As population ages, doctors' strategies shift

The American College of Physicians says the population age 85 and over will increase 50 percent from 2000 to 2010. The American Medical Student Association projects a 73 percent increase in the over-65 population between 2010 and 2030. 

That means that more doctors will have to know how to treat the aging population. 

Physicians have to employ different strategies than they do when dealing with younger patients. They have to pay special attention to medications, for example, because the potential for drug interactions is high. 

The average 75-year-old has three chronic medical conditions and takes five prescription medications, according to the Alliance for Aging Research. There are also other issues that physicians must consider when treating older patients.
 
Physicians who treat the elderly have to have knowledge of specific diseases and also know how those illnesses affect a patient's functional and psychological state, said Dr. Robert McCann, a member of the American Geriatric Society. 

"The fun of geriatrics is looking at multiple variables and looking at the approach to make them better," said Dr. Michael Wolff of Cohoes, N.Y. "There is all sorts of satisfaction to making them better, if not making them whole." 

Focus on subspecialty 

Before medical students can even learn about the rewards in treating the elderly, they must take an interest in geriatrics, which is the subspecialty of internal medicine that focuses on elderly care. 

Residents in family and community medicine at Albany (N.Y.) Medical College are required to follow nursing home patients during their last two years of residency. 

They also do home visits and have experience with older patients in both inpatient and outpatient settings, said Dr. Neil Mitnick, a professor and chair of family and community medicine at the medical school. 

In addition, residents learn about end-of-life issues such as hospice care and having family meetings to deal with death and dying. 

Internal medicine residents are required by the American Board of Internal Medicine to do a one-month geriatrics experience. 

John Collins, chief medical officer at Northeast Health, a health care system in Troy, N.Y., said medical and nursing school education programs need to be shifted so students receive enough exposure to the field. 

That may dispel many of the stereotypes associated with geriatrics, such as that patients are difficult to treat, or that this field only deals with people who are close to death or in nursing homes. 

Although medical students may be exposed to patients in skilled nursing facilities, Collins said, they do not always get exposure to patients who are living with "top-notch" home health care. 

"If they don't hear about this or learn about the existence of this sort of thing, they may never develop this kind of interest," he said. 

Starting early 

He said the medical community should make an effort to interest even middle-school students in health care careers to help promote the opportunities that are available. 

Another issue that may turn young doctors away from the field of geriatrics is finances. Many come out of medical school with debts ranging from $120,000 to $200,000. 

Geriatrics is not a high-income specialty. It is not very glamorous, either, Wolff said. Some students opt for higher-paying fields such as surgery or technically oriented fields that appear to be more exciting. 

To become certified in geriatrics, physicians must complete at least a one-year fellowship after completing an internal medicine or family practice residency.

To encourage residents to go into the field of geriatrics, McCann said, the University of Rochester School of Medicine increased its geriatrics faculty so residents have exposure to faculty who really enjoy their jobs. 

McCann said geriatricians have the highest job satisfaction rate among physicians in the United States. As a result, he said, a lot of the school's top residents are going into the field. 

Health care for the elderly population goes far outside the circle of geriatricians, said Henry Pohl, vice dean for academic administration at the Albany College of Medicine. 

"It's very important to train experts in geriatrics, but that is not meant to take care of all the aging population," Pohl said. 

Primary-care physicians and specialists need to understand the needs and different requirements of elderly patients. Integrating geriatric curricula into the mainstream curricula in medical schools could help address this need. 

Copyright © Global Action on Aging
Terms of Use  |  Privacy Policy  |  Contact Us