives, decision-making capacity, health care rationing and end-of-life care. They work on their communication skills so they can explain proposed treatment plans in a way that promotes understanding, compliance and health-care team building. </p><p>Many geriatricians are committed to teaching other health-care professionals. There will probably never be enough geriatricians to provide necessary care to all seniors, but by teaching others, they can share their skills and spread their wealth of knowledge. They also function as consultants for other primary-care physicians, providing intermittent patient management visits to support other providers on the senior's health care team.</p><p>For geriatricians, the learning never stops. They attend continuing education conferences to keep up with new findings in their field. They must recertify their CAQ regularly. But that is not the only place they learn. Most geriatricians take great pleasure in sharing what only older people have to offer — life stories and a point of view unique to advanced age and a lifetime of experience. </p><p>Caring for the elderly is challenging, but physicians who choose this specialty find it rewarding. They know they have the opportunity to make an enormous difference in the quality of life for many. </p><p>Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and has been certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hand-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. E-mail comments to drkerr@the-doctors-inn.com.</p>