The doctor pulled out a stethoscope and Gladys Martinez stopped smiling.

She inhaled. Her heart-shaped earrings trembled. The doctor listened. Two years ago, Mrs. Martinez survived a heart attack. Stethoscopes remain a cold reminder, the dreaded moment of any medical exam.

But the angst passed with unusual speed. The doctor finished the checkup, and without moving an inch, Mrs. Martinez, 75, resumed rocking in her favorite chair, in the living room of her Bronx apartment, surrounded by the soft comfort of family photographs and porcelain dolls. 

No more waiting rooms or tedious paperwork, never mind the two buses she took to the hospital or the times she collapsed trying to get there.

Now, Mrs. Martinez's doctor is coming to her, as part of a growing trend in geriatric care, and some say a necessary one. She is among 65 patients enrolled since October in the Montefiore Medical House Call Program at Montefiore Medical Center, the latest of several efforts by hospitals in New York City to care for a rapidly growing elderly population.

Toting state-of-the-art equipment, like portable EKG and Doppler machines, doctors and nurses enter the homes of older patients to conduct complex, if routine, exams. Technological advances have made the practice possible, but in some ways it is a throwback to another era.

"In the history of medicine, this is what doctors did," said Dr. Laurie G. Jacobs, the director of geriatrics at Montefiore Medical Center and the Albert Einstein College of Medicine, in the Bronx. 

In the modern age, perhaps never has the need for home health care been greater. The city's elderly population, like the nation's, is booming as people live longer. Roughly 1.25 million New Yorkers are over age 60. In the next 10 years, this group is expected to grow by 20 percent, according to the City Department for the Aging. By 2050, the number of people over 65 is expected to double nationally to 87 million.

Longevity brings a host of new medical challenges. People are more likely to survive heart attacks, strokes and cancer than they were decades ago, but survival often comes with chronic ailments. Heart disease patients are frequently short of breath and cannot walk far, limiting their ability to get out of the house. Stroke victims often have trouble performing basic tasks. As more people live longer, more suffer from dementia. Going to the doctor or taking the right medication every day can prove daunting, if not impossible.
"They're in their homes very quietly, and nobody knows they're not managing until they haven't paid their rent or their mail piles up," Dr. Jacobs said.

Compounding the problem is the fact that families are often ill equipped to care for their oldest members. Adult children are more dispersed, and less able to provide help. "You no longer have the unemployed housewife who might have been available decades ago to take care of Grandma," said Dr. F. Russell Kellogg, chairman of the department of community medicine at St. Vincent's Hospital Manhattan, which pioneered one of the first home visit programs, in 1973. 

In New York City, roughly one-third of people over the age of 65 live alone - more than 300,000 people - according to the Department for the Aging. Many of them struggle, with piecemeal help. 

Filling the void are at least four New York City hospitals, which now regularly send doctors, nurses and social workers into the homes of more than 1,000 patients. They do a range of things to help patients manage their lives, from handling insurance claims and checking the refrigerator to taking blood samples and conducting hearing tests.

Mount Sinai School of Medicine, on the Upper East Side, began its Visiting Doctors Program in 1996 with 23 patients. It now has 813. North General Hospital, in East Harlem, started making home visits two years ago and now treats 121 patients.

The programs find their patients through referrals by hospital staff members, case management organizations or, sometimes, city services like Meals on Wheels. But often, word is spread among neighbors.