Geriatric Consult: For Assistance with a Known Medical or Social Issue
If you are caring for a loved one, relative or friend with a specific medical issue, a geriatric consult may be beneficial.
- »What is a geriatric consult?
A geriatric consult is a scheduled appointment with a geriatrician (and other members of the Geriatric Medicine team as needed). In some ways, a geriatric consult is similar to a Geriatric Evaluation and Management (GEM) assessment, except a consult focuses on a specific situation or medical condition.
For example, you may seek a consult if your loved one needs a comprehensive discharge and recovery plan after emergency surgery or is dealing with health complications related to malnutrition. In the first instance, the consult would be with a Cleveland Clinic geriatrician and social worker/discharge planner; in the second, it would be with one of our geriatricians and/or a diet and nutrition consultant. All records, test results and suggestions generated during a geriatric consult are shared with the patient's primary care physician.
While a geriatric consult focuses on a specific situation or condition, it is "like a GEM assessment" a holistic consult that draws upon the expertise of Cleveland Clinic's entire geriatric team, as needed. During and after a geriatric consult, team members will work closely with you and your loved one's primary care physician to coordinate care.
The geriatric consult team includes some or all of the following:
- Certified nurse practitioner
- Social worker
- Rehabilitation therapist
- Consulting pharmacist
- »When is a geriatric consult advised?
Geriatric consults are strongly advised if the patient's primary care physician would like outside expertise to help evaluate and coordinate care for a specific age-related condition, or if the patient:
- Is frail, over age 75 and lives alone
- Is taking multiple medications to manage chronic health conditions
- Has impaired heart, kidney, liver and/or lung function
- Has memory impairments, Alzheimer's disease, or is experiencing significant cognitive decline
- Is depressed
- Has been hospitalized and will require long-term rehabilitation
- Lacks a good support network
- Requires help with end-of-life care and/or decisions
- Consults also are advised if the patient has experienced a medical emergency, such as a stroke or fall that results in hospitalization; has undergone stressful treatments or surgery; or is transitioning to a new age-stage or living environment.
- »What is the cost of a geriatric consult?
Costs of a geriatric consultation usually are covered by Medicare Part B. Many private insurance companies also cover some or all of the costs. Costs of diagnostic tests and referrals to consult team members are covered by Medicare Part B and by many private insurance companies. Specialists may bill separately, but referrals for their services will be reviewed with you and your loved one before the services are ordered.
- »How do I or a loved one make an appointment for a geriatric consult?
As the person's primary caregiver, you may make an appointment for a geriatric consult. The patient's primary care physician also may refer the person. If the person is in the hospital, the hospitalist (attending physician) may schedule an appointment. In addition, the Geriatric Medicine team accepts referrals from community health care providers, including local offices on aging and senior centers.
To make an appointment, call 216.444.5665 or toll-free 800.223.2273, ext. 45665.
Geriatric Falls Clinic: For Evaluation and Follow-up for the Treatment and Prevention of Falls
The Geriatric Falls Clinic involves a multidisciplinary assessment, including screening of vision, medical conditions, polypharmacy, nutritional status, mental alertness, physical function, balance and strength.
After the assessment, a summary letter will be provided to the patient and physician. The Falls Clinic is advised for any elderly patient who has had a fall or fracture, has balance problems, or is at high risk for falls.
Before the Appointment
The patient should plan to arrive 15 minutes early and wear comfortable shoes. The patient will meet separately with a nurse practitioner and a physical therapist. The appointment will last about 90 minutes.
The patient should bring the following to the evaluation:
- All medicine in original containers, including over-the-counter medicines
- Medical records for care obtained outside the Cleveland Clinic’s hospitals and family health centers (including results of bone mineral density tests)
- Lab tests from the past two years
- Details of past falls, prior evaluations, illnesses, surgeries and allergies
- Current insurance information
Clinical nurse specialist Anne Vanderbilt, MSN, CNS, CNP, will talk with the patient about health issues, nutrition and living environment as related to falls, evaluating for the following:
- Medical conditions
- Neurological issues
- Multiple medications
- Safe living environment
A physical therapist will assess the patient’s physical function, balance and strength and, if appropriate, recommend a physical therapy program tailored to the patient’s needs. The patient can go to any Cleveland Clinic facility to carry out this program. The team will generate a summary of recommendations for the patient and primary care provider and facilitate testing and referrals to other specialists if needed. A follow-up appointment typically is requested in six weeks.
Scheduling an Appointment
To schedule an appointment, please call 216.444.5665 or 800.223.2273, ext. 45665.
Center for Brain Health: For Assistance with Memory-related Issues
As people age, they expect to "slow down" a little. But if your loved one is experiencing severe symptoms of aging – difficulty with balance and walking, tremors, impaired thinking, memory issues or urinary incontinence – an evaluation by team of specialists in the Brain Health Clinic may be able to offer strategies, medications or treatments to help deal with such conditions. The earlier a problem is diagnosed and treated, the better the chance for a successful outcome.
The primary assessment and evaluation team includes physicians who specialize in geriatric medicine, neurology and neurosurgery. Experts in other medical specialties, such as urology and cardiology, as well as professionals in social work, nutrition, psychiatry and neuropsychology also may be on the team.
- »What should I or a loved one expect during an appointment?
Based on the patient's symptoms, concerns and health history, the person will be scheduled to see the most appropriate specialist within the Brain Health Clinic. Because a series of evaluations and tests will be done, you should plan to spend the entire day at the Brain Health Clinic.
When you arrive, you and your loved one will need to complete a screening questionnaire, and the patient's medical history will be taken by a nurse practitioner. Next, the person will undergo a comprehensive evaluation to detect conditions associated with aging, such as multiple-medication use, cerebrovascular disease, and chemical or metabolic disorders. All of these can mimic the symptoms of memory impairment, dementia, and Alzheimer's or Parkinson's disease. If required, laboratory, imaging and/or other diagnostic tests will be done at this time.
At the conclusion of the assessment, you and your loved one will be presented with a diagnosis and, where appropriate, treatment options. Using the leading-edge technology and therapies available at Cleveland Clinic, many conditions are highly treatable.
Some of these conditions include:
- Normal Pressure Hydrocephalus (NPH): This is the most treatable form of dementia. The main symptoms of normal pressure hydrocephalus (NPH) - difficulty walking, mild dementia and impaired bladder control - so closely resemble those of other age-related diseases that patients with normal pressure hydrocephalus often are misdiagnosed. Treatment for normal pressure hydrocephalus (NPH) involves the surgical implantation of a shunt (drainage tube), which diverts excess fluid from the brain or spinal canal to another part of the body, where it is safely absorbed. Cleveland Clinic neurosurgeons use an improved method of implantation, which has resulted in better outcomes and fewer complications in normal pressure hydrocephalus (NPH) treatment.
- Cerebrovascular Disease: Traditionally, cerebrovascular disease which includes cerebral atherosclerosis (hardening of the arteries), stroke and stroke-related conditions - has been treated with open surgery. Today, several minimally invasive treatment options are available, including stent technology.
- Alzheimer's Disease/Dementia: Dementia comes in many forms, the most common of which is Alzheimer's disease. If Alzheimer's is suspected, Alzheimer's treatment will include medications to enhance memory function and behavior, and/or medicine to help control symptoms.
- Movement Disorders/Parkinson's Disease: Parkinson's disease and essential tremor are progressive neurological movement disorders. While there is no cure for these disorders, patients may be helped with medications or a pacemaker-like device that delivers mild, electrical stimulation to block the brain signals that cause tremors.
- »What is the cost of a Brain Health consult?
Costs of the consultation usually are covered by Medicare Part B. Many private insurance companies also cover some or all of the costs. Costs of diagnostic tests and referrals to consult team members are covered by Medicare Part B and by many private insurance companies. Specialists may bill separately, but referrals for their services will be reviewed with you and your loved one before the services are ordered.
- »How do I make an appointment for a Brain Health Consult?
To make an appointment at the Center for Brain Health, please call 216.444.5665 or toll-free 800.223.2273, ext. 45665.
- »How do I or a loved one participate in a clinical trial?
Many clinical trials focus on diseases associated with aging, cerebrovascular disease and movement disorders. For information about clinical trial participation, please speak with your loved one's physician or the Brain Health's geriatrician, Dr. Ronan Factora.
Geriatric Oncology Clinic: For Assistance with Issues Related to Cancer Treatment
If your loved one is 60 or over and has been diagnosed with cancer, the person may benefit from a specialized assessment at the Taussig Cancer Center's Geriatric Oncology Clinic. This assessment is designed to identify and manage problems related to cancer that otherwise may get overlooked. The goal is not just to improve the patient's quality of life, but also to empower the person's family and caregivers to make informed health care decisions.
- »When could a geriatric oncology clinic assessment help?
A geriatric oncology assessment may help if your loved one is experiencing severe side effects from standard cancer treatment, including confusion, extreme weight loss, breathing or swallowing difficulties, as well as two or more of the following:
- Multiple health problems and/or issues resulting from the use of multiple medications
- Behavioral changes, including depression or anxiety
- Difficulty performing daily activities
- Physical weakness, frailty
- Difficulty living independently, functional decline
- Difficulty with walking or balance
- Urinary incontinence
- Osteoporosis or osteoarthritis
- The potential need for nursing home placement
- »What can I or a loved one expect during an assessment?
A geriatric oncology assessment may last two hours or more. During the assessment, a specially trained geriatrician will complete a thorough evaluation of the person's health issues and living situation, paying special attention to social and family circumstances. Following the assessment, the physician will provide you and your loved one with a written report summarizing the findings and recommendations. The physician also will also discuss an individualized plan of care.
Recommendations may include consulting with other health care professionals, including a psychologist or psychiatrist, pain management specialist, palliative medicine specialist, social worker, nutritionist, pharmacist, and physical and/or occupational therapist.
In addition, the physician will provide written materials and information about the patient's health issues and concerns, along with information on community and private agencies and support groups associated with the cancer diagnosis. If you wish, the physician also will provide a full report to the patient's primary care physician (PCP) and oncologist.
- »What is the cost of an Oncology Clinic consult?
Costs of a geriatric oncology assessment typically are covered by Medicaid and Medicare and by most major health insurance plans. Call the insurance plan for specific requirements and/or co-pay information.
- »How do I or a loved one schedule an appointment for an Oncology Clinic consult?
To schedule an appointment, please call 216.444.7923 or toll-free 866.223.8100.
- Cleveland Clinic Taussig Cancer Center
- Chemocare.com is a source for chemotherapy drug information and side effects.
- CancerCare.org is a national non-profit organization that provides free professional support services to anyone affected by cancer: patients, caregivers, children, loved ones and the bereaved.
- Cancersurvivors.org is an award-winning site which provides information about cancer, resources and support groups.