The Undervaluation and Future of Geriatric Care

Key Insight

Society largely avoids confronting the realities of aging, clinging to fantasies of agelessness and overlooking the necessary adaptations for an increasingly older population. This denial has led to significant societal challenges, such as the 'rectangularization' of survival, where the population distribution is shifting from a pyramid (largest base of young children) to one with as many fifty-year-olds as five-year-olds today, and projected equal numbers of over eighty and under five-year-olds in thirty years. Despite these demographic shifts, societal norms like retirement at sixty-five remain, even as the over-sixty-five population approaches 20% of the population, and people save less for old age than at any time since the Great Depression, with little thought given to living alone in later years.

The medical profession, paradoxically, has been slow to address the very changes it has instigated through extended lifespans. The number of certified geriatricians in the United States fell by 25% between 1996 and 2010, while interest in adult primary care has plummeted, with lucrative fields like plastic surgery attracting record numbers of applicants. This disinterest stems partly from the low incomes in geriatrics and partly from a prevalent view among doctors that caring for the elderly is unglamorous, involving patients with multiple, chronic, often uncurable conditions who may also have sensory and cognitive impairments—a stereotype sometimes referred to as the 'Old Crock' who has 'fifteen chief complaints.'

Despite this, specialized geriatric care offers profound benefits. A University of Minnesota study demonstrated that older adults who saw a geriatrics team were 25% less likely to become disabled, 50% less likely to develop depression, and 40% less likely to require home health services, even though death rates remained similar to those receiving standard care. These interventions often involve basic, high-value measures like simplifying medications, ensuring proper foot care and nutrition, and addressing social isolation and home safety, rather than expensive, high-tech procedures. However, such care is severely undervalued; the University of Minnesota's geriatrics division was closed due to financial losses, as Medicare does not cover the additional 1,350 dollars cost per person, in stark contrast to costly devices like 25,000 dollars pacemakers which are readily funded. With a severe shortage of geriatric specialists ('too late' to create enough), a new strategy is proposed: training all primary care doctors and nurses in geriatric care, aiming to establish courses in all relevant schools within a decade, to ensure existing knowledge can be widely applied to improve the quality of life for older people.