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Thursday, May 9, 2024

Who Will Care for Us as We Age?

A shortage of doctors, particularly those specializing in care of older adults, tops a laundry list of worries surrounding senior care in the coming years.

Today, the US has a little over 7,400 geriatricians who are trained to work with older adults. In the year 2000, there were 10,270. The population of Americans aged 65 and older has grown more than 60% in the intervening years. 

That’s concerning Jerry Gurwitz, 67 and chief of geriatric medicine at the University of Massachusetts Chan Medical School. “I understood the demographic imperative and the issues facing older patients” when he chose the specialty, says Gurwitz. “I felt this field presented tremendous opportunities.”

Cohousing for Older Adults Solves Many Problems 

Seniors living with seniors, or senior cohousing, is growing. These communities for people age 55 and up are designed for maximum accessibility and a ready group of neighbors who look after each other. Social engagement is easier with the many common areas and shared meals. Everything from finding three more people for a card game to gathering a group to hit a local hiking trail (and taking the community van) becomes easier in a cohousing community. For more information, check the nonprofit cohousing group.
Nowadays, medical schools are under no obligation to teach students about geriatrics, and only half do. Nearly a third of 411 geriatric fellowships were unfilled in 2022-23. “Sadly, our health system and its workforce are wholly unprepared to deal with an imminent surge of multimorbidity, functional impairment, dementia and frailty,” Gurwitz says in his recent JAMA piece.

Modern Changes for the Better

However, it’s not all bad news. Experts in senior health care have worked toward a standard of care that is in the patient’s best interest, including:

  • The priorities of the older adult should inform plans for their care.
  • Doctors must keep in mind how prescribed treatments might affect the patient’s independence and functioning. 
  • Interdisciplinary teams are needed to meet the medical, social, and emotional needs of senior patients. 
  • Frailty affects the response of senior patients to illness and therapies. 
  • Medications need to be evaluated at regular intervals, and sometimes removed. 
  • Walking after an illness is vital to preserve mobility.
  • Non-medical assistance, such as training family caregivers or getting help in the home, can be as or more critical than medical care. 
  • Physical and social wellbeing of the patient must be considered in a holistic way.

“What we’re really trying to do is broaden the tent and train a health care workforce where everybody has some degree of geriatrics expertise,” said Michael Harper, board chair of the American Geriatrics Society and a professor of medicine at the University of California-San Francisco.

Geriatrics Focus

Medical facilities are responding, although progress can be slow. On the bright side, more than 3,400 hospitals, urgent-care facilities, and nursing homes have adopted a focus on an age-friendly protocol known as the “4Ms”. It prioritizes mentation (brain health), managing medications, preserving or improving mobility, and focusing on what matters most to the older adult.

Changes have also come to many emergency departments, which have made efforts to dampen noise, dim bright lights and calm the harried atmosphere for older patients seeking emergency care. More than 400 emergency departments have been accredited as geriatric-friendly by the American College of Emergency Physicians. 

Other Resources

What can you do if you need more help? For healthcare, nurse navigators or personal advocates can assist patients of any age to navigate the system, going to appointments, explaining plans and procedures, addressing emotional needs as well as physical, and following up as needed. These trained professionals often specialize in working with patients who have received a cancer diagnosis.

If you’re looking for someone to help manage an overall care plan from the doctor’s office to following through at home, a life care management team may be the answer. Their professional organization is the Aging Life Care Association, a non-profit with more than 2,000 members across the country. 

They specialize in holistic elder care, not necessarily health care per se, and the best ones can monitor medications and equipment, and work hand-in-glove with doctors and psychiatrists to help ensure patient compliance – such as keeping on a diet. They can also help out with quitting smoking, poor sleep, lack of exercise, and even lack of socialization. Doctors can advise and prescribe, but life care managers can ensure there’s someone to help actually implement protocols. Their emphasis is on promoting independence, safety, and wellness.

To be clear, life care managers are often the ones who will find clients a home aide for showers and giving pills, but they don’t do that work themselves. However, they can provide a central point of contact for managing medical and non-medical needs. 

A life care management team may include registered nurse advocates, client care specialists and other professionals such as a daily money manager who can do routine money tasks such as help pay bills, open mail, file for insurance and prepare for tax filing while a patient is undergoing treatment, and beyond. For patients without a partner or friend physically and emotionally able to complete these tasks, life care managers can fill the void. 

Due to doctor shortages, many of us will never be able to have a geriatric specialist. But as health care facilities prepare for a deluge of senior clients and individuals and teams trained in geriatric standards of care fill in the gaps, the health care landscape for seniors is looking better.