Terrence E. Holt MD PhD holds several titles in the UNC Hospital System and works in two medical departments and also the department of English and comparative literature.

Mr. S. lies on a bed in the Emergency Room, thin, tremulous and confused. His daughter found him in his home that afternoon, lying on the floor beside an overturned chair. Every chair in the house was upended. “He told me he fell,” she says, stroking his hand, “and tried to pull himself up.” Affection and concern mingle in her expression.

Four days later, Mr. S. is sitting up in bed, chatting with his nurse as the medical team files in. “Hey, Docs,” he calls. His daughter, who has been at his side throughout his stay, looks tired but no longer worried. “It’s like night and day,” she says. “I haven’t seen him this happy in years!” He was to be discharged that afternoon to a rehabilitation facility where he’ll regain his strength with every expectation that in a few weeks he’ll be back home.

For many of our elders, independence is the part of their life they value most highly. But under the diverse strains of aging in America, maintaining that independence is challenging. Geriatric medicine is a specialty that recognizes the extraordinary complexity of staying healthy as we age. Our elders require an approach that draws on a range of expertise, including doctors, pharmacists, social workers, physical therapists, occupational therapists, and others. Consider what happened to Mr. S. and what it took to get him home.

Before he fell, he had been feeling ill for several days—tired and unsteady, even more than usual. It started a couple of days after he broke his glasses. He had an older pair, not very good any more, but he made do.

Or tried to. Unable to see, he’d confused two of his 14 prescription medications, and before long had taken the wrong pills in the wrong amounts. Their combined side effects left him weak and disoriented. When he fell that morning, he was too weak to pull himself up and too confused to call 911. Stubborn, determined, and delirious, he tried time and again to get back on his feet, growing weaker with every attempt.

The list of conditions that can lead to weakness and confusion in an older adult is long, ranging from heart attacks to bladder infections; symptoms of such conditions often differ from those in younger people. In the hospital, the medical team ran down multiple leads, and every test came up (thankfully) negative. With assistance from the hospital pharmacist, they did a thorough review of his medications and discovered the explanation.

Mr. S. had been seeing three different specialists and an internist for years, and over that time his medication list had grown. Complicated to manage, it was even harder to afford. At the same time, age-related changes in his kidneys and liver left him vulnerable to side effects he would never have suffered when he was younger, but which had left him feeling chronically fatigued long before he’d lost his glasses. Fatigue made him less active; inactivity undermined his strength; his balance suffered. He reached the point where very little would leave him helpless on the floor.

After review, his medication list was down to six drugs, at doses appropriate to his age and physiology. In the hospital, physical therapists assessed his strength and balance and began a program to help him regain his strength. An occupational therapist did a home survey to make his home safer, recommending simple changes such as bathroom grab bars and improved lighting. A social worker put his daughter in touch with county resources to help her dad get around on important errands—like getting new glasses. Four weeks later, Mr. S. was home again, more active and alert than he had been in years.

Cases like Mr. S.’s are gratifying and the kind of preventable emergency we see too often in our elders. Keeping older patients well is a special challenge: the accumulation of chronic illnesses makes every aspect of diagnosis and treatment more complex, requiring specialized knowledge, care and insight. With the benefit of a team approach, geriatricians are seniors’ best allies in their quest to maintain their independence and enjoy full active lives.