Bracing for the Silver Tsunami
America as a nation is getting older. The fastest-growing segment of the population is those older than 85, with a rapidly increasing group older than 100. We’re living longer, and we’re doing so with comorbid conditions and chronic illnesses that killed off previous generations at younger ages. The recurring question has been: Who will care for us as we age?
Every geriatrics provider has at least one story of an older patient whose ailment was missed or misdiagnosed. There is the woman who was seen twice in the hospital by an otherwise excellent neurologist, who missed her Parkinson’s diagnosis because the patient didn’t present with the expected tremors. Or the woman awaiting surgery for a fractured shoulder, who was about to be discharged to a house with multiple staircases where she lived alone, because no one thought to ask about her home situation (and with a prescription for Vicodin, no less, despite a previous hospitalization in which she had an adverse reaction to the drug).
Perhaps the most egregious case was the woman who wasn’t eating and who told hospital staff the reason was that her mouth hurt. No examination was performed, but a PEG tube was placed. Kemle saw the woman later in a nursing home and diagnosed candidiasis; within two weeks, the tube was removed. “Now, she didn’t have a complication from the tube,” Kemle says, “but I’ve seen three people die as a direct result of their PEG tubes. What a tragedy if this woman had had a complication from something she never needed.”
To be blunt: People have filed lawsuits for less.
Even if malpractice doesn’t become an issue, patient demand may force changes to the way health care is provided to older adults. Baby boomers are anticipated to be quite vocal about what they expect.
“Right now, we’re caring for an older population that pretty much says, ‘If you say so, doc,’” says Bakerjian. “But we’re going to be challenged more and more with the patient who comes in with his laptop and you’ll be talking and he’ll say, ‘Well, let me check that out on the Internet.’ There is a very demanding group of folks heading our way, and they’re going to want the best care they can get. That means we have to be ready for them.”
Expectations will be high and finances may be low—a classic recipe for widespread dissatisfaction. “I’ll be expecting to get the care that my dad gets now, in his mid-80s, and I won’t get that for the money I put into the system,” says Baker. “And my kids, who are in their 20s and in the working world, are going to be largely unhappy that they’re spending a huge amount of their salary just to support people like me.”
The only sure thing is that older adults are going to appear more and more in nearly every practice setting. The best things a clinician can do are accept and act.
“You’re not going to be able to escape the aging population—your practice is going to be more and more geriatric-infiltrated, whether you picked that specialty or you didn’t,” says Baker. “So accept the reality that you’re going to care for these people. And once you’ve accepted that, you need to get some of this specialized knowledge, through the CE/MOC process or postgraduate education. You need to seek out opportunities to become better at this particular set of competencies.”
And you’d better do it before Baker joins the geriatric set!
