The right doctor at the right time: Geriatricians focus on healthy aging for older adults

In just 15 years, people in the U.S. over the age of 65 will outnumber children for the first time in history, according to the U.S. Census Bureau. 

The aging population comes with a new set of health care challenges. This month’s news of former President Jimmy Carter’s hospitalization after his third fall this year may feel familiar to middle-aged adults trying to help their parents navigate a new stage of life.

Geriatricians, doctors who are specially trained to care for older adults, can be an invaluable resource.

“A geriatrician has specialized medical training for older adults,” said Amanda Overstreet, D.O., who is board certified in geriatrics and oversees geriatrics education for internal medicine residents at MUSC Health. “One reason it’s important is the physiology of an older adult is different than the physiology of a younger adult.”

Despite the aging population, geriatrics remains an undervalued specialty, Overstreet said. Medical students aren’t exposed to many geriatric specialists simply because they are few and far between. For example, she said, she joined the faculty of MUSC in 2016 and “that year, I was the only new geriatrician in the state of South Carolina. So that just gives you a sense of – there are just not many of us.”

But MUSC is working to change that. It launched a new geriatric fellowship program in July, said Mark Newbrough, M.D., a geriatrician who oversees the fellowship.

The fellowship will be a cornerstone for program development that will help MUSC better meet the needs of the community, he said. The program has two slots, one of which is filled this year. He expects that specialists trained through this fellowship will likely remain in South Carolina. The program also will facilitate development of additional programs and training of other health care professionals in addition to physicians.

In addition to training geriatricians, MUSC incorporates geriatric training for family and internal medicine residents. Overstreet supervises the internal medicine residents, all of whom complete one-month rotations working with her and her patients in an outpatient setting, as well as in the neurology, memory and movement disorders clinics and the Community Living Center at the Ralph H. Johnson VA Center and on the hospital consult service.

Overstreet, whose patients are all over the age of 70, said they run the gamut from frail centenarians to people in their 70s who regularly play golf and tennis. Although some patients come to her because they’re worried about possible signs of dementia or because they need help managing a health condition, others just want someone familiar with the health needs of older people.

“I think some patients recognize that their bodies feel different as they age, and they want someone that specializes in caring for older adults,” Overstreet said.

Geriatricians focus on healthy aging by understanding how the body changes with time, she said. As people age, they lose body water and lean muscle, regardless of whether they exercise. Kidney and liver function naturally decline with age. These changes mean that older adults are more susceptible to dehydration and their bodies metabolize medication differently, so doses that might be fine for a younger adult could be unsuitable for an older adult. Skin becomes less elastic, so minor bumps that might not have caused injuries in the past can now cause tearing.

When it comes to hospital admissions, older patients are more at risk of certain complications like delirium. To help manage care, Newbrough provides a geriatric consultation for surgeons and other doctors. He primarily works with trauma and general surgeons but also consults with services like neurosurgery and urology.

Not only are geriatricians trained in the physical aspects of caring for older adults, they can also help people deal with the unwelcome challenges of aging, such as not being able to live independently. Geriatricians can also provide counseling and care coordination around end-of-life issues, Overstreet said.

With changing population demographics, the need for these specialists will only increase. There’s already a greater need for community support systems, Overstreet said.

“How do we help people live as well as they can? Some of that comes from having the right doctor, but some of that comes from having the community supports in place, which we struggle with in this state,” she said.

However, Newbrough noted that as reimbursement models changes, it makes sense for health care institutions to develop their geriatric workforce to provide efficient, holistic care for older patients.