Docs treat aging population inadequately

The aging of the patient population is placing new strains on physicians to manage older patients' time-consuming, complex care; and according to a recent poll of patients age 65 and older, their doctors are doing an unsatisfactory job meeting those challenges.

"The percentage of older people in everybody's practice is going up," Gregg Warshaw, a professor of family medicine in the Department of Family and Community Medicine at the University of Cincinnati's College of Medicine, told AAFP News Now. Specifically, according to the article, the proportion of Americans 65 and older is projected to increase from 12 percent in 2005 to 20 percent by 2030, with even higher rates in rural areas. Meanwhile, as of March of 2011, there were only about 7,162 certified geriatricians in the United States--a shortage that forces all physicians to step up to the plate.

The main challenges for primary care physicians in caring for older patients include managing the time required to address multiple problems, go over lengthy medication lists and coordinate care with other providers. "The truth is, I can see three 25-year old women with urinary tract infections in the time it takes me to see one 85-year old with the same problem," Ariel Cole, director of the geriatric medicine fellowship at Florida Hospital in Orlando, noted in a separate AAFP article.

Thus, according to a recent poll from the John A. Hartford Foundation, many patients over 65 aren't getting the recommended interventions to maintain their health, Kaiser Health News reported. In particular, the results, which cover a 12-month period, revealed the following shortcomings in seniors' care:

  • One-third of older adults said doctors didn't review all their medications
  • More than two-thirds of the time, health providers didn't conduct a fall-risk assessment or history for older patients
  • 62 percent of seniors surveyed said they were not screened for depression

A total of seven interventions examined in the Hartford study are all part of Medicare's annual wellness visit, though more than half of the patients surveyed by the foundation had never heard of the no-cost benefit, KHN reported.

This visit, however, provides physicians with a valuable tool in managing the business side of geriatric medicine and keeping older patients healthy, Mina Zeini, a certified medical director in long-term care, told the AAFP.

"[That visit] allows you to plan for preventive care for the next five to 10 years and talk about advance directives. Even in healthier patients, there's a lot to talk about, and you usually have to follow up with other visits," said Zeini, who is a faculty member for geriatric education at Orlando's Florida Hospital, the hospital's geriatric medicine fellowship and the Florida Hospital Family Medicine Residency.

In addition, adoption of newer delivery models, such as the patient-centered medical home, can make it easier for family physicians to meet the needs of older patients, Warshaw told AAFP News. "With the PCMH, you are focusing more on care management and care coordination. I have a staff in the office that helps me care for the patient. I am not doing it all myself. And that makes care of older patients more enjoyable, while also improving the quality of care."

To learn more:
- read the post from Kaiser Health News
- see the post from the John A. Hartford Foundation
- read coverage from the American Academy of Family Physicians here and here