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01/07/2009

Can Humanistic approaches solve a crisis in geriatric care?

As millions of older Americans watch their retirement savings get wiped out by the financial crisis, medical experts are warning that the system of geriatric health care is in a crisis all its own - one that money can't solve. 

Dr. Atul Gawande, a surgeon and Associate Professor of Public Heath at Harvard, told the New York Times this week that the number of geriatricians has declined significantly over the last 20 years, while the number of Americans 65 and older is on track to double in the next 20. 

The Washington post called this a crisis, noting that seniors make up just 12 percent of the population, but account for 34 percent of all prescriptions and 38 percent of all emergency medical service responses. 

Even if we had the money to spend, experts agree, the system of care we've set up - too few doctors who can spend too little time with patients whose conditions are often complicated - won't adequately care for them.  We need to do better.

A Humanistic approach to health care, which some practitioners have been applying to small groups, may offer a better approach - and that care is often community-based, focusing on patients' human needs as much as their medical needs.

Marie DiCowden, a Saybrook faculty member, founded the Biscayne Institutes of Health and Living, in Florida, which cares for hundreds of people, from young children to the elderly.  She says that focusing on the health of patients before there’s a crisis, rather than addressing their symptoms afterward, can save money and prevent suffering.  But that takes more than just visits to the doctor's office.

“Our society has to become more prevention oriented and not just rush to provide expensive medical services AFTER issues are already apparent,” she says.  “There will always be frail elderly and we need good in-home care for them. But we need to begin thinking about what can be done to promote health before illness and frailty become primary issues.”

In her own work at the Biscayne Institutes, she says she’s seen that while physicians, nurses, and social workers can be crucial parts of a health care team, they can’t replace a strong sense of community involvement and interpersonal ties. 

“Keeping the elderly motivated to get out of their homes and engage in activities for care in a supportive environment is most important in preventing future frailty, stopping further decline and maintaining healthy involvement,” she says.  “The HealthCare Community model at Biscayne for example has a program called Life Enhancement which is specifically designed to maintain elders in the community.  The focus is on physical, cognitive, social and emotional services to address issues of aging and decline. If there is more focus on prevention and education to access such services --which should be coordinated under one roof and provided by an inter-professional team--that would help change the focus of caring for geriatric patients.”

These are things that the medical community, with its focus on addressing symptoms rather than treating people, hasn’t wanted to hear – but Dr. DiCowden says the good news is that the current crisis may be opening minds.

“Given the climate of change we may expect if there is ever going to be health reform that now is the time,” she says.  “Dollars spent on reforming health care delivery actually will provide jobs (good for the economy) and reduce spiraling medical costs in the future (also good for the economy).  We have to address the issues of aging and the elderly in a more comprehensive manner – there are a number of demonstration projects, and they show promising results.”

Posted at 04:00 PM in

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