see one,” says Dr. Manisha Parulekar. As
interim chief of the division of geriatrics
at Hackensack Meridian Health
Hackensack University Medical Center,
Parulekar oversees a comprehensive
outpatient program staffed by four full-time
and two part-time geriatricians who,
together, see approximately 1,000 patients.
Getting patients to tune into why
and when they should transition to a
geriatrician is especially challenging, says
Parulekar. “Your internist might not know
the differences a medication can have on a
50-year-old versus a 70-year-old. As you
age, your kidney function decreases,
your body redistributes fat and muscle
differently, your metabolic rate and
mobility declines,” she adds. “These are a
normal part of aging, but they affect you
differently as you age.” Although there is
no specific age at which patients should
begin seeing a geriatrician, Parulekar
recommends that those with chronic
conditions like high blood pressure and
COPD consult a geriatrician at around
65 years of age, while those who are com-
pletely healthy can go four or five years
longer. “Living at home is our goal. We do
everything we can to help our patients stay
in their own environment,” she says.
Safety First
To enable his elderly patients to age in
place for as long as possible, Karatoprak
outlines common sense steps adult
children can take to make their parent’s
homes safer and reduce their risk of
falling, which can be caused by any
number of medical conditions, including
poor eyesight, incontinence and muscle
weakness. The Centers for Disease Control
and Prevention confirms that falls are the
number one cause of injuries and deaths
from injury among older Americans. In
addition to removing hazards like area
rugs and choosing proper footwear,
Karatoprak recommends installing grab
bars, stair railings and other support
mechanisms to improve in-home safety.
Medicine Checks
Another area of concern is access to
medication. “There is so much we can do
in the preventative stage to maximize
quality of life and physical health,”
explains Parulekar, who seeks to reduce
her patients’ number of medications. “We
see health benefits in minimizing the
medications. I have patients who, over
the years, have accumulat-
ed a lot of prescriptions.
Often, the doses are not
adjusted as they age or
the medications they are
taking precipitate a decline
in memory function. We
need to look at the whole
picture.” Karatoprak also
believes in dialing back
the number of medica-
tions, if possible, and
advises caregivers to keep
an eye on all prescriptions
to ensure they are
organized and arranged
properly. He particularly
recommends avoiding
sleeping pills and
antihistamines, which can
increase the risk of falling.
“As older patients begin
to experience vision and
hearing loss, feelings of
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worse,” he says.
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Dr. Terri Katz, a special-
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medicine at Englewood
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