The Changing Nature of Geriatrics

BayCare Physician Discusses Factors That Affect Our Aging Population 


The field of geriatric medicine generally focuses on patients older than 65, but the determinants of socioeconomics, education, access and lifestyle can make it somewhat of a moving target.


“Geriatrics is perhaps a bit of a misnomer,” says Dr. Robert Atkins, a BayCare Medical Group primary care physician and geriatrics specialist. “It’s really a constellation of things that can determine when a person needs to see a specialist in geriatrics.”  


Some patients may need additional expertise with age-related problems in their 50s if they are experiencing early-onset dementia, advanced heart disease or complications such as diabetes. Other individuals may not need a geriatrician until their 70s.   


Atkins has had an interesting and diverse career path, which has given him a window to the large variation in the aging population. An eastern Kentucky native with a background in engineering, Atkins was witness to individuals with labor-intensive jobs who sometimes had limited health education, and struggled with food insecurity and poor health habits. With the added stress of job-related environmental exposures, their health sometimes deteriorated much more quickly than that of individuals in more affluent life situations. It was this disparity that initially drove Atkins’ desire to practice medicine and, specifically, geriatrics. 


“I was very interested in underserved populations,” he says. “These individuals were sometimes having to choose between paying for food and refilling their metformin prescription.”  There were also challenges in access to care, since many lived in extremely rural areas and transportation could be a problem. 


On the flip side of this, Atkins also has seen patients who are in higher level executive jobs who also have not fared well in the aging process. Added stresses of the job often can leave these patients with high blood pressure and more advanced cardiac conditions despite their better access to care. 


One area that may be helping all patients with the issue of access is technology and telehealth services. Atkins has noticed that the vast majority of his patients have eagerly embraced the online availability of services. 


“We’ve had a good response to the [BayCare Medical Group] patient portal, and even people in their 90s are contacting us!” he says.


Health services available through technology may be particularly advantageous for geriatric patients because it eliminates the additional obstacles of transportation and the need to drive to attend an appointment. The convenience of not having to travel to an office or clinic from an extremely remote location, particularly when not feeling well, has made care more accessible.


Though there are obvious differences in treating more senior patients, the goals for the outcomes remain the same as for younger patients. 


“The body acts differently,” Atkins explains, “but we want someone over 65 to have the same blood pressure as someone in their 30s. We want to manage their diabetes for optimal levels, the same way that we would for a younger person. The goals may be the same, but how you get there may be different. We have to take into account that their renal and liver function may not process these medications in the same way. But we want the end result to be the same as for younger patients.”


Atkins says he believes a holistic approach is needed for patients with more life experience in order to achieve the best health. 


“Physical activity is not the only determinant of health. Mental activity is also very important… involvement in the community, civic or religious organizations also play a part. They help take the focus off the individual, which is helpful.” 


A holistic approach that helps with emotional, mental and social components, as well as the physiological yields the best outcomes. 


“Stress increases the enormity of disease and increases cortisol, which while it helps aid in healing also lowers immunity. Stress decreases life.”


Atkins cites a critical need for more doctors in Polk County who specialize in geriatrics, explaining that roughly 20 percent of the county’s population is 65 and older. 


Atkins clearly sees the value in all phases of life. “There is so much wisdom in this group. They have been through a lot, and they have a lot of wisdom to offer us on how to handle difficulties.”

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