The attending physician may refer an elderly person to a geriatrician when he notices a situation of frailty. Dr. Yves Passadori, geriatrician, reveals everything you need to know about this medical specialty.

Gerontology, definition

Geriatrics is characterised by the study of the sciences related to ageing and the elderly. The geriatrician can take care of people aged 80 years or 60 years affected by polypathologies, in other words, several pathologies present in the same individual, which are at the origin of a situation of physical incapacity or dependence.

A geriatrician or a gerontologist?

"Gerontology is a medical and human science that studies the problems of ageing. It also includes other sciences such as psychology, epidemiology and demography, which are involved in ageing issues. Geriatrics is therefore a branch of gerontology. A large majority of geriatricians are gerontologists because they need this global approach," explains Dr Yves Passadori, a geriatrician and Deputy Treasurer of the French Society of Geriatrics and Gerontology (SFGG).

When should a geriatrician be consulted?

The attending physician generally refers to a geriatrician when he/she observes a situation of frailty in the elderly. This specialist can in particular take charge of a patient affected by sensory disorders such as poor eyesight or deafness, neurological and cognitive disorders such as Alzheimer's disease, Parkinson's disease or dementia. It offers comprehensive care for the patient.

"In some cases, the general practitioner does not identify situations where he or she could call on a geriatrician. It could be interesting to have a real apprenticeship in spotting alerts of frailty in the elderly. Networking would make it possible to postpone institutionalisation by two or three years. For example, two falls per month should be an alert that prompts tests to be carried out," emphasises Dr Yves Passadori.

Geriatrics cannot cure chronic pathologies, whether cardiac, neurological (Parkinson's or Alzheimer's disease), rheumatological or vascular, but this medical speciality can prevent their aggravation or the complications associated with these conditions, particularly when the patient is affected by polypathologies. "We also evaluate the risk-benefit of therapies, because we cannot go too far when the patient is affected by several diseases," says the geriatrician.

The geriatrician carries out secondary prevention, especially after the diagnosis of cardiac pathologies. "The keys to good ageing are physical exercise, social life and nutrition. This helps to prevent loss of autonomy. Fragility in an elderly person can be biomedical, but also social, psychological and financial. It is very difficult to classify it because it is not necessarily noticeable," says the specialist. He adds, "Almost 20% of 80-year-olds still live at home and are not dependent, but they no longer have the same functional reserves. Running after a bus, for example, is more difficult than before.

The cascade phenomenon can be prevented by sport, activities that keep people mentally fit and a healthy diet. This is manifested in falls, malnutrition, infections and lower immunity in the elderly.

Geriatrician: which professionals work with this specialist?

Geriatrics is not an isolated profession, according to Dr. Yves Passadori. The geriatrician works in conjunction with various health professionals depending on the place in which he or she practices. The geriatrician intervenes in particular in re-education, rehabilitation, and dependency support, as well as in palliative, terminal, and end-of-life care.

In the elderly person's home, the geriatrician works in a team with the nurse, psychotherapist, speech therapist, and occupational therapist. This intervention generally takes place following a request from the attending physician for the care of a patient in a fragile situation. In a geriatric centre, this specialist deals with people over 60 years of age who are sedentary and under medical supervision. They may organise exercise sessions to teach them to adopt a healthy lifestyle in coordination with the general practitioner, nurse, and occupational therapist.

In the hospital, the geriatrician can support primary care. "During a day or week hospitalisation, we take stock of the geriatric syndromes. Management must be adaptive to the different diseases that can affect an elderly patient. We can't treat them all at the same time, otherwise, we risk endangering the life of our patient," says Dr Yves Passadori.

In a hospital rehabilitation department, the geriatrician collaborates with a large majority of health and paramedical professionals, including physiotherapists, speech therapists, adapted physical activity professionals, psychologists, occupational therapists, and psychomotor therapists. This multidisciplinary approach makes it possible to prepare for the patient's institutionalisation in a residence for senior citizens or in a long-term care unit.

During a short stay in the hospital, the presence of a physiotherapist and a psychologist is essential, in addition to that of the geriatrician. In the case of a patient with multiple diseases, it is necessary to keep him walking, otherwise, he will never walk again. The psychologist also plays a very important role with regard to attitudes of abandonment.

In which cases should a person be placed in a specialised institution?

First, the geriatrician assesses the situation, measures the incapacities and resources and identifies the resources that the patient can mobilise to cope with the incapacities. This consultation helps to determine whether the patient can be sent home or placed in an institution.

"For example, a patient who has had a cerebrovascular accident (CVA) that affects his mobility can no longer move on his own. A person must therefore change his position regularly to avoid the risk of bedsores, and it is necessary to install an adapted bed. In an institution, the change of position can be programmed every two to three hours, but it is almost impossible to do it at home," says the geriatrician.

Geriatrician: what studies are required to enter this profession?

There are two ways for a student to enter medical school: the specific health access course (PASS) or a licence with a "health access" option (L.A.S). If this first year is validated, he/she can be admitted to the common core of medical studies for five years. The future doctor then prepares for the national competitive examination (ECN) to begin his internship and specialisation. Since 2014, geriatrics is one of the specialities of the internship and lasts three years. Following the internship, the student can decide to continue his or her training for two to four years as a clinician or assistant.

Thanks to Dr. Yves Passadori, geriatrician and Deputy Treasurer of the French Society of Geriatrics and Gerontology (SFGG)