Geriatricians in Asheville: What They Do and When to Seek One
Most older adults see a primary care physician their entire adult life and assume that physician is equipped to handle whatever aging brings. Often that is true. But for people with multiple chronic conditions, complex medication regimens, cognitive changes, or difficult-to-diagnose symptoms, a geriatrician can offer something a general internist or family physician often cannot: specialized training in the way aging bodies and minds actually work.
This guide explains what geriatricians do, how they differ from primary care physicians, when a referral or consultation makes sense, and how to find geriatric care in Buncombe County.
A geriatrician is a physician who has completed additional fellowship training specifically in geriatric medicine after finishing residency in internal medicine or family medicine. That training focuses on the unique physiological, psychological, and social dimensions of caring for older adults, particularly those with multiple overlapping health conditions.
The core of geriatric practice is what clinicians call a Comprehensive Geriatric Assessment: a systematic evaluation that goes beyond a standard medical visit to examine not just diagnoses and medications but cognitive function, physical function, fall risk, nutrition, depression and mood, social support, and living environment. This whole-person approach often surfaces problems that disease-focused visits miss, and it produces care plans built around what matters to the patient rather than what is standard for a given diagnosis.
Geriatricians are particularly skilled in:
- Diagnosing and managing dementia and mild cognitive impairment — including distinguishing between dementia types and identifying reversible causes of cognitive change
- Medication management and deprescribing — reducing polypharmacy, which is one of the most common and underrecognized sources of harm in older adults
- Falls assessment and prevention — identifying the underlying causes of falls rather than treating only their consequences
- Frailty evaluation and rehabilitation — helping patients and families understand what frailty means functionally and what can be done about it
- Managing care transitions — hospital to home, hospital to rehabilitation, home to residential care
- Advance care planning conversations — helping patients and families clarify goals of care before a crisis forces the question
A primary care physician manages a patient’s overall health across a lifetime. A geriatrician’s training is specifically calibrated to the way aging changes that picture. The difference is not in the quality of care from a good primary care physician — it is in the depth of specialized knowledge applied to common but genuinely complex aging-specific problems.
Consider medication management. The average older adult over 65 takes five or more prescription medications. Many drugs that are appropriate for middle-aged adults are riskier in older ones — sedatives, anticholinergics, certain blood pressure medications, and pain medications all carry disproportionate risks in people over 75. Geriatricians use tools like the Beers Criteria to systematically evaluate medication lists for drugs that may be causing more harm than benefit. This is standard training in geriatrics. It is not standard training in internal medicine or family medicine.
Or consider cognitive assessment. A general physician may note that a patient seems forgetful and order basic labs. A geriatrician uses validated cognitive testing tools, takes a detailed functional history, distinguishes between dementia subtypes based on clinical pattern, orders appropriate neuroimaging, and creates a longitudinal plan for the patient and their caregivers. The difference in depth is substantial.
There is no bright line for when to seek geriatric care. But certain situations tend to benefit from the specialized lens a geriatrician brings. If several of these describe your loved one, a geriatric consultation is worth pursuing:
When someone is seeing multiple specialists for different conditions, each writing their own prescriptions, the overall medication list can become problematic in ways no single specialist is positioned to see. A geriatrician’s assessment cuts across specialty silos and looks at the whole picture.
Whether the concern is early forgetfulness or a more significant decline in thinking and function, a geriatrician is trained to evaluate cognitive changes systematically, identify reversible contributors, and provide an accurate diagnosis rather than a general reassurance that things seem fine.
Falls are not simply a sign of getting old. They often reflect identifiable and addressable problems: medication side effects, orthostatic hypotension, muscle weakness, vision changes, or neurological issues. A geriatrician evaluates falls as a clinical problem with causes and solutions, not an inevitable outcome of aging.
When an older adult is declining without a clear explanation, a comprehensive geriatric assessment can identify contributing factors that a standard diagnostic workup misses. Frailty syndromes, nutritional deficiencies, subtle mood disorders, and medication effects are all on the differential in ways that a geriatrician is trained to pursue.
A growing number of adults in their late 60s and 70s seek geriatric care proactively to establish a baseline, review medications preventively, and develop a care plan before complexity sets in. This is particularly valuable for people who have watched a parent navigate a chaotic trajectory and want to manage their own aging differently.
Hospital discharge, a new diagnosis of dementia, or a change in living situation all create moments where a geriatric perspective can help families make better decisions. Geriatricians are trained in care transitions and can provide the kind of integrative assessment that helps families plan rather than react.
There are not enough geriatricians in the United States, and there have not been for decades. Despite an aging population, geriatrics remains one of the least-entered medical specialties. The American Geriatrics Society estimates that the country will need roughly 30,000 geriatricians by 2030 to meet demand; there are currently fewer than 7,500 in practice.
Western North Carolina reflects this national pattern. Buncombe County has a handful of board-certified geriatricians, and access varies significantly depending on whether someone is seeking a concierge model, a health system affiliation, or academic medicine through MAHEC. Waiting lists exist. This is a reason to pursue geriatric evaluation before a crisis makes it urgent.
Buncombe County has a small but growing concentration of geriatric expertise, anchored by two main avenues: an independent concierge geriatric practice and the academic medicine programs at MAHEC.
Golden Oak Medicine is a concierge geriatric practice in Asheville founded and led by board-certified geriatricians Dr. Golnosh Sharafsaleh and Dr. Kate Blaney-Marshall. The practice serves adults 55 and older and offers comprehensive geriatric assessment, cognitive evaluation using advanced neuroimaging and biomarker tools, medication management, and coordinated care for complex chronic conditions. As a concierge model, it provides a level of time and access that a standard insurance-based practice cannot. Patients typically pay a membership fee in addition to using their insurance for services covered.
The Suzanne Landis Center for Healthy Aging at MAHEC is the Mountain Area Health Education Center’s geriatric-focused initiative, co-directed by Dr. William McLean and Dr. Tasha Woodall, a clinical pharmacist with board certification in geriatric pharmacotherapy. MAHEC’s model emphasizes team-based geriatric care, with a particular focus on medication management and linking clinical care to social services. MAHEC is located at 121 Hendersonville Road, Asheville, and can be reached at (828) 257-4400.
The Council on Aging of Buncombe County can also help families understand the local geriatric care landscape and identify referral options appropriate to their situation: (828) 277-8288.
For a full list of geriatricians and geriatric-informed providers in Buncombe County, see our Geriatrician Provider Directory.
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