Geriatrics is the branch of medicine focused on the specialized healthcare needs of older adults, typically those aged 65 and over. Primary care is the provision of integrated, accessible healthcare services by clinicians who address a large majority of personal healthcare needs and develop sustained partnerships with patients. The question of whether geriatrics constitutes primary care is frequently asked because a geriatrician often serves as the main doctor for an older patient. While general primary care physicians (PCPs) treat adults across the lifespan, geriatricians possess additional, focused training to address the unique complexities of aging.
Defining Geriatric Medicine and Primary Care
A geriatrician is a physician who completes a residency in Internal Medicine or Family Medicine, followed by a one- or two-year fellowship focused on geriatrics. This specialized training positions the geriatrician as a primary care provider who possesses an advanced understanding of aging-related health issues. General PCPs manage common illnesses and provide preventive care for patients of all ages.
Geriatric medicine is essentially a sub-specialized form of primary care, similar to how pediatrics focuses on children. Geriatricians are board-certified physicians who specialize in diagnosing, treating, and managing the unique physical, cognitive, and social needs of the elderly. The majority of care provided by certified geriatricians, ranging from 78% to 90%, is primary care for their older patients. The core distinction lies in the specific depth of expertise concerning the aging process, especially for those with complex health profiles.
Distinguishing Clinical Focuses of Geriatric Care
The practical difference in care is most evident in three clinical areas where geriatricians concentrate their expertise.
Polypharmacy
Polypharmacy refers to the management of multiple medications and the potential for adverse drug events in older adults. Geriatricians are skilled at reconciling complex drug regimens and adjusting dosages for age-related changes in metabolism. They focus on deprescribing unnecessary or harmful medications to minimize side effects and interactions.
Atypical Disease Presentation
A second distinct focus is the recognition of atypical disease presentation, where illnesses manifest without the classic symptoms seen in younger adults. For example, a urinary tract infection or pneumonia may present as new-onset confusion or a sudden fall, rather than a fever or cough. Geriatricians are trained to look for these subtle, non-specific changes, including a decline in functional status or a change in appetite.
Functional Status Assessment
The third major focus is the assessment of functional status, which is central to maintaining independence and quality of life. This involves evaluating a patient’s ability to perform Activities of Daily Living (ADLs), such as bathing and dressing, and Instrumental Activities of Daily Living (IADLs), like managing finances and cooking. A decline in these abilities is a significant indicator of health changes that a geriatrician systematically addresses. This proactive focus on function contrasts with the general PCP model, which may be more disease-focused.
The Comprehensive Geriatric Assessment Model
The specialized care offered by geriatricians is delivered through the Comprehensive Geriatric Assessment (CGA). This holistic, multidimensional evaluation goes far beyond a standard physical exam. The CGA systematically assesses four main dimensions: physical health, functional ability, psychological health, and socioenvironmental circumstances.
The assessment is a multidisciplinary process involving a team of healthcare professionals. The team collaborates to identify a patient’s medical, social, and functional needs. This coordinated effort results in an integrated care plan that addresses the patient’s individual circumstances, not just a list of medical conditions.
The functional component of the CGA uses standardized tools, such as the Katz ADL scale or the Lawton IADL scale, to objectively measure a patient’s current level of independence. Psychological domains include screening for cognitive issues, like memory loss and dementia, and mood disorders such as depression. By synthesizing this detailed information, the geriatric team develops targeted interventions, such as fall prevention strategies or medication optimization.
Deciding When to Seek Specialized Consultation
The primary care provided by a geriatrician is valuable when health complexity exceeds the scope of general practice. A clear indicator for consultation is the presence of multiple chronic conditions, often defined as managing five or more separate diseases simultaneously. An unexplained functional decline, such as new difficulty with walking or dressing, also warrants a specialized assessment.
Consultation is highly recommended if a patient experiences frequent hospitalizations or emergency department visits, suggesting a lack of coordinated care. Complex medication management, especially taking multiple drugs that may cause side effects, is another strong trigger to seek a geriatrician’s expertise. Finally, any new or worsening cognitive issues, such as memory loss or confusion, should prompt a specialized evaluation for appropriate diagnosis and care planning.