Fellowship Series: Geriatric

By: Nikki Clark, MD, FAAFP

Often people (mostly residents and medical students) ask why on earth did I choose to do a geriatric fellowship? My response is because it is the medicine of the future. While we are all aging, the fastest growing age groups are those born between 1946-1964. The Baby Boomers. The Silver Tsunami. The Grey Hoard. Call it what you will, but estimates are that by 2060, 98 million (24%) Americans will be >65! The demand for physicians to care for this population is tremendous, especially as we are living longer, higher quality lives. As a result of this, there is specific research that is including the aged in their studies rather than excluding as the tradition has been. This has led to the realization that what works for your 50-year-old doesn’t necessarily work for your 90-year-old. We have found that many medicines have more risks than benefits in our elderly compared to those in their middle ages. Goals of care will often shift from quantity of life to quality of life, which can often change as well. What one considered a “good life” in their 60s might be very different than in their 80s.  

The actual medicine of geriatrics is growing in part due to “the Silver Tsunami.” The Baby Boomer generation funded the extensive research into breast cancer because it was what was affecting them the most 25 years ago when they were in their 50s and 60s. This research led to the ability to diagnose and cure most breast cancers. Now that they are older, the disease plaguing this group is Alzheimer’s dementia. Their money and energy has shifted focus to research on risk factors and causes of Alzheimer’s dementia. This will lead to a treatment, and a cure in your lifetime, changing your practice much like insulin did in the 1930s!

We all have different reasons for going into our specialty; for me, it was the lifetime doctor-patient relationship that drew me to primary care and geriatrics. I really believe that working with your patient for 20 years, seeing them through the ups and downs, helps to better care for them. This is especially true in geriatrics. Due to the nature of aging, there are more health issues–chronic diseases, cancers, debility, loss of independence, etc. These often lead to lengthy discussions and decisions, which can be easier with a trusted, established relationship. This is challenging when you have 10-minute appointments. Most geriatricians tend to have longer appointment to get through these issues, allowing time for the benefits of that doctor-patient relationship which has been so important to me. Having more time means less pressure and the ability to address multiple, complex issues that this patient population often has. Identifying the patients’ goals of care and guiding them to achieve these to the end of their lives is quite rewarding.

The specialty of geriatric medicine, like all areas of medicine, is calling. Unfortunately, many young students and doctors ignore it thinking it’s not as sexy or exciting. I would argue that thinking is completely wrong. Geriatrics is the future of medicine and what is more exciting than that?

Nikki Clark, MD, FAAFP, serves as Faculty at Utah Valley Family Medicine Residency, Medical Director at Orchard Park Nursing and Rehab, and President of the Utah Academy of Family Physicians

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