Geriatric Consultation

What is a geriatric consultation?

The consultation is a specialized evaluation by a Geriatrics physician, in order to address aging-related challenges for patients aged 65 and up. Geriatrics physicians (or geriatricians) take a whole-person approach which is sensitive to the particular circumstances which can arise in older adults.

We offer consultation for the following:

• Memory problems
• Alzheimer's disease and other dementias
• Falls and difficulty walking
• Difficulties with day to day personal care and other activities due to health
• Incontinence
• Planning for medical care in later years
• Connections to community services

MGH Geriatric Medicine implements the Age-friendly Health Systems (AFHS) approach

Massachusetts General Hospital is part of a AFHS movement! AFHS is a new model for patient-centered care for older adults. The framework for all staff to implement is called the 4Ms:

• What Matters Most
• Mentation
• Medications
• Mobility

We use the 4Ms for every interaction with our older patients. This movement is spreading to all hospitals and medical practices here and abroad. For more information, email jgwillett@mgh.harvard.edu.

Who can make an appointment?

Any patient aged 65 and over can make an appointment or can be referred by their physician or a community agency. Each patient must have a primary care physician available to follow up on consultation suggestions.

Is a geriatric consultation covered under Medicare Part B and other insurance plans?

If you have standard Medicare, it will cover your evaluation at the same level (80%) that it covers your office visits. If you have a secondary insurance such as Blue Cross – Medex or AARP, they will pay for the remaining 20%. At the beginning of each calendar year, you may have additional deductibles.

If you are insured by any kind of managed medicare plan you will need a referral from your primary care physician. Please check your specific policy before arranging for this appointment as you will be responsible for any uncovered portion of this service. Please bring your referral order or your primary care physician can fax it to: 617-228-6306

What can I expect at the consultation?

The 60-minute evaluation consists of a complete medical and social history, an examination, discussion about the findings and development of a plan. Because of the complexity of some situations, patients may be asked to return for a follow-up visit to complete the consultation process. If appropriate, a social worker can be available to participate in the follow-up consultation.

Who can come to the appointment?

With the patient's permission, family or other concerned individuals are invited to participate so that a complete picture of the patient's problems can be obtained. It is very helpful to have family or caregivers present who will be assisting in the implementation of the treatment plan.

What should be done to prepare for the appointment?

Because the consultant has a limited amount of time to spend with the patient and the patient's situation may be very complicated, here's how to prepare for the appointment:

• Arrange for medical records to be made available in advance for the physician to review 
• Send or bring copies of discharge summaries from any recent hospitalization, a summary of recent events from the primary care or other specialists and any special testing that has been completed
• Bring an up to date medication list or bring all the medication bottles for the physician to review during the visit

What kind of report will the geriatrician develop?

Depending on the nature of the problem, the consultant will provide a report that includes the patient's history, physical examination and recommendations. This report will be sent to the patient's primary care physician, who will work with the consultant to implement the recommendations. The consultant will be available to the patient's physician to help with patient care around the issues of concern. The patient's primary care physician will continue to be responsible for long term care of the patient. The patient will receive a copy of the recommendations.