HEALTH-FITNESS

Patients in need

Dealing With An Insufficient Supply of Geriatrics-Trained Professionals for Growing Number of Vulnerable Elderly

Robin Williams Adams Your Health correspondent
Gary Voorhees, 71, and Julius Grant, 61, share a Fellowship Dining meal at Wabash Community Center in Lakeland. Assistance with nutrition is one of the added services to which doctors who focus on geriatrics learn to steer seniors. [ROBIN WILLIAMS ADAMS]

Finding a doctor with specialty certification in geriatrics, or one whose primary interest is in elderly patients, isn’t easy in Polk County.

Only a handful of doctors list the specialty in their listings on the medical staff of hospitals where they practice.

At Lakeland Regional Health Medical Center, Polk’s largest hospital, four were listed under geriatrics.

The picture isn’t any brighter at other Polk hospitals or major medical clinics. Nor is this problem limited to Polk.

At least 20,0000 geriatricians nationwide are needed to take care of more than 14 million older Americans. There were just 7,293 in 2016.

Those 14 million aren’t the total number of people 65 and older. They’re considered the “most vulnerable” 30 percent, the ones most in need of specialized geriatric care.

These are patients with multiple medical conditions, taking numerous medications and having issues with mobility, endurance, vision or hearing, said Dr. Gordon Rafool, a Winter Haven geriatrician who retired in 2015 from Gessler Clinic.

The gap is even more dismal for Florida’s more than 1.2 million most vulnerable seniors.

The state needed 1,772 certified geriatricians for them in 2016, based on 700 patients per geriatrician.

It had 408, a shortfall of 1,364, according to the American Geriatrics Society’s Geriatrics Workforce Policy Studies Center.

“We’ve known for a long time there weren’t going to be enough geriatricians to meet the demands of an aging society,” said Dr. Lisa Granville, professor of geriatrics and associate chair of the department of geriatrics at Florida State University.

Polk County was projected to have 137,385 residents 65 or older last year, according to the Florida Department of Elder Affairs. Of those, 41,216 would fall into the most vulnerable 30 percent.

Not all physicians are on hospital medical staffs, so hospital websites aren’t the whole story. There’s no denying, however, that more doctors with a geriatrics focus are needed.

What are some solutions?

Solutions include more awareness among the public of what geriatric care should include and incorporating more geriatrics into primary care doctors’ medical training, an area where FSU has taken the lead.

The University of South Florida also made changes in those medical students’ training.

Elderly patients are a major element among patients seen by family practice and internal medicine doctors.

Encouraging medical clinics and hospitals to join programs for patient-centered homes are another way to improve care, Granville said.

Not all primary care doctors have the same comfort level with older patients or similar awareness of their unique needs, Rafool said.

Constraints on how doctors are paid discourage some from taking the extra time needed to sort through complex issues of frail elderly patients and coordinate resources available to them, he added.

Learn to speak up

Older seniors and their families need to pay attention in choosing their primary care doctors.

Coordinated care, with the primary care doctor keeping track of all medications prescribed by different specialists and reviewing them regularly to see if changes are needed as someone ages, is vital.

“Know to ask for it,” said Peggy Crowley, executive director of the Florida Geriatrics Society.

That includes being willing to reduce or remove some medicines because older seniors’ physiology changes.

“You want a caring physician,” Rafool said, but one willing to be the patient’s advocate in getting other help they need.

Granville suggested patients look for comprehensiveness, a holistic approach and psychosocial support in addition to monitoring medical conditions. She’s an internal medicine and geriatrics trained physician.

Observe how the doctor and other staff professionals interact with seniors and their relatives.

“Are they treated respectfully?” is a key thing to watch for, said Kathryn Hyer, professor in the University of South Florida School of Aging Studies.

“Is someone listening to their questions?”

Hyer, who has a doctorate in public administration, was principal investigator in getting federal grant money from the Geriatric Workforce Enhancement Program for changes in USF’s primary care curriculum.

One of its goals was making medical residents “more sensitive to and aware of (needs) of older adults, she said, adding “Not only did we train medical residents, we also trained nurse practitioner students, pharmacists and doctors of physical therapy.”

USF Health worked with others in the community, such as a federally qualified health center, Byrd Alzheimer’s Institute and Senior Connections Center.

FSU geriatrics training in Polk

Grants from that GWEP program enable Florida State to continue boosting geriatrics training throughout its medical residency programs, designed for expanding primary care statewide.

FSU is opening a family medicine residency program with Winter Haven Hospital/BayCare Health System.

“Residents are specifically trained in geriatric medicine throughout their three-year training,” said Dr. Nate Falk, a family medicine doctor who is director of the Winter Haven program.

Among the training topics: Fall prevention, dementia screening and treatment, osteoporosis, arthritis, mental health and the risks of multiple medication interactions as patients age.

Training will take place in the hospital and a residency clinic, in addition to long-term care facilities.

That will include a two-year program in learning to care for the elderly in long-term care facilities at which they follow the same patients. Home visits and assisted living facility care will be part of an “intensive” one-month rotation, Falk said.

These experiences equip residents to care for elderly patients in various settings and coordinate care among them, he said.

FSU has an accredited family medicine program in Fort Myers and accredited internal medicine programs in Sarasota and Tallahassee.

Its relatively new physician assistant program also infuses geriatrics training throughout the program.

Granville expects many physician assistant graduates will stay in Florida, spreading geriatrics knowledge to doctors statewide.

Robin Williams Adams can be reached at robinwadams99@yahoo.com

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