The Frontal Cortex

Aging and Geriatrics

Another great Atul Gawande article on the aging process and the need for more geriatric specialists:

The single most serious threat she [an 86 year old woman] faced was not the lung nodule or the back pain. It was falling. Each year, about three hundred and fifty thousand Americans fall and break a hip. Of those, forty per cent end up in a nursing home, and twenty per cent are never able to walk again. The three primary risk factors for falling are poor balance, taking more than four prescription medications, and muscle weakness. Elderly people without these risk factors have a twelve-per-cent chance of falling in a year. Those with all three risk factors have almost a hundred-per-cent chance. Jean Gavrilles had at least two. Her balance was poor. Though she didn’t need a walker, he had noticed her splay-footed gait as she came in. Her feet were swollen. The toenails were unclipped. There were sores between the toes. And the balls of her feet had thick, rounded calluses.

Gawande convincingly argues that the secret to successful aging is to pay attention to the details (like a person’s feet), a task for which geriatric specialists are uniquely trained. And yet, because geriatric specialists don’t use expensive medicine (they spend most of their time talking to their patients), the field is slowly withering away:

Little of what the geriatricians had done was high-tech medicine: they didn’t do lung biopsies or back surgery or PET scans. Instead, they simplified medications. They saw that arthritis was controlled. They made sure toenails were trimmed and meals were square. They looked for worrisome signs of isolation and had a social worker check that the patient’s home was safe.

How do we reward this kind of work? Chad Boult, who was the lead investigator of the St. Paul study and a geriatrician at the University of Minnesota, can tell you. A few months after he published his study, demonstrating how much better people’s lives were with specialized geriatric care, the university closed the division of geriatrics.


  1. #1 Micah Jones
    May 1, 2007

    I am so fed up with institutions and individuals complaining about a problem, funding a solution, seeing it solved, and then closing the solution. Medicine is not an unemployment program – it’s not something you have until there’s no more patients, and then shut down! Especially not something like geriatrics that intrinsically requires check-ups and maintaining health.

    We are only going to start finding long term solutions when we are willing to set up long term services/projects, instead of temporary ones.


  2. #2 MattXIV
    May 1, 2007

    This is a very interesting article. It seems like a good example of a place where a using a MD may be a poor use of health care resources. Prescribing and chronic illness management could be handled by a nurse practioner. MDs may bring more specialized knowledge to bear, but their time is a scarce quantity and spread across a broad set of patients. Having the normal treatment and monitoring of chronic illnesses managed by an appropriately licensed nurse who can dedicate more time to working with the patient (especially given the division of the exam process between nurse and MD that currently exists) may be a better alternative to the MD popping in briefly at the end of the visit, which seems to be the standard for most primary care. Having a MD be able to devote that level of attention may be nice, but the Guided Care strategy and other approaches focusing on cultivating the geriatric care knowledge of nurses may be the most practical solution to the need for routine but effort-intensive geriatric care.

  3. #3 Mark
    May 1, 2007

    Decisions about geriatric care funding should be made by people of a certain age – the age at which their parents require geriatric care.

  4. #4 Longevity Science
    May 13, 2007

    Thank you for your interesting comments!
    I thought perhaps you may also find this related post and a subsequent discussion interesting to you:
    Longevity Science: The Way We Age

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