She was sick with a bacterial blood infection and had multiple fractures.
That’s what was quickly learned about Marjorie Weaver when she was admitted to Seattle’s Harborview Medical Center. The 74-year-old West Seattle woman had fallen at home and remained unconscious until a neighbor found her in respiratory failure and saved her life by calling 911.
Twenty years ago, medicine’s attitude might have been to treat Weaver’s immediate physical problems and then release her, with the explicit or implicit message: “These things happen. You’re getting older.”
But things are different now.
Soon after Weaver was checked in to the hospital, she got a visit from Harborview’s geriatric team–a group of students and doctors headed by an attending physician trained as a geriatrician.
They began applying modern medicine, patience and tender loving care. One team member, University of Washington medical student Karin Harp, mixed a breakfast shake for Weaver every morning and encouraged her to eat and do her exercises.
The team’s goal: Stabilize her medically, boost her mental status and get her back to a higher level of functioning.
The field of geriatrics never used to exist in medical-school curriculum, had no leaders and offered little opportunity to students.
But in the past few years, student interest in learning to treat and care for older adults has increased significantly at the UW and other medical schools across the country.
Harp chose this four-week rotation “because I’ve always been interested in geriatrics and wanted to see if it was something I wanted to do for the rest of my life.”
That’s the hopeful news. But the less-hopeful reality, many say, is still that there may never be enough geriatricians trained to care for aging Baby Boomers, who are expected to survive into their 80s and 90s in record numbers.
“The sad fact is that not enough is going on. There is a tremendous national shortage of people who are qualified in the area of geriatrics,” said Joseph Cerquone, spokesman for the Alliance for Aging Research in Washington, D.C.
The Alliance predicts that there will be only 7,000 qualified geriatricians in the United States next year, when the country will need 22,000 or 23,000.
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Still, the field of geriatrics today finds itself the object of increased attention, even a little bit popular.
And everyone agrees the field has seen tremendous change.
More students of better quality are applying for geriatrics fellowships and scholarships at medical schools such as University of Washington, UCLA and the University of Michigan.
Geriatrics is one of the fastest-growing disciplines in medicine, drawing 67 percent more fellows than it did three years ago, compared with applicant drops in fields such as cardiology, traditionally considered more glamorous, according to the American Board of Internal Medicine. However, the numbers in geriatrics remain tiny compared with those in other fields.
Philanthropic organizations, particularly the John A. Hartford Foundation in New York, are pouring money into research and clinical scholarships in geriatrics at selected medical schools.
Most of the country’s 125 medical schools now teach geriatrics as part of a required course. They have broadened their electives in geriatrics and beefed up research. National boards that regulate the training of doctors have instituted requirements for geriatrics in primary care, family practice and internal medicine.
Still, the number of doctors actually graduating with a specialty in geriatrics is still minuscule: a little more than 200 a year among the 15,000 to 16,000 who graduate annually from medical schools.
That means the bulk of the care for older people still will be provided by generalists, many of whom don’t understand the unique medical needs of older adults, said Dr. David Reuben, chief of the geriatrics division at UCLA.
“If these doctors don’t know how to care for old people, then we’re in deep trouble,” he said.
Inadequate Medicare reimbursements likely will continue to play a huge negative role, according to several physicians.
“The big reason more doctors don’t practice geriatrics is that basically you get paid 30 percent less per hour under Medicare fees than any other insurance,” said Dr. John Addison, who has practiced the specialty in Seattle for the past 16 years. On top of that, older patients take more time and have more complex medical issues, he says.