A colleague of mine is in emotional limbo, waiting for his elderly mother to die. Should he drive the 200 miles back and forth to work, so he will have time to sit with her when her death becomes imminent? Or should he take time off now and stay with her, just in case "it" happens? Will his mother go on for weeks or last only hours? No one can really tell him that.
My colleague's family has been lucky in one way. Unlike many families seeking care for an elderly loved one, they have a geriatrician at hand. Geriatricians are doctors who specialize in caring for those 65 and older. In general, they seek to improve the quality of life and functional ability of patients, instead of focusing on a definitive cure, which may have too high a physical toll for an elderly patient to bear.
My colleague's mother has had a heart attack and has a leaking aneurism. She has emphysema. She is in her 90s. No one is in denial about her impending death. No one, that is, except for the heart specialist who wanted to operate on the aneurism. If it weren't for the intervention of a geriatrician who knew that the surgery would likely kill this elderly woman, surgery would have happened. The geriatrician also knew that, if the woman did survive the trauma of surgery, she would be kept alive only to drown in her own fluids, as her worsening emphysema took over.
The heart specialist is a good doctor and a good person. He's trained to save lives. But he isn't trained to know when it's time to stop saving a life, and start looking at the quality of the life this woman has left.
In the New York Times article "Geriatrics Lags in Age of High-Tech Medicine," reporter Jane Gross writes about a woman named Margaret Mary Foley who faced a situation very similar to that of my colleague's mother. Gross writes, "Margaret Mary Foley, 97, just wasn't herself. Overnight, she stopped eating, went from mildly confused to disoriented, and was unable to urinate. When her panicked family rushed her to the emergency room, doctors did invasive tests, difficult for a woman her age, and then suggested surgery."
Gross goes on to explain that when Mrs. Foley was seen by a geriatrician, the doctor immediately picked up on the fact that the patient didn't have a fever. Elderly people often don't have a fever, when they are ill. Her other symptoms indicated a need for antibiotics. Mrs. Foley was given antibiotics and she recovered, without surgery.
This happy result for Mrs. Foley and her family came about because there was a doctor available who specialized in treating elders. A geriatrician. Unfortunately, we are facing a shortage of these doctors. "There are approximately 7,600 certified geriatricians in the nation, despite an estimated need of approximately 20,000 geriatricians," according to a report in the Annals of Long-Term Care, a journal published by the American Geriatrics Society.
We are facing this geriatrician shortage just when our country is seeing a rise in the number of elders, both because people are cured of diseases that, at one time, killed them at a younger age, and because of the aging baby boom generation.
The Times article goes on to talk about the lack of interest among medical students in geriatrics. Gross' article says, "Caring for frail older people is about managing, not curing, a collection of overlapping chronic conditions, like osteoporosis, diabetes and dementia....The best-paid doctors are those who do the most procedures."
Geriatricians aren't doctors that will be doing a lot of complicated or expensive new procedures, thus they aren't in a field where they will be financially rewarded to the extent of say, a heart surgeon.
This article and others on the geriatrician shortage mention that a proposed solution to the shortage is to limit patients who see geriatricians to the oldest and most frail, generally those over 85. Another solution mentioned is to train all physicians better in the care of the elderly.
While, hopefully, all physicians will be trained to be more in tune with the elderly, I personally can't see a physician whose primary interest and duty is to save lives through heart surgery, as a person who would have time to study all of the complicated nuances involved in caring for aged patients.
The options mentioned that make the most sense to me are to use more geriatric nurses and more geriatric nurse practitioners. But they, too, need to be trained. Will we reward these people as well financially as nurses and nurse practitioners in other fields? If we don't, what will we gain? We'll still have shortages.
Unless we change the way pay and incentive medical professionals; unless we start to view compassionate care of elders as an important specialty deserving of the same respect and financial rewards as other specialties, our elders will pay a heavy price. They will be misdiagnosed, they will suffer surgeries when they only needed therapy; they will be mistreated and misunderstood, because the people who are trusted with their care haven't been properly trained to care for their unique needs.
In my opinion, this all goes back to our values. This has been said in many ways, by many people, and I believe it to my core. The character of a nation is judged by how it treats its most vulnerable citizens.
Our elders are vulnerable people who deserve medical practitioners who understand their unique needs. Somehow we need to attract good, caring people into the field of geriatrics. And we need to reward them, financially, for devoting their education and their lives to this cause. Our elders deserve no less.
Published On: July 23, 2007