A geriatrician is a doctor who specializes in the health care of older adults, typically those over 65. These physicians complete additional training beyond standard medical school and residency to focus on the unique and often overlapping health challenges that come with aging, from memory loss and falls to managing a long list of medications safely.
What Geriatricians Do
Unlike a primary care doctor who sees patients of all ages, a geriatrician focuses specifically on conditions that become more common and more complex in later life. These include delirium (sudden confusion), dementia, falls, frailty, urinary incontinence, malnutrition, and osteoporosis. What makes many of these conditions tricky is that they rarely have a single cause. A fall, for instance, might involve weak muscles, a blood pressure medication causing dizziness, poor vision, and an unsafe home environment all at once. Geriatricians are trained to untangle these overlapping factors rather than treating each one in isolation.
A large part of the job involves medication management. Older adults frequently take five or more prescription drugs, a situation called polypharmacy. Each additional medication raises the risk of harmful drug interactions and side effects. Geriatricians use structured tools to review every medication a patient takes, weigh the risks against the benefits, and discontinue drugs that may be doing more harm than good. This process, known as deprescribing, can reduce confusion, lower fall risk, and improve quality of life. One widely used framework, the Beers Criteria, identifies specific drugs that should be avoided or used cautiously in older adults because of age-related changes in how the body processes them.
Training and Certification
Becoming a geriatrician takes significant training. After medical school, a physician completes a three-year residency in either internal medicine or family medicine. They then complete an additional 12-month fellowship in geriatric medicine, which focuses on the clinical, cognitive, and social dimensions of aging. Board certification is awarded jointly by the American Board of Internal Medicine and the American Board of Family Medicine after the physician passes a certification examination.
How Geriatric Care Differs From Standard Care
The defining feature of geriatric medicine is a comprehensive, team-based approach. Rather than focusing on a single disease, geriatricians coordinate with nurses, pharmacists, social workers, physical and occupational therapists, dietitians, and sometimes psychologists or palliative care specialists. The team collectively sets goals and shares responsibilities. If a patient’s biggest challenge is navigating insurance and home care services, the social worker may take the lead. If the central issue is a complicated medication list, the pharmacist steps forward. The physician writes the medical orders, but the care plan reflects input from everyone involved.
This model exists because aging rarely presents one clean problem. A 78-year-old who comes in after a fall might also have early cognitive decline, depression, chronic pain, and a caregiver at home who is burned out. A geriatrician’s evaluation, called a comprehensive geriatric assessment, looks at all of these dimensions: physical function, mental status, nutrition, mood, living situation, and even whether the patient can still manage daily tasks like bathing or cooking. The goal is not just to treat disease but to preserve independence and quality of life for as long as possible.
When to See a Geriatrician
Most people begin seeing a geriatrician after age 65, and especially after 75, though some geriatric centers start working with patients as early as 50 depending on their health needs. You don’t necessarily need a referral to see one, but certain situations make geriatric expertise especially valuable:
- Multiple chronic conditions that interact with each other, making treatment decisions complicated
- Frequent falls or a noticeable decline in balance and mobility
- Memory problems or confusion, whether sudden or gradual
- Taking many medications and experiencing side effects or uncertainty about whether each one is still necessary
- Functional decline, such as difficulty with daily activities that were previously manageable
- Caregiver stress, where family members need guidance on how to support an aging loved one
Geriatricians also play a role in preoperative assessments for older adults, helping surgical teams understand the risks that frailty or cognitive impairment may add to a procedure.
Where Geriatricians Practice
You can find geriatricians in a range of settings. Some work in outpatient clinics dedicated to senior primary care, functioning as a patient’s main doctor. Others work in hospitals, consulting on older patients admitted for surgery, infection, or other acute problems. Geriatricians also practice in skilled nursing facilities, retirement communities, and specialized programs that help frail older adults remain living at home. Some hospitals have senior-friendly emergency departments designed with geriatric input, with quieter environments and staff trained to recognize conditions like delirium that are easy to miss in a chaotic ER.
Do Geriatricians Improve Outcomes?
A meta-analysis of hospital-based geriatric consultation teams found that their involvement significantly reduced mortality in the months after discharge. Patients who received geriatric consultation had roughly a 34% lower risk of death at six months compared to those who received standard care alone. The benefit was even more pronounced at eight months. However, the same analysis found no significant effect on hospital readmission rates or length of stay, suggesting the value of geriatric care lies more in the quality and safety of the care plan patients leave with than in shortening the hospital visit itself.
The Geriatrician Shortage
The United States has approximately 7,000 board-certified geriatricians, which works out to roughly one geriatrician for every 10,000 older adults. Workforce projections have estimated that the country needs about 28,000 geriatricians to adequately serve its aging population. This gap means many older adults will never see a geriatrician directly. In practice, geriatricians increasingly serve as consultants and educators, training primary care physicians, nurses, and other providers in the principles of geriatric care so that more patients benefit from the approach even without a specialist visit.