The aging of America’s senior citizens
The meeting room at Christ the King Retreat House and Conference Center in Syracuse was filled to capacity with senior citizens Jan. 9, all listening intently to Dr. Sharon A. Brangman’s thoughts on what the healthcare landscape will look like in five, ten or even twenty years.
Dr. Brangman, MD, FACP, AGSF, a professor of medicine and division chief of geriatrics for SUNY Upstate Medical University, was this month’s guest speaker for the center’s Conversation Series, a new program that invites community leaders to speak on topics of concern to the public. Once a speaker’s presentation is complete, attendees pose questions to the experts.
Brangman’s presentation, entitled, “The Silver Tsunami: Meeting the Health Care Needs of Our Aging Society,” addressed the aging of America’s senior population and the drastic need for more trained medical personnel.
“It’s not just that Americans are getting older,” explained Brangman. “They are living longer, which requires more medical personnel trained in dealing with geriatrics. Seniors make up 12 percent of the population, but 26 percent of all physician visits, 35 percent of hospital admissions, 34 percent of prescription use and 90 percent of all nursing home use.”
But the term “senior citizen” can cover a wide range of ages, Brangman pointed out. “The baby boomers have been hitting age 65 at a rate of 10,000 a day. By 2030, the last group of baby boomers will turn 65, which isn’t even considered old anymore; it’s considered young-old,” explained Brangman. “Age 75-plus is considered middle-old and anything over 85 is considered old-old.”
There are four states that report the largest segments of seniors ages 65 and older: California, Florida, New York and Texas. Within these states there is a serious need for doctors trained in caring for the elderly.
In 1980, according to Brangman’s figures, 38 percent of senior citizens went to a specialist and 62 percent went to their regular primary care doctor, but in 1990, 47 percent went to a specialist for treatment and 53 percent to primary care. By 2004, 58 percent of seniors went to a specialist and 42 percent went to primary care, indicating seniors were being referred less to a primary care doctor and more to specialists. But the rise in seniors going to specialists may also have to do with a lack of trained doctors in geriatrics.
“There are only 3.9 trained geriatricians for every 10,000 elderly adults who are 75-plus,” stated Brangman. “Medical schools are not training students in geriatrics, but they are providing [residents] the opportunity to train in other areas, such as rotations in obstetrics, while they are residents. This needs to change.”
According to Brangman, of the 9,694 students who graduated from medical school in 2007, only 3 percent went into geriatrics following their residency and of the 1,028 medical doctors who graduated from psychiatric residency programs in 2007, only 6 percent entered a geriatric practice fellowship.
According to Brangman, the problem seems to be that far too many doctors are becoming specialized in a certain area, which depletes the number of doctors for general care.
“Doctors these days are focused on specialties and patients who have an ailment may end up going to see several doctors instead of just one that looks at their entire system,” stated Brangman. “The problem with seeing a specialist is they treat just the area of the problem, not the entire person.” Another concern is the type of treatment a patient receives may not always be the best type of treatment given the medical problem.
“You have to look at all the factors,” explained Brangman. “If a patient is given high blood pressure pills and gets dizzy from the pills, too often they may seek out a specialist to determine why they are dizzy and that doctor will prescribe something to end the dizziness. This just compounds the problem.”
This is not the approach that Upstate University uses in geriatrics. “It used to be in traditional medicine a doctor, primarily working alone, searched for a cure that was disease-based and determined a treatment plan using an organ-based model. Today, we don’t believe in looking for the magic pill: we care more about care versus cure, the simultaneous management of several ailments or diseases and a team approach to problem solving.”
Is the marketplace prepared for more doctors concentrated in geriatrics? Brangman seems to think so, although the growth is slow.
“In 2005 and 2008, 23 percent of medical schools required a geriatric clerkship. In 2005, 48 percent integrated geriatrics into a required clinical rotation and this went up to 56 percent by 2008. In 2005, 34 percent said geriatric curriculum experience depended on faculty interest in geriatrics, but this figure still climbed to 37 percent in 2008. So things are changing.”
Where will the next wave of trained geriatricians and aides come from? Brangman feels they are already in the workforce but in other capacities.
Brangman indicated during her presentation that the average health aide receives between $8.97-$12.35 per hour while the average fast food worker receives $7.76 per hour. “Our workforce needs retooling,” explained Brangman. “Someone might prefer to make less but not have to deal with changing adult diapers or feeding or lifting adults in and out of bed.” This thinking, though, is just the kind Brangman feels results in a workforce shortage of direct-care workers such as nurse’s aides, home health aides and adult nursing home aides.
There are also other barriers to recruitment and retention of health aide workers. “There is a negative perception about working with older patients, stereotypes of working with the aging, such as all older adults have dementia or incontinence as well as more physical and emotional demands.”
What’s the solution to entice a greater pool of workers? Brangman suggests that public and private payers provide geriatric workers incentives such as loan forgiveness, scholarships or having Medicare dollars fund geriatric medical education.
An interesting incentive for those being trained in geriatrics now and in the years to come is the knowledge that this field has a high satisfaction level. In career satisfaction, according to Brangman’s research, geriatrics ranked second to pediatric emergency with dermatology in third place; pediatrics [general] in fourth; internal medicine and pediatrics in fifth; other pediatric subspecialty, neonatal and perinatal medicine, in seventh; allergy and immunology in eighth place; children and adolescent psychiatry in ninth; and radiation oncology in tenth.
Although the interest is high in primarily the pediatrics field, Brangman knows eventually geriatrics will be something that concerns everyone.
“Common sense is that we are all getting older. Everyone eventually will be taking care of an older population but it’s important to really enjoy what you do. I love working with my patients. It’s tremendously satisfying,” she said.
Following Brangman’s presentation, seniors asked questions and interacted in lively debates regarding the physician shortage. A small line gathered waiting to speak directly to Brangman.
Rosemary Carr of Syracuse stood on line and smiled. “This was an amazing presentation,” stated Carr. “It was important to understand that there is a physician shortage in geriatrics. This will be of concern for everyone’s future.”