This article appeared on LinkedIn, published June 27, 2016 by Carole Larkin, Certified Dementia Consultant who is a personal friend as well as a Certified Care Manager. This was posted with her permission.
This is insider information taken from the leading academic journal in the United States called “Generations”. It is produced by the foremost academic and professional organization in America, The American Society on Aging. All content in their journal is researched and documented by the highest credentialed researchers in Aging topics. For more information on “Generations” and the American Society on Aging go to: www.generationsjournal.org and www.asaging.org. All information in quotation marks is directly from the Spring 2016 issue of Generations. (Volume 40 number 1)
Question: How many doctors specialize in diseases of the aging (and therefore know something about dementia)?
Answer: “There have been only 7,000 actively certified geriatricians for more than 10 years.” That’s for 46 million Americans over the age of 65 (as of 2015), never mind older adults with dementia. Geriatricians are doctors specifically trained in diseases in older adults. Not many- huh? Only “about 300 new geriatricians” are trained in medical schools each year. Not many- huh? Worse, “more than 40% “of fellowships for training geriatricians went unfilled for the last 3 years. And some current geriatricians are letting their certifications lapse.
Question: What does that mean? How does that affect me?
Answer: These are the specialists, along with neurologists, for elders with dementia (most people with dementia are elderly). Clearly there are not enough experts for the number of people who need their expertise. And there are less in the pipeline coming up, rather than more. Why? Geriatricians pay is lower than most other doctors, and loans to go to medical school can be well over $100,000! And of course the anti-aging bias we have here in America. Look at old wrinkled bodies? Ugh- I don’t think so! So, what are you left with? Your regular family doctor, of course, or the local clinic, or the emergency room. In other words, the general healthcare system.
Question: How much training do general healthcare system doctors get in older adult issues including dementia?
Answer: “Less than 3% of medical students choose geriatric electives, meaning most medical professionals will enter the field without any exposure to serving elders.” Also there is currently a “lack of faculty, lack of funding, lack of time in [an] already busy curricula (courses that have to be taken) and the lack of recognition of the importance of geriatric training.” In the past, in most medical schools there weren’t even courses in geriatrics at all, so if your doctor had been practicing for a while, chances are huge that they have no training in geriatrics (or dementia). And currently, there is no requirement to have any training in geriatric conditions to keep up their medical doctor certification, except in California, and that is limited to doctors who have over 25% of their patients are elderly.
Question: What does that mean? How does that affect me?
Answer: Chances are high that your family doctor and the doctors in the hospitals don’t have the knowledge that you think they do in relation to your elderly family member (especially one with a dementia). That means that you have to ask them how much actual training they have had over the years to know if you have to question their knowledge/advice for your loved one. Taking their knowledge/advice for gospel could be detrimental to your loved one’s health, if in fact they don’t know the intricacies of good care of elderly people. It can lead to medical mistakes, as they are now known. Things like misdiagnosis’s, non-diagnosis’s, the wrong medications prescribed, medications that react badly with the other medications given, too much medication, not enough medications, surgery advised when not needed, and no surgery prescribed when some is needed. The list of errors can go on and on.
Question: If my doctor doesn’t have the training what can I do?
Answer: Ask them to include a course in geriatric medicine for their next certification for their medical license.
Question: What about other health care personnel who deal with my loved one?
Answer: OK, let’s go through some professions.
As you can see, there is a severe shortage of all types of healthcare professionals trained in providing all types of healthcare to older adults, not to mention the subset of them with a dementia. You could call it a crisis, if you wish. And as more and more people enter the age group of elderly every day, it is reasonable to assume that it is going to get a lot worse before it gets better.
Question: What can I do to try and make things better?
Answer: Get loud and demand action of the right people. Who are the right people? Believe it or not, its Politicians! Generations says (and I agree), that there is “no political will” to do anything to address this crisis. Heck, the crisis isn’t even on anybody’s radar, no matter what political party you are talking about. Yes, you may hear about the Affordable Care Act, but guess what? The Affordable Care Act doesn’t even address the issue of next to no knowledge how to properly care for the elderly or how to get professionals interested in caring for the elderly, or in training others to care for the elderly.
It seems as long as our citizens allow the politicians to define the problem as an “individual family” problem, and not a reason to come up with any answers for the problem, then no headway can be made in getting the resources it would take to increase knowledgeable health care for the elderly. It’s got to become the politician’s problem too. How to do that? What about starting with a phone call, a text or an email to your local state and federal congressman and senator? Or maybe to your preferred political party candidate? It could be as simple as, “What will you do to address the lack of knowledgeable health care out there for our elderly? I want to know, and I vote.”
Below is a photo of the author, Carole Larkin. What do you think about the status of appropriate elder care by our health care system? Feel free to comment. Carole and myself have both taken care of a parent with dementia and really care about this issue. Thank you Carole for your contribution.
I Have worn many hats in my day: Nursing Home Assistant Admin and Activities Director, Assisted Living Admin, Case Management for the State-wide Medicaid Program, and Trainer for Dept of Elder Affairs.