Monday, November 9, 2009

Respect Your Elders

Sometimes, the easiest option is denial-- denial that one is aging, denial that one cannot do it alone, denial that death is inevitable. Modern Americans, who market anti-aging creams and other fountain-of-youth beauty products which are supposed to reverse the process of aging rather than make aging a more secure and graceful process, are especially guilty of this denial. However, the consequence is an increasing struggle to survive comfortably. In a country where the elderly population grows dramatically bigger each year, the need for assistance swells as well. Unfortunately, the number of geriatrics, women and men who specialize in “long-term care for chronic conditions or helping seniors to manage their day-to-day life,” is plummeting in supply. Geriatricians must be given more respect and pay for their work in order to increase the lacking number of graduates in the field.

“Throughout most of human history, a society’s population formed a sort of pyramid: young children represented the largest portion… and each successively older cohort represented a smaller and smaller group.” (‘The Way We Age Now’) But because of rapid advances in medical knowledge, a growing wisdom of cures and drugs, what used to be the point of the pyramid, the smallest contributor to the population, is now even with the bottom level. “The result has been called the ‘rectangularization’ of survival. People 65 years or older numbered 36.8 million in 2005 and represented 12.4 percent of the population. By 2030, this number will almost double to 71.5 million and represent… 20 percent of the population.”
With all of these older people, who, as one well knows, have commonly deteriorating health, there is a high demand of intelligence for an elder’s special needs-- geriatricians. But “since 2000, the number of geriatricians in the U.S. has fallen by a whopping 22 percent to a mere 7,100.… by 2030, there will be just 8,000 geriatricians, despite the fact that the U.S. will need about 36,000 to cover the workload” (Karvounis).
The cause of this problem is poor care for our older generation of men and women. “Too many seniors are overmedicated…. Too many receive high-tech care that they don’t really want,” notes one doctor. Too many end up declining early and precipitately, with an old age of enfeeblement and dependence, sustained primarily by nursing homes and hospitals. “What many need is not more operations, but counseling, patience, and compassion,” the kind of help that a trained geriatrician is willing to provide.
But why is there such a remarkable deprivation of help? According to Karvounis, “both our health care system and our medical schools devalue the kind of care that geriatricians provide.” This is evident when one looks at a geriatrician’s pay, which is at the bottom of the medical income ladder, averaging $150,000 a year. “It is low compensation of important, exhausting work…. It’s stuff that takes a lot of time, that is frequently off hours, at nights and on weekends.”And in the medical field, which is abundant with students who hold high importance on both respected social standing and pay, “the perception that geriatrics isn’t ‘real’ medicine because it’s not super-technical and procedure-based… is a dangerous bias,” say the pros. Who would want to be in a business that is looked down upon by his super- specialty colleagues?
Because of this popular attitude, support for geriatrics is more and more limited. “Congress recently eliminated funding for a number of geriatric educational programs, geriatric research funding is declining, clinical reimbursement is flat or declining,” Karvounis, one blogger on the subject, reports. In addition, scores of medical centers across the country have shrunk or closed their geriatric units. Several no longer advertise their geriatric training for fear that they’ll get too many elderly patients. People have not insisted on a change in priorities.
In order to repair damages that will be even more harshly seen in a few years, the whole country will need a little change of attitude, says Meyers. “The most obvious solution is adjusting reimbursement rates so that geriatric care can get a little financial respect…. Physicians must see that this work is valued not only by the patients but also by society. Schools must work to publicize and encourage those considering a career in geriatrics. They need to get serious about securing funding, professional connections, mentorship programs,” says a Meyers, a specialist in the field. Schools could provide incoming students with scholarship opportunities and required classes in geriatrics (there are none currently.) Schools can also offer loan forgiveness to students who specialize in geriatrics in order to encourage broader recruitment.
The future of our senior citizens does not have to look so dim. By giving those who care for the elderly the respect and financial assistance that they deserve, by embracing change and age rather than denying it, the country in medical care can begin to reverse the hurt that has been done. It is time to not only respect our elders, but to give a higher respect to those who care for them.

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