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Geriatricians and the Care of Our Aging Population

Michael Spilane and Jane Pederson

Many in the health care profession are concerned about how we will provide quality care to the 72 million Baby Boomers aging into the senior population over the next 20 years. The American Geriatrics Society suggests we need an additional 9,600 certified geriatricians to care for our current population of about 12 million older Americans.

Practicing geriatricians, Michael Spilane, Stratis Health Board member and Jane Pederson, Stratis Health medical affairs director, discuss the role of geriatricians in care delivery as the U.S. population ages.

With the changing demographics, what impact are you seeing on care/care delivery in your practices? How does this impact quality of care?

JP: The average age of my patients in nursing homes and assisted living facilities is in the high 80s, with some patients in their late 90s. It will be interesting to see what the expectations of the baby boomers will be having grown up in a high-tech world and representing a generation that comes from a more diverse ethnic background.

MS: A doubling of the number of older Americans in the next 20 years is going to have enormous impact on all aspects of our society. How we deal with this problem is going to severely test the ingenuity of politicians and health care leaders.

How have you seen your practice change over the years?

MS: When I began my practice as a geriatrician 35 years ago, there were no geriatric nurse practitioners, or very few of them. Today, I couldn’t accomplish my work without teaming with an advance practice nurse.

JP: With more services available today to help people stay in their own homes, those moving into nursing homes and assisted living settings are requiring much more support than 20 years ago. There is a much higher percentage of patients who have dementia as their primary diagnosis.

I feel I need to be more aware of community resources and have a good relationship not just with the patient but also with their family or caregivers.

Is the mismatch between the growing number of seniors and the number and availability of geriatricians a concern?

JP: Yes, if our model of care stays as it is. The unique needs of older adults are not always recognized by physicians who do not specialize in that area. And they are not familiar with the many regulations required for nursing homes.

MS: I am far less concerned about the relative scarcity of board certified geriatricians than I am about the number of general primary care physicians who have the desire, knowledge, and skills necessary to care for older adults.

While much of the practice of geriatric medicine is similar to the practice of internal medicine or family medicine, much is also different. Learning the difference and building skill and competence in caring for the older of the old demands that a physician be primarily, if not exclusively, involved with patients in this age group and not have just a small number of them in his or her practice.

What is the impact of the rapidly changing payment and care delivery on seniors and your practice?

MS: Changes in payment and in the mechanisms for delivering care are desperately needed, but like a huge freighter at sea, changing course takes time. Next year, we won’t see much change. In 10 years, hopefully we’ll see a lot.

JP: If geriatricians can manage the chronic health and social needs of the older population, ACOs (Accountable Care Organizations) will fare better overall from a cost and quality perspective. Without a change in reimbursement, geriatric care likely will remain a money loser because the time needed to care for a patient’s social and functional needs is not reimbursed.

MS: To adequately care for a greatly increasing elderly population with critical needs, many more innovative, costeffective solutions will be required—solutions like medical homes and bundling of services, as well as transformed reimbursement and geriatric education for health care professionals across disciplines.

Jane Pederson, MD, MS, is director of medical affairs at Stratis Health and is a practicing geriatrician for Allina Senior Care Transitions.

Michael Spilane, MD, is a member of the Stratis Health Board of Directors. He is co-head of the Division of Geriatrics in the HealthPartners Medical Group, and is a faculty member for the Division of Geriatrics in the Department of Internal Medicine at the University of Minnesota Medical School.