As the population of the United States grows older and lives longer, the shortage of doctors trained to treat the problems of the elderly has become acute.
Most doctors, even those who have a lot of elderly patients, have had little, if any, systematic training in geriatrics, and medical schools are only now introducing such training.
According to Dr. Louis J. Kettel, a former medical school dean who is now a vice president at the Association of American Medical Colleges, doctors and medical educators nationwide are finding that their patient population has aged dramatically -- but that much basic knowledge about older patients is still lacking.
"We don't know the normal lung volume or hemoglobin of someone who's 90, because the charts and research didn't go out that far," he said. "There's now a lot going on to try to catch up on that. We need geriatricians to teach and do the research, but they can't possibly treat all the elderly. Every internist, every surgeon, every anesthesiologist, every gynecologist needs to know more about treating older people."
In recent years, a new body of knowledge has developed on some common medical problems affecting the elderly, including incontinence, depression, dementia and falling. Such chronic problems, one on top of the other, often snowball to the point where the frail elderly can no longer manage an independent life, especially when doctors unaware of the latest research simply dismiss their problems as an untreatable fact of aging.
"I had a 79-year-old lady, sharp as a tack, who was wheelchair-bound and incontinent when I met her," said Dr. Walter Ettinger, a geriatrician at the Bowman Gray School of Medicine in Winston-Salem, N.C.
"She had pains in her knees and early Parkinson's, which made it hard to walk, and was taking diuretics for her high blood pressure, which made her wet herself because she couldn't get to the bathroom, and without exercise, she had put on weight, making it even harder to get around."
Dr. Ettinger found that the knee pain was treatable bursitis. Along with treatment for the Parkinson's and weight training for strength and fitness, the woman was ultimately able to walk and use the bathroom.
"Like most of our patients, it wasn't that she had had terrible treatment," Dr. Ettinger said. "But no one else had the time to think about her problems overall or the resources to try to restore her function."
