What Does a Geriatrician Do

A geriatrician is a physician who specializes in the health care of older adults, with particular expertise in the complex, overlapping medical conditions that accumulate with age. This page covers the clinical scope of geriatric practice, the processes geriatricians use to evaluate and manage patients, the settings where that work occurs, and the boundaries that define when geriatric involvement is appropriate versus when primary or subspecialty care is sufficient.

Definition and scope

Geriatricians are physicians who have completed training in either internal medicine or family medicine and then pursued an additional fellowship — typically 1 year in duration — in geriatric medicine (American Board of Internal Medicine, Geriatric Medicine Certification). Board certification in geriatric medicine is issued jointly by the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine (ABFM), depending on the physician's primary specialty track.

The clinical scope of geriatric medicine, as defined by the American Geriatrics Society (AGS), centers on patients aged 65 and older — and more specifically on those whose complexity, frailty, or functional decline places them beyond the practical capacity of standard primary care. Geriatricians do not simply treat older adults; they specialize in the intersection of aging biology, polypharmacy, functional status, cognitive change, and social context simultaneously.

Geriatric medicine sits at the foundation of geriatrics as a discipline, which itself is organized around the principle that aging produces qualitative changes in disease presentation, drug metabolism, and treatment goals — not merely quantitative accumulation of diagnoses.

The regulatory context for geriatrics in the United States involves oversight from multiple federal bodies, including the Centers for Medicare & Medicaid Services (CMS), which governs reimbursement structures that directly shape how geriatric care is delivered and documented.

How it works

A geriatrician's work is structured around the Comprehensive Geriatric Assessment (CGA), a multidimensional, interdisciplinary evaluation that extends well beyond standard history-taking and physical examination. The CGA evaluates medical, functional, cognitive, psychological, and social domains simultaneously, producing an integrated care plan rather than a diagnosis-by-diagnosis treatment list.

The CGA process typically includes the following discrete components:

Medical assessment — Review of all active diagnoses, recent hospitalizations, and organ system function, with attention to atypical disease presentation common in older adults (e.g., infection presenting as delirium rather than fever).
Medication review — Systematic evaluation of all prescribed, over-the-counter, and supplemental agents. The Beers Criteria, published by the AGS, identifies medication classes that pose heightened risk in adults over 65.
Cognitive screening — Standardized tools such as the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE) quantify cognitive function and flag domains requiring further workup. See cognitive screening tools for detailed methodology.
Functional assessment — Evaluation of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) to determine independence level and care needs. The functional status assessment framework operationalizes this process.
Fall risk assessment — Geriatricians use validated instruments to stratify fall risk, given that falls represent the leading cause of injury-related death among adults aged 65 and older (Centers for Disease Control and Prevention, STEADI Initiative).
Frailty assessment — Tools such as the Fried Frailty Phenotype or the Clinical Frailty Scale classify patients by physiological reserve, which predicts surgical outcomes, hospitalization risk, and treatment tolerance.
Psychosocial and advance care planning — Goals of care, advance directives, caregiver capacity, and social support structures are assessed as clinical variables, not administrative afterthoughts.

This process distinguishes geriatric medicine from primary care. A primary care visit optimized for chronic disease management may allocate 15–20 minutes per encounter; a comprehensive geriatric assessment typically requires 60–90 minutes across one or more visits, often involving a geriatric care team that includes social workers, pharmacists, physical therapists, and nursing staff working in parallel.

Geriatricians also function as resources across the broader network of geriatrics information, supporting primary care physicians, hospitalists, and specialists who encounter older patients but lack subspecialty geriatric training.

Common scenarios

Geriatric referrals are initiated across a range of clinical presentations. The five most frequently encountered scenarios in outpatient and inpatient geriatric practice include:

Polypharmacy management — Patients taking 5 or more concurrent medications require systematic deprescribing analysis. Geriatricians use structured tools including the STOPP/START criteria and Beers Criteria to reduce medication burden without destabilizing chronic conditions. See polypharmacy and medication reduction.
Cognitive decline evaluation — Distinguishing normal aging from mild cognitive impairment, and mild cognitive impairment from dementia subtypes, requires clinical assessment that primary care is often insufficiently resourced to complete. See dementia and cognitive decline.
Recurrent falls — A patient who has experienced 2 or more falls in a 12-month period meets CDC STEADI criteria for high-risk classification and warrants a structured multifactorial fall risk assessment. See fall risk assessment.
Functional decline — A patient losing capacity for independent living at home — whether from physical deconditioning, cognitive change, or both — requires assessment of the contributing factors and coordination of rehabilitation or support services.
Goals of care and advance planning — Geriatricians regularly lead conversations about prognosis, palliative care eligibility, and the alignment of treatment intensity with patient values, particularly in the context of serious illness or surgical candidacy.

Decision boundaries

Geriatric medicine is not equivalent to primary care for older adults. The distinction matters clinically and administratively.

Geriatrician vs. Primary Care Physician (PCP) for older adults:

Dimension	Primary Care Physician	Geriatrician
Age focus	Lifespan	65+ with complexity or frailty
Visit structure	Episodic or preventive	Comprehensive multidomain assessment
Team model	Physician-led	Interdisciplinary team standard
Medication scope	Treatment of conditions	Deprescribing as primary clinical tool
Functional goals	Diagnosis and disease control	Function, independence, and quality of life

Geriatrician vs. Geriatric Psychiatrist:

Geriatric psychiatrists are physicians who completed psychiatry residency followed by a geriatric psychiatry fellowship. Their scope centers on late-life mental illness, behavioral symptoms of dementia, and pharmacological management of psychiatric conditions in older adults. Geriatricians address cognitive and mood disorders as part of a broader medical picture but refer to geriatric psychiatry when psychiatric complexity exceeds medical management capacity.

When geriatric referral is not indicated:

A 70-year-old patient with well-controlled hypertension, no cognitive symptoms, no falls, and independent functional status does not typically meet the threshold for geriatric subspecialty involvement. The AGS and ABIM both frame geriatric medicine as a complexity-driven subspecialty — not an age-gated one. The presence of frailty, functional decline, cognitive impairment, multiple concurrent chronic conditions, or caregiver crisis are the primary clinical drivers of appropriate referral.

Geriatricians also establish clear handoffs. Following a CGA and care plan formulation, a geriatrician may transfer ongoing management back to the primary care physician, with specific recommendations embedded in the record — functioning as a consultant rather than a longitudinal provider.

References

The law belongs to the people. Georgia v. Public.Resource.Org, 590 U.S. (2020)