Doctors who specialize in caring for older adults remain rare
Dr. Michael McCloud chats with audience members in Davis last week after giving a lecture titled “Old People Say the Darndest Things … and Why We Should Listen.”
Karen Robison, a retired registered nurse who relocated in Carmichael from Wisconsin with her husband a year ago, has strong beliefs about the medical care of older people.
“I want to see a specialist,” said Robison, 72. “This is too important a stage of life not to go to someone who really knows what’s going on with older adults.”
But the specialists are in short supply.
According to the California Medical Board, only 15 doctors in Sacramento, Yolo, Placer and El Dorado counties currently identify themselves as geriatricians – primary care physicians who specialize in treating older people. (By comparison, 350 local physicians are pediatricians.)
Dr. Michael McCloud, the UC Davis geriatrician known widely for his annual Mini Medical School on healthy aging, thinks only a handful of local physicians have completed, like him, multiyear fellowships in geriatrics.
“I’d surmise that your average American medical school student has never met a geriatrician,” he said.
In a rapidly aging society, the numbers are clearly out of whack. The country’s fastest growing age group is 85 and older, with the leading of edge of the baby boom already well into their 60s.
Even as the number of geriatricians in the nation has dropped by a quarter since 2000, down to 7,000, the American Geriatrics Society estimates 36,000 will be needed by 2030.
As Sutter Senior Care geriatrician Dr. Christine Rozance points out, there’s also a shortage of young doctors going into primary care in general, partly because the income potential tends to be lower than in other specialties.
“But all primary care doctors are increasingly seeing older and older patients,” she said, “and they are increasingly required to have training to keep up in this area. It’s not being ignored.”
At issue for geriatric specialists is whether medical schools and the managed care system value the kind of medicine they practice, heavy on prevention, the comprehensive assessment of lifestyle and the treatment of chronic conditions that require management, not cure.
For example, McCloud says, when an older person breaks a hip, an orthopedist treats the fracture and an internist tests for osteoporosis.
“But the geriatrician says, ‘Why did this person fall and how will we keep them from falling next time?’ ” he said. “Has anybody taken the blood pressure, not just sitting but standing up and after a meal, when it’s likely to be lower?
“Has anybody looked at the number of medications this person takes? There’s a good correlation between the number of medications and how often someone falls.”
Old age doesn’t have to mean a dozen or more prescription bottles lined up on the bathroom window sill, and it doesn’t have to mean infirmity. But too often, society and medical professionals alike brush older patients’ complaints aside, because they equate aging with ongoing physical disintegration.
Not surprisingly, overmedication is a continuing problem for older adults, especially considering that many meds have complications specific to the elderly.
“I don’t have much tolerance for docs prescribing inappropriately for older adults,” said Robison. “I think that borders on malpractice.”
When Kuichi Takei, 96, moved to Sacramento in 2007 to live near his daughter, he suffered from severe osteoporosis, the result of taking steroids for two years for another condition.
McCloud gradually reduced his meds, said Barbara Takei, and discovered that he has a vitamin D deficiency, a problem common to older people.
“My father’s so much stronger now,” she said. “He still lives on his own. He shops for himself and does his own cooking. He takes care of himself completely.
“I don’t think we could have done it had we not had a physician who was diligent in monitoring my father’s condition and assessing his needs.”
Dr. Michael McCloud chats with audience members in Davis last week after giving a lecture titled “Old People Say the Darndest Things … and Why We Should Listen.”
