Closing the Gap: The Growing Need for Elder Care Specialists

Jerry Gurwitz, now 67 and the chief of geriatric medicine at the University of Massachusetts Chan Medical School, was one of the pioneering physicians in the United States to receive credentials as a geriatriciana doctor, specializing in the care of older adults. Recognizing the importance of the demographic shift and the unique challenges faced by older patients, Gurwitz saw great potential in this field.

But today, Gurwitz is concerned about the decline of geriatric medicine. In a recent article in JAMA, he pointed out that despite the growing population of older individuals, the number of geriatricians has actually decreased. In 2000, there were 10,270 geriatricians, but now there are only just over 7,400. (During this time, the population aged 65 and older has increased by more than 60%.) Research indicates that each geriatrician should ideally care for no more than 700 patients. However, the current ratio of providers to older patients is 1 to 10,000.

An Austin-Travis County medic is seen assisting a patient in an ambulance in Austin, Texas. The patient had passed out and become dehydrated near the Texas State Capitol, prompting a call to the Emergency Medical Technicians (EMTs). Austin is currently facing a prolonged heat wave, leading to the issuance of excessive heat advisories throughout the state. The photo was taken by Brandon Bell and is courtesy of Getty Images.

Heat-related fatalities are anticipated to rise in the United States, particularly among the elderly and Black population. Additionally, it is worth noting that medical schools do not have a compulsory curriculum for geriatrics education, with less than 50% of them incorporating specialized skills training or clinical experience in this field. Moreover, the number of physicians pursuing a one-year fellowship to specialize in geriatrics is limited, resulting in 30% of the available 411 positions remaining vacant for the 2022-23 period.

The implications are alarming: Due to the increasing elderly population in the U.S., geriatricians will be incapable of meeting the growing demand for their services for many years to come. There is simply a shortage of these professionals. "Regrettably, our healthcare system and its workforce are ill-prepared to handle the impending rise in multimorbidity, functional impairment, dementia, and frailty," Gurwitz cautioned in his article for JAMA. This concern is not new. A report from the National Academies of Sciences, Engineering, and Medicine fifteen years ago stated, "If immediate action is not taken, the healthcare workforce will lack the capacity (in terms of both size and ability) to meet the needs of elderly patients in the future." According to the American Geriatrics Society, there will be a requirement for 30,000 geriatricians by 2030 to provide care for vulnerable, medically complex older adults.

There is no chance of achieving this goal.

Progress has been hindered by several factors according to Gurwitz and his colleagues. These include low Medicare reimbursement for services, comparatively low earnings compared to other medical specialties, a lack of prestige, and the perception that older patients are unappealing, too challenging, or not worth the effort.

"There is still a significant prevalence of age discrimination in both the healthcare system and society," expressed geriatrician Gregg Warshaw, who holds a professorship at the University of North Carolina School of Medicine.

Nevertheless, it is important to acknowledge that this pessimistic viewpoint fails to capture the entirety of the situation. In certain aspects, geriatrics has achieved noteworthy success in spreading principles and practices aimed at enhancing the quality of care provided to elderly individuals.

"What we aim to accomplish is to expand the reach and provide training to a healthcare workforce equipped with comprehensive knowledge in geriatrics," expressed Michael Harper, the board chair of the American Geriatrics Society and a professor of medicine at the University of California-San Francisco.

Medicare Part B monthly premiums will rise to $174.70 next year.

Bill Oxford/iStock Unreleased/Getty Images

Medicare Part B premiums are set to increase by almost $10 for the year 2024.

Geriatricians advocate for certain principles, such as prioritizing the care of older adults according to their specific needs. Doctors should take into account how treatments will impact the functioning and independence of seniors. Frailty plays a significant role in how older patients respond to illness and therapies, irrespective of their age. Interdisciplinary teams are the most effective in addressing the complex medical, social, and emotional needs of older adults.

Regular medication reevaluation is necessary, and de-prescribing is frequently necessary. Maintaining mobility is crucial after illness by engaging in physical activity. Nonmedical approaches, such as hiring assistance or providing training for family caregivers, hold equal or greater importance than medical interventions. It is crucial to have a comprehensive comprehension of the physical and social circumstances of older adults.

Geriatricians have spearheaded numerous innovative initiatives. Several noteworthy examples include:

Content Hospital-at-home. Seniors often experience setbacks during hospital stays, such as staying in bed, experiencing sleep deprivation, and having poor nutrition. In the hospital-at-home model, older adults with acute but non-life-threatening illnesses receive care in the comfort of their own homes. They are closely monitored by nurses and doctors. As of the end of August, hospital-at-home programs were authorized in 296 hospitals and 125 health systems across 37 states.

Age-friendly health systems. The focus of this comprehensive initiative is on four key priorities, also known as the "4Ms": safeguarding brain health (mentation), carefully managing medications, preserving or improving mobility, and addressing what matters most to older adults. The age-friendly health system movement includes over 3,400 hospitals, nursing homes, and urgent care clinics.

Geriatrics-focused surgery standards: In July 2019, the American College of Surgeons established a program consisting of 32 standards aimed at enhancing the quality of care provided to older adults. Despite facing challenges due to the covid-19 pandemic, the program initially progressed slowly, resulting in only five hospitals obtaining accreditation. However, it is anticipated that approximately 20 hospitals will apply for accreditation next year, according to Thomas Robinson, co-chair of the American Geriatrics Society's Geriatrics for Specialists Initiative.

Geriatric emergency departments: Hospital emergency rooms often present difficulties for older adults due to their intense lighting, noisy environment, and frenzied atmosphere. Geriatric emergency departments have been developed to address these issues by employing staff members who have received specialized training in the care of seniors, and by creating a more soothing environment. Over 400 geriatric emergency departments have received accreditation from the American College of Emergency Physicians.

New models of dementia care were announced this summer by the Centers for Medicare & Medicaid Services. These models are based on successful programs created by geriatricians at UCLA, Indiana University, Johns Hopkins University, and UCSF over the past few decades. Sign up for CNN Health's weekly newsletter to learn more.

Sign up here to receive The Results Are In with Dr. Sanjay Gupta every Tuesday, brought to you by the CNN Health team.

Artificial intelligence presents a new frontier, where entrepreneurs and engineers consult geriatricians to develop a variety of products that enhance the independent living of older adults in their own homes. Lisa Walke, the chief of geriatric medicine at Penn Medicine, affiliated with the University of Pennsylvania, views this as a tremendous opportunity.

After years of extensive research and innovation concentrated on geriatrics, there is now ample understanding of effective methods to enhance the care provided to older adults, as stated by Harper from the American Geriatrics Society. However, the real test lies in further developing and investing substantial resources to expand the reach of these programs. Considering the various priorities in medical education and practice, there is no assurance that this will occur. Nevertheless, it is crucial for geriatrics and the entire healthcare system to progress in this direction.

KFF Health News, previously called Kaiser Health News (KHN), is a nationwide news organization specializing in comprehensive reporting on health matters. It functions as a primary program within KFF, an independent authority for health policy research, polling, and journalism.