Geriatricians: Specialized Care for Older Adults

As the population ages, the demand for physicians who understand the unique complexities of aging grows. Geriatricians are internists or family physicians with additional fellowship training in geriatric medicine, equipping them to manage the multi-system, multi-morbidity challenges common in later life.

Training & Certification

• 4 years medical school
• 3 years residency (internal medicine or family medicine)
• 1-2 years geriatric medicine fellowship
• Board certification in geriatric medicine (ABIM/ABFM)
• Some pursue subspecialty expertise (cardiology, oncology, palliative care, neurology)

Scope of Practice

Comprehensive Geriatric Assessment (CGA)

The cornerstone of geriatric care—a multidimensional, interdisciplinary evaluation covering:

• Medical: Chronic disease management, medication review (deprescribing), comorbidity interactions.
• Functional: ADLs (bathing, dressing), IADLs (cooking, finances, meds), gait/balance, fall risk.
• Cognitive: Screening for dementia, delirium, depression.
• Social: Support network, caregiver burden, housing safety, financial resources.
• Nutritional: Weight loss, malnutrition, swallowing issues.

Core Clinical Domains

• Preventive care: Age-appropriate cancer screening, vaccinations (flu, pneumococcal, shingles, RSV, COVID), osteoporosis management.
• Acute illness: Atypical presentations (e.g., confusion as only sign of UTI), rapid functional decline.
• Chronic disease management: Tailoring guidelines to life expectancy, goals, and frailty (e.g., less aggressive HbA1c targets).
• Geriatric syndromes: Falls, incontinence, delirium, pressure ulcers, sarcopenia, polypharmacy.
• Palliative & end-of-life care: Advance care planning, goals-of-care discussions, hospice coordination, symptom management.

Team-Based Approach

Geriatricians lead interdisciplinary teams: nurses, social workers, pharmacists, physical/occupational therapists, nutritionists, and caregivers. This model improves outcomes for complex patients.

When to See a Geriatrician

• Age 65+ with multiple chronic conditions (≥3) or medications (≥5).
• Functional decline, falls, memory concerns, or frailty.
• Complex medication regimen needing deprescribing.
• Caregiver stress or care coordination challenges.
• Transition planning (hospital to home, independent to assisted living).

Future Outlook

With the 65+ population projected to reach 80 million in the U.S. by 2040, geriatricians are essential. Career paths include clinical practice, academia, health systems leadership, policy, and home-based primary care. The American Geriatrics Society (AGS) offers resources for trainees and practitioners.