Meeting the Needs of Older Adults

About one in eight Americans - a little more than 12% of the population - is an older adult, a number that will continue to increase in the decades ahead. Edmund Duthie, Jr., MD, discusses how the field of geriatric medicine and the Senior Health Program at Froedtert & Medical College of Wisconsin are meeting the needs of this growing population. Dr. Duthie is a Professor of Medicine at the Medical College of Wisconsin and Chief of Geriatrics and Gerontology. He practices at Froedtert Hospital and the Clement J. Zablocki VA Medical Center and was named one of the "Best Doctors in America®" 2004 by Best Doctors, Inc.

Q. As people grow older, do they require the specialized care provided by a geriatrician?
Unlike Medicare or Social Security, the practice of geriatric medicine doesn't make a cut off at a certain age. In that sense, senior health doesn't have as much to do with chronological age as it does with function. There is no need for the fittest and most functional of older adults to be treated by a geriatrician. This group can continue to see a primary provider or a specialist if necessary for treatment of common conditions such as arthritis, heart disease, high blood pressure and cancer. This system works well and is a better allocation of our healthcare resources, since there is a tremendous shortage of practicing geriatricians in our country.

But there are older adults who do require the care of a geriatrician. They are what we call vulnerable elders. This group of people is struggling to function. They probably have deficits and are in jeopardy of losing some more function, to the point that they may require institutional care. They may also have quality of life issues that do not necessarily result in institutionalization, but are not always covered in the traditional primary approach. The main conditions that fall into these categories are incontinence, mobility and falls, problems with medications, cognitive thinking abilities and dementia, mental and emotional health, and lack of reserve. A geriatrician will focus on these areas of health and try to find ways to improve a person's situation.

Q. How does the Senior Health Program address these health issues?
Our approach is unique in that it doesn't focus on a specific organ or disease, but instead on conditions that affect a person's ability to function. Our multidisciplinary team of physicians, nurses and social workers develops a plan in unison. We usually work in collaboration with a person's primary physician, and when needed, specialists in other fields such as cardiology, neurology, urology, pharmacology and psychiatry.

Patients are often first seen at our Geriatric Evaluation Clinic. We make a thorough assessment of a patient's needs and develop recommendations for care. The goal of the evaluation is to help patients and their families including caregivers better understand health problems and care options and to help the patient live as independently as possible. The evaluation will include a review of past medical records and medications and a complete physical exam that includes screenings of hearing, vision, memory and mood.

If needed, we selectively schedule additional testing. We also assess the patient's self-care abilities and living needs. Based on this evaluation, we will make recommendations for treatment, support services and ongoing care, and provide a written summary for the primary care physician. Sometimes patients are referred to other clinics in the program that focus on memory disorders, mental health and incontinence.

Q. You mentioned there is a shortage of geriatricians. Is anything being done to deal with this problem?
There are not enough geriatricians in the United States to take care of individuals who need their care, let alone all people over 65. And as the population of older American increases, we know there is going to be an even greater need for physicians with geriatric skills. Froedtert & Medical College of Wisconsin is addressing this problem through a partnership with the Reynolds Foundation Initiatives in Geriatrics Education.

We are one of only 10 medical schools in the nation to receive a significant grant to improve and expand geriatrics training at all levels of medical education. Our efforts include a medicine-geriatrics residency that recruits students right out of medical school and combines the typical three years of internal medicine training with two years of geriatric medicine fellowship into a four-year "med-ger" residency. Additionally, we are developing a geriatric medical education fellowship for internists and family physicians to prepare them for roles as clinician educator leaders in academic medicine.

Q. What can people do to stay healthy as they grow older?
Just as you don't start planning for your economic future the day before you retire, you can't ensure your golden years will be healthy if you don't take care of yourself throughout your life.

Lifestyle choices you make when you're young will affect you when you're older. We're seeing that with the World War II generation and its smoking habit, problems with emphysema and lung cancer. And although it's true each generation is healthier than the one before, our country's current obesity epidemic is certainly going to affect future generations as they age.

But at the same time, it's not too late to make changes as you get older. Staying active and living a healthy lifestyle are the best things you can do. There is no reason healthy older adults can't engage in strenuous activities. People's reserve - their ability to bounce back from stressful or strenuous situations - does decline has they age, but activity also helps create reserve. By building up their reserve, older people are better able to handle stress on their bodies, such as illness. The adage - use it or lose it - is very true, especially in older adults.

Edmund H. Duthie, Jr., MD
Chief of Geriatrics and Gerontology
Professor of Medicine
Medical College of Wisconsin

This article originally appeared in Froedtert Hospital's Every Day magazine.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.