Advocacy Group details Treatment Needs for Older Patients

By Jessica Marcy

KHN Staff Writer

May 12, 2010

As the "silver tsunami" prepares to hit the U.S. health care system, some officials worry that there aren't enough professionals who have been properly trained to work with the unique needs of these senior patients.

Today, the Partnership for Health in Aging, a coalition of more than 20 organizations dealing with care of seniors, released a set of 23 skills that all health care professionals - doctors, dentists, nurses, social workers and others - should have by the time they graduate.

Currently, a student's exposure to geriatric care varies widely, depending on the curriculum. Some students get virtually no training in seniors' special needs, the partnership said.

"Older people are not just big children," said Dr. Todd Semla, the chair of the PHA and the American Geriatrics Society.  

They present health problems and metabolize medications differently than other age groups. For instance, an 80-year-old woman with pneumonia might have milder symptoms than a 40-year-old. Older adults may even have a lower-than-normal temperature, instead of a high fever.

And, health care providers should monitor these patients for age-related risks, such as falls, and should know how to gauge pain experienced by seniors with Alzheimer's disease or other cognitive problems because communication and memory issues can hinder their responses.

Dr. Judith Beizer, a clinical pharmacy professor at St. John's University in Queens, N.Y., said pharmacy schools often don't have specialists in geriatrics or electives in geriatrics. "When I was in school, geriatrics wasn't mentioned at all. It wasn't something I was introduced to really until my residency and that was only because I was accepted to do a fellowship in geriatrics."

Even now, pharmacists aren't always aware that seniors may be getting inappropriate doses, may be experiencing different side effects than younger adults and may not be able to read a pill bottle label because the type is too small. Beizer said those issues arise especially with pain, diabetes and psychotropic medications.

"If you don' have that sensitivity and knowledge, you can really harm somebody," Beizer said.

The number of seniors is expected to almost double between 2005 and 2030. Because the supply of geriatricians and other professional specifically trained to help seniors cannot meet the growing demand, PHA is urging all professional training to include seniors’ needs.

The PHA recommendations span six general areas: health promotion and safety; evaluation and assessment; care planning and coordination, including end-of-life care; interdisciplinary and team care; caregiver support; and health systems and benefits. For instance, the group recommends that health professionals be able to assess risks for seniors in their homes or the community, including falls or abuse.

"Many health care disciplines operate within their own silo," said Dr. John Barr, a physical therapist and member of PHA. "What we were really trying to do here is to take a step back and write broad, encompassing general areas in which health care professionals should be competent."

PHA was formed in 2008 as a response to the Institute of Medicine's report "Retooling for an Aging America"  that recommended that "health care professionals should be required to demonstrate their competence in the care of older adults as a criterion of licensure and certification."