Wednesday, December 7, 2005

An increase in elderly Americans is coming as Baby Boomers age and that will likely mean an increased demand on health care resources. Those involved in the medical field say they will be hard pressed to meet the demand.

     

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This story was produced with assistance from Michelle Chyatte.

Like or not, our bodies won’t be working as well when we’re old as they did when we were young but most oldsters age pretty well. Professor Harvey Sterns at the University of Akron says the percentage of elderly with serious health care needs will be about the same but the absolute number will rise dramatically

And we know that it’s coming and we have known that it’s coming for 20, 30 years. And I want to emphasize…we know where old people come from. It’s no surprise. They’re formerly young people.

All of the social services that work with elders will feel the pressure but health care is already experiencing a worker shortage. The director of the Ohio Dept of Aging, Joan Lawrence, says there’s time.

Even though they start turning the magic age in 2006, it’ll be 10, 15 years before there’s a great crunch on the system.

Mark: Will they be forced to get along with say, fewer benefits of the elderly today?

It’s a little hard to picture the system. I think it will change as we go along. It will develop. I certainly don’t imagine as much disability as we have now or let’s put it another way. There’ll be other ways to take care of those disabilities, both medications, technology, some help with mobility because of technology.

But others in the field are less sanguine about health care demands. The Director Of The Center For Applied Gerontology at Cuyahoga Community College says there are shortages of geriatricians, nurses, and direct care workers. Janice Dziegel advocates physicians who specialize in geriatrics.

I think it makes a huge difference. It’s just someone who’s trained to recognize and treat that older individual at their stage in life. It would be the same thing as “would you take your infant to a general practitioner rather than a pediatrician?” Same sort of thing in reverse.

The chief of Geriatric Medicine for the Summa Health System, Dr Kyle Allen, says the geriatric model is not so much about treating a single problem and moving the patient along. But on bettering his or her quality of life

A unique twist of geriatric medicine we’ll see how much of that function can we optimize. Whereas a lot of current health care systems just react to that problem. You say “O.K., mom needs to go..” in other words, we want to see if we can improve her function. Does she need better nutrition? Does she need a little bit more help if she doesn’t necessarily need to leave her home? She just needs a little bit of help every day and she can still maintain independence for the next 12 months.

Several area hospitals use a team approach. They like to say it’s not multi-disciplinary but inter-disciplinary. Dr Robert Palmer is head of Geriatric medicine at the Cleveland Clinic…

We conducted a clinical trial of our intervention, the ACE intervention, in which we focused on interdisciplinary care…getting the doctors, the nurses, the social care workers, the case managers, PTOT folks to work together right away. And to figure out what patients need in order to be well enough, strong enough to get home at the end of their planned hospitalization. So the physician working with the team would tell them what the diagnosis is, how long the patient is likely to be in the hospital, and then the team figured out what it takes to get that patient literally back on his or her feet, eating and able to manage their self-care.

The field of geriatrics began in the late 1960’s and grew during the 80’s and 90’s but the number in the field has leveled off even as those involved say its needed more than ever. Barbara Palmisano of the Northeast Ohio Universities College of Medicine says it’s a daunting field for students

Older adults are very challenging. They take a lot of time. They’re presented when they’re frail with multiple co-morbid conditions which can be overwhelming to the student. And it is so important that we link the students with role models that find this exciting and challenging rather than overwhelming.

It’s not as exciting as returning a patient back to perfect health, adds the Clinic’s Dr Palmer

For example, if you’re in obstetrics and you’re taking care of a 20 year old woman, she’s basically healthy….she has a single medical issue which is her pregnancy, you know if you can help her, she’ll get through the next 9 months fine and you’ve done a good job and you feel good about yourself. In contrast, when a young person is trying to treat an older patient, that older person has multiple, and often complex, medical problems. Not just arthritis, not just diabetes, not just high blood pressure or heart disease, but maybe vision problems, bladder problems, bowel problems, memory problems…where do you start? How do you sort through all of these issues?

While the pay is less than most medical specialties, Palmer says a medical journal survey of specialties found that geriatricians reported the highest level of satisfaction. In 2001 Ohio was below the national average for numbers of geriatricians per 1000 people over 75 years old. But Dr. Allen from Summa says Northeast Ohio is lucky . . .

Today, there’s only about 76-hundred certified geriatricians in the nation. Right now, we need about 20-thousand. So there’s already a significant deficit. I think we’re rather unique if you take those numbers on a national level, and we say between Cleveland Metro, Cleveland Clinic, University Hospitals and Summa, we have a pretty high density of geriatricians.

NEOUCOM’S Barbara Palmisano says the coming boom in numbers of senior citizens may spur an increase in geriatricians . . .

Even though the boomers have, you know as a whole, are healthier, better educated, better financial resources, they also have changed the culture in every phase of life that they have come into. And we are grossly unprepared to care for the onslaught of what’s going to happen demographically. Those of us that have been predicting this for many, many, many years are hoping though that the boomers as a consumer group will demand that their physicians will have the skills and the knowledge in geriatrics.

Forbes Magazine figured out that starting January 1st, a member of the Baby Boomer generation will hit the age of 60 every seven seconds for the following 19 years.

     

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