A caregiving daughter brought up a common question during a Helping Older Parents Q&A call:
“How can I find a geriatrician near me to review medications, and help care for my mother with dementia?”
As you may have noticed if you’re a regular reader, I often emphasize the importance of spotting and reducing risky medications, especially those associated with falls or memory problems.
Understandably, this caregiver wants to find a geriatrician who can review her mother’s medications, and otherwise oversee her mother’s care.
Now, medication review is usually included in geriatrics primary 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 article, I’ll describe 3 places to look for geriatric primary care, and then 3 options for medication review.
Since this caregiving daughter’s family lived in Nebraska, I 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.
- 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 geriatrics 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.
- This webpage lists the University of Nebraska’s geriatric patient care 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 depend on 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 and ChenMed.
Where to look for a 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.
- Medication review is usually included in a geriatric consultation.
- Some medical centers have fall prevention clinics, which sometimes include a comprehensive medication review along with an assessment of other fall risk factors. To find a fall prevention clinic near you, try Googling “fall prevention 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 it 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.
This article was revised and updated in May 2023.
Jeanne Cronin says
My experience with geriatric care is this: I receive the best! medical care ever at the MGH Geriatric Consultation and Palliative Care Practice in Boston MA. I joined this practice when I was 65 and had the apprehension that I was going to many doctor appointments around the city. My neighbors also recommended this practice. Now I am 81 and the care I get and have gotten is superlative. I have ‘my’ doctor from a team of many, all of whom I have worked with one way or the other. We have nurse practitioners and physician assistants, all geriatric specialists. We have a wonderful social worker on staff. We are treated with kindness and respect and a lot of caring. I am so very grateful for this medical experience. When I take an elderly friend to his doctor “team” (not a geriatric practice) I make comparisons. Us geriatricks are tricky, with complicated problems, unusual complaints, confounding challenges. We don’t always hear or understand or react to information we are given. And cranky! and stubborn! and genuine and always loveable.
Leslie Kernisan, MD MPH says
Oh, this is wonderful, I’m so happy for you! Thank you for sharing your story. I hope others are able to find a similar experience for their care.
gisella gordon, RN says
My (young) PCP is leaving practice.
There is a regional crisis with PCPs retiring or leaving practice.
ALL PCPs at the University of Rochester have CLOSED PRACTICES.
As a retired Public Health Nurse (with public honors) – I know
there is a wide range of quality. I want to “vett” my PCP.
Very upsetting. Thankful for this blog.
Leslie Kernisan, MD MPH says
Thanks for sharing your story. Unfortunately it’s not a regional crisis, it’s a national crisis!
I wish I had an easy solution to offer but I’m afraid there is none…as a society we have opted to let mainly market forces determine how healthcare is provided, and for various reasons, the market does not value PCPs much.
Beth Krackov says
An avid reader of this site, I’m grateful for the issues presented and the information you provide. Helps me better care for older adults.
Any suggestions for those of us who don’t yet need a geriatrician (almost 70), but want an internal
medicine doc who is informed about aging issues? Are there any organizations for doctors who
have geriatric training or interests, but are not board certified? Or any other strategies for
finding a good internal med provider with experience in geriatrics? My wonderful internist will likely retire in the next couple of years.
Nicole Didyk, MD says
Thank you for being an avid reader and for letting us know that the information is helpful, Beth!
There are many “young” and healthy older adults in my practice! They’re often surprised to be referred to me, thinking they don’t need a geriatrician “yet”. They may not be the most complex patients I see, but we can usually find some recommendations to try to prevent disability and promote health.
I would check out the “Find a Geriatrics Health Professional” link at HealthinAging.org: http://www.healthinaging.org/find-a-geriatrics-healthcare-professional/
Dave deBronkart says
Hey Dr. K, remember me??? 🙂 Guess what: I’m ten years older than when we met ten years ago! Amazing how that works. I remember this chat so well: https://participatorymedicine.org/epatients/2013/09/lets-bring-e-patient-to-geriatrics.html
The good news is that ten years later a LOT more of my peers are interested in what you’ve been teaching here. I’m also just reading the terrific book “Elderhood,” which has far more relevance than a decade ago.
I ended up here because I too decided to start hunting for a board certified geriatrician, BEFORE it gets to the point where I urgently need one. Among other things as my own med list grows, I want to be certain about Beers issues. Indeed, in my state of NH, as you say, HealthInAging shows only ONE member in their database, though (just as you say) I get lots more if I google “board certified geriatrician near me.”
OTOH, as someone else said, CertificationMatters does not offer search at all: it only checks the certification of a given doc.
I’m taking the time to drop this here late on a Saturday night just to say PLEASE keep up the good work. Time is on your/our side.
Nicole Didyk, MD says
Hello Dave and what a treat to watch that clip from 2013! It’s really exciting to see how far Dr. K has come in her mission to bring geriatric education to older adults and their caregivers! Encouragement from advocates like you means the world to her, I know.
Sorry to hear that it’s difficult to find a geriatrician close by. We’re still in pretty short supply (here in Canada too). Don’t give up and please keep reading!
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.
Nicole Didyk, MD says
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.
I see an internist as a PCP. But I am 76 and thinking about finding a geriatrician. I have many issues that my current doctor seems to blow off. Also, she talks to me with her back turned, and I think she knows I can’t hear well. I am going to need a new doctor anyway because she’s retiring.
chava kern says
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.
Leslie Kernisan, MD MPH says
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.