“There’s no escaping the tragedy of life, which is that we are all aging from the day we are born,” writes Dr. Atul Gawande in his latest book, Being Mortal: Medicine and What Matters in the End.
Accordingly, I’ve reached that point in life when I wish I could consult with a geriatrician, or specialist on the aging process. Given that we are increasingly an aging population, you’d surmise it’s no problem finding one.
Count yourself lucky, if you do. And if you do, that you’ll get in.
I live in a city of 300,000, and home of a major university with a respected medical school and first class hospitals. Still, I couldn’t find one.
In fact, it may surprise you to learn that geriatricians are an increasingly rare breed.
Take the University of Minnesota, for instance. It recently shut down its Department of Geriatrics, despite its success in enhancing the quality of life for many seniors, reducing disability, both physical and mental, remarkably and, what’s more, the need for costly home services.
Unfortunately, treatment costs exceeded any savings (Gawande 45).
Other medical centers have followed suit, reducing or eliminating their geriatric services.
The medical establishment prides itself on fixing things, when for the elderly it’s management, not healing, that should define appropriate treatment.
Technology, however, is where the big bucks are and even Medicare, tailored for those 65 and over, falls short in paying for services specific to seniors.
Additionally, doctors often feel overwhelmed by elders coming to them with not one, but several ailments. Think hypertension, diabetes, asthma, arthritis, anemia, failing hearing and eyesight, etc.
in the meantime, most Americans will ultimately spend at least a year in a nursing home at considerable expense, which quality geriatric care might well have preempted.
I can’t help but think this sorry state of affairs is somehow related to our general disregard of older people in America, often the butt of jokes or derision.
One study indicates that 68% of the elderly believe that the public is indifferent to its older citizenry.
I don’t think it was always this way. I grew up in a time when we revered age. It’s still this way in countries like China, Japan, Korea and in Latin America. China recently enacted an Elderly Rights Law, mandating its citizens “never snub or neglect the elderly.”
In Korea, turning 60 and 70 are celebrated events.
In contrast, American culture–as in other Western countries–is youth-centric, with emphasis on independence.
Maybe it’s because, thanks to many of modern medicine’s achievements, there are too many of us now, with 20% of Americans projected to be over 65 in the next twenty years.
Currently, those over 65 constitute 26% of all doctor visits, 47% of all hospital stays, 34% of all prescriptions, and 90% of all nursing home stays (Institute of Medicine Report: Retooling for an Aging America).
Unfortunately, there are only 7,000 geriatricians, and that number is declining. As such, it’s only half of what’s needed to meet a growing need (americangeriatrics.org).
The elderly often have emotional as well as physical needs. Sadly, only 3% of psychologists devote the majority of their practice to those over 65.
Geriatric psychiatrists number only about 2,000 and, like geriatricians at large, that number is declining, according to the American Association for Geriatric Psychology.
How foolhardy all of this is, since the elderly constitute a minority most of us are destined to join.
Most of us don’t like to go there when it comes to thinking about growing old and confronting our mortality. Certainly, we don’t prepare ourselves for it very well, though it may be closing in on us sooner than we think.
The UN associates age 60 with elderly status.
In the USA, several states use the same criterion.
The bottom line is that sound medicine isn’t about money. It’s about compassion
–rj
Brimmings: up from the well 