Older adults don’t necessarily need to switch to a geriatrician
My husband is 77, and I am 68. Our health deteriorated during the pandemic. When should we switch to a g erontologist for our general care? -- A.M.P.
Nearly all adult primar y care doctors, including family medicine doc tors and internists, have expertise in taking care of older adults, as older people tend to see doc tors more than younger people. However, geriatricians focus their practice exclusively on older people and have additional training in the special health- care needs of older adults.
There is no one right answer to your ques tion. If your regular primar y care doctor is handling all your medical needs, there ma y be no reason to switch. A geriatrician is most valuable in older patients who have multiple medical problems, patients who take a lot of medica tions, or patients whose functioning has recently deteriorated. Some geriatricians assume primary care for their patients, while others work collaboratively as consultants.
There are some so- called “g eriatric syndromes” ( dementia, incontinence, delirium, falls, pressure ulcers and others) that occur commonly, in which all geriatricians are experts. Some general physicians are less comfortable with managing these conditions. There are several new treatments in dementia requiring special expertise that only a few generalists have acquired. These treatments
DEAR DR. ROACH: ANSWER:
are often managed by geriatricians or neurologists with a subspecialty training in memory disorders.
Again, though, if your regular doc tor is treating your issues well, a person sa tisfied with their care doesn’t need to leave. But if they aren’t, a geriatrician is an excellent resource.
I was recently diagnosed with complex regional pain syndrome (CRPS), and I’m undergoing continuous testing. It was recommended by one of the man y doctors that I might want to tr y ketamine infusion therapy. But I’m getting mixed reviews. Do you have any thoughts on this approach? -- R. S.
CRPS is a poorly unders tood pain disorder that usually begins after trauma, such as a fracture, surgery or another injury.
DEAR DR. ROACH: ANSWER:
Initial treatment with physical and occupational therapy helps retain function of the affected area, which is usually a limb. When drug ther apy is considered, there are man y drugs that are shown to be useful in some people with CRPS, although there is no single trea tment that is effective for everyone. Pain management specialists will often try an injection called a sympathetic block, along with one or more s tandard medications for nerve- induced pain. Topical treatments may also be used in combina tion.
I don’t prescribe ketamine, but some of the consultants I refer to have used it. Ketamine is not a first- line treatment. The evidence supporting its use is limited to small s tudies and suggests that the benefit lasts around one to three months. As you say, most experts use ketamine as an infusion under observation instead of oral ketamine, which has a significant potential for harm. In the few patients I have known who received bene fit from ketamine, the infusions are repea ted every three months. Unfortunately, not everyone responds to it.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.