Written by Judith Graham
KFF Health News
Thirty-five years ago, Jerry Gerwitz was one of the first doctors in the United States to become a certified geriatrician, a doctor who specializes in caring for older adults.
“I understood the demographic imperative and the challenges facing older patients,” Gerwitz, 67, chief of geriatric medicine at the University of Massachusetts Chan School of Medicine, told me. “I felt there was great opportunity in this field.”
But now, Gerwitz worries that geriatric care is in decline. Despite the rapidly growing elderly population, there are fewer geriatricians today (just over 7,400) than there were in 2000 (10,270), he noted in a recent article in JAMA. (In this 20-year period, the over-65 population has increased by more than 60%.) Research suggests that each geriatrician should be responsible for no more than 700 patients. . Currently, the ratio of medical workers to elderly patients is 1:10,000.
Furthermore, medical schools are not required to teach students about geriatrics, and fewer than half require geriatrics-specific skills training or clinical experience. And the pipeline for doctors completing the one-year fellowship required for the geriatrics specialty is narrow. Of the 411 geriatric fellowship positions available in 2022-2023, 30% were unfilled.
The impact is clear. As the U.S. elderly population grows over the coming decades, geriatric physicians will be unable to meet the rapidly increasing demand for their services. There are too few. “Sadly, our health care system and its workforce are woefully unprepared to handle the impending surge in multimorbidity, impairment, dementia, and frailty,” Gerwitz wrote in a paper in JAMA. I warned you.
This is by no means a new concern. Fifteen years ago, a report from the National Academies of Sciences, Engineering, and Medicine concluded: future. ” According to the American Geriatrics Society, 30,000 geriatricians will be needed by 2030 to care for frail and medically complex older adults.
There is no chance that this goal will be achieved.
What kind of progress is holding us back? Gerwitz and his physician colleagues believe that low reimbursement for services by Medicare, low income compared to other medical specialties, lack of prestige, and older patients are unattractive, too difficult, or not worth the effort. Many factors are cited, including the idea that
Greg Warshaw, a geriatrician and professor at the University of North Carolina School of Medicine, said, “There is still significant ageism in our health care system and society.”
However, this negative view is not the whole story. In some respects, geriatrics has had remarkable success in disseminating principles and practices to improve the care of older adults.
“What we’re really trying to do is expand that horizon and train health care professionals in everyone with some degree of geriatric expertise,” said the American Geriatrics Society president and director of the University of California. said Michael Harper, a professor of medicine. -San Francisco.
Some of the principles espoused by geriatricians include: The senior’s priorities should guide care planning. Physicians must consider how treatment will affect the older person’s functioning and independence. Regardless of age, frailty influences how elderly patients respond to disease and treatment. Multidisciplinary teams are best able to meet the often complex medical, social, and emotional needs of older adults.
Medications need to be reevaluated periodically and often the prescription needs to be discontinued. Getting up and moving after illness is important for maintaining mobility. Non-medical interventions, such as paid help at home and training for family caregivers, are often just as important, if not more important, than medical interventions. A comprehensive understanding of the physical and social situation of older adults is essential.
The list of innovations that geriatricians have spearheaded is long. Some notable examples:
home hospital. Elderly people often experience setbacks while in the hospital, such as lying in bed, lack of sleep, and poor eating quality. This model allows older adults with acute but non-life-threatening illnesses to receive care at home, closely supervised by nurses and doctors. As of the end of August, 296 hospitals and 125 health systems (partially total) in 37 states were authorized to offer home health programs.
Elderly-friendly medical system. In this broader effort, it is important to focus on four key priorities (known as the “4Ms”): Protect your brain health (metersentation), carefully managed metersEducation, preservation or development metersFlexibility and what to work on metersThe people who are most concerned are the elderly. More than 3,400 hospitals, nursing homes, and emergency clinics are participating in the age-friendly health systems movement.
Surgical standards focused on the elderly. In July 2019, the American College of Surgeons created a program that includes 32 standards designed to improve care for older adults. The start was delayed due to the coronavirus pandemic, and only five hospitals were certified. But up to 20 people are expected to apply next year, said Thomas Robinson, co-chair of the American Geriatrics Society’s Geriatrics Initiative.
Geriatric emergency department. The bright lights, noise, and hectic atmosphere of a hospital emergency room can be confusing to older adults. Geriatric emergency departments address this issue with staff trained in geriatric care and a gentler environment. More than 400 geriatric emergency departments are accredited by the American College of Emergency Physicians.
A new dementia care model. This summer, the Centers for Medicare and Medicaid Services announced plans to test a new model of care for people with dementia. The program is based on programs developed over the past several decades by geriatricians at UCLA, Indiana University, Johns Hopkins University, and UCSF.
The new frontier is artificial intelligence, and geriatricians are being consulted by entrepreneurs and engineers who are developing a variety of products to help older adults live independently at home. “This is a great opportunity for me,” said Lisa Wolk, chief of geriatric medicine at Penn Medicine at the University of Pennsylvania.
Conclusion: After decades of geriatric-focused research and innovation, “we now have a very good idea of what works to improve care for older adults.” said Harper of the American Geriatrics Society. The challenge is to build on this and invest significant resources to expand the reach of the program. Given the competing priorities in medical education and practice, there is no guarantee that this will occur.
But that’s what geriatrics and the rest of the health care system need to address.
