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Caring for the Elderly

The Boston Globe, 11/25/09


One thing that is lost in the health care debate is how to care for the elderly. It’s ironic that at a time when thousands of Americans are struggling to find appropriate care for their failing parents, the field of geriatric medicine appears to be vanishing.

For geriatricians, one distinguishing feature of the specialty - and one that most threatens its future - is the in-depth conversations about care between doctors, their older patients, and their families. Critical issues covered include treatment options, the efficacy of treatments, and the impact of these treatments on quality of life. It takes time to manage multiple interacting medical, social and psychological problems, weigh the risks and benefits of various interventions, and discuss goals of care with patients and their families.

The problem is that geriatricians are not adequately compensated for the time they take to address their patients’ complex medical, psychological, and social needs. Consequently, the specialty is not attracting enough physicians to care for our rapidly expanding elderly population. In 2008 there were 7,128 certified geriatricians in the United States. By 2030, we will need 36,000 geriatricians. But the number of graduating physicians seeking specialty training in geriatrics is going in the wrong direction, dropping from 167 in 2003 to 91 in 2007. Fewer doctors are specializing in geriatrics, in part because it does not provide sufficient income to pay off their loans or compensate them fairly for the labor-intensive work.

Geriatric medicine cuts across all diseases that contribute to the functional problems an older adult might have. An older patient typically goes from one specialist to another, with each doctor treating a single problem, but often not looking at the patient as a whole. The patient may receive treatment, but quality-of-life goals are rarely discussed.

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