The nation's healthcare system is endangering the elderly. But few outside the geriatric medical community seem to notice.
I learned about this problem the hard way — when caring for an aging parent. My father, a highly regarded orthopedic surgeon, developed Alzheimer's when he turned 78. As his disease worsened, so did the stress of trying to navigate the healthcare system.
After my mother and I moved him to a memory care facility for his increasing needs, he fell and broke his hip. He had surgery, which he tolerated remarkably well, and was transferred to a skilled nursing facility to recover. But within two days he'd lost the ability to speak. He grew rapidly weaker. When we visited, he made frantic circles with his arms and picked incessantly at his gums.
The staff told us he was going into renal failure and to say our goodbyes.
Thankfully, an astute pharmacist figured out what no one else did. My father was dying — not from his kidneys shutting down after the surgery but from dehydration. Now on high alert, our family observed that none of the trays delivered to his room included any fluids.
In desperation, we took turns supplementing every meal with water. My father's speech and strength returned. There was no more talk of renal failure. The staff at the nursing home referred to the matter as a "communication breakdown somewhere."
As I came to learn, such incidents are quite common in healthcare for aging people. Over the 14 years, as I cared for my father and later my mother, we experienced many "communication breakdowns" and serious healthcare delivery problems.
Many times different providers prescribed too many drugs at once, a problem known as polypharmacy.
When my mother had a serious urinary tract infection, she experienced "delirium" — a medical emergency with a hospital death rate of 50%. But the doctor thought she had dementia, an all-too-frequent misdiagnosis that nearly cost my mother her life.
Often there was a lack of continuity of care — providers would finish shifts without fully debriefing colleagues.
All these failures were preventable.
My parents' healthcare changed dramatically for the better once we found a geriatrician — a physician with years of additional training in the health of older people — who could fill the role of primary-care provider. But we were lucky. In 2014, there were fewer than 7,500 geriatricians in practice in the United States. In 2013, only 75 physicians nationwide entered a geriatric fellowship. The American Geriatrics Society projects that there will be only one geriatrician for every 4,000 seniors in the next 15 years.
How can this be? For one, the high cost of training, when compared with salary, makes the geriatric track financially unfeasible for young doctors.
It takes eight to 11 years of medical training, after college, to become a geriatrician, yet geriatrics is the least-well-compensated area of specialization in the entire medical profession. And geriatricians rely mainly on Medicare and Medicaid reimbursement. Students coming out of medical school with $200,000 in loans cannot afford to choose geriatrics even if they want to.
Additionally, many hospitals and clinics argue that they cannot afford to keep geriatricians on staff because of low insurance reimbursements. It is often more profitable for a doctor to remove a wart than for a geriatrician to engage in an hourlong consultation and keep track of an elderly patient's medical history.
We're in trouble. The federal Administration on Aging reports that in 2030 there will be 72 million Americans over 65. The doctors we need won't be there. Our rapidly aging nation is facing a future of substantial costs and needless pain and suffering. But discussions about living with frailty are virtually nonexistent in the media, in professional education and in the political arena.
There is much discussion today about the so-called American way of death — the sometimes absurd lengths we go to prolong life for just a few weeks or months. As we debate end-of-life care, we may have lost the ability to appropriately treat people who aren't yet dying but are old and sick.
Marcy Cottrell Houle is the author, most recently, of "The Gift of Caring: Saving Our Parents from the Perils of Modern Healthcare," with physician Elizabeth Eckstrom.