As we age, number of specialists in aging lags

Warren Wolfe, Star Tribune, Minneapolis
Knight Ridder/Tribune Business News

12-27-10

Dec. 26--By day, Hanaa al-Khansa is a fourth-year medical student at the University of Minnesota, hoping to practice family and pediatric medicine.

But on evenings, weekends and holidays, she's part of a small but significant experiment that could ease the widening gap between the needs of America's increasing population of elders and the supply of specialists who serve them.

Last week, at Augustana Apartments in Minneapolis, where she and her husband live amid people in their 80s, 90s and 100s, Al-Khansa was plying the halls, delivering holiday treats. It was a gentle way to check on frail neighbors -- and to master subtle lessons of aging that will help her be a better physician.

"You learn to listen with a different ear, to ask about problems in terms of daily life -- not 'How is your gait?' but 'Did you get to the grocery store today?'" said Al-Khansa, 26, whose family emigrated to Duluth from Malaysia a decade ago.

The leading edge of Minnesota's 1.5 million baby boomers is about to turn 65, eligible for Medicare, the federal health care program for the aged. Nationwide, for the next 18 years, about 10,000 more boomers will join them each day.

"But we're not ready for them," said Dr. Robert Kane, a physician and nationally known expert who heads the University of Minnesota's Center on Aging.

"Doctors, nurses, social workers, psychiatrists, dentists, pharmacists -- you name a geriatric speciality, and we're short," said Kane, who tried unsuccessfully to persaude university officials to develop a geriatrics training center. "We're far behind, and I don't see how we can catch up."

The looming consequences are serious. The nation has 7,200 certified geriatricians, one for every 2,500 older Americans. Among Minnesota's 20,036 physicians, 186 are geriatricians. Some experts suggest that five times that many will be needed by 2030, when the country's aging population will have nearly doubled.

Scores of programs in Minnesota and elsewhere are working to develop specialists to care for the swelling ranks of the aged. Community colleges are training aides to work in nursing homes and home care. The U is training gerontological nurses and nurse practitioners -- a step between nurses and physicians.

Professionals with geriatric training can improve older clients' quality of life and lower medical costs by providing appropriate help, experts say.

"But a lot of people seem afraid to work with seniors," said geriatric social worker Christie Cuttell, 36, at Augustana Care Center, across the street from Al-Khansa's apartment building.

"People ask me, 'Isn't your work depressing?' Well, it's not. Yes, people die. But they also live, and many are still living fascinating lives, with fascinating stories," she said. "When I talk to students, I tell them about the demographics and the opportunities and how rewarding my work is. But they'd rather work with kids."

Most older people remain active and independent, but advancing age brings many chronic health conditions.

"An 85-year-old with heart disease may also have diabetes, respiratory problems, arthritis and maybe the beginning of dementia, with five different doctors and 15 prescriptions," said Thomas Clark, who operates a commission in Virginia that has certified about 2,250 geriatric pharmacists nationwide, 22 of them in Minnesota.

"The goal in treating a middle-aged man with heart disease may be just to fix his heart, but for an old man it may be to allow him to get to church, join friends for lunch and hold his grandkids," he said.

Along with helping doctors and nurses coordinate treatment of complex health problems, some geriatric pharmacists have set up new businesses to help older patients reduce debilitating problems caused by prescriptions from doctors who are more focused on diseases than aging patients.

"A little dizziness or dehydration may an annoyance to a 40-year-old," Clark said, "but it can cause a fall in a 90-year-old that sends her to a nursing home or kills her."

Geriatric car mechanic?

Not all experts on aging are pushing the panic button to get deeper training for health professionals.

"Let's quit worrying about getting docs and nurses and social workers with geriatric certification. We won't get enough because that's not where the money is," said H. Rick Moody, a philosopher, ethicist, gerontologist and director of academic affairs for AARP. "We pay people less, not more, to care for the elderly.

"Lets give a bunch of generalists -- in just about every profession -- some training in gerontology, because that's who the customers will be," said Moody, who is working with several trade groups to offer age training.

"Older people are the fastest-growing segment of America, and guess what? They've got the money. So I want to see my barber, my waiter, my banker and insurance salesman understand how aging is changing my needs," he said. "Heck, I want to find a geriatric car mechanic next week."

That's part of a new 3-D, virtual reality training project for nursing aides that's being developed at Pine Technical College in Pine City, Minn.

The idea is to use such technology for a role-playing exercise that can teach them how to respond on the job to common situations involving older patients.

"We'll have an Internet program to help nursing aides right after training, but we want to make it available to anybody," said John Heckman, who directs the school's spinoff business venture. "That might be high school kids considering a career in health care, or those bankers and salesmen who want to learn more about aging and their customers."

Learning by doing

For 11 years, Dr. Ed Rattner took university medical students to Augustana Care Center while he made his rounds, a modest introduction into geriatrics.

It wasn't enough. Two years ago, he approached Augustana with a proposition: You provide discounted housing, and I'll supply medical students to live there and, for course credit, interact with residents.

This year, eight graduate students, including social workers, seminarians and a physical therapist, live there -- two for a second year. Each connects with residents, especially those most at risk of needing nursing home care.

"One student told me she needed a new resident because hers had gone into the nursing home after being hospitalized," Ratter said.

"I said, 'Oh, no. Your job now is to get her home again,' so the student met with the nursing home staff and helped that resident get back home. That's geriatric education."

Ratter, a geriatrician who makes house calls, doesn't despair about the shortage of professionals with geriatric training -- partly because new state and federal health-system laws "will encourage us to do better at treating chronic diseases.

"We can keep chipping away, and I think we can improve care of older people," he said. "We'll never get it perfect, but I suspect baby boomers will demand that we do a better job -- now for their parents, and then for themselves as they age."

At Augustana last week, Al-Khansa sat with neighbors Herb Hanson, 84, a retired Lutheran pastor from Iowa, and his wife, Joyce, 80.

"Herb and Joyce are a perfect example of what I'm learning," she said. "They are so active, and some of my other neighbors are younger but much more frail.

"Don't assume you know much about an older person and what they need until you talk -- really talk. I realize, as I practice medicine, I will always be the student, and my patients will be my teachers."

Warren Wolfe --612-673-7253

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