What age should we become patients of a geriatric physician?

Hi Steve

IADLs are what you have to keep your eye on to know when you or your wife are slipping.
“Instrumental” Activities of Daily Living. Look this up as well as ADLs. Many health facilities use these as a guideline when assessing an elder for appropriate services.

Be aware as a caregiver and a senior yourself, your chances of passing sooner are increased. Often the caregiver passes before their loved one. So good for you to be planning next steps now. The more help you allow in, the longer you will be able to live at home if that is your desire.

Some retirement communities require early buy ins. If you see one in your future, begin your search soon.

Diet and exercise are still primary for the best life.

Books like “Being Mortal: Medicine and What Matters in the End” by Atul Gawande encourages us to focus on well being instead of just medical care.

Which doctor you use will depend to a degree on your insurance. Be careful when you sign up for Medicare. There is much to learn and best not to learn it the hard way.

I take my aunt (94) to a geriatric primary or I did pre Covid. She lives in a small town and we had to drive two hours one way for this doctor but it has really been worth it. We saw her once a year and have used telemed several times since Covid. She utilized home health services in order to age in place. She is now on hospice instead of home health.
As a widow with no children, she made it her mission to be friends with her bank, her insurance agent, her vet, her church staff, her neighbors, her stock broker, her pharmacy. It was easy for me to step in and help her as all her affairs were in order down to the opening and closing of her grave. The marker has been in place for years.
She has a daily aide now to help with ADLs. All her reoccurring bills were set up for auto pay.
She insisted that all her legal work be in order so that I had the ability to do whatever was needed for her.
She could have done better on the deferred maintenance of her home.
It’s good to find a plumber, a lawn service and a handy man to keep from making foolish decisions that wind up causing accidents. Someone you can use over the years. To keep you off the roof etc.

Doctors never mentioned not driving to aunt until I asked them to back me up. My parents quit when “they knew they had no business driving”. Be sure to ask your optometrist to let you know when you could benefit from an eye or brow lift to keep your vision sharp.

Embrace technology for all the shopping and deliveries that you can. Hire a regular housekeeper even if only for annual or semi annual deep cleanings. The mindset of accepting help will serve you well.

Maintain Or begin social connections for all the usual reasons but also to prevent becoming a victim of those who will take advantage of lonely elders.

The structure of work is a loss to many and it takes awhile to develop new patterns that are enriching.

And just know that even folks with children don’t necessarily have help as they age. The children are busy with their own lives and can cause a lot of stress as well as provide help.

Regardless of family we should all be prepared for the next stage of life. It’s coming. Ready or not.

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I did want to add I've found it helpful to see a specialist for any issue at least once. It’s very difficult for any primary to keep up with all advancements for all health issues. Going to a geriatric doesn't stop that ability. It’s usually the right insurance that makes it possible or not.

My observation of my mother's care at a regular MD tells me when ailments or tests are no longer considered worth the time or trouble, from dr perspective, it's probably time to move on to geriatric doctor who caters more to the needs of elderly.

Some examples: osteoporosis with several compression fractures that meant rehab in facility where she was released in worse shape than she arrived - and wearing a diaper. Another doctor advised Forteo shots, daily, two years for new dense bone growth. Family dr's comment, when I asked about that drug, said what's the point - she's XX years old. After using the Forteo 2 years, I asked at the annual exam if he was going to do bone density test. Again, what's the point, she's XX years old. The dr who ordered the forteo ordered a new bone density test. Her results were in the normal range (better than my own). There are other issues that were followed for years, but lately same response - what's the point, she's XX years old.

My point, as I explained to him, is she is old however my primary goal is to keep her walking. Knowing a problem lurks under the surface gives me a heads up on what to watch for. If it was important to test for it 5 yrs ago, it's just as important now. If they found some serious problem, would she want to go through the treatment??? Knowing her, the answer is yes. I would explain the pros and cons, but as long as she has a good mind, it's her decision. She is in no way ready to pass and would want treatments to fix problems. Her mother was over 100 when she passed, so to meet my goal of keeping her moving, I have to know how her health is doing.

With all this said - these are the kind of brush offs from a doctor that indicate it's time to find someone more in tune with the elderly. Unless you ask, none of the doctors are probably going to spend any of their 15 minute appt slot telling you about available resources. Multiple falls or failing health might open a conversation about you no longer being safe at home - with suggestion for some sort of facility care. Don't depend on it though. Ask what you need to ask at each appt, no matter what kind of dr you see.

As for driving, if you have any children or relatives - ask them to ride with you and give you a 'score' on how well you did. Perhaps ask them to do this with you several times a year. The dr would never know you have driving problems if you don't tell him - and it's possible you don't even know when you have problesm.

A good family doctor can take care of your through your entire life span. Geriatric specialists - and there are not many - are for those with problems usually associated with advanced age. Your wife's scoliosis can be managed quite well with an orthopedic doctor.

Now is the time to have regular examinations by your physician - family doctor or internal medicine - to establish a baseline. Make sure to get your regularly scheduled "special" examinations - eyes, hearing, dental, colonoscopy, PSA for men... to catch any problems early when they are much easier to address). 75% of seniors age 75 years and older have some mental decline or dementia. It might be a good idea to start getting screened for dementia now. In early stages, Alzheimer's disease and Parkinson's disease can be managed with medication.

Driving. There are people in their 90s that drive without problems and folks in their 40s that are terrors on the road. AARP has good ideas on driving for seniors. Basically, when a person can not see well enough or react appropriately, it is time to stop driving. Before that happens, consider living arrangements that make is easier to get to all the places you need to go OR consider what transportation is available in your area.

Housing. If you can manage your home care tasks and self care tasks without problems there is no need to move. My MIL has advanced Alzheimer's disease and can live in her condo with a caretaker/companion. Of course, this arrangement only works because of finances being available. Other people can get along with housekeeping services, food/grocery delivery, and home health aide as needed. If your home is multistory and mobility is already a problem, you might consider moving to a 1 story arrangement with a smaller, simpler lay-out. Assisted living and full care residential options are for those who can not manage home care and/or self care tasks and can not have those tasks met any other way. If dementia impacts your ability to remember medications and daily tasks, moving to assisted living makes sense.

Legal/Financial. Since you do not have children, it would be wise to talk to a lawyer who specializes in family law. He/She can advise you about legal documents such as power of attorney for medical and for financial matters, advanced directives, wills, DNR, and any other areas of legal concern covered by your area's laws. Only select totally reliable people for POAs. Otherwise, it might be wiser to allow the court to select a legal guardian for you if you become mentally incompetent. A banker can advise you about ways to streamline bill payments and their financial options if you become incapable of managing your finances.

I am an RN. My husband is 60 and I am late 50s so we are starting these discussions now. We don't many troubling long term health problems. So questions you bring up are ones we are discussing now.

First of all no one NEEDS a geriatric MD, if you are happy with whom you have now stick with that person. That is a hassle no one needs, unless you have a particular reason. Like maybe for a 2nd opinion if you don't like the opinion offered by the first person whom you seem to trust and have a good relationship with. Your regular MD can check you out or refer you to maybe a neurologist for questions related to your memory or functioning; some places via nursing homes with rehab may offer a driving assessment (you can also take on line courses to brush up your skills/knowledge and even get a discount on your insurance! Check out AARP! Do you love your home you are in? Then rather be considering assisted living you might want to consider investing in some modifications to make your own home more accessible. Will you need a ramp if there are steps? Or a stair lift chair? Modifications to a bathroom so you have no steps to climb into the tub? Grab bars (some are quite stylish now and even double as a towel rack. Maybe an emergency alert button? A knox box for your door so fire fighters etc can gain access in the event god forbid of an emergency? Some cities loan them out or take a small deposit. You may prefer hiring some regular in home help to assist rather than the expensive assisted living which can be a more regimented lifestyle. However you can get a feel for the places by touring them, having a meal, talking to others. Be sure to check into your local city and available resources for transportation or private hire. Not all geriatric MD's are cut from the same cloth as they say, and too often many MD's are clueless as to local resources. Many cities are covered by an Area Agency on Aging. Look yours up see if they have a resource guide they can send you. Also before you make any major decisions touch base with your local long term care ombudsman's office as they often know which places are better than others, have complaints etc. It's a major decision, take your time with it. It can be a good thing as far as being in a protected environment, but there are loads of rules as well. My aunt is in one and more of her meals wind up down the drain than in her stomach. They also make announcements in the morning over a PA system that can wake some later sleepers up, something I would find intolerable. But she does have friends there and there are opportunities, and for whomever outlives the other, there has to be some comfort in knowing the surviving spouse has that cushion of a familiar safe place and people around to support them.

Searching for a new PCP, I was disappointed to be told that the geriatric specialist saw 80-90 year olds.
I was raised in the generation that saw 60-65 year olds as aged.

A doctor who is a geriatric specialist may become my only doctor after 80+.

Early on in adulthood, my only M.D. was a gynecologist for many years.

Things change, especially now with managed care-they want everyone to have a PCP as a gatekeeper to keep costs low. That person can specialize in geriatrics.

With your wife's severe scoliosis, have her see a specialist-maybe a teaching hospital-that specializes in movement disorders-to keep her mobile. imo.

Unfortunately, we cannot plan in great detail, but the fact that you are plotting a course is admirable. Keep in mind that just before most doctors retire, they bring in a younger M.D. to take over their practice, and will introduce you.

Have you seen the (new?) walkers that allow you to stand erect while being supported? No leaning over or facing the ground trying to walk.

You can come here and ask many aging questions, at the very least you will get some resources and referrals.

There don't seem to be a lot of geriatric specialists in the KC area. It seems most of them are associated with SNC and AL facilities. Mom and Dad's PCP seemed to have experience with geriatrics - but her specialty was family/internal medicine.

When dad complained that I made him stop driving she said "Richard, we talked about that." In all honesty I didn't make him stop driving, but I did bring up to him that he should stop several times - so I guess I was guilty of nagging him into it.

Because of the pandemic and the safety issues of taking mom out to the doctor, I did have her switch to the physician associated with her CCC.

So my suggestion is, if you can't find a geriatric specialist to look for a family/internal physician that has experience with geriatrics.

I became a packet of my present PCP when his practice opened. He is probably now in his late 50s - early 60s.
At the time he was recommended as a “general practice physician” and he now identifies as a geriatrician.

I’m hoping HE LASTS as long as I LAST.

Since geriatrics is the care of the aging, it's reasonable to put yourself in the care of one now. They should help you navigate - hopefully delay or avoid - conditions (like frailty, chronic pain, balance) that can make aging so hard.
A good doctor will refer you to care management which can assist with non-medical assistance.
I have a friend who is a financial care manager, does banking and bill paying for elderly who don't have close family or whose family isn't near by. Had no idea such a thing existed; but it makes sense.
Aging does mean losing some abilities; but many things (nutrition, exercise, medication management) can be done to minimize the worst of it. A geriatrician can help you be prepared.

With a doctor your age, now is a good time to find a geriatric doctor for the time your doctor retires. It is usually a very sudden change when they do and you usually find out because your appointment is being cancelled and you must find a new doctor.

My husband and I have learned a great deal dealing with our parents older years and we put in writing, held at our certified elder law attorneys office, the instructions that we want for our lives. With the instructions that we want to be diagnosed by 2 specialists in the disease or injury, at the point the professionals determine mental incompetence our wishes are executed.

Your children will thank you for putting in writing what you want in your old, mentally disabled life. It leaves no decision for any of them and we put in that we knew we would probably say something different and to please ignore us, as we know that it is a real possibility that we will not agree with our choices made from a rational mind.

So in my personal opinion, you need a younger geriatric doctor lined up but, 1st you need to get together with a certified elder law attorney (www.nelf.org) to insure that your wishes and desires are in writing and governed by a licensed fudiciary or at least over seen by one to ensure that your wishes are being carried out.

It is a bit odd feeling when we are facing these issues, so be prepared for some emotional rollercoaster rides but, know that you are giving your children the very best gift you could ever give them. Taking on a parent's care is not easy and very traumatic to some, so kudos to you both for looking ahead.

Reasons to See a Geriatric Doctor

While there’s no set age to start seeing a geriatric doctor, most see patients who are 65 years and older. You should consider going to one if you:
- Become frail or impaired
- Have multiple conditions that require complex care and medication routines

source: https://www.webmd.com/a-to-z-guides/what-is-geriatric-doctor#:~:text=While%20there's%20no%20set%20age,complex%20care%20an%20medication%20routines

The "when to stop driving" thing may be tricky in your case... usually family members see declining driving skills and then act to alert the DMV and remove the vehicle to prevent driving. Doctors don't know and don't see your driving skills and don't do any direct reporting to the DMV. Perhaps you should consider giving someone legal authority to act in your stead? Do you have PoAs assigned? If you don't do this the county/state will become your guardian.