We as geriatricians are doctors who specialize in the care of older adults, usually aged 65 years and older. We take a holistic approach to caring for older adults. A well known geriatrician, Dr. Frank Molnar describes “The Geriatric 5 M’s” in highlighting the particular health considerations unique to older adults. These “5 M’s” are: Mind, Medication, Mobility, Multicomplexity, and Matters Most.
The American Geriatric Society estimates that based on research about 30% of older adults would benefit from seeing a geriatrician.
When considering the mind, geriatricians focus on mentation and cognition and assess if deficits are present. Some older adults experience normal aging of the brain, others have mild cognitive impairment (MCI), and some even progress to dementia. We have options for treating MCI and dementia. We commonly focus on helping older adults to keep their independence for as long as possible. We can also educate patients and their loved ones on coping with these diagnoses.
Some people experience delirium, a sudden change in baseline mental abilities. Older patients are at risk of developing delirium when they are hospitalized. Geriatricians strive to prevent delirium in the hospital, but when this is not possible, we foster families' understanding of the condition while aiding in patient recovery.
Another area of the mind that geriatricians think about is mood. Anxiety, depression, or a combination of both can be very problematic for older adults. We screen for such conditions and specialize in the treatment of them. We prescribe medicines which are safer for older adults who have multiple health problems. We can also prescribe those which have the lowest risk of interacting with other medications
Most older adults typically take several medications; some even take enough to consider it as polypharmacy, the taking of 5 or more medications. Geriatricians can address if medications are appropriate or if some are no longer needed.
Some medications may have unfavorable interactions with other medicines. We can recommend stopping certain medications or switching to safer alternatives. Any medication can have side effects. Sometimes it is difficult to tell if symptoms are a side effect of a medication or if symptoms are coming from an actual disease process.
Our bodies undergo many changes during aging, one of which is the way medicines are processed. This means that a dose of medicine that was appropriate in younger years may not be the best dose later in life. Geriatricians can fine-tune a medication regimen to account for the changes of aging.
Geriatricians focus on patients maintaining function and keeping their independence. We evaluate walking and balance problems with simple in-office tests. We also look at the many factors that cause falls which can ultimately lead to loss of independence, injury, or death. Our goal is to prevent a fall before it occurs. If a fall has been sustained and resulted in a broken bone, we start treatment to strengthen bones if appropriate. We also make recommendations to prevent future falls from occurring by addressing various factors that could have contributed to the injury.
Multicomplexity is the inherent complication of having multiple medical problems with each affecting the others. Geriatricians look at the big picture and take a holistic approach to addressing these complex problems. We evaluate frailty, an age-related decline in physical function and reserve in multiple body systems. We prompt older adult to focus on quality of life. We counsel and educate as diseases progress and help plan for the future.
As you age, it is very important to consider what matters most to you. Is your main goal longevity, living as long as possible at any cost? Is your intent to maintain a certain quality of life even if that means not living as long? Is your preference to be as comfortable as possible if you have an illness that will take your life?
Geriatricians can guide you through completing advanced directives, aligning your care preferences with your goals, and appointing a health care agent as the person responsible for carrying out your wishes if you are unable to communicate.
It is vitally important to share your wishes with both your healthcare agent and your loved ones. In the end, you don’t want to leave them guessing what you would want and saddle them with the worry and guilt of making wrong decisions. You can give them peace of mind in knowing they did what you wanted.
The time to see a geriatrician is when you need assistance in navigating the 5 M’s - Mind, Medication, Mobility, Multicomplexity, and Matters Most. We can support you as you age.
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I hope you enjoyed this post. Golden Oak Medicine PLLC is located in Asheville, NC. We are board certified geriatricians providing primary care services for adults 55 years and older.
References
American Geriatric Society, Geriatrics Workforce By the Numbers | American Geriatrics Society (accessed 2/18/2021)
Molnar F, Frank CC. Optimizing geriatric care with the GERIATRIC 5Ms. Can Fam Physician. 2019;65(1):39.
Molnar F, Huang A, Tinetti M. Update: the public launch of the geriatric 5Ms. Can Geriatr Soc J CME 2017 Apr 28. Available from: http://canadiangeriatrics.ca/wpcontent/uploads/2017/04/UPDATETHE-
PUBLIC-LAUNCH-OF-THE-GERIATRIC-5MS.pdf. (accessed 2/18/2021)
Tinetti M, Haung, A, Molnar F. The Geriatrics 5M's: A New Way of Communicating What We Do. Journal of the American Geriatrics Society.2017;65(9).
