Why the health system needs geriatricians

Geriatricians can make a big difference to your diagnosis, treatment and recovery. We look at their important role in the health system.

Wellington geriatrician and stroke specialist, Dr Gerry McGonigal (pictured) recently talked to Age Concern about the role.

Ideally, geriatricians should be part of every medical team treating older people. Ask your GP about access to geriatricians in your area.

Seniors' special needs

Older people's bodies are substantially different physiologically from other age groups'. Responses to medicines, treatments, and illnesses can all be different, presenting challenges to doctors not familiar with these changes.

Geriatricians are specialist doctors trained in the conditions that commonly affect older people and are well aware of these issues.

Like television's Dr House, they can be medical detectives, advising colleagues as they sort through symptoms that can be unique to older people, or more subtle than in younger bodies, or frustratingly contradictory.

Years of training and experience help geriatricians recognise the difference between what is normal ageing and what is in fact disease. For example, renal impairment may be a part of ageing but renal failure is not.

Most emergency admissions to hospitals are older people. Ideally, geriatricians should be part of the admitting clinical team and play a key role in acute assessment. Dr McGonigal emphasises the importance of having specialists in seniors' health distributed through the health system, including emergency care.

Older people's health issues include:

Multiple problems – a fever may lead to a fall, which leads to a 'broken hip'.
Diagnosis can be harder, because diseases may present in vague and non-specific ways.
Polypharmacy – there may be complex interactions between different medications that older adults are prescribed.
Some doctors can have "nihilistic" attitudes; they wrongly assume that they shouldn't subject older patients to procedures.
Awareness of the importance of knowing the level of support that older people have at home. It’s important they aren't sent home from hospital without a discharge plan.
On the other hand, some Maori and Pacific older people can have the opposite problem: families are so keen to 'take Nana home' and care for her, that the patient can miss out on rehabilitation.
People in rest homes also have a right to care in a hospital. There's a perception that "hospital level care" in a resthome means that they don't need to go to hospital, but this isn't true.
Some older people are easily stressed or disoriented if they're suddenly removed from their familiar surroundings; this can make them appear sicker than they are. Dr McGonigal advises that this 'hospital-induced delirium' is a problem that geriatricians are aware of and can advise on.

"What matters is what you can do – not your illnesses," Dr McGonigal advises. "Most so-called acute illness is decompensated chronic ill health."

He warns against the new catch-all diagnosis of "Acopia", which simply means that someone (the patient, caregivers, or clinician) isn't coping.

Geriatricians can act as advisers and team leaders for other medical staff, helping older people overcome this complex web of factors that can see them often perceived as difficult to treat or a drain on the health system.

Medical emergencies

You can make a difference if you suspect something's not right!

Some medical emergencies, such as strokes, can have much better outcomes if emergency procedures are used. For example, medication can reduce the seriousness of strokes if given within the first three hours.

Dr McGonigal's advice is to call 111 immediately if you think someone may be a having a stroke.

Emergency! Use the F.A.S.T. test if you suspect something's not right.

> VISIT 'recognising a stroke'