Bone Health, Falls, Medications & Healthy Longevity | Dr Deborah Kado

Simon Hill (0:04)

We were just having a bit of a giggle off air that longevity science, it really is a hot topic right now.

Deborah Kado (0:10)

No kidding.

Simon Hill (0:11)

Right? Yeah. And so I'm interested off the top here, as a gerontologist and a geriatrician, of which we will define in a moment, is longevity science just basically a sexier way of saying gerontology?

Deborah Kado (0:27)

I will just say yes, probably, because at a party, everybody wants to talk about longevity. But who wants to talk about gerontology?

Simon Hill (0:37)

Well, I do. That's why you're here today.

Deborah Kado (0:40)

Good.

Simon Hill (0:42)

So familiarize us with these terms.

Deborah Kado (0:45)

Okay.

Simon Hill (0:46)

If someone hasn't heard of a gerontologist before or gerontology, what is that the study of exactly? And how does that differ from geriatrics?

Deborah Kado (0:56)

Okay. So a gerontologist is someone who studies aging at any point in the lifestyle and from all different types of angles. So it could be from a biological angle, it could be from a medical angle, it can be from a social angle, philosophical, just a policy, all over the spectrum, psychology. Whereas a geriatrician is actually a practitioner, usually an MD or a DO, or who gets specialized training in how to provide clinical care to older adults.

Simon Hill (1:30)

So to be a gerontologist or to study gerontology, it's not a specific degree as such?

Deborah Kado (1:39)

No, it's not. There are undergrad courses that people can take with a gerontologic focus. There are probably master's degrees that I don't know about, that would be in gerontological science. They're definitely PhDs in gerontology, I think. Yeah.

Simon Hill (1:53)

I think a lot of people that I see who sort of say they work in the field of gerontology are often biologists or had some sort of undergraduate science degree.

Deborah Kado (2:04)

Correct.

Simon Hill (2:05)

Then they've chosen to study the biology of aging.

Deborah Kado (2:07)

Correct.

Simon Hill (2:08)

Yeah. Geriatrics, so you're both gerontologist and geriatrician.

Deborah Kado (2:15)

Correct.

Simon Hill (2:16)

So geriatrics, if I was a medical student, what would the pathway look like for me to become a geriatrician? How long would that take?

Deborah Kado (2:26)

Actually, it's not too bad. It's the general in the United States, four years of medical school training, three years of residency or in family medicine, which is also a three-year residency. From there, you do one additional year of training specifically in geriatric medicine.

Simon Hill (2:44)

Do you think that the public have a pretty good idea, understanding of the role of a geriatrician and where they fit into health care and the breadth of their knowledge and role in improving the health of elderly?

Deborah Kado (3:01)

I would argue no. I would say actually very few, just because there's so few in the United States, for example. So just about, depending on what estimate and what year you look at, but somewhere around 7,000 practicing board-certified geriatricians across the country.

I would also posit to say that because there's not a lot of education in geriatric medicine across our United States medical schools, that there are a lot of doctors in practice who also don't really get a sense of what geriatricians do. So sometimes what they, if they know about a geriatrician and let's just say we're in the inpatient setting, they might call for a geriatrician's help and think that it's all for social reasons, as opposed to understanding the two differences that happen with biological aging and how that might affect both diagnoses and treatments.

Simon Hill (3:51)

You said to me in an earlier conversation that we had, that there are less geriatricians today, I think in the US than when you first started.

Deborah Kado (4:01)

That's correct.

Simon Hill (4:03)

Yet, I have to imagine there's more elderly.

Deborah Kado (4:06)

That's correct.

Simon Hill (4:08)

What's going on there and how is that affecting clinical care?

Deborah Kado (4:12)

Just like in geriatric medicine, when we think about conditions that affect older people, we use the term multifactorial. There's not just one cause for why we might see a manifestation of an illness or disease in an older adult. Same idea with why there are so few geriatricians. I think one is people in medical school are not exposed to geriatric medicine because there's so few.

An internal medicine teacher once told me, if you don't think of the diagnosis, you'll never make the diagnosis. Same thing, if you never encounter a geriatrician, why would you think to become one? So that's one. Two, I think that in previous years, it's not cool. It's not competitive. It doesn't have some cache. If you say, I'm a dermatologist or I'm a cardiologist or I'm a neurosurgeon, whoa, that's something special. But a geriatrician, oh yeah, that you take care of old people who are about to die. So I think it's that kind of identity of what people think a geriatrician is like. Then I think they're not the highest paid specialty in the setting in the United States.