Coping with baby boomers, and staggering statistics
■ A message to all physicians from Ardis Dee Hoven, MD, chair of the AMA Board of Trustees.
America's 78 million baby boomers will begin turning 65 next year at a rate of one every 10 seconds (3 million to 4 million per year). We know that even though they are the best-educated, richest and healthiest seniors the country has ever seen, they are still aging. Chronic diseases, obesity and simply the demographic bulge mean that seniors are becoming a larger and larger part of nearly every physician's practice.
The statistics are staggering. By age 65, around two-thirds of all seniors have at least one chronic disease and see seven physicians. Twenty percent of those older than 65 have five or more chronic diseases, see 14 physicians -- and average 40 doctor visits a year. Situations like these are a nightmare for patients and the physicians who treat them. Variations in therapies, medications and even differing instructions can be confusing, conflicting and hard for patients to remember.
On top of that, many seniors have physical impairments that make just getting to a physician's office difficult.
Not all of us are prepared to treat an office full of aging boomers. However, we are making progress:
- AMA policy calls for all physicians with older patients to be competent in geriatrics. This policy applies to physicians at all levels -- undergraduates, residents and practicing physicians.
- There is already a program of 26 geriatric competencies for medical students. These competencies cover a broad range of topics -- including being able to explain the impact of age-related changes on drug selection and dosage, diagnosing dementia and talking with patients and families about palliative care -- and are now in place. The competencies were developed by the American Assn. of Medical Colleges through a long consensus process involving academicians from more than 40 medical schools, representatives of multiple specialty societies and the AMA.
- Similar competencies in geriatrics also are in development for residents in the fields of surgery, family medicine, internal medicine and emergency medicine, and for other specialists involved in treating older patients. In addition, opportunities now exist for resident training in nursing homes and community- and home-based care.
- On a very positive note, this year's health system reform law -- the Patient Protection and Affordable Care Act -- provides 100% Medicare coverage for annual preventive sessions for seniors. This will be a great benefit to practitioners with geriatric patients. It allows us time not only to conduct functional assessments but also actually to discuss a variety of important subjects with our older patients. The law is broad enough that we will be able to tailor these sessions to our patients, and it should make a tremendous difference.
- The AMA website, through our program on Aging and Community Health, offers a wealth of resources for dealing with seniors, and for making that process easier for all involved -- you, your staff and your patients (link).
- In the next few weeks, the AMA Dept. of Aging and Community Health will issue Geriatric Care By Design -- a short book written by 47 contributors, most of whom are physicians. Based on personal experience in a variety of fields, the work is designed to fit the lives of busy practitioners and offer insights on how to tailor practices for older patients.
Each chapter begins with a case study, an overview of the issue, opportunities to address the situation and challenges that may occur.
It will be published as an e-book with checklists, tables and links to resources. Topics include structural design of practice space, how to evaluate how well your practice serves seniors, staffing and human resources, health literacy, patient self-management, culturally effective care, health disparities, coordination of care in "medical homes" and the family caregiver's role.
Geriatric Care by Design was borne out of the AMA's Aging and Community Health Aging Team's Expert Panel in the 2009 meeting. It should be a valuable resource for those of us moving toward more geriatric-centered practices.
Future of elder care
Elder care has always been an important topic for me. It is one that is regularly in the news, whether it be the chronic diseases that afflict more and more Americans, boomers who are pushing the limits of what their aging bodies can handle, the specter of Alzheimer's disease hanging over the population, issues involving nursing home care, or young seniors stretched and stressed as they learn to care for aged parents as they deal with their own issues of aging.
Every one of those subjects involves physicians.
I don't know what the situation will be for geriatric patients in 25 years, but I do know it will be different.
Steps we take today will lead to a more enlightened, caring, competent and better-equipped world to help older patients age gracefully and live out their final years in dignity.