Geriatric medicine the branch of medicine concerned with all aspects of health and illness in older adults. It is the largest medical specialty.

Nature of the work

Geriatricians have an interesting and varied job which involves providing comprehensive medical care to older people, who may have may have several medical conditions and are often taking multiple

medications. The work also involves promoting better health in old age.

Changes that occur as a result of ageing mean that older people have different patterns of disease presentation when compared to younger adults, and they respond to treatments and therapies in different ways.

Common problems faced by elderly people include falls with or without fracture, delirium, dementia, incontinence, poor mobility and frailty.

Geriatricians may work in a variety of hospital and community settings including:

outpatient departments

A&E

medical assessment units

acute care wards (eg coronary care, high dependence, intensive care and acute stroke care)

rehabilitation wards

intermediate and long term care wards

day-care centres

care homes

hospices

Geriatricians provide a patient-centred, compassionate and holistic approach. They work very closely with GPs, other hospital doctors, social workers and many others involved in caring for elderly people including families and carers. Diagnosis and management of acute illness as well as chronic disease, disability and frailty is all part of the job.

Working very closely with other professionals in multidisciplinary teams (MDTs) is vital. With the integration of community care and health, NHS trusts work closely with community organisations to offer a joined-up service.

Providing rehabilitation after an illness is a key aspect of the work, and geriatricians will work with other team members to enable patients to work towards specific rehabilitation goals. Developing a good knowledge of physical treatments and adaptations and aids is important.

Another vital aspect of the role is enabling patients to be supported at home rather than being admitted to hospital and to enable those who have been in hospital to return home where possible. Planning the effective transfer of frail older patients from hospital can be complex and the geriatrician is closely involved in this process.

During training geriatricians need to develop competence in palliative or end of life care and planning, orthogeriatrics (medical care for people with orthopaedic trauma), old age psychiatry and specialist stroke care.

Older people may react differently to drugs and geriatricians need a comprehensive knowledge of adverse drug reactions, drug interactions and how these might be affected by different diseases.

Understanding the legal and ethical issues surrounding work with elderly people is important, including appointment of power of attorney, guardianship, mental health legislation and resuscitation.

Consultants are involved in the effective management of geriatric services and there are also ample opportunities for research.

There are also many opportunities to develop special interests within the specialty. These can be based around a particular stage in a person’s illness (known as temporal) or based around specific disease

processes. Most geriatricians enjoy looking after a wide range of conditions.

“Every patient brings a different challenge and no two days are the same” Adam Gordon Consultant geriatrician and clinical professor in medicine of older people.

Common procedures/interventions

These include:

performing a comprehensive assessment of an older person, including mood and cognition, gait, nutrition and fitness for surgery, including physical examinations where necessary

assessing a patient’s suitability for continuing care in the NHS or community

assessing the outcome of rehabilitation

Understanding Geriatric Medicine

Aging as a specialty

Geriatric Medicine is a specialty that focuses on medical issues and diseases of aging, and of old age. A Geriatrician most often treats people over the age of 60 who are either healthy or have multiple medical issues.  Medical care becomes more complex as you age and encounter more medical conditions.  A Geriatrician is an expert in how medical conditions impact one another, in how each medication interacts with others and how both medical conditions and medications uniquely affect you as you age.

Your doctor, your specialist: One place, one person

In order to become a Geriatrician a doctor must be certified by two separate medical boards.  Geriatricians like other medical doctors are certified in either internal or family medicine as a foundation, but then they intensively work with patients ages 60 and older to qualify to become board certified in geriatrics. The benefit to you is that with every appointment you see both your doctor and your specialist, all in one place and one person.  

Continuity in care

A person should choose a geriatrician because as they age they are not just your doctor and specialist, but in times when other specialists are needed, they also manage your care and work directly with those specialists making your care seamless by using a team approach.

Taking that care a step further, the physicians in the UNC Center for Aging and Health are actively training physicians, fellows and residents in other departments to respond more effectively to you, no matter where you are within UNC. We have board certified geriatricians in family medicine, oncology, palliative care, social medicine, pharmacology and emergency medicine.

I'm not geriatric!

Right now you are thinking, "I am healthy, active, fit and I do not need a specialist in aging. I am not Geriatric."

Encountering patients who are proactive with their health, diet and exercise is wonderful, because that is exactly what everyone, to the best of their ability, should do.  This is how you maximize your ability to age gracefully both physically and mentally, but there is even more you can do.

The word Geriatrics most often brings to mind the image of advanced age and a state of severely declined health. What Geriatrics actually refers to is a highly specialized field of medicine that encompasses all of the things that make aging an incredibly complex balancing act. This is true not just because you are aging, but because your individual health as you age is exactly like your fingerprints, entirely unique.

Your Geriatrician is a specialist in how your body will naturally change over the age of 60, in how all of your medical conditions impact each other, in how every medication you take affects you and affects all of your other medications.  

Geriatric Medicine is also a team environment.  As other specialists are required in your care, your Geriatrician, as your overall health manager, will often talk directly with your specialists.  Together we identify the best treatment for you based on all aspects of your current health.

You have planned in so many ways for your best possible future.  You have ensured things that are important to you are not just handled, but planned and managed.  Why not take the same proactive approach now with your healthcare? Make sure your health portfolio is well-managed by the one person, a specialist so your care proactively changes with you and manages all of your medical care.

Do you have arthritis? Have you had cancer? Do you have old sports injuries? Are you taking medication for a thyroid disorder? How about osteoporosis, allergies, diabetes, high blood pressure, pain or sleep problems?  Each new medical condition not only impacts you physically making care more complex, but as we add more medications for each new condition, and take into consideration common over-the-counter medications and supplements, well, management of medications alone becomes complex and critical.