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Crisis of Age Requires Cure
By Lauren Foster, Financial Times
April 5, 2008 When Mark Lachs, an internist who specialises in the care
of the elderly, looks into the not-so-distant future, he sees millions of
retirees and not enough doctors. “The baby boomers are moving through
the belly of the beast and are coming out 65,” he says. “The numbers
are just overwhelming; about 7,000 geriatricians for millions of older
people.” Every day an estimated 6,000 Americans turn 65. Four years
from now, that figure will swell to 10,000 people a day so that by 2030,
one in five Americans will be 65 or older. At the same time, geriatrics
programmes across the “We are in a significant crisis – it is no longer
looming,” says Lachs, a professor of medicine and a chief of the
division of geriatrics and gerontology at Weill Medical College of Cornell
University. “The manpower deficit extends from the physician level to
the frontline workers and everywhere in between.” The consequences are dire; unless systemic changes are
made, the “silver tsunami” of retiring baby boomers will cripple the
country’s health systems. Consider this: there are 7,128 board certified
geriatricians in the Usually, when public and private resources fail to address
a societal problem, philanthropy is the answer. Yet ageing, for the most
part, is ignored by foundations and donors. Why think about old people
when there are glamorous causes with star-studded fundraisers and
celebrity spokespeople? (Think malaria or the plight of refugees in the
developing world.) “Ageism is alive and well in our society,” says
Corinne Rieder, executive director and treasurer of The John A. Hartford
Foundation, the largest private foundation in the This age-defying quest is fuelled by best-selling books
with titles such as How Not to Look Old and a society that
celebrates the virtues of Botox parties and plastic surgery. For many,
thinking about old age means confronting uncomfortable topics such as
dementia and Alzheimer’s disease. But as Atul Gawande put it in an
article last year in The New Yorker, “people naturally prefer to avoid
the subject of their decrepitude”. Fundraising
to fight abuse of the elderly
Geriatrician Mark Lachs recently made his way to a meeting
of the Manhattan Elder Abuse Case Co-ordination and Review Team (EACCRT),
a group he helped found in late 2006. Those attending included colleague
Risa Breckman, director of social work programmes and education for
geriatrics and gerontology at Weill Cornell Medical College, and Elizabeth
Loewy, a prosecutor who leads the elder abuse unit at the Manhattan
district attorney’s office. One important matter to discuss was a proposal for a
planning grant that had been submitted to a private foundation and on
which, in a few weeks, the trustees would decide. There was also an
anonymous donor in the wings who was considering a matching grant. The
room stirred; a modest infusion of philanthropic dollars would jumpstart
the planning process needed to transform this ad hoc group of social
workers, doctors and lawyers into a formal entity. It would also represent a fundraising triumph – very few
philanthropies focus on ageing, and even fewer fund work in the area of
elder abuse. One notable exception is the Archstone Foundation in Yet the number of elder abuse and neglect cases is
increasing – and the victims are rich and poor alike. (Studies show that
between 2 and 10 per cent of people over 65 have experienced elder abuse.) “Elder abuse is pervasive in subtle and significant
ways,” says Lachs, who is writing a book about ageism and healthcare.
“One not so subtle area is financial exploitation. This is the most
rapidly exploding category – especially in a down economy – where
older people are exploited for property, money and all kinds of things
either by family members, care givers or scammers. It is becoming
increasingly common and much more difficult to identify until the
person’s resources have been completely rifled.” Some believe this aversion affects funding decisions.
“Older people and ageing are not seen as sexy topics and oftentimes the
people on [foundation] boards are ageing and this can be painful to think
about. They are in denial themselves,” says Brian Hofland, head of the
international ageing programme at The Atlantic Philanthropies, the
world’s largest private funder of ageing issues. Yet ageing is a universal issue. Gara LaMarche, “Ageing is not a niche funding area or a special
interest group. The number of funders with a primary focus on ageing, like
our close friends at The John A. Hartford Foundation, will always be
finite, though it too needs to grow,” he told the 2007 annual meeting of
Grantmakers in Aging (GIA), a national membership association. “But the
number of foundations which ought to be concerned with ageing is almost
infinite, for no funder ought to get away, in this day and, well, age,
with saying ‘we don’t do ageing’.” A small group of US foundations has embraced funding
programmes to prepare for the dramatic ageing of the population. Through their grants, foundations are tackling issues that
range from researching and treating elder abuse to changing how society
views older people and helping more doctors, nurses, psychiatrists, social
workers and other health professionals receive the necessary training. For The Donald W. Reynolds Foundation, a private
philanthropy that funds journalism, ageing care, and cardiovascular
research, the way to improve the quality of healthcare for elderly people
across the “We are not in the business of training people to become
geriatricians. We are in business of training all physicians, no matter
what field they enter, to better care for frail older people, so it
includes both faculty and practising physicians,” says Rani Snyder, a
senior programme officer for Reynolds. This skills shortage was highlighted in a 2002 report –
“ Six years on, the outlook remains bleak. For academic year
2006-07, 468 first-year fellowships in geriatric medicine were available,
and only 253, or 54 per cent, were filled, according to the American
Geriatrics Society. For the same year, there were 136 geriatric psychiatry
fellowship first-year training slots, and half went unfilled. “The population numbers clearly point to older patients
dominating the healthcare delivery in the An ageing population is a triumph of medical science, but
longevity has downsides that extend far beyond wrinkles. Having enough
geriatricians and geropsychiatrists – as well as primary-care doctors
trained in caring for the elderly – is one way to ensure that older
people have access to a better quality of life. This is because caring for older adults is not simply a
matter of treating older versions of middle-aged patients. Many common
diseases of adulthood, such as depression, have different characteristics
in the elderly than in younger people. And the elderly tend to have
multiple problems: the average 75-year-old has three chronic medical
conditions and regularly uses about seven prescription drugs, as well as
over-the-counter remedies. “The internal medicine is really complicated and really
interesting. Rarely is it just heart failure. It could be heart failure
plus diabetes, plus depressive disorder, plus cataracts,” says Lachs,
who is also director of geriatrics for the NewYork-Presbyterian Healthcare
System. He spends much time encouraging doctors to become
geriatricians. But it is difficult; the pay is a lot lower than most other
medical specialisations and the field lacks prestige. “Geriatric
medicine remains an under-subscribed field for people coming out of
medical school,” he says. “Yet if you do anything other than
paediatrics you will be seeing mostly older people.” The Hartford Foundation is working to change this. One of
its initiatives – centres of excellence in geriatric medicine and
training – was designed to address the shortage of geriatric faculty
members in US medical schools. The centres are a network of 26 medical
schools at which about 70 per cent of the future professors of geriatric
medicine receive training. Funding geriatric medicine is just one area where
philanthropy can make a big difference. To achieve wider impact, however,
ageing needs to move from an orphan to a mainstream issue. More big
funders also need to emerge as To help raise awareness, GIA, in partnership with Carol
Farquhar, GIA’s executive director, says ageing
“is coming into its own” and the organisation’s membership has
swelled from fewer than 60 foundations eight years ago to 115 today.
Still, this is minuscule considering there are about 70,000 private
foundations in the “It is important to note that there is a seat for
everyone at the table,” Farquhar says. “There are more needs and
issues than funding resources. Ageing can be meals on wheels; an elaborate
research project; or taking a national model and bringing it to the
community for less than the cost of the original grant. There are many
opportunities for partnering and collaboration. Ageing is very broad –
you can pick your issue and really make an impact.” More Information on US Health Issues
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