A geriatric consultation may help when several health problems, a complex medication regimen and different treatment priorities make a care plan hard to coordinate. A geriatrician can work with the existing care team to assess the older adult's needs and develop a person-centered plan that reflects their goals.
When health needs and daily life collide
Older adults with complex needs may be managing several chronic conditions, a complicated medication regimen and help with daily tasks, according to Steven Counsell of the Indiana University School of Medicine. When treatment decisions involve several health issues at once, different priorities can be difficult to weigh together.
A consultation may be useful when the person's health care plan feels disconnected from what matters in daily life. In the GRACE care model described by Indiana University, a nurse practitioner and social worker reviewed a care plan with the primary care doctor in line with the patient's goals. One example was maintaining the ability to take part in valued social and religious activities.
How a geriatric team can bring care together
A consultation can include a broader assessment and coordination with clinicians already involved. The Integrated Care Team, a primary care model for older adults with complex needs, used nurse practitioner-led shared care supported by a pharmacist, family physician and geriatrician. Patients received a geriatric assessment and a person-centered care plan.
That team structure can help make medication concerns part of a wider conversation about health needs and treatment priorities. Geriatric training emphasizes interdisciplinary care, according to an American Geriatrics Society statement. Geriatricians typically work with nurses, pharmacists, social workers and other providers when caring for very ill patients.
Making room for goals before a hard choice
Care planning can happen over time, before a critical treatment choice arises. Amy Berman told a U.S. Senate committee that goals-of-care conversations are part of care planning and that seriously ill people often are not told their prognosis. She said people need to understand how ill they are and the likely course of illness to make reasonable decisions and plan for the future.
When treatment goals conflict, a conversation can clarify which outcomes the person values and what tradeoffs the care team should consider. A geriatrician can contribute to that discussion alongside the primary care doctor and other clinicians. For a person's specific health decisions or medication changes, they should talk with their own doctor.
What to bring into the conversation
A practical starting point is to bring the current medication list and describe the outcomes the person hopes to protect, such as daily activities that matter to them. This helps the care team consider medication questions alongside health conditions and personal priorities. It does not assume that one clinician should make decisions alone.
This page is general education only. It is not medical advice. Talk with your own doctor about your health.
Frequently asked questions
Does a geriatric consultation replace a primary care doctor?
It need not. Leslie Kernisan, a geriatrician who runs a direct-pay house call and consultation practice, describes her specialty consultations as complementing existing primary care.
Can care preferences be discussed before a serious illness?
Yes. Patricia Bomba's testimony to a U.S. Senate committee described advance care planning as planning for future medical preferences if a person loses decision-making capacity and said it is appropriate for adults of all ages.
How often had older adults discussed treatment preferences with a doctor before Medicare paid for advance care planning?
The authors of an article in Innovation in Aging, citing Kaiser Family Foundation data, reported that 27% had discussed their treatment preferences with a physician, though 88% considered it important.
Sources
- IU and Regenstrief GRACE study selected as landmark article in care of older adults (Indiana University School of Medicine)
- The Integrated Care Team: A primary care based-approach to support older adults with complex health needs (Healthcare Management Forum)
- Todd Semla testimony, The Future of Medicare: Recognizing the Need for Chronic Care Coordination (Senate Special Committee on Aging, May 9, 2007) (U.S. Senate Special Committee on Aging)
- Amy Berman testimony, The Right Care at the Right Time: Ensuring Person-Centered Care for Individuals with Serious Illness (U.S. Senate Special Committee on Aging)
- Testimony of Patricia Bomba, U.S. Senate Special Committee on Aging, September 24, 2008 (U.S. Senate Special Committee on Aging)
- Advance Care Planning: Contemporary Issues and Future Directions (Innovation in Aging)
- One Woman Brand: How one Doctor Started Over Again With a New Practice, a New Specialty and a Great New Outlook on Life, The Health Care Blog (The Health Care Blog)
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