Seniors are treated for many conditions and face a confusing range of doctors. This guide to geriatric care specialists explains which professional treats what, and why starting with one coordinating doctor is the smartest move you can make.
Why Coordination Matters First
On average, seniors see 12 different physicians a year, which one expert calls a recipe for disaster. Yet only about 5 percent of seniors truly need specialty care; the rest need a coordinating “medical home.” That’s why it’s best to start with a Primary Care Physician (PCP) rather than assume you need a roster of specialists. Coordination also guards against dangerous medication mix-ups, especially since about 50% of all U.S. prescription medicines go to seniors, who are only about 13% of the population.
Generalist Physicians
- Geriatrician: an MD trained in clinical care of adults 65+ (family practice or internal medicine plus geriatric training). There’s a critical U.S. shortage of geriatricians, so most seniors are cared for by their PCP. Geriatricians take an interdisciplinary approach and ask broad quality-of-life questions; back pain, for example, may really signal that someone needs help with housekeeping or shopping. Their team can include nurse practitioners, psychiatrists, surgical specialists, pharmacists, social workers, and physical and occupational therapists. [As noted by Dr. Patricia Borman, Director of Advanced Training in Geriatrics at Swedish Medical Center, Seattle.]
- Gerontologist: studies aging and provides non-clinical care, such as social work, and shapes programs and policy.
- Family Practice Physician: broad care for all ages; handles most routine care without referrals.
- Internist: an MD in diagnosis and non-surgical treatment of adult diseases, with many subspecialties.
- Osteopath: training similar to an MD, but uses manipulation of the muscular and skeletal systems; may prescribe medications and perform surgery.
Medication Management
Stick to one pharmacist and be on a first-name basis. Tell both your doctor and your pharmacist every medication you take to avoid dangerous interactions. Consultant Pharmacists specialize in geriatric care, often in nursing homes.
Organ and System Specialists
- Cardiologist: heart and blood-vessel disorders such as coronary artery disease and heart failure; may recommend medication, a pacemaker, or a defibrillator.
- Pulmonologist: lung conditions like emphysema, asthma, bronchitis, and pneumonia, which can also cause pulmonary hypertension, arrhythmias, and heart failure.
- Neurologist: disorders of the nervous system; checks strength, movement, balance, reflexes, memory, speech, and cognition; treats stroke, dementia, and Parkinson’s; may order CAT scans, MRIs, or spinal taps.
- Geropsychiatrist: an MD who evaluates, diagnoses, and treats older adults’ mental health; may prescribe and counsel.
- Endocrinologist: thyroid, pancreas, and adrenal disorders; manages Type 2 diabetes.
- Rheumatologist: arthritis and diseases of joints, muscles, and bones, including gout, lupus, osteoporosis, and fibromyalgia.
- Oncologist: cancer; a radiation oncologist uses radiation, a medical oncologist uses drugs. (Lifetime cancer risk is about 50% for men and 30% for women.)
- Nephrologist: kidney disease, transplantation, and dialysis.
- Urologist: a surgical specialist for the urinary system and male reproductive organs; treats UTIs, bladder cancer, incontinence, and sexual dysfunction.
- Gynecologist: women over 65 may still need cervical and ovarian cancer screening.
- Ophthalmologist: vision conditions. AMD is the leading cause of visual impairment and blindness in Americans over 65, cataracts are the leading cause of blindness worldwide, and glaucoma causes loss of peripheral vision.
Allied and Therapy Professionals
- Physical and Occupational Therapists (not doctors): PT restores mobility and strength after a fall, stroke, or surgery; OT helps with self-care for independence.
- Nutritionist/Registered Dietitian: assesses nutrition and helps with appetite, weight loss, or chewing problems.
- Speech Therapist: needed after a stroke or injury affecting voice or swallowing.
- Audiologist: diagnoses and treats hearing loss, which affects about 30% of people over 65 and half of people in their 80s, and is reported as the third most common chronic condition in seniors [University of Florida].
The doctor-patient relationship should be collaborative. Find someone who truly listens.