SOSMagOctoberDecember2021

Like Pediatrics, Geriatric Medicine is also a specialized field of practice. The difference is that Pediatrics has achieved mainstream acceptance and Geriatrics has not. Dr. Ardeshir Hashmi, Cleveland Clinic Endowed Chair for Geriatric Innovation and Section Chief Center for Geriatric Medicine points out that Pediatrics, as a field of medicine, was born after adult medicine. As a result, more children began living into adulthood and life expectancy increased. As a person about to turn 60, who lives in a county where 30% of its population is age 60+, I have to ask myself… Shouldn’t the same occur for older people if Geriatric Medicine had mainstream acceptance? Hashmi explained that the physiology of someone 60+ is different from a young or middle aged adult. “One would never treat a 10 year old and a 50 year old in the same way. Yet, the health care system seems to have no problem treating an 80 year old as if that patient were a 40 year old,” he said. Geriatricians are trained in treating older bodies. All are Board Certified Internists or Family Medicine physicians with additional Board Certification in Geriatrics. When they further their education in geriatric medicine, Hashmi explains, “We are trained to ‘unlearn’ what was taught in med school and residency and we ‘relearn’ medicine through a different lens. We see the same health problems, but as a Geriatrician, we will approach the treatment in a very different manner. In general medicine, when an older patient isn’t getting better another medication is often prescribed. Frequently, medications are as much of the problem as part of the solution.” Culturally, ageism is an unfortunate influence in health care. Hashmi knows why. “Medical training is often targeted at younger patients and heavily focused on additional medications or procedures. It is not tailored to age related changes. Therefore, doctors are trained to address medical challenges by treating the dominant medical concern. Very little Why Geriatric Medicine Needs To Become Mainstream By Sue Daugherty, Director time is spent to understand the unique needs of older patients and their physiology. For this reason, general medicine is often practiced using presumption or dismissiveness. This occurs when doctors are not trained to be aware of the possibility of alternative ways to effectively treat older patients. The use of presumption , Hashmi explains, is when it is presumed that the older person can be treated in the same manner that a 20 or 30 year old would be treated for the same condition. Dismissiveness is when the condition is seen as being “normal for your age” and the patient is led to believe that there is nothing more that can be done to improve the patient’s quality of life or functional health. As an older adult who desires to maintain my health and functional independence, it is clear that this will only occur when Geriatric Medicine becomes mainstreamed medicine. That means the health care system needs to be redesigned so it incorporates using the advice of Geriatricians -- “Consultative Geriatricians.” In November 2021, I will drive to my first “Successful Aging Visit” also called a “Geriatric Assessment” at the Cleveland Clinic. (I will write about it in the January 2022 issue of Serving Our Seniors Magazine.) I’m doing this because I want to have AND I want my primary care doctor to have a thorough and objectively measured “baseline” of my health and my capacity to function at age 60. As I continue to grow older, my doctors (a consultative geriatrician and a primary care doctor) and I will use this baseline to compare and monitor my functional health as I age into older adulthood. I believe that’s how health care should work for all of us who want to “live” in later life. Dr. Ardeshir Hashmi 4