Grant geared to increase doctors’ geriatric knowledge

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By Liz Taylor

Special to The Seattle Times
Older people are not simply younger people with wrinkles “” our bodies change dramatically as we age, both inside and out, and some parts wear out before others, unpredictably, sometimes several parts at once.

While we recognize this intellectually, few of us appreciate how it affects our diagnosis and treatment when we’re ill. The fact is, adults at age 80 are markedly different in their physiology and chemistry compared to when they were 20, 40, or even 60.

Even if you stay the same weight (though few do), some or much of your muscle tissue is replaced by fat.

The water content in your body decreases from roughly 60 to 40-50 percent, causing drugs to work differently.

The flexibility of your lungs diminishes, along with changes in the functioning of your heart, metabolism, blood vessels and other organs.

These are all normal and natural, but they have major implications for your health and health-care team.

For example, let’s say you need surgery; a tube may be inserted in your throat to help you breath. At age 45, no problem. At age 88, when your lungs have grown stiff, you may not get adequate oxygen. Normal changes in your blood vessels increase your blood pressure, compromising your heart’s ability to handle additional stress. With more body fat, the anesthetics may work differently. The presence of multiple other chronic conditions and medications add to the complexity.

It’s made the job of taking care of us vastly more complicated, critical and time-consuming when we’re older, and it requires special training. The result: a relatively new specialty among doctors known as “geriatrician.” Unfortunately, a severe shortage of geriatricians exists “” just 900 who are formally trained out of 700,000 physicians nationwide, according to the American Geriatric Society.

Compare this to the demographic reality of our aging nation. Today 35 million people are age 65 and older. By 2050, they are expected to be 78 million. In the United States today, there are about 4 million people 85 years of age and older, a time of life when people usually require the most medical services. By 2050, that number will be 18 million, or, if current trends in life expectancy continue, 30 million.

I’ve told you about the difficulties many older people have finding physicians willing to accept Medicare. According to many of my readers, including physicians, it’s become a crisis in many parts of our state and nation and will continue as Medicare payment levels to physicians decline. Now add another problem: a shortage of physicians with the training and experience to care for us as we age, just as our numbers skyrocket.

Congress and the voting public hold the key to improving Medicare reimbursements, something that must happen soon. However, a powerful movement to increase the geriatric knowledge of physicians has already begun, and that’s good news.

This month, the John A. Hartford Foundation announced an award of $5 million to the American Geriatrics Society (AGS), a professional organization of physicians and other health-care practitioners who focus on treating older patients. Its purpose: to dramatically expand the geriatric training of surgical and other related-specialty medical students. Parallel initiatives are under way to educate physicians in established practices, as well as nurses, social workers and other members of the health-care team.

The grant targets 10 specialties that see large numbers of older patients, among them: anesthesiology, emergency medicine, general surgery, rehab specialists and urology.

“The outcomes of this initiative “” which started in 2001 “” have been striking so far,” says Dr. Myron Miller, a geriatrician and professor of medicine at John Hopkins University School of Medicine in Baltimore and co-director of the AGS’ geriatrics-education project.

For one thing, physicians who were once reluctant to see older patients because of their lack of knowledge in geriatric care and their patients’ complex and time-consuming needs are learning that older people can be a nice part of their practice. They’re often more appreciative than younger patients, more compliant with treatment, and, because they’re older, can be very interesting people.

For another thing, he said, several of the targeted specialties are making major changes in their training requirements and physician-credentialing programs. The American Academy of Physical Medicine and Rehabilitation, among several others, has formally recognized the inclusion of aging content as a required part of training and will include geriatric care as part of their board certification examinations.

Thus, the Hartford Foundation’s generosity is helping to establish a permanent change in educating most specialists in geriatric medicine. This brings all of us a much better prospect of receiving good quality care tailored to our needs as we grow older.

Liz Taylor’s column runs Mondays in the Northwest Life section. With 30 years experience in the field, she writes and lectures on a host of aging topics. E-mail her at [email protected] or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at

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