Caring for an Aging America: Are We Prepared?
Older age is the time of life when we are most likely to need high-quality medical care. It’s also when we are least likely to get it.
Gabriel Solomon, M.D., sits in front of a computer in the Turner Geriatric Clinic staff room scanning medical records for patients he’ll see this afternoon. There’s been a last-minute addition to his schedule — a retired teacher who often shows up at the U-M Geriatrics Center without an appointment. When Mrs. Smith (not her real name) wants to see a doctor, she comes to the Geriatrics Center, because she says other doctors just see her for a few minutes and then say everything’s normal.
Mrs. Smith came to the clinic today because she’s worried about a swollen, painful knee that makes it hard for her to walk and do housework. She also wants to know if she should keep using an inhaler (prescribed by another physician) and whether she should switch her Medicare Part D insurance to Blue Cross Blue Shield.
Solomon is unfazed. A soft-spoken father of two and former social worker at a homeless shelter, Solomon has lots of patience and never seems to be in a hurry. He listens carefully and answers every question. Not only does he give Mrs. Smith verbal instructions; he writes everything down, and arranges to have a Turner Clinic social worker call to answer her insurance question.
A graduate of Wayne State University Medical School, Solomon is one of six physicians in the U-M’s geriatric medicine fellowship training program. One of the first of its kind in the country, the program provides specialized training for physicians who want to become geriatricians — doctors who specialize in geriatric medicine. After a three-year residency in either internal or family medicine, fellows spend one or two years conducting research and working with elderly patients at Geriatrics Center clinics, University Hospital and area nursing homes.
After examining Mrs. Smith’s knee, Solomon brings in his attending physician, Jocelyn Wiggins, an assistant professor of internal medicine who received her medical degree in her native England. Wiggins is a warm, outgoing woman who completed a U-M geriatric medicine fellowship in 1997. Wiggins tells Mrs. Smith to stop the inhaler, reassures her it’s OK to take Tylenol every day for her knee pain, and reminds her how important it is to take her daily blood pressure medication.
After Mrs. Smith, Solomon moves on to his next patient. This time, it’s Mrs. Jones (also not her real name), a woman with advanced dementia who arrives with her daughter for a check-up. Multiple strokes have destroyed her ability to speak or understand, but she greets Solomon with a radiant smile and a hearty punch in the arm.
“She seems happy,” Solomon says with a grin, as he checks her blood pressure.
As he does with every patient, Solomon makes it a point to ask if the family has a problem paying for Mrs. Jones’ medicine. He works with a Turner Clinic pharmacist to help patients cut costs by switching to generics or, whenever possible, stopping some medications.
“A lot of geriatrics is just trying to simplify a patient’s complex medication regimen,” Solomon says. It not only saves money and improves compliance, it also reduces the risk of adverse drug interactions, which can be a big problem for seniors whose bodies don’t process drugs as efficiently as younger people.
Mrs. Jones’ daughter mentions that her mother has had several episodes of decreased responsiveness lasting 20 or 30 minutes. After these episodes she seems fine. Solomon thinks seizures might be a possibility. The question is what’s causing them and how aggressively should they be treated.
Solomon and Wiggins don’t want to prescribe an expensive, anti-seizure medication that has side effects without knowing what’s causing the problem, but Mrs. Jones doesn’t have much tolerance for diagnostic tests. It’s a fight just to get blood drawn and lying still for an EEG or brain scan is out of the question.
After much discussion, everyone agrees to wait and see if the seizures continue. In geriatric medicine, less is often more.