Caring for an Aging Population
How Will Providers Adapt to an
Older Patient Base?
Looking through blurred eyeglasses, with cotton balls in their ears and cumbersome leather gloves on their hands, a group of Florida medical students were asked to perform the simple tasks of buttoning their lab coats and counting out pills.
They found the assignment to be nearly impossible. It was an “aha” moment.
These students were participating in aging sensitivity training -- learning first-hand about some of the common physical limitations experienced by older patients. The Florida program is one of many across the country designed to help prepare tomorrow's doctors face an anticipated tidal wave of aging patients.
Blame It on the Boomers
The driving force behind the country’s aging populace is the huge generation of Baby Boomers who swelled the ranks of the young in the 1950s and 1960s, and flooded the workforce as they entered adulthood 20 years later. Now many Boomers are well into their retirement years.
Now many Boomers are well into their retirement years. Consider the following:
- By 2030, when every Baby Boomer will be age 65 or older, one out of every five U.S. citizens will be of retirement age.
- By 2035, Boomers will outnumber children for the first time in U.S. history.
This aging population is expected to impact healthcare services in a number of ways
More Geriatricians Needed
Geriatricians not only monitor and coordinate treatment for the many afflictions older citizens must endure, but they also help seniors determine ways to maintain or enhance their well-being and quality of life.
Medical Collections
Decrease with Age
A 2018 federal study indicated that, although healthcare use and spending increase significantly with age, medical collections actually
decrease
substantially as patients get older.
Researchers found that patients in their late 20s were almost three times as likely to have an unpaid medical bill sent to collections than were patients in their late 60s. In addition, the average size of medical debt dropped nearly 40% from ages 27 to 64.
Source:
Health Affairs
Right now there are only about 7,300 certified geriatricians practicing in the U.S. By 2025, at least 30,000 will be needed to meet the demand for services.
One big reason fewer students pursue geriatrics is money. According to Salary.com, the median annual salary for a geriatrician in 2021 is $204,155, compared with $224,414 earned by the average internal medicine doctor, and less than half what the average orthopedic surgeon earns ($498,080).
Medicare, the primary payer for senior adults, typically offers lower reimbursement rates than private insurance providers. The need to pay off medical school debt often motivates new doctors to pursue the higher-paying specialties. So public health officials may need to increase financial incentives for medical students to choose geriatrics as a career.
Some states, like South Carolina, are doing just that by establishing debt-relief programs for new doctors who agree to treat senior adults in the neediest communities.
Another deterrent to practicing in geriatrics is the nature of the work itself, which typically involves the treatment of chronic diseases, most of which are not curable. There is very little opportunity for medical heroics in a geriatric practice.
Of course, not every senior adult needs a geriatrician. But federal data indicates that about 30 percent of them do right now, and their numbers are climbing. In Retooling for an Aging America: Building the Health Care Workforce, the U.S. Institute of Medicine (IoM) Committee on the Future Health Care Workforce for Older Americans recommended the following:
- The enhancement of payments to geriatric specialists,
- An expansion of the Geriatrics Academic Career Award (GACA) program to promote geriatrics education at accredited medical schools, and
- The institution of scholarships, loan forgiveness, or other financial incentives to assist with the high cost of tuition among all types of healthcare professionals who care for older adults.
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Although these recommendations were made in 2008, a 2020 update of the committee’s report revealed that the situation has not changed. As a result, “The 2008 IoM framework and recommendations remain relevant and constitute an important roadmap to complete unfinished goals.”
Team-Based Care
Caring for older adults often requires the collaboration of health professionals across multiple fields. Which is why team-based care has become an emerging trend in geriatrics. In fact, the AMA recommends using physician-led team-based care when addressing the increasingly prevalent chronic conditions of an aging population.
The best geriatric care teams utilize both clinical and non-clinical staff to provide a better patient experience. Physicians, nurses, care managers, nurse practitioners, physician assistants, dietitians, pharmacists, social workers and mental health professionals work together with counselors, receptionists and community workers to deliver comprehensive care to aging patients. Personnel from other specialties are sometimes added also, depending on the individual needs of the patients.
Geriatrics Training for All
With the demand for geriatric services expected to surge, and so few geriatricians available, tomorrow’s healthcare providers will require more training in elder care, regardless of their intended field of practice.
Iowa's Seniors
The proportion of Iowa's population that is over 60 is growing while the proportion that is under 60 is shrinking. The U.S. Census Bureau estimates that 27% of Iowa's population will be over age 60 by the year 2030 -- an increase of 34% since 2012.
539,830 -- The estimated number of Iowa residents age 65 and over in 2018. This age group accounted for 17.4% of the state's total population . Iowa ranks 17th nationwide in the percentage of residents age 65 and older, while the state's overall population ranks 32nd in the nation.
687,787 -- The projected number of Iowans age 65 and older in the year 2050. According to Woods & Poole Economics Inc., this age group will constitute 20.3% of the state's total population at that time.
Source:
State Data Center of Iowa
As a result, more medical schools will incorporate the care of older adults into all of their preclinical studies. One way this can be achieved is through online training.
For instance, the Mayo Clinic College of Medicine has developed an online curriculum which allows medical schools instant access to 26 cases that address the fundamentals of senior care.
And Aquifer Geriatrics tests competencies in medication management, palliative care, and the ability for self-care. The curriculum is appropriate not only for primary care residents, but also for physician assistants and nurse practitioners.
In addition, it will become increasingly important in the coming years that medical practitioners in all fields maintain competence in geriatric principles.
Every U.S. state requires some type of Continuing Medical Education (CME) courses in order to maintain licensing. However, only one – California – currently requires geriatric education.
But as the demand for senior care increases, more states are expected to include a geriatric component to their mandatory CME for all providers.
Dr. Mary Tinetti is the chief of geriatrics at the Yale School of Medicine. She envisions an elite workforce of geriatricians who would train entire institutions in the specifics of caring for seniors. According to Tinetti, “The most important thing geriatricians can do is make sure all their other colleagues understand” how to properly care for older adults.
Her colleague, Dr. John Moriarity, an associate professor of medicine at Yale, agrees there’s an enormous need to provide geriatric training to PCPs.
“Primary care providers are on the front lines and will be the initial point of contact for many patients with geriatric syndromes,” he said.
With 10,000 Americans turning 65 every day, this is the future of healthcare.
Sources:
Featured Image: Adobe, License Granted
Assoc. of American Medical Colleges
National Center for Biotechnology Information
American Academy of Family Physicians
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