‘Geriatric Champions’ Are Changing Medicine for Good

From Next Avenue — 

Dr. Subhechchha Shah recently saw an 80-year-old patient with a long list of medical ills, including chronic pain from multiple back surgeries, Parkinson’s disease and related dementia. In the past, Shah would have referred the patient to specialists, who in turn would likely order a battery of tests, procedures and medications. But this time, Shah spent the visit listening to the patient and her husband.

“She said she was tired of going to doctors almost every day,” said Shah, who is a family practice physician with Providence Medical Group in Medford, Ore. “She said, ‘I don’t want more medications and more appointments. I want a little more control of the pain and to live my life a little bit better.’ I was happy that I was able to have that conversation.”

Shah’s newfound appreciation of learning what is meaningful to her patients is the result of an intensive geriatric training program she recently completed. The “geriatric mini-fellowship” launched in 2018 by Providence St. Joseph Health in Oregon, is offered to small groups of the system’s primary care providers to deepen their understanding of treating older adults. Shah and her six physician classmates met in Portland, Ore. for four one-week sessions, spread throughout the year.

Health Systems Need Help

Providence operates 45 primary care clinics in Oregon, whose patient population includes 83,000 people 65 and older. But as of 2018, the state has only 88 board-certified geriatricians — doctors who specialize in the care of older people. And that’s not just an Oregon problem. The entire country has just 7,047 geriatricians.

To help provide a fraction of Oregon’s older patients with better care, geriatrician Dr. Marian Hodges and geriatric clinical nurse specialist Colleen Casey developed the fellowship. Health care providers welcomed the program. “They all know they do it lousy,” Hodges said of geriatric care.

One problem, said Shah, is that physicians have been trained to treat older adults the same as younger ones. Older patients’ changing bodies, cognition or social structure are not taken into account. “What we do in medicine is one size fits all — the research, the evidence that we have, is based on the adult population, and we just apply that to the geriatric population,” said Shah. “This is a population that needs a different approach.”

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Part of the AGE-FRIENDLY HEALTH CARE SPECIAL REPORT