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Tuesday, September 29, 2015

Encountering the Other: Old People


Last November, I joined two other presenters at a professional development seminar for therapists, including social workers, titled, “Aging: Much Wisdom, Much Grief.”  The focus was on the aging process, for both clinicians and their clients.

And though I am neither, I was pleased to be invited as someone who writes about, and offers workshops on, aging.  And, of course, there’s the personal angle: I am myself old.

One of my co-presenters, a clinician and professor, gave what I thought were some interesting, maybe even startling, stats:  only 4% of social work students study gerontology, while 70% will end up working with older clients.

I thought of this disconnect while reading an Op-Ed piece in the September 22 issue of the New York Times: “An Aging Population, Without the Doctors to Match.”

Here’s the sentence that caught my attention:

Most health care professionals have had little to no training in the care of older adults. Currently, 97 percent of all medical students in the United States do not take a single course in geriatrics.

And, further on:

Currently there are fewer than 8,000 geriatricians in practice nationwide — and that number is shrinking. “We are an endangered species,” said Dr. Rosanne Leipzig, a geriatrician at Mt. Sinai Medical Center in New York.

At the same time, the nation’s fastest-growing age group is over 65. Government projections hold that in 2050 there will be 90 million Americans 65 and older, and 19 million people over age 85. The American Geriatrics Society argues that, ideally, the United States should have one geriatrician for every 700 people 65 and older. But with the looming shortage of geriatricians, the society projects that by 2030 there will be only one geriatrician for every 4,484 people 75 and older. [emphasis mine]

Now while I’ve a few years to go before I hit 75, in 15 years I’ll have just entered the Land of the Old-Old: those over 85. (According to the World Health Organization, here’s how the generic “old” currently breaks down: “Young-Old, 65-74”; “Old, 75-84”; and the aforementioned “Old-Old, 85+.”)

I’m not one to seek medical care on any regular basis; I don’t show up in a doctor’s office until some mysterious pain or weird symptom just won't go away. But when I’m well into my 80’s that might change. 

So this particular supply/demand conundrum is of more than passing interest.

The author of the NYT piece, Marcy Cottrell Houle, offers one possible, but compelling, answer: geriatric medicine is low-paying, “even though it requires years of intensive specialization.”  We also know that medical training involves boatloads of student debt. 

A definite bad match.

I couldn’t help wonder, though, if there was more to it than that, one not hinted at in her article: exactly how rewarding might it be for physicians to work with patients at the tail end of their lives?  What might we, as patients, offer our care providers other than advancing decrepitude and certain dying?

I mean, how much fun could it be to work with old people?

Fortunately, the day after the New York Times article, a NPR segment appeared, the title of which—“To Sell Medical Students on Joys of Geriatrics, Send in 90-Year-Olds”—gave me some hope that help was on the way.  And it was, in the form of six of the Old-Old who showed up to share their stories—some touching, some funny, all informative—to close to 200 medical students at Case Western Reserve School of Medicine in Cleveland.

And at the end of their shared time together, one of those students, Jeremy Hill, said:

"I have such respect and admiration for this population, and if I could somehow give them one extra good day they would not have had otherwise," said Hill, who then paused for a moment, "I would be privileged to work with them."

It's a beginning.

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For more on both pieces:





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