Geriatric care

What Is Geriatric Care?

Geriatric care is a specialized field of healthcare focused on addressing the unique physical, mental, and social needs of older adults. It falls under the broader umbrella of Healthcare finance and is distinct from general adult medicine due to the complexities often associated with aging, such as multiple chronic conditions, polypharmacy, and varying functional abilities. Professionals in geriatric care aim to promote health, prevent disease, and manage the diverse health concerns of the elderly population. This comprehensive approach often involves a multidisciplinary team to ensure holistic support for an individual's well-being and independence. Effective geriatric care can significantly impact an individual's quality of life and reduce overall healthcare costs in the long run.

History and Origin

While interest in aging and age-related ailments has existed since ancient times, the formal establishment of geriatric medicine as a distinct medical specialty is relatively recent. The term "geriatrics" itself was coined by Austrian-American physician Ignatz Leo Nascher in 1909.²⁰,¹⁹ However, modern geriatric care, as it is largely understood today, gained significant traction in the mid-20th century. A pivotal figure in its development was British physician Marjory Warren, who, in the 1930s, championed the rehabilitation and active management of older patients in hospitals, emphasizing their potential for recovery and independent living rather than passive custodial care.¹⁸,¹⁷ In the United States, the field began to formalize more significantly in the latter half of the 20th century, with the first professorship in geriatrics established in 1977 and board certification for geriatric medicine initiated in 1988.¹⁶,¹⁵ Institutions like the Veterans Health Administration also played a crucial role in developing geriatric research and education centers starting in 1975.¹⁴,¹³

Key Takeaways

• Geriatric care provides specialized medical and supportive services tailored to the complex health needs of older adults.
• It often involves a multidisciplinary team to address physical, mental, and social aspects of aging.
• Effective geriatric care emphasizes functional independence, quality of life, and preventive care.
• Planning for geriatric care is an essential component of comprehensive financial planning and retirement planning.
• Despite growing demand, there is a recognized shortage of healthcare professionals specializing in geriatrics.

Interpreting Geriatric Care

Geriatric care is interpreted as a holistic and person-centered approach to healthcare for older individuals. It moves beyond treating isolated diseases to considering the individual's overall functional ability, cognitive status, social support, and personal values. When evaluating a patient, a geriatrician or geriatric care team assesses factors such as Activities of Daily Living (ADLs), medication regimens, nutritional status, and mental health. This comprehensive assessment informs a personalized care plan that seeks to maintain or improve the individual's independence and quality of life. The goal is not merely to extend lifespan, but to enhance "healthspan," ensuring older adults can live as fully and independently as possible.

Hypothetical Example

Consider Martha, a 82-year-old widow who lives independently but has recently experienced several falls and is forgetting to take her medications regularly. Her children are concerned about her safety and well-being. They decide to seek geriatric care for her.

The geriatric care team begins with a comprehensive geriatric assessment. This involves a detailed medical history, a review of all her medications, a cognitive assessment, a physical examination, and an evaluation of her living environment. The team identifies that Martha is on several medications that could contribute to dizziness, has early signs of cognitive decline affecting her medication adherence, and her home has tripping hazards.

Based on this assessment, the team proposes a multi-faceted plan. They adjust her medication schedule to simplify it and reduce side effects, recommend physical therapy to improve her balance and strength, suggest home modifications to reduce fall risks, and connect her with local services for medication reminders and meal support. This coordinated geriatric care helps Martha maintain her independence and reduces her risk of future falls and hospitalizations.

Practical Applications

Geriatric care has significant practical applications across various aspects of an older adult's life and the broader healthcare system. It plays a crucial role in:

• Managing Complex Health Issues: Many older adults live with multiple chronic conditions such as diabetes, heart disease, and arthritis. Geriatric care professionals are skilled in managing these co-occurring conditions, minimizing adverse drug interactions, and developing integrated treatment plans.
• Preventive Health: Geriatric care emphasizes preventive care and early detection of age-related issues through regular screenings and annual wellness visits. This proactive approach can prevent minor issues from becoming major health crises.
• Care Coordination: Older adults often interact with numerous specialists and healthcare providers. Geriatric care teams help coordinate this complex network of services, ensuring seamless communication and continuity of care, which is vital for effective health management.
• Financial Planning for Healthcare: Understanding the potential healthcare costs associated with aging is crucial for financial planning. Geriatric care can help families anticipate future needs and navigate funding options, including Medicare and other forms of health insurance. For instance, while Medicare Part B generally covers visits with a geriatrician, it typically does not cover geriatric care management services geared toward care coordination.¹²,¹¹ According to the Administration for Community Living, the U.S. population aged 65 and over represented 17% of the total population in 2020 and is projected to grow to 22% by 2040, highlighting the increasing demand for specialized elderly care.¹⁰,⁹

Limitations and Criticisms

Despite its crucial role, geriatric care faces notable limitations and criticisms, primarily concerning its accessibility and the broader healthcare infrastructure. A significant challenge is the severe shortage of board-certified geriatricians. In the U.S., there is approximately one geriatrician for every 10,000 older adults.⁸ This shortage is exacerbated by several factors, including fewer medical students choosing geriatrics fellowships—less than 42% of positions were filled in 2023—and the fact that geriatricians often earn less than general internists despite having more specialized training., Ma⁷n⁶y medical schools also do not extensively teach geriatrics as a core requirement.

Th⁵is supply-demand imbalance means that a growing proportion of older adults who could benefit from specialized geriatric care are unable to access it, often receiving care from primary care physicians or specialty care providers who may have limited training in the unique complexities of aging., Fu⁴r³thermore, while Medicare covers geriatric medical care, it generally does not cover comprehensive geriatric care management services, which involve coordinating care with various professionals, leading to potential out-of-pocket costs for beneficiaries., Th²e¹se systemic issues underscore the need for greater investment and training in the field to meet the evolving needs of an aging global population.

Geriatric Care vs. Long-term Care

Geriatric care and Long-term care are related but distinct concepts in the provision of services for older adults.

Geriatric care primarily refers to the medical specialty and comprehensive health management services provided by a geriatrician or a multidisciplinary team. Its focus is on diagnosing, treating, and preventing diseases in older adults, managing complex health conditions, and optimizing functional abilities and quality of life through a holistic medical lens. This can occur in various settings, including hospitals, clinics, and sometimes in the home, and is often covered by traditional health insurance plans like Medicare.

Long-term care, on the other hand, refers to a range of medical and non-medical services designed to assist people who have lost their capacity to care for themselves due to chronic illness, disability, or cognitive impairment. These services primarily help with Activities of Daily Living (ADLs) such as bathing, dressing, eating, and mobility, as well as instrumental activities of daily living (IADLs) like managing medications or household chores. Long-term care is typically provided over an extended period in settings like nursing homes, assisted living facilities, or through home healthcare. Financing for long-term care often comes from personal savings, Medicaid, or long-term care insurance, as Medicare generally does not cover most long-term custodial care. The confusion often arises because older adults receiving long-term care may also require ongoing geriatric medical attention.

FAQs

What age group typically receives geriatric care?

Geriatric care generally focuses on individuals aged 65 and older, though the specific age can vary. It is particularly relevant for older adults with complex health issues, multiple chronic conditions, or functional limitations that require specialized medical attention.

Is geriatric care only for people who are very sick or frail?

No, geriatric care is not exclusively for the very sick or frail. While it certainly benefits those with complex health challenges, it also focuses on preventive care and maintaining wellness for healthy older adults. Many choose to see a geriatrician as a primary care physician to proactively manage health as they age.

How is geriatric care typically paid for?

Geriatric medical care, including visits to a geriatrician and certain screenings, is generally covered by Medicare Part B and private health insurance plans. However, services specifically related to long-term custodial care, such as assistance with daily activities in a nursing home or assisted living facility, are typically not covered by Medicare and may require personal funds, Medicaid, or Medigap policies.

Can geriatric care help with financial planning?

While geriatric care directly addresses health needs, insights gained from a geriatric assessment can significantly inform financial planning. Understanding potential future healthcare needs and associated costs allows individuals and families to better prepare their finances, consider options like long-term care insurance, and integrate healthcare expenses into their overall estate planning strategies.