Q&A: When should you consult a geriatrician?

Doctor Suzanne Salamon, associate chief for geriatric clinical programmes at the Beth Israel Deaconess Medical Center in Boston, says problems like osteoporosis are becoming more prevalent as people live longer. Photo / Thinkstock

Exactly what is a geriatrician and when are you considered old enough to consult such a specialist?

Harvard Medical School's Health Letter published comments from Doctor Suzanne Salamon after she was added to the editorial board. She's associate chief for geriatric clinical programmes at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston and just the person to answer those questions. We asked her to elaborate.

Q: When should someone see a geriatrician? Do most of us need such a specialist?

A: The vast majority of older patients are doing just fine with their own internal medicine doctor. We tend to see patients who have many medical problems, are seeing multiple specialists and are taking many medications.

This can get complicated and difficult to coordinate, so some doctors feel their patients should see a geriatrician.

The definition of geriatrics, which is care of patients over age 65, is probably going to change to care of older, frailer people. The average age of our patients is 82.

Q: Do you have a philosophy about how to stay healthy as you age?

A: The more you keep active, the better. Whether you exercise on your own, dance to music or videos, go to the senior centre and join an exercise class or walk it doesn't matter as long as you are moving.

People are living longer. The problems of falling, of memory loss, of osteoporosis are more important.

Q: Is memory loss the biggest fear of ageing?

A: We probably will see more and more people with this problem, and many doctors will say that's normal with aging. And lots of time that is true.

About 50 per cent of memory loss is real dementia. Not just slowing down in memory. There is tremendous fear, more than there used to be. We don't yet know what causes it or how to prevent Alzheimer's.

Sometimes it is true that people forget, but Alzheimer's is a real disease and it's important to plan for that as a potential in your future. Don't try to live by yourself or take care of yourself if you are diagnosed with this disease.

Vascular disease causes about 25 per cent of the other cognitive decline in older Americans. By vascular disease, I mean disease that inflames and clogs up blood vessels that supply the brain. And in many cases, we can prevent that or at least keep it from getting worse.

The main thing older people can do about vascular disease is to get their blood pressure under good control. The top number should be below 140. Cholesterol has to be controlled and for many people, a baby aspirin a day can help.

Q: What about exercising the brain with crossword puzzles or so on? Do you think that helps?

A: I don't. But I do believe the brain should be kept active. Being social is associated with less depression, and depression can make cognitive decline worse.

Q: You said old age is not depressing?

A: I think that's how many people view ageing. You see people with canes and walkers. It all looks like such hard work. But surveys have found there is actually less depression among older people than commonly believed.

Q: What advice do you have?

A: Older people should establish a health care proxy who can make medical decisions for them. And if a parent is already cognitively impaired, it is very helpful if someone comes to the appointments with them.

Everybody will be old someday. Treat the ageing as you would want to be treated.

- AAP