Care Providers: Practitioners

Older people may see many different kinds of doctors: family practice doctors, general internists, specialists in such areas as heart disorders (cardiologists) or cancer (oncologists), and surgeons. Sometimes general internists and different specialists work together in a group practice. A group practice makes referrals and communication among doctors easier, and people do not need to travel to many different locations.

Geriatricians are doctors, usually internists or family practice doctors, who are trained specifically to care for older people. A geriatrician may be the person’s primary care doctor or may be called in for a short time for consultation. Geriatricians are trained to manage many disorders and problems at once. They focus on maximizing function and quality of life, as well as managing chronic conditions, rather than trying to cure them. They have studied how the body changes as it ages, so that they can better distinguish when a symptom is due to a disorder rather than to aging itself. They evaluate older people in terms of social and emotional as well as physical needs. Then they can help older people live as independently as possible. The people most likely to benefit from seeing a geriatrician include those who

• Are very frail

• Have many disorders

• Need to see several different types of health care practitioners

• Take many medications and are thus likely to have drug side effects

Nurses may work in a doctor’s office, hospital, rehabilitation facility, long-term care facility, or senior center, or they may provide care in a person’s home. Nurses may help coordinate care by communicating information to the different practitioners involved, the person, and family members. Also, they are often more readily available for questions that older people may have about their disorders or treatment. Nurses may teach older people about measures to help maintain good health, such as diet, safety, stress management, sleep, and exercise. Other duties include checking vital signs (blood pressure, pulse, and temperature), taking samples of blood, giving treatments, and teaching people how to care for themselves. Nurses may ask questions about the person's health (for the medical history) and home situation.

Registered nurses (RNs) often provide most of an older person’s health care. RNs supervise care provided by licensed practical nurses (LPNs) and nurses’ aides. RNs are taught to do a physical examination and check for changes that need to be evaluated by a doctor. They also can administer medications to the person, as prescribed by a doctor. LPNs may do many functions but always under the supervision of an RN. Nurses may obtain advanced training in specialty areas. Nurses who have advanced training in the care of older people are called geriatric nurse specialists.

NPs are registered nurses who receive additional training in diagnosis and treatment. Thus, NPs have more responsibilities than RNs. They can write prescriptions and order tests for people. Some NPs, called adult-gerontological nurse practitioners, are specially trained to care for older people. Family nurse practitioners also receive training in the care of older adults but not with as much emphasis as adult-gerontological nurse practitioners.

PAs have some of the same functions as doctors and nurse practitioners but always under a doctor's supervision. Their functions include the following:

• Asking about the person's health (for the medical history)

• Doing physical examinations

• Ordering diagnostic tests

• Helping doctors develop treatment plans

• Assisting in surgery

• Doing routine procedures, such as giving shots and stitching up wounds

• Providing people with information about following their treatment plan and taking care of themselves (such as information about a healthy diet and exercise)

PAs work in most care settings, including long-term care facilities. They may provide health care in a person’s home. Some PAs specialize in treating older people.

In addition to dispensing drugs, pharmacists evaluate prescriptions to make sure that appropriate medications are being used. Pharmacists can check to make sure that older people are not taking medications that pose special risks for them. Pharmacists also make sure that instructions are clear and include information about how much and how often a medication is to be used. They keep track of a person's prescriptions and refills. In this way, they can check for interactions between medications. They also provide other practitioners with information about how to use medications appropriately in older people.

In hospitals and other inpatient settings, pharmacists play a major role in medication reconciliation. Medication reconciliation is the process of creating the most complete and accurate list possible of a person’s current medications and comparing the list to those in the person's medical record or medication orders from a health care practitioner. This process is done to make sure no medications are duplicated or omitted and that no errors have been made. Medication reconciliation should be done at every transition of care.

Some pharmacists specialize in the care of older people. They are sometimes called consultant (senior care) pharmacists. They often work in nursing homes.

Dietitians assess how well nutritional needs are being met. When needs are not being met, they provide specific recommendations about which foods to choose and how to prepare foods. About 1 in 6 older people are undernourished. Many older people can benefit from the assistance of a dietitian.

Different types of therapists may be needed, depending on the disorders and problems a person has.

Physical therapists evaluate and treat people who have difficulty functioning—for example, difficulty walking, changing positions (standing up, sitting down, or lying down), transferring from bed to chair, lifting, or bending. They work with people who have had problems such as a stroke, amputation of a limb, or hip surgery. Treatments may include exercise, heat, ultrasound, and positioning (for example, placing them in a chair that suits their size and body structure so that they are as comfortable as possible).

Occupational therapists evaluate and treat people who have difficulty doing specific activities, particularly those involving caring for themselves (for example, dressing or bathing), working, and doing other daily activities.

Speech therapists help people who have difficulty using and understanding language. They may also help people who have trouble swallowing, particularly after a stroke.

Social workers help coordinate discharges from hospitals and transfers between institutions. They may help people fill out insurance and other forms. They help people identify services that can be provided in the home and community and often help arrange for these services. They also evaluate how people are responding to the care and services obtained.

Social workers may bring family members together for discussions about important health care issues. Many social workers counsel people with anxiety, depression, or difficulty coping with a disorder or disability.

Most social workers are familiar with the special needs of older people. But some are specially trained to counsel older people and to determine whether they need supervision or additional help.

Nurses’ aides care for people in hospitals, rehabilitation facilities, nursing homes, assisted-living communities, or other medical facilities under the direction of nurses. They are generally trained to do some simple assessments of health such as measuring temperature, and taking pulses and blood pressures.

They are also trained to help with basic daily activities such as bathing, dressing, and eating.

Nurses’ aides may respond to signal lights or bells indicating that someone needs help.

Home health aides tend to provide homemaking-related services such as preparing meals, helping with laundry, and doing light housework.

Medical ethicists help resolve conflicts about moral issues that come up during health care. For example, health care practitioners and family members may disagree about whether a treatment that appears to be ineffective should be stopped. Medical ethicists may be doctors, other health care practitioners, lawyers, or other people who have been specially trained in medical ethics. Some hospitals have a medical ethicist or a team of medical ethicists on staff.