This guest post is authored by Aviva Yoselis, MPH, director of Health Advize and lead healthcare advocate for the Shira Pransky Project. Aviva has more than 20 years of experience in health advocacy and health system navigation. She has a broad understanding of the biological sciences, bio-statistics, epidemiology, clinical trials and current issues in healthcare.
Aviva began her career in the U.S. in health education and medical advocacy for low-income minority communities. She has a master’s degree from the Braun School of Public Health at Hadassah-Hebrew University and is also certified in sexual health facilitation and lactation counseling. She is a member of the APHA [Alliance of Professional Health Advocates].
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About 15 years ago, a good friend of the family, who was about 65 at the time, started feeling chest pains, dizziness and nausea as she was on her way to work. The pains were strong enough, that she turned around and drove herself to the hospital. It turns out she was at the beginning of a heart attack! The story gets better. Through the various tests they did on her, the doctors discovered a lump, and she was diagnosed with stage II breast cancer.
Basically, that heart attack saved her life.
This is all a rather dramatic way of saying that the last time this friend had been in a doctor’s office was five years prior. Because of these two dramatic incidents, she found an internist who specialized in older patients. That led me to recommend to my mother to sign herself for this gerontologist as well.
As we age, obviously, our medical needs change. We are bombarded by messages like “mammography once a year!” “Make sure you do weight bearing exercises to keep your bones strong!” “Successful Aging: anyone can do it!”.
But do we need to see a specialist regularly? If yes, than, whom? When? And, in Israel, how on earth do I find them?
The specialists you need, and those you don’t
I recommend that everyone over 70 find a geriatric specialist to become your regular GP. Why? For one reason, the elderly metabolize medications differently than their younger counterparts. Meaning? Someone aged 75 needs a different dosage of Zoloft than someone experiencing the same type of depressive/anxiety symptoms who is 45. In addition, different drugs have different negative side effects in the elderly. That same Zoloft has the ability to cause SIADH (or abnormally low sodium levels in the blood which can cause serious physical harm) in older patients, a side effect rarely seen among the young. If you’re being treated by someone with experience in this field, they would know and understand this and other relevant information. This geriatrician (as they’re known abroad), will become your primary care physician.
However, as there is a serious shortage of geriatric specialists in Israel, you may not find one in your area. Therefore, I recommend that you make sure you see the following specialists:
If you have been diagnosed with diabetes, see an Endocrinologist: Diabetes, prediabetes syndrome and complications from diabetes are one of the main causes of illness affecting older people today. Although the family doctor says that s/he can help you manage the disease, all the protocols strongly recommend that you seek out an endocrinologist at least once a year. These specialists have a wealth of knowledge and experience, and as you age with diabetes, you need an expert in your corner.
If you have had heart attack, stent, or suspected heart disease, see a Cardiologist: A six month routine follow up with a cardiologist is crucial. You need someone who knows your situation, and can tell when minor changes may have major repercussions.
If you have a previous cancer diagnosis, even if you no longer have the illness, see an Oncologist: Cancers are slower acting as we age, and a diagnosis at age 80 may not even require chemotherapy. However, if you have experienced cancer, routinely (every 6 months) seeing a specialist in the field of cancer that you had, means that any small recurrence can be treated when the growth is relatively small, which is the best way to avoid future complications.
When you have been diagnosed with Alzheimer’s, you need to visit a Memory Clinic: To adequately assess cognitive functioning, effectiveness of medication, and so forth, the best place to go is a clinic, and not an individual doctor. At a memory (or sometimes the kupah calls them geriatric) clinics, you meet with an occupational therapist, physical therapist, geriatric specialist, and a nurse, who all have various assessments designed to identify problems before they become more significant. These centers are sometimes designed in general to assess the older population, and may be worthwhile as a baseline assessment. However, for Alzheimer’s patients, these types of bi-yearly checkups are crucial, and should be sought out right after diagnosis.
Public or Private?
All of the specialists recommended above can be seen within the boundaries of the kupah. For routine follow up, there is no reason to pay for a private doctor. Rather, you know that you will need to see the doctor in six months’ time, so it won’t be a problem that you can only get an appointment with Dr. Moshe, the endocrinologist, in four months. Make sure that at least one month before your scheduled appointment, you conduct all relevant imaging and blood tests, so that all the results will be in when you arrive at your follow up appointment. If the kupah specialist sees an abnormal finding, or suggests several possibilities for treatment, then that may be the time to pay for a private specialist.
Even if you see a private specialist, bring the results/decision back to the kupah specialist for the actual follow up.
Fifteen years later, that family friend I mentioned is alive and well. She sees her geriatric specialist every six months, along with her treating cardiologist, and only recently stopped going for yearly reviews with the oncologist. She was lucky, but I think, in retrospect, she feels she would have been better off with bi-yearly checkups with her doctor before the heart attack/breast cancer.