Are Doctors Neglecting Their Older Patients?

Leigh Page

Disclosures

February 19, 2015

In This Article

A Lack of Curiosity About Older Patients

Whatever the reason, elderly patients are often ignored in the healthcare system. Robert Stall, MD, a geriatrician in Amherst, New York, thinks that many doctors simply lack curiosity about what's going on with these patients.

For example, when an elderly person brings up a health concern, such as loss of bladder control, decreased mobility, or memory impairment, he said, "the doctor will often say, 'What do you expect at your age?'" Dr Stall has a reply to this. "Old age is not an illness," he said. "Older people get sick from disease, not old age."

One common issue with elderly patients is that they take longer to treat. "Just going through the meds takes time," he said. But many doctors are under time restraints. To stay on schedule, "doctors may ask older patients a minimum number of questions and send them on their way before they get to the bottom of things."

Dr Stall experienced this phenomenon when his 82-year-old father was experiencing significant pain and had lost almost 30 lb, and he took him in for a check-up. "The doctor who examined him knew he had a mitral valve prolapse," Dr Stall said. "She commented that his heart sounded like it had a murmur, but she didn't take it any further. She didn't ask for his regular doctor to come in and have a listen." Dr Stall said it was later discovered that the sound was due to a blockage in the heart valve.

Similarly, he said some doctors are uninterested in improving treatment of their elderly patients. Dr Stall runs a company that monitors care for patients in a Medicare Advantage plan. The plan, which is financially rewarded for improving patients' outcomes, wants patients to take advantage of Medicare's new annual wellness visits, which waive payments from patients but require practices to train the staff to provide the care. Dr Stall said two solo practices contracted with the plan aren't offering the visits. "These doctors feel the annual Medicare physical is enough," even though it's a very different kind of visit, he said.

Too Difficult to Treat

Many physicians limit the number of Medicare patients they see. This is often attributed to low reimbursements, but it also has something to do with problems in treating older patients. To find out more about these problems, a research team led by Wendy L. Adams, MD, a family physician at the University of Nebraska Medical Center, conducted in-depth interviews with 20 primary care physicians.

Their study,[12] published in 2002, quoted a litany of complaints. Elderly patients presented "various obstacles to getting the whole story, getting the truth out," one physician reported. "They don't remember, and sometimes they just don't think it's important, and sometimes they're just in denial of what's really wrong."

Another physician said she had to cut back her practice because elderly patients are "so complex and they take so much time," she said. "It's just not physically, humanly possible. It just isn't. You would need to have a smaller patient population to do a good job."

One doctor said cognitively impaired patients left him cold. "I don't find any particular satisfaction in taking care of them," he said. "The essence of their humanity is long since gone and I'm tending to a body which has no hope of recovery, and it's hard for me to get real excited and enthusiastic in that setting."

Another doctor complained that he couldn't make elderly patients better. "There are some patients that they're always going to have the same problems year after year after year," he said. "They're not going to be fixed. You know, it's their back pain from their osteoporosis and scoliosis and you can't do anything about it."

These problems are about to get much worse. The baby boomers are coming. In the next decade or so, the medical profession will gradually be deluged by a huge wave of elderly patients. The first baby boomers turned 65 in 2011, and by 2030, the over-65 population will be triple the size it was in 1980.

Geriatricians can't even come close to treating all elderly patients today, much less when the baby boomers come in full force. There was one geriatrician for every 10,350 Americans aged 75 years or older in 2004,[13] and the number of fellows in geriatrics programs, which already was quite low, actually fell in the latest report.[14]

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