Geriatricians focus on what matters most
By Jay Nachman
A national initiative for age-friendly care focuses on the four Ms: what matters, mentation, mobility and medication, according to the Institute for Healthcare Improvement.
“Those four Ms are what geriatricians focus on, but we’re also making sure we’re not making recommendations or treatments that adversely affect any of those,” said geriatrician Dr. Lisa Walke, chief of the Division of Geriatric Medicine at the University of Pennsylvania Perelman School of Medicine.
Geriatric care begins with determining what matters most to the patient. For example, what matters most to one older adult may be remaining independent. For another person, it may be longevity. “Depending on what matters to you, there might be a different path you go with either treatments or interventions, or things you do, because what matters to you is what’s going to drive our decision making,” said Dr. Walke.
Mentation means optimizing a patient’s brain health by making recommendations on how to keep thinking sharp and what to avoid that might negatively impact the brain.
Regarding mobility, Dr. Walke works with patients to make sure they are as functional as possible and able to do as much as they would like and can do.
As people age, their bodies may not respond to medication the same way they did when they were younger. Because of these physiologic changes, geriatricians may decrease or deprescribe medications that are likely to have adverse effects. They may also lower the dosage or switch to a different medication.
As people live longer, there is an emphasis on living well. “We focus on wellness, not just longevity for longevity’s sake,” said Dr. Walke. “You want to live longer, while still being able to do as much as you enjoy doing and being functional.”
Increased longevity for older adults also means that geriatricians must focus on whole-person care. This might include helping older adults think about financial planning, which people wouldn’t necessarily think of as health care. Older adults need to have enough income and resources to cover a longer lifespan.
“Do they need to have long-term care insurance? If they needed (financial) assistance, how would they get it? People need to include that in their plan for their financial well-being,” said Dr. Walke.
Older adults are the fastest-growing segment of the population. There are more than 65 million older adults and approximately 7,000 geriatricians in the country, Dr. Walke said. As longevity increases, there will be fewer doctors specializing in geriatrics to treat older adults.
To address the anticipated geriatrician shortage, the federal Geriatrics Workforce Enhancement Program funds institutions to develop programs that increase geriatric knowledge among trainees and engage older adults and family members in aging issues. “The government is trying to help expand the knowledge base of everyone as well as trying to get more people to specialize in this field,” Dr. Walke said.
The good news in the geriatrics field is that new treatments are proving helpful for treating older adults faced with dementia. Following decades of research, there are what Dr. Walke called “game-changing” treatments that may reverse the trajectory of Alzheimer’s disease. These treatments lower the amyloids, a plaque-like substance, that gets tangled in the brain and causes Alzheimer’s disease. By lowering the amyloids, these new infusion treatments may improve cognitive function.
Dr. Walke also points to artificial intelligence (AI) and other forms of technology as cutting-edge areas that will provide benefits for older adults. There are many tech companies that are investigating what technologies can help older adults live independently in the community, she said.
“I love geriatrics because I often feel that I get more than I give in the field, and that’s what attracted me to going into the field to begin with,” Dr. Walke said. “People tend to get more generous with their wisdom and experience over the years. I have enjoyed people sharing their advice or wisdom with me, and as I’m trying to help them live their best life, they’re trying to do the same for me.”
Jay Nachman is a freelance writer in Philadelphia who tells stories for a variety of clients.
