“How can I find a geriatrician to review medications, and help care for my mother with dementia?”
Although my recent posts have been about preventing falls, I’ve often emphasized the importance of spotting and reducing risky medications. That’s because medications are one of the easier risk factors to modify, when it comes to preventing falls.
Understandably, this caregiver — who lives far from her parents — wants to find someone to help her mother directly.
Now, medication review is usually included in geriatric primary care care. Geriatric care, after all, means healthcare modified to be a better fit with what happens as people get older. And being careful with medications is pretty integral to this approach.
But, although geriatric primary care is certainly worth looking for, it can be hard to find. (Read on for suggestions below.)
So it’s good to have a plan B, which can be getting a medication review — and fall risk assessment — outside of geriatric primary care. This can also be a good option if your parents are reluctant to change primary care doctors.
In this post, I’ll describe 3 places to look for geriatric primary care, and then 3 options for medication review.
Since the caregiver above is concerned about her parents in Nebraska, I’ve tried to find some examples in that area.
Where to look for geriatric primary care
Many people start their search by looking for a geriatrician to be a primary care doctor. It certainly never hurts to try finding one. Here are a few options to search:
- HealthinAging.org provides a Find A Geriatrics Health Professional referral tool. This database only includes professionals who are currently paying members of the American Geriatrics Society (AGS), so it will miss some providers who are board-certified in geriatrics but not currently in the AGS.
- CertificationMatters.org is a website maintained by the American Board of Medical Specialties. You can search to find board-certified doctors by specialty (e.g. geriatrics) and location.
- I’ve noticed that my own record on CertificationMatters.org is inaccurate in terms of whether I’m enrolled in “maintenance of certification.”
- If you want the best information on a particular doctor’s board-certifications, check the website of the related specialty board. Geriatrics is a subspecialty of internal medicine and of family medicine, so geriatricians are initially certified by either the American Board of Internal Medicine, or the American Board of Family Medicine.
It’s great to be under the care of a geriatrician. But geriatric primary care is best practiced as a team sport.
So I always recommend people look for a clinic that’s been designed to provide good care to older adults. As a bonus, many such clinics are good at working with family caregivers.
Again, it’s better to look for clinics and doctors that practice the geriatric approach, rather than to focus on finding “a geriatrician.”
Now, here are three places to look for geriatric primary care:
Academic medical centers: These are medical centers and clinics that are affiliated with a medical school. Most medical schools have a Division of Geriatrics that often sponsors a geriatrics primary care clinic. They may also sponsor innovative programs in eldercare, such as house calls programs.
- According to this webpage, the University of Nebraska Medical Center offers geriatric primary care, along with consultation services. They also have a “Home Instead Center for Successful Aging.”
PACE (Program of All-Inclusive Care for the Elderly) centers: PACE is a wonderful all-inclusive model of care which includes medical care, supportive services, and day center services. I recommend that all caregivers concerned about a frail older person consider PACE. The care is provided by an interdisciplinary team which includes doctors, nurses, therapists, and social workers. PACE programs currently are operating in 31 states.
- To learn more about PACE, visit “Who, What, and Where is PACE?” (The state-by-state list of PACE programs indicates that there may be a PACE program in Omaha, Nebraska.)
- Note that patients have to be nursing-home eligible in order to enroll in PACE. This usually means the older person needs help with Activities of Daily Living, but nursing-home eligibility varies state-by-state.
- PACE is covered by Medicare, but if the older person doesn’t also qualify for Medicaid, a monthly premium is charged.
Senior Health Centers. These are non-academic primary care clinics that are designed to meet the needs of older adults. They are worth investigating, although how good the care actually is will dependson the clinic, how well it’s set up, and how good the doctors are at addressing geriatric issues. As Medicare adapts to the growing older population, I expect these types of clinics will become more common.
- To look for this kind of clinic near you, try Googling for “senior health center + [name of location]”.
- I was not able to find any such clinic near Lincoln, Nebraska. Some senior clinics I have come across include Oak Street Health in Chicago, and Senior Care of Colorado. (The Senior Care page includes some interesting history regarding the financial issues that often affect whether such clinics survive without extra subsidies.)
Where to look for medication review consultation
Finding new primary care for an older adult can be difficult, and new patient appointments are sometimes not available for months.
If this is the case for you, consider looking for help getting a medication consultation. Here are three options to consider:
Academic medical centers: Many Geriatrics Divisions offer consultation services that are meant to complement existing primary care. As noted above, geriatric consultation is available at the University of Nebraska.
- Medication review is usually included in a geriatric consultation.
- Some medical centers have falls clinics, which will include a comprehensive medication review along with an assessment of other fall risk factors. To find a falls clinic near you, try Googling “falls clinic geriatrics + [location].”
Pharmacy consultations: Reviewing the medication list with a pharmacist can be a good way to identify medications to ask the doctor about. Although finding someone specialized in geriatrics is ideal, pharmacists are generally very knowledgeable about medication side-effects in older adults.
- If your parent lives near a medical school or university, see if there is a School of Pharmacy offering medication review. Although I didn’t find anything online at the University of Nebraska School of Pharmacy, I know that UCSF’s School of Pharmacy has been involved in such efforts.
- You can also ask the pharmacist at your parents’ retail pharmacy. In truth I have no experience with such consultations, so I’m not sure how comprehensive they are likely to be. But, it’s probably worth a try.
- If your parent is in a Medicare HMO, consider asking if a medication review is available.
Consulting pharmacists: The American Society of Consultant Pharmacists can connect you to a “Senior Care Pharmacist.” This is another service that I have no personal experience with, but may be worth trying.
- This type of medication review probably is paid out-of-pocket, although it’s possible that sometimes they are able to bill insurance.
If you do get a consultation for medications and falls, be sure to ask about the plan for communicating the recommendations to your parent’s usual primary care provider. Especially if your consultation took place with a pharmacist, you’ll need the regular doctor to implement any changes to prescription medication.
If you’ve had any experiences finding geriatric primary care or consultative services: what worked for you? I’d love to hear from you in the comments below. Bonus points if you’ve tried pharmacy consultation, as I have relatively little experience with these and I’d love to know whether I should be recommending this more often to families.