A new milestone was recently reached: a man living 112 years.
It used to be eighty-year-olds were the most common people in the hospital. Maybe it's me, but the the ninety-year-olds seem to be supplanting the eighty-year-olds these days in hospitals.
That's because their 70-something-year-old kids can no longer take care of them.
-Wes
Showing posts with label aging. Show all posts
Showing posts with label aging. Show all posts
Monday, December 29, 2008
Friday, September 28, 2007
The Next Huge Challenge
The next time you're in a large amphitheater with quite a few folks, try asking this unsolicited yet provocative request:
"Raise your hand if you are going to die."
Usually about one third of the people raise their hand, but the remainder sheepishly acknowledge that they really didn't want to think about it and hesitate.
But as we all know, we all will die. And before death comes aging late in life. One senior at my father's assisted living facility commented: "Getting old ain't for sissies."
But many of our population are living longer than ever.
It's great to that we're keeping older folks alive longer, isn't it?
Well, maybe.
Our next big challenge will be caring for the chronic health needs of the over-85 crowd. In England, they have noticed a record number of centenarians:
With the current market pressures, will we have enough doctors to tend to these seniors? The yearly threats to shrink physician Medicare reimbursements by the Centers for Medicare & Medicaid Services (a.k.a. CMS) as they continue to follow Congressional guidelines intended to slow the rise of health-care costs leaves many a physician with little incentive to continue with the current rat race. After all, after expenses, some have estimated the average annual primary care physician earns about $80,000 per year - less take-home pay than many nurse practitioners.
To amplify staffing concerns, physician recruitment and retention has recently become a global issue. An Indian colleague of mine has commented that many foreign medical physicians who immigrated to the US to find profitable jobs are now moving back to their home countries. Why? Because technology in even remote towns has met or exceeded that of the US and the economics of their health care systems are far more lucrative for them. This, then, leaves many US hospitals and training programs woefully understaffed for many primary care specialties like internal medicine or family medicine. While some would counter that internal medicine training programs should increase the number of trainees, program directors are keenly aware that training extra doctors diminishes the collective bargaining power of current physicians as they struggle to thwart ongoing salary concessions mandated by Congress.
So what to do?
First, it goes without saying that Congress should avoid further Medicare cuts for physician reimbursement - after all, who will take care of them if they approve these cuts? But the outcome of negotiations is never certain. So we wait on the sidelines.
Secondly, civic and community leaders should look at their strategic plans and consider options to facilitate aging-at-home initiatives. What are communities providing in terms of transporation, home meals, distaster preparedness, and even financial planning assistance? Adequacy of assisted living facilities, nursing home facilites and staffing requirements should be carefully considered now as our seniors continue to age.
Finally, economic incentives for physicians to enter these much-needed fields of gerontology and internal medicine would go a long way to securing the health of all of our aging senior population.
-Wes
Image credit.
"Raise your hand if you are going to die."
Usually about one third of the people raise their hand, but the remainder sheepishly acknowledge that they really didn't want to think about it and hesitate.
But as we all know, we all will die. And before death comes aging late in life. One senior at my father's assisted living facility commented: "Getting old ain't for sissies."
But many of our population are living longer than ever.
It's great to that we're keeping older folks alive longer, isn't it? Well, maybe.
Our next big challenge will be caring for the chronic health needs of the over-85 crowd. In England, they have noticed a record number of centenarians:
Dr Lorna Layward, from Help the Aged, said: "It's hard to know whether these extra years are providing extra years of good health.The US is in a similar predicament. I have been struck by the increasing number of 90 and 100-year olds I find on the hospital wards on the weekends. Which leads to the next important question.
"Hopefully, with better medical provision, these extra years can be happy and healthy."
Emma Soames, the editor of Saga Magazine, said: "The government has got to get its act together, because the care services in this country are really not fit for purpose at the moment.
"We have a whole generation in their 50s and 60s who are looking after elderly relatives."
Gordon Lishman, director general of Age Concern, said: "Demographic change presents a number of opportunities and challenges to public services and public spending.
"For example, most people living in care homes are over the age of 85. As the number of people over the age of 90 increases, so will the need for care home spaces.
"All too often we are failing to respond adequately to the changing demographic challenge facing the UK."
With the current market pressures, will we have enough doctors to tend to these seniors? The yearly threats to shrink physician Medicare reimbursements by the Centers for Medicare & Medicaid Services (a.k.a. CMS) as they continue to follow Congressional guidelines intended to slow the rise of health-care costs leaves many a physician with little incentive to continue with the current rat race. After all, after expenses, some have estimated the average annual primary care physician earns about $80,000 per year - less take-home pay than many nurse practitioners.
To amplify staffing concerns, physician recruitment and retention has recently become a global issue. An Indian colleague of mine has commented that many foreign medical physicians who immigrated to the US to find profitable jobs are now moving back to their home countries. Why? Because technology in even remote towns has met or exceeded that of the US and the economics of their health care systems are far more lucrative for them. This, then, leaves many US hospitals and training programs woefully understaffed for many primary care specialties like internal medicine or family medicine. While some would counter that internal medicine training programs should increase the number of trainees, program directors are keenly aware that training extra doctors diminishes the collective bargaining power of current physicians as they struggle to thwart ongoing salary concessions mandated by Congress.
So what to do?
First, it goes without saying that Congress should avoid further Medicare cuts for physician reimbursement - after all, who will take care of them if they approve these cuts? But the outcome of negotiations is never certain. So we wait on the sidelines.
Secondly, civic and community leaders should look at their strategic plans and consider options to facilitate aging-at-home initiatives. What are communities providing in terms of transporation, home meals, distaster preparedness, and even financial planning assistance? Adequacy of assisted living facilities, nursing home facilites and staffing requirements should be carefully considered now as our seniors continue to age.
Finally, economic incentives for physicians to enter these much-needed fields of gerontology and internal medicine would go a long way to securing the health of all of our aging senior population.
-Wes
Image credit.
Tuesday, December 26, 2006
Advanced Medicine for the Advancing Aged
While performing a pacemaker implantation today, I asked for DeBakey forceps (seen above) today – forceps named after an iconic figure in cardiothoracic surgery, Dr. Michael E. DeBakey who underwent an operation at the tender age of 97 that he devised to correct a dissecting aortic aneurism. Although the article that appeared yesterday in the New York Times (and again today in the Chicago Tribune) seemed somewhat apologetic regarding the number of resources used, it nonetheless was a reminder of the incredible capabilities of our health care system when it works the way it should. Gratefully for his family, colleagues and friends, Dr. DeBakey made it through the ordeal in what can only be considered a miracle of modern medicine. Certainly the hard work by all of those involved in his care should not go unacknowledged.
But the bigger story beneath this story is a more subliminal and troubling one: just because care can be delivered, should it be delivered to someone at such an advanced age, in such an abysmal condition with such low probability of surviving to discharge? Circumstances in hind-sight would suggest they should. But in the best of circumstances, a healthy 97-year old male in the United States has about a 2.8 to 3.0 year actuarial survival. Now take a ninety-seven year-old with a Stanford Class A, Debakey subclass II, dissecting ascending aortic aneurism which is leaking into the pericardium who is unconcious and near death - well this individual has a much, much lower probability of surviving the surgery, let alone surviving to discharge. And after the surgery, rehabilitating a ninety-seven year-old is an expensive and arduous undertaking. As a doctor practicing in Chicago, I have to ask myself honestly an important question: would I have proceeded along the same course in a patient with a clear “do not resuscitate” order on his chart that demonstrated such a reluctance to proceed with surgery in the first place?
At this time of shrinking resources in health care, physicians are increasingly pressured to ponder such decisions. These decisions are never made lightly. There was a lot of emotion tied to Dr. Debakey’s illness – he mentored many of the colleagues involved in his care. The irony of the affliction was not lost on those caring for him either. They wrestled with the decision to perform surgery, and only when the wife barged into the meeting room, did they decide to proceed.
But Methodist Heart is also a public “non-profit” charitable organization. Money from the institution went to Mr. BeBakey’s care and will likely be itemized under “charitable care” when their income tax Form 990 is filed for 2006. The organization has authority to authorize funds for such care. But with the growing number of uninsured, ever-increasing costs of providing such health and rehabilitative care coupled with the aging of the population, especially the numbers of patients over 90 years of age, who will decide if John Q. Public gets a full court press or more conservative therapy? When such precedents are set, can we continue to turn our cheek to other younger patients with better chances of long-term survival and similarly difficult-to-manage illnesses? Will this level of aggressive care now become the de facto standard of care for all of our patient’s over 90 years of age? Should it? Certainly there were others in Houston with similar concerns.
Hopefully, there not be hard and fast rules guiding us in these circumstances. But while I commend the spectacular care that Dr. DeBakey received, I do so with some trepidation regarding the solvency of our health care system: especially as it pertains to our younger patients in the years ahead.
-Wes
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