Geriatric Medicine: Specialized Care for Older Women

When should an older woman seek care from a geriatrician? There is actually no fixed age when she should switch from her primary care doctor to a specialist in geriatric medicine, says Dr. Emily Fessler, a primary care geriatrician at the Center on Aging at Weill Cornell Medicine and an Assistant Professor of Clinical Medicine at Weill Cornell Medicine.

Geriatricians treat adults who are over 65, she says, but “in reality, most of our patients are in their late 70s and up. To geriatricians, it is less about numerical age and more about a woman’s overall health and wellness. An older adult with multiple medical conditions, a long list of daily medications, more than one recent hospitalization or who is facing new changes in day-to-day function may benefit from the geriatric lens.

“We are also privileged to treat patients in multiple care settings: as outpatients, in the hospital and in institutional settings such as assisted living, rehabilitation facilities and nursing homes,” she continues.

Dr. Fessler shares a mnemonic called “the 4 Ms” that serve as a reminder of the unique challenges that come with the geriatrician’s territory:

• Medications – Older people take a lot of medications, some of which may cause harm. That’s why we pay close attention to the medications our patients are taking.
• Mind – The two major components of “mind” are cognition and mental health.
• Mobility – We aim to keep our patients as independent as possible for as long as possible, helping to prevent falls by improving their balance and their walking.
• What Matters Most – We take our patients’ values and priorities into account. The more we know about their goals, the more personalized the care we can provide.

Exercise and diet

“Physical activity is crucial across the life span,” says Dr. Emily Coskun, also a geriatrician at the Center on Aging and Assistant Professor of Clinical Medicine at Weill Cornell Medicine.

Exercise is critically important for metabolic health, bone density, mental health and cognitive function, she explains. It also helps to alleviate pain, bring down high blood pressure and high cholesterol and even increase longevity.

“We recommend 150 minutes of aerobic activity per week,” says Dr. Coskun. “Walking, swimming and cycling all count as aerobic exercise. But if you have any questions about what would work best for you, ask your doctor to refer you to a physical therapist.”
Exercise and food are medicine, and they’re often safer than the kind that comes in a pill bottle, she says.

Here are Dr. Coskun’s top three tips for optimal nutrition and weight control:

• Prepare your own food. Doing so will give you control over what you eat and how much you eat.
• Eat vegetables with lunch and dinner—a strategy that will keep you fuller longer. Vegetables are also rich in micronutrients and fiber, both critical to good nutrition and optimal digestive health.
• Set healthy limits on foods you love but don’t love you back, such as cheeseburgers and ice cream. No need to eliminate them altogether. Have your favorite no-nos once or twice a month.

Note that some women in their 80s and 90s tend to struggle with weight loss rather than weight gain. “We don’t limit high-fat or high-sugar foods with these women,” Dr. Coskun says. “The goal is to make sure they get enough calories, wherever they feel comfortable getting them.”

Ideally, she adds, eating should be a social experience. If possible, arrange to have lunch or dinner with a friend, or have a meal at a community center, assisted living facility or other group setting.

Screenings

First, let’s review cancer screenings, Dr. Fessler says:

• Cervical cancer – An annual Pap smear is recommended for women from 21 to 65.
• Breast cancer – Women from 50 to 75 are encouraged to have a mammogram every year or two. Guidelines may vary, depending on the patient’s history and risk factors, so make sure to discuss these with your doctor.
• Colon cancer – Women from 45 to 75 who are at average cancer risk should have a colonoscopy every 10 years. Those at higher risk may need to be screened more frequently. Women from 75 to 85 can discuss their need for continued screening with their primary care physician or geriatrician.

Dr. Fessler points to additional screenings that can affect a women’s quality of life in older age. These include screening for depression and anxiety, cognitive health, bone health and fall risk—all covered under Medicare’s annual wellness visit.

“The symptoms of depression and anxiety may be different in older adults,” she says. “They can appear in the form of fatigue or brain fog. The screening tools we use to assess mental health can take time, so if you as a patient are concerned about your mood, be sure to raise that issue at the beginning of your appointment rather than waiting until the end.”

Be aware that psychotherapy and medication can make a big difference in the quality of life of older people. There’s no need to accept a mood disorder as a given. Remedies are available, she emphasizes.

Finally, bone health is a major concern for women as they age. A DEXA scan is usually administered to women at age 65 and periodically thereafter.

Vitamin D is also important for bone health. An older woman’s vitamin D levels can be checked via a routine blood test, Dr. Fessler says, but supplementation is not required for most women. That’s because it’s a common nutrient, normally absorbed by the skin with sunlight exposure. But there are exceptions: Women receiving treatment for osteoporosis, or those with inflammatory bowel disease (IBD), celiac disease or other conditions that affect the body’s ability to absorb nutrients, may require a vitamin D3 supplement.

Sleep

Your physical and mental health depend hugely on getting enough sleep, says Dr. Coskun, and also on high-quality sleep. Aim to get 7 to 8 hours a night.

Below, she reviews the main elements of sleep hygiene: a multi-pronged approach that, over time, can improve the quantity and quality of your sleep:

• Go to bed at night and get up every morning at the same time.
• Adopt habits that relax you before bedtime. Have a cup of herbal tea, meditate or read a book. Avoid stimulating activities, such as exciting movies or checking your devices.
• Keep your room dark.
• If you don’t fall asleep within 20 minutes, get up and go back to doing something calming again.
• Get enough exercise during the day.
• Avoid caffeine in the afternoon and evening.

If you feel you need to take sleep medication, run it by your doctor, as some of these—Ambien (zolpidem), clonazepam and Benadryl, for example—can cause dizziness, confusion, and other side effects in older people.

How to stay healthy in your 70s, 80s, 90s and beyond

Here are the top takeaways per all aspects of health in later life:

• To protect your cognitive health, take care of your body. Physical activity has a positive effect on attention, memory, executive function and processing speed.
• Get enough sleep through better sleep hygiene.
• Avoid recreational drugs and alcohol.
• Listen to your body and raise any concerns with your doctor.
• Stay cognitively and socially engaged.

…and advocate for yourself. What are the health issues you feel are most important to you?

Not every older woman needs a geriatrician, but if you’re a woman of a certain age, you need a doctor who cares; one who will collaborate with the specialists and other members of your care team, which may include a physical therapist, a nutritionist and a social worker. Make sure you’re being heard by all concerned.

To learn more about geriatric care at Weill Cornell Medicine or to make an appointment, please visit here to schedule.