Growing Older, Living Well

By Billings Clinic

Growing older is one of the most natural things we do, and for many, it’s a time of real richness. New perspectives, deeper relationships, and hard-earned wisdom don’t come any other way. But like any season of life, it brings its own physical changes: managing medications, shifts in balance, or a memory that doesn’t fire quite as fast. These aren’t signs that something has gone wrong. They’re part of the journey, and with the right support, you can navigate them well. In fact, Billings Clinic geriatrician Dr. Christina Tieu says getting older is about figuring out what matters most in our lives and building a lifestyle that supports just that.

After completing medical school, residency and a geriatric fellowship at Mayo Clinic, Dr. Tieu spent seven years practicing geriatrics at the University of Virginia before joining Billings Clinic, where she now cares for older adults and helps train resident physicians. She originally planned to become an oncologist but realized what she loved most wasn't treating cancer. It was getting to know older adults, learning about their interests and goals, and helping them build their changing lives around them.

One of the biggest misconceptions about geriatric medicine is that it is only for people who are seriously ill or living with dementia. Dr. Tieu says that is simply not the case.

"The vast majority of my patients are actually really healthy and doing great," Dr. Tieu said. "Our job is just to keep you doing really well."

Many people she sees aren’t looking for someone to take over their care. What they really want is someone who understands the new challenges that can arise with aging, and someone who can help them stay healthy for as long as possible.

Rather than focusing only on illness, geriatric medicine places a strong emphasis on helping people stay independent, active, and engaged in the things they enjoy. Much of that work means identifying small changes before they become bigger problems and creating a plan that helps people continue living the life they want.

“I like to think of what a geriatrician does as primary care plus,” she said.

Geriatricians, like primary care physicians, run the gamut from treating everyday illnesses and providing routine care to managing chronic conditions. The difference is that geriatrics also focuses on helping people maintain independence and quality of life as they age.

A visit with a geriatrician may sound different than people expect. Dr. Tieu says many appointments begin with questions that have little to do with blood pressure or lab results. Commonly, she’ll ask: How steady are you on your feet? Are you eating enough protein? Are you staying active? Have you had any falls? Is managing your medications becoming more difficult? What matters to you most right now?

Those conversations, she says, shape the care plan just as much as the medical information gathered along the way.

Dr. Tieu says many people feel like health care can become “a conveyor belt” as they age. One diagnosis leads to a follow-up appointment, a new medication, additional testing, and one more specialist on a growing list.

“Sometimes patients feel like they’ve been put on this conveyor belt, and they don’t have any agency,” she said. “What I find rewarding is being able to tell them, ‘No, actually, we can get you off this conveyor belt. Tell me what it is exactly that you are wanting from your life.’”

Those answers look different for everyone. One person’s main focus might be staying healthy enough to travel. Another may simply want to be able to remain in their own home, tend to their garden and pick up their grandchildren after school. Whatever the goal, Dr. Tieu says it becomes part of the care plan.

Good medical care doesn't always mean adding something else. Sure, sometimes another medication, test or referral is exactly what's needed. But Dr. Tieu says there are just as many times when the best thing she can do is take something away.

"A lot of times it's deprescribing," she said. "It's peeling medications off and making you feel better."

It's a thoughtful process. As we get older, medications that once worked well may begin to carry more risk. Side effects become more common, drug interactions become more likely and what made sense at age 50 may not make as much sense at 80. That doesn't mean stopping medications without a plan. It means taking a careful look at the whole picture.

"Sometimes it's de intensifying medical care," Dr. Tieu said. "Really being thoughtful about how we do that so there's less time spent on medical interventions and treatment, and more time spent enjoying your life."

That philosophy extends beyond prescriptions. Instead of asking, "What else can we add?" geriatric medicine often asks, "What's getting in the way of living the life you want?"

Maybe a medication has begun causing dizziness. Appointments have started taking time away from family, hobbies or simply enjoying everyday life. The goal isn't simply to add another medication, schedule another test or make another referral. It's to make sure each part of a person's care supports the life they're trying to live. Sometimes that means more treatment. Sometimes it means less.

We are all aging, every second of every day, and it’s part of life to see it in those around us. We may begin to see things like diminished balance as dad gets out of his chair, or mom walking a little slower.

“Children grow up seeing their parents a certain way,” Dr. Tieu said. “Then you start to see them get smaller, get weaker. They’re not able to do the things they used to. It’s hard.”

The challenge, she says, isn’t a lack of love. It’s knowing how to help while still respecting a parent’s independence.

“I think love really pushes us to jump in and help,” she said. “But you also have to respect

that relationship. Sometimes what you think is right isn’t something your mom or dad is ready to accept.”

Conversations about accepting help, giving up driving, or considering assisted living can be some of the most difficult families ever face.

"I've seen this hundreds—maybe thousands—of times. It's always hard."

Her advice is to approach those moments with patience and compassion, offer options instead of ultimatums, and recognize that some decisions just take time.

Getting connected with a geriatrician can begin with a simple conversation. If you feel you or a loved one could benefit from specialized care focused on the needs of older adults, talk with your primary care provider or call Billings Clinic to learn more about scheduling an appointment with Dr. Tieu or another member of our geriatric medicine team.

Aging is part of life. It brings changes, challenges, and sometimes difficult conversations. But it also brings the opportunity to focus on what matters most and make choices that support the life each person wants to continue living.

That, Dr. Tieu says, is where geriatric medicine can make a difference.

Because maybe the most important question isn’t, “How do we stop aging?” It’s, “How do we keep living well through it?”  

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