So when would a geriatrician be helpful in caring for the health of the older person?

1. (When to Refer to a Geriatrician)
MARC EVANS M. ABAT, MD, FPCP, FPCGM
Head, Center for Healthy Aging and Section of Geriatric Medicine
The Medical City

2. Outline
• Who is the geriatrician?
• What can a geriatrician
bring to patient care?

3. Disclosures
• Received honoraria for lectures
from: Nestle, Getz Pharma,
Sanofi Pasteur, The Medical
City
• Received honoraria for clinical
trials from: Novartis, Bayer
• Received travel grants and
support from: Nestle, Abbott,
Bayer, The Medical City

4. The Geriatrician
primary care doctors who have additional specialized training in treating
older patients
coordinate overall care with other physicians and guide the patient in making
treatment choices
manage all the health issues of an older patient, designing care plans to deal
with the whole person
https://www.hopkinsmedicine.org/health/healthy_aging/healthy_connections/specialists-in-aging-do-you-need-a-geriatrician
https://www.everydayhealth.com/senior-health/going-to-a-geriatric-specialist.aspx
https://www.aarp.org/health/conditions-treatments/info-2016/geriatrician-geriatric-doctor-physician.html

5. Education Committee Writing Group (ECWG) of the American Geriatrics
Society recommends that undergraduate students should be trained
profoundly in the 13 most common geriatric syndromes
dementia inappropriate prescribing of
medications
osteoporosis
depression incontinence sensory alterations including hearing
and visual impairment
delirium iatrogenic problems immobility and
gait disturbances
falls failure to thrive
pressure ulcers sleep disorders

6. What can a
geriatrician
bring to patient
care?
• Management of older person with
multiple co-morbidities and complex,
interacting problems
• Management of a peculiar clinical
manifestation in the older person
• Frailty and failure-to-thrive management
• Polypharmacy management and
medication rationalization
• Discharge planning
• Continuity of care including home care
• Palliative care
• Institutional care

7. Comprehensive
Geriatric
Assessment
Medical
History
Physical
Functional
Behavioral
Emotional
Environmental
Spiritual
Social

8. The older person with multiple co-morbidities and complex, interacting problems

10. Geriatrician’s role
• Management of most conditions in
the elderly
• Coordination of care, especially if with
need for more complex care
• Prioritize and stratify management
based on patient-centered goals
• Cure
• Palliation
• Quality of life
• Mobilize appropriate resources

11. Management
of a peculiar
clinical
manifestation
in the older
person

12. Case in point….
The unresponsive patient
The agitated patient
The patient who consults for “MASAMA LANG PO PAKIRAMDAM KO”

13. Geriatrician’s role
Acknowledging that
diseases can manifest
in many ways in older
personsHIGH INDEX
OF SUSPICION
Multitrack
investigation and
management of
interacting causation

14. Frailty and failure-to-thrive management

15. Frailty
a syndrome of physiological decline in
late life, characterized by marked
vulnerability to adverse health outcomes
Failure to thrive
not a single disease or medical condition;
rather, it's a nonspecific manifestation of
an underlying physical, mental, or
psychosocial condition; presents as as
weight loss of more than 5%, decreased
appetite, poor nutrition, and physical
inactivity, often associated with
dehydration, depression, immune
dysfunction, and low cholesterol

16. Geriatrician’s role
• Multitrack investigation and
management of interacting
causation
• Coordination of care, especially if
with need for more complex care
• Prioritize and stratify
management based on patient-
centered goals
• Cure
• Palliation
• Quality of life

17. Polypharmacy
management and
medication
rationalization

18. The use of more than 5
medications, some of
which may be clinically
inappropriate

19. Geriatrician’s role
Manage
Drug appropriateness
Interactions
Adverse effects
Rationalize medications
vis-a-viz appropriateness
Care goals
Quality of life

20. Discharge planning

21. Geriatrician’s
role
Comprehensive needs and provider
assessment
Comprehensive care planning
Accurate and effective hand offs
Procurement of needed tools/equipment
Discharge location preparation
Endorsement of care

22. Continuity of Care
patient's experience of a
'continuous caring
relationship' with an
identified health care
professional
delivery of a 'seamless
service' through integration,
coordination and the sharing
of information between
different providers

23. Continuity of care occurs when separate and discrete
elements of care are connected and when those
elements of care that endure over time are maintained
and supported.
http://www.cfhi-fcass.ca/Migrated/PDF/ResearchReports/CommissionedResearch/cr_contcare_e.pdf

24. Home Care
wide range of
health care
services that can
be given in your
home for an
illness or injury
usually less
expensive, more
convenient, and just
as effective as care
you get in a hospital
or skilled nursing
facility (SNF)

25. Home Care Services
• Doctor’s visits
• Nursing visits, chronic nursing
care
• Case management
• Procedural visits (doctor/nurses)
• Intravenous therapy (e.g.
fluids, antibiotics and other
medications)
• Foley catheter, Nasogastric
tube insertion
• PEG, tracheostomy
replacement
• Pain management
• Wound care and Ostomy care

26. Palliative care

27. Institutionalized
Care

28. Geriatrician’s
role
Case
management
Optimal geriatric
management of
chronic and
acute diseases
Optimal nursing
and ancillary
health
management
Optimization of
functionality and
degree of
independence
Minimization of
morbidities,
acute
hospitalization
Advance care
planning

29. In summary
• Referral to a geriatrician is recommended for
• Management of older person with multiple
co-morbidities and complex, interacting
problems
• Management of a peculiar clinical
manifestation in the older person
• Frailty and failure-to-thrive management
• Polypharmacy management and medication
rationalization
• Discharge planning
• Continuity of care including home care
• Palliative care
• Institutional care

30. Thank you for listening!