Focusing on Senior Health Needs

WASHINGTON — Doctors diagnosed dementia in an 80-year-old woman when, in fact, depression caused her memory loss. Once she finally saw specialists who uncovered and treated the depression, her memory rebounded.

The heart drug verapamil caused another patient severe constipation. Doctors didn’t make the connection, instead prescribing laxatives too strong for an elderly person, leaving her dangerously dehydrated. Again it took specialists to solve the real problem and switch her heart medicine.

The specialists involved were geriatricians, doctors trained to care for the elderly in an era when the health care system is poorly equipped to handle their complex medical problems. But even as the nation is bracing for the number of elderly to soar, there’s a critical shortage of geriatricians.

With the shortage unlikely to ease soon, the American Geriatrics Society is launching new programs to train surgeons and general practitioners to improve their care of older patients. Treating the elderly, especially the very old, can be remarkably different than treating younger patients. In fact, seniors often don’t have the usual symptoms a younger person would show for the same disease.

Take heart attacks. Less than half of elderly people report the chest pain most middle-age victims feel. Instead they may complain of vague symptoms such as labored breathing, numbness, tingling or dizziness.

And many drugs work differently in the elderly, who typically take multiple medicines. There’s poor coordination among doctors.

Geriatricians are specially trained to deal with those unique senior problems, and coordinate proper care among competing specialists. As for other doctors, a survey found one-third of recent medical school graduates believed their elder care instruction was inadequate. By 2030, the American Geriatrics Society estimates more than 36,000 geriatricians will be needed as the older-than-65 population approaches 70 million. The older-than-85 population will more than quadruple to 18 million by 2050.

Not all seniors need a geriatrician. “Most older people are actually very healthy” and regular doctors do fine, says Dr. Kenneth Brummel-Smith of Portland, Ore., the society’s president-elect.

But about 20% of seniors are very frail or have multiple complex conditions. These are the patients geriatricians help.

Now the society is working to train other doctors about elderly patients’ unusual needs, starting with surgeons. Why? Surgery poses classic dilemmas, Brummel-Smith says. A healthy 80-year-old, for example, can undergo bypass surgery as successfully as a younger person, yet some surgeons are reluctant to operate on the old. On the other hand, studies show older patients suffer more complications while hospitalized.