A caregiver brought up a common question during a recent Q&A call:
“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.
Having a Geriatric Care Manager can also be invaluable. They know how to find Geriatricians and also provide medication management and oversight. It is not unusual for GCM’s to ask MD’s to relook at or reduce certain medications and become the advocate for their clients.
Agree! Geriatric care managers are a wonderful resource and I often recommend families consider working with a GCM.
My name is Ann Louise Chandler. I will be 87 years old in February 2019. I live on my own and manage pretty well. I have a son who is very supportive and lives close to me. We check with each other almost daily. I am unhappy with my primary care doctor and would like to see someone more in tune with my age-group, with a more wholistic approach, who is near Chelmsford.
Great that you are being proactive about your healthcare. I have suggestions in the article above. I would especially recommend looking for a clinic focused on older adults. If you can’t find either that or a health provider specialized in older adults, it might help to discuss your concerns with your usual health provider. Perhaps if you ask for certain things, they will find a way to provide you with more of what you want from them. good luck!
There just happens to be a medical school close to where I live. I never knew they had a division of geriatrics. That really makes things convenient for me.
Leslie, I can see how academic medical centers could help you with medical reviews. My grandparents are constantly getting sick, and it has really taken a toll on them. I definitely think that they should consider trying natural health care to see if it helps to make a serious difference.
I am always in favor of trying non-pharmacological approaches in older adults; it is often safer than using prescription drugs. Not sure what you mean by “natural health care”; supplements are poorly regulated in the US and are sometimes contaminated. Other alternative modalities can help people improve; depends on the modality and the problem in question.
I’m looking for a Geriatric Doctor near me . I’m 76 and live in Arnold. I’m close to south county Missouri . Do you know of a Doctor?
I don’t personally know of any Geriatricians in your region, but Dr. Kernisan has an article that covers this topic, and has some helpful suggestions. You can read the article here.
My wife and I have been looking for a good family health clinic that can care for our kids, her father who lives with us, as well as the two of us! I’m glad that you talked about looking for a clinic that has been molded to work with older adults when searching for a primary care option for her father. I think that if we could find a good family health clinic in our area that is good at helping all of us, we’d be really happy, so wish us luck!
I actually do not know of any clinics that are very good at both kids and geriatrics…the two groups have such different needs. So you may need to look for one type of clinic for your wife’s father, and then another for your kids, or perhaps you and your kids.
I am looking for a clinic that specializes in total analysis of a geriatric health. Even a check-in facility where a total examination, heart, lungs, stress, etc. is available. I live in the NYC area but can go to any facility that is considered the #1. Thanks
New York City has several medical schools, so I am sure several of them will have geriatric clinics or services that offer a comprehensive geriatrics evaluation. You can also try the Find a Geriatrics Health Professional Referral tool. Good luck!
So glad to find this page! I talked to a geriatric pharmacist several years ago and didn’t save the info. At that time, my mom was unwilling to talk to one, now she is. Issues I’m facing since moving to help my mom: none of her many doctors talk to each other, so they can only go by what she tells them; her primary care doc is basically worthless (sorry! I was the one who figured out she has Hashimoto’s), as was her previous doc, but she won’t change. She does not want me to go to appointments with her (I do understand still wanting privacy), but she does have some memory issues so I really have no idea what happens during appointments. I’m left with faxing my observations to each doctor, knowing that due to HIPAA they can’t contact me. As she has more issues, and now a car accident…. I’m exhausted myself!
Glad you found this helpful but sorry you are in a tough situation re your mom’s reluctance for you to be involved.
Yes, it’s unfortunately quite common for doctors to be bad at coordinating with each other, and then since things are often so rushed in clinic, health issues sometimes fall through the cracks.
Great that you are faxing observations to the doctors, that will almost certainly go into her chart and then the doctor has a little bit more of a duty to address it. I also have an article on HIPAA that explains when doctors can disclose information even if a patient doesn’t consent (basically, if the patient is lacking capacity and the clincian thinks the disclosure is in the patient’s best interest). You may eventually be able to get a clinician to talk more with you, esp if you remind them that they have some leeway if they think your mother is impaired:
10 Things to Know About HIPAA & Access to a Relative’s Health Information
Otherwise, if you are trying to get your mother to accept your involvement, you may want to consider hiring a geriatric care manager or a similar expert. They have experience persuading older adults to accept a little more help or involvement from family.
It certainly is tiring to keep trying to help under such worrisome circumstances. Good luck and try to take care of yourself while taking care of your mom.
I’m searching all over trying to find a geriatric pharmacologist. Someone qualified to look at medications from an orthopedist a psychiatrist and internist and a cardiologist. The person taking these is having some memory problems and it’s felt that she is taking way too much medication. Therefore I am seeking help
As noted in the article, you can try academic pharmacy clinics near you or try searching through the association of consulting pharmacists.
We’ve been looking for a good general health clinic, and I think that being able to get some tips would be nice. I like that you talked about finding a clinic thats designed to treat older adults, which I think would be great because we’re wanting help with my grandmother. I’m going to have to look for a good general health clinic and see what we can find!
Good luck finding something suitable for your grandmother!
I’m glad you pointed out that if you get a consultant for medications, you should talk about communicating the recommendations to your loved one’s usual provider. My mother-in-law is in need of medication quickly, so she could definitely benefit from the services of a consulting pharmacist. I’ll definitely remember to ask about the process of communication with her primary care provider!
My mother is reaching her golden years, and I want to find a good doctor that will take care of her and all her medical issues. Your article had some great tips for finding geriatric care, and I liked how you said to look for a clinic that’s been designed to provide good care to older adults. Thanks; i’ll keep this in mind when choosing the best doctor for my geriatric mother.
My Aunt will be 95 in December. She has had emergency gall bladder surgery about 4 months ago and since then has been in the hospital 3 more times in the past month and a half. Her primary doctor is so short with her, basically saying she’s getting old and to just deal with it. I have been talking to my family about finding her a doctor who’s primary service is with the elderly. We live outside of Tulsa, Oklahoma and have no idea how to go about finding a new doctor for her. Any suggestions from you would be greatly appreciated. Thank you, Susan
Oh, I’m sorry to hear this about your aunt’s doctor. It definitely sounds like she’d be better served by someone with more interest and training for helping people her age.
All my suggestions on finding a geriatric specialist are listed in the article. You may want to see if there is a PACE program in your area, and I also recommend considering any “senior care” clinics. Lastly, a new PCP with a better bedside manner might be an improvement. Good luck!
Your sites are extremely useful, just terrific. I’ve spent the whole day reading various pages, links and studies. Thank you.
BTW, the link on a “find a geriatrician” takes you to a search box that will only verify a physician whose name, and location you enter.
Under the Board Certified search it was also just a verification.
Neither brought a list of local geriatricians.
Thank you for your comment, I’m so glad you find the site useful.
I just tried the find a geriatrician directory at HealthinAging.org. You can just enter a state and it will show you geriatricians. However I’m not sure if it works well, because when I searched California, I didn’t see several of my UCSF geriatrics colleagues on the list, and I am pretty sure most of them are members of the AGS.
I imagine Google is more likely to bring you good results, and should be able to provide local results.
Hi there, thank you very much for your very informative site, I was using it when I was getting ready to see my internist for my physical exam. You are being very kind in helping people with their problems, questions, worries, especially nowadays, when it is so hard to find healthcare providers willing to get involved, and very hard to find good doctors that are seeing new patients.
I would like if I may to ask you a question about BNP test, never had it before, and had it done this time. I have not had any symptoms that can have anything to do with heart failure, but just this time have this test done and levels were 115 K/ul. So I started reading about reasons, that can elevate the levels. I was going through a lot of stress, my sleep was deprived, dehydrated. I decided to repeat this test next month. In your opinion, do you think I have a legitimate reason for an elevated level of BNP? I have never had any symptoms of heart problems, maybe occasional palpitation, but that is all, I am very active, working out, lift weights. Will appreciate your thoughts.
Thanks for your kind feedback! I’m so glad you find Better Health While Aging to be a good resource.
The natriuretic peptide system is involved salt, water and blood pressure regulation and is usually measured in people with heart failure. Its value in those without known heart disease is less well understood. A number of variables affect BNP readings, like the type of test used, age (higher normal values with age), sex (higher values in women), body mass index (lower levels with higher body mass index), and genetic factors
In studies of BNP levels in those without heart disease, an elevated BNP seemed to increase the lifetime risk of a heart issue, but it’s hard to say how this data would guide your doctor to make any medication changes or order any other tests. It probably just underlines the importance of keeping up those healthy habits, as well as keeping a closes eye on blood pressure and weight management, and quitting smoking if that’s an issue for you.
I hope your internist can offer some insight as well.