Your mother is losing her memory. Your father suffers from multiple illnesses. Your elderly spouse is no longer completely independent. This is often when we first hear about the geriatrician. But what does this specialty really cover? We asked a doctor.
France has around 2,400 geriatricians, which is largely insufficient given the aging of the population. According to INSEE, nearly one in three French people will be over 60 by 2030. “There are really not enough geriatricians, or even hospital places”warns Dr Cyril Roman, practicing doctor at HAD Dracénie (Elsan group). The specialty still attracts little young doctors. “It’s not necessarily a first choice”he admits. However, elderly patients want to stay at home, including at the end of their lives. “Patients are increasingly demanding to end their lives at home, but qWhen several illnesses are added with age, daily life sometimes becomes difficult”underlines the doctor.
What is geriatric medicine?
This medicine is not interested in a particular organ. Geriatric medicine focuses on a person as a whole – their illnesses, their home, their entourage, their lifestyle habits. It’s another way of healing. And with the aging population, it has never been more necessary. “Unlike a specialty dedicated to an organ, it will be more of a global care”explains Dr Cyril Roman, practicing doctor at HAD Dracénie (Elsan group). “We will consider the patient as a whole – his environment, the social context, the surroundings, the necessary supports.” The geriatrician is a doctor specializing in aging, not to be confused with the gerontologistwho studies aging more broadly without necessarily being a doctor.
At what age do you consult a geriatrician?
Certain aid linked to aging is accessible from the age of 60 — the APA (Personalized Autonomy Allowance) or entry into an EHPAD, for example. But in practice, geriatricians begin to see patients around the age of 75, often when several health problems accumulate or a loss of autonomy begins to appear. The most frequent reason for consultation? Memory disorders. “THE memory consultations are often the main gateway“underlines Dr Roman. Dementia, behavioral disorders, new cancer diagnoses in a vulnerable person — all situations where the geriatrician’s perspective makes the difference. Of the repeated falls, unexplained weight loss, significant fatiguedifficulties managing medications or a loss of autonomy after hospitalization can also lead to consultation. In all cases, your attending physician remains the first point of contact to assess whether referral is necessary. Consultations are carried out in hospital, in clinics, in certain memory consultations or sometimes directly at home via specialized teams.
What is the geriatrician for?
The geriatrician provides medical support to the elderly who are often faced with several illnesses and several medications.“It is sometimes complicated to balance treatments because we have more fragile patients with several concomitant pathologies”explains Dr. Roman. Doses must be adapted and side effects closely monitored. This is sometimes what justifies a short hospitalization, the time to find the right balance. The geriatrician can also re-evaluate prescriptions that have become too heavy or unsuitable. Mental disorders (anxiety, depression, behavioral disorders) are also part of the daily lives of geriatricians. A dedicated specialty once existed for this: geriatric psychiatry. “This is less and less the case,” observes Dr. Roman. This specialty still exists but remains unevenly developed depending on the region. Geriatricians also work, when necessary, with psychiatrists, neurologists, physiotherapists or social workers. Another central concept in geriatrics: fragility. An elderly person may seem independent on a daily basis but become very vulnerable after an infection, a fall or a simple change in treatment.
Medicine that comes to your home
This is one of the strengths of geriatrics: it moves. Mobile teams – doctor, nurse, psychologist, social worker – can intervene directly at your loved one’s home. “Seeing the patient at home allows us to assess the real environment and the daily difficulties that we do not necessarily perceive in consultation”explains Dr. Roman, who works within a home hospitalization structure. “We are here to support people as best as possible at home, in safety”he said. These visits also help prevent falls, adapt housing, coordinate care and relieve caregivers.
And Dr Roman sums it up simply: “Old age is not a pathology. But ultimately, when you have a lot of added illnesses, as you get older, everyday life sometimes becomes difficult.” An observation that says everything about the importance and urgency of this specialty.
Is this reimbursed?
Yes, consultations with a geriatrician are reimbursed by Health Insurance, like those of other specialist doctors. Reimbursement depends mainly on the doctor’s sector (sector 1 or 2), compliance with the care pathway and your mutual insurance.
