\n\t\t\t\t\t\t\tin Geriatrics<\/a>
\n\t\t\t\t\t\t\t\tby\t\t\t\t\t\t\t\tContributing Writer<\/a><\/p>\n
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The United States is in the midst of a demographic shift that primary care medicine cannot afford to ignore. By 2034, adults aged 65 and older will outnumber children under 18 for the first time in American history \u2014 a milestone that carries profound implications for how we deliver outpatient care. In communities like Plano, Texas, where the population has grown rapidly over the past two decades and a significant percentage of long-term residents are now entering their senior years, the gap between what aging patients need and what the healthcare system routinely provides has never been more apparent.<\/p>\n
At Express Internal Medicine, we have built our practice around closing that gap. As a geriatric care doctor<\/a> in Plano, I see firsthand how aging patients are often passed between specialists without anyone coordinating the full picture: managing polypharmacy risks, monitoring for cognitive decline, addressing mobility and fall prevention, and taking the time to understand what a patient\u2019s life actually looks like outside of a clinical encounter. Internal medicine, practised well, is where that coordination belongs.<\/p>\n The Geriatric Care Gap in Outpatient Primary Care<\/p>\n Older adults present with a complexity that most standard 15-minute primary care visits are structurally unable to address. A 72-year-old patient may arrive with type 2 diabetes, hypertension, early-stage dementia, chronic joint pain, and three medications that interact with one another in ways that none of the three specialists who prescribed them fully tracked. This is not an unusual case \u2014 it is a Tuesday.<\/p>\n The core challenge of geriatric primary care is not any single diagnosis. It is the simultaneous management of multiple chronic conditions, functional decline, medication burden, caregiver dynamics, and the patient\u2019s own evolving understanding of what quality of life means to them. No specialist manages all of that. The internal medicine physician does \u2014 or should.<\/p>\n According to the American Geriatrics Society, the number of physicians with formal geriatrics training is declining relative to the aging population. This makes the role of the internist in providing geriatric-competent primary care more critical than ever. In areas like Collin County, TX \u2014 which encompasses Plano, Frisco, Allen, and McKinney \u2014 access to dedicated geriatric specialists is limited. Primary care internists are often the first, and sometimes the only, physician coordinating care for older adults.<\/p>\n Our Clinical Approach at Express Internal Medicine<\/p>\n Geriatric care at Express Internal Medicine is not a separate programme \u2014 it is built into how we practise internal medicine for every patient over 65. The framework we apply addresses five domains consistently.<\/p>\n 1. Comprehensive Medication Review<\/p>\n Polypharmacy \u2014 the concurrent use of five or more medications \u2014 is one of the leading causes of preventable hospitalisation in older adults. At every geriatric visit, we conduct a full medication reconciliation: reviewing each drug for indication, dosage appropriateness, drug-drug interactions, and whether deprescribing is warranted. This alone frequently improves patient function, reduces fall risk, and lowers out-of-pocket costs for patients on fixed incomes.<\/p>\n 2. Cognitive and Functional Screening<\/p>\n We incorporate validated cognitive screening tools into annual wellness visits for patients 65 and older, including assessments for early-stage dementia and mild cognitive impairment. Equally important is functional status \u2014 we assess activities of daily living, gait stability, fall history, and home safety. Early identification allows us to put supportive structures in place before a crisis occurs, rather than reacting after a fall or hospitalisation.<\/p>\n 3. Chronic Disease Optimisation for Aging Physiology<\/p>\n Treatment targets for conditions like diabetes and hypertension require recalibration in older adults. Aggressive glucose control that is appropriate for a 50-year-old may carry unacceptable hypoglycaemia risk for a 78-year-old with impaired renal function. Blood pressure targets must account for orthostatic changes and fall risk. We apply age-appropriate clinical guidelines \u2014 including those from the American College of Physicians and the American Geriatrics Society \u2014 to individualise every chronic disease management plan.<\/p>\n 4. Preventive Care and Immunisations<\/p>\n Older adults are disproportionately affected by vaccine-preventable illness, yet immunisation rates among seniors remain below national targets. We maintain current immunisation schedules for influenza, pneumococcal disease, shingles (Shingrix), RSV, and COVID-19, and integrate cancer screenings \u2014 including colonoscopy, mammography, and lung cancer CT \u2014 based on individualised risk-benefit assessment for each patient\u2019s age and health status.<\/p>\n 5. Caregiver and Family Integration<\/p>\n Aging patients rarely navigate their health alone. With patient consent, we actively involve family members and caregivers in care planning conversations. This reduces the information gap between what a patient hears in the office and what happens at home, and it gives caregivers a clinical contact they can reach when questions arise between visits.<\/p>\n Why This Matters: The Numbers<\/p>\n Adults 65 and older account for 36% of all hospital stays in the U.S. (CDC, 2023) Telemedicine as a Tool for Aging Patients<\/p>\n One of the practical barriers to consistent geriatric care is access. Older adults with mobility limitations, transportation challenges, or multiple competing appointments often skip follow-up visits \u2014 precisely the visits where medication adjustments, lab review, and functional check-ins matter most.<\/p>\n
\nPolypharmacy affects approximately 40% of older adults and is associated with a 2x increased fall risk
\nEarly identification of cognitive impairment reduces hospitalisations by up to 30% through proactive care planning
\nOnly 1 in 4 older adults in the U.S. has access to a geriatrician, making geriatric-competent internists the de facto providers for most aging patients<\/p>\n