Web edition: March 20, 2008
One of the first things most new parents do is identify a good pediatrician. They know that whatever befalls their little bundle of joy, they want it attended to by a doctor who’s especially familiar with what’s normal—and not—in little ones. Similarly, there’s reason for the elderly to be seen by physicians who specialize in the other end of the age spectrum. These docs are called geriatricians—and there aren’t nearly enough to go around.
In the near future, this shortfall will only worsen.
Of the 300 million people living in the United States today, more than 37 million are at least 65 years old—more than 5 million are at least 85 years old. That’s based on the most recent census data. The total number of geriatricians available to serve them numbers a mere 7,000, according to an editorial in the March 22 Lancet.
I did the numbers. That’s just one geriatrician for every 700 people 85 and older—or one for each 5,285 people 65 and older. And unlike the nation’s elderly, who are scattered all over the country, most geriatricians work in just a few major metropolitan areas.
“Despite a poll in which doctors rated geriatrics as the most satisfying specialty, the perceptions of poor pay and lack of glamour in youth-obsessed culture are blamed for dwindling numbers of recruits [to geriatrics],” the editorial says.
And things won’t be getting better in the near term. Baby boomers, who begin reaching 65 in 3 years, will add another 1.6 million people to the Medicare ranks in the United States throughout the next 2 decades. Meanwhile, doctors-in-training are not rushing into the specialty best trained to understand medical needs of our seniors.
The Lancet editorial argues that society has to give the elderly—and their needs—more respect. There’s something to that.
Many cultures have venerated senior citizens for their wisdom, lifetimes of achievement, and roles in stabilizing the family and community. U.S. culture is one that certainly doesn’t do this. People are useful to society as long as they are—well, useful. Once they become frail, forgetful, and sensory deprived (ie hard of hearing and dependent on eyeglasses they can never find), too many of us are ready to warehouse our elderly in segregated communities.
With a 90-year-old in my household, I understand why. We love them, but they are a challenge. And whatever their limitations are, they’ll only diminish further with time. I laugh when I hear my mother-in-law say it, but it’s true: “Getting old sucks.”
After decades of looking after all of us, our elders deserve better. At a minimum, they deserve first-rate medical care. The question is how to lure more physicians into this growth market.
The first step may be to sensitize our youth to appreciate their elders as more than a source of a holiday check. If children were encouraged to spend time with their geriatric family and neighbors—perhaps for high-school community-service credit or as part of class programs that investigate the needs of this quiet segment of our neighborhoods—coming generations might begin to value seniors more. If lobbying for seniors’ health needs were as vocal as those for animal rights, medical schools might place more focus on our Golden Girls—and Guys.
It’s time you and I began brainstorming on how to rectify the low esteem that we allow our society to accord our elders and their health needs. Consider it enlightened self-interest, because if you aren’t old yet, you’re certainly on your way to getting there.
2008. Who Cares for the Elderly? Lancet 371(March 22):959.