Threadbare safety net for aging boomers

Scripps Howard News Service

Medical column

By LEE BOWMAN

Scripps Howard News Service

There it is, baby boomers -- another dire report about the prospects of a health care system unready to care for you as you begin turning 65.

For some decades now, ever since it became apparent that most of some 78 million people born between 1946 and 1964 would likely live to a ripe old age, health care analysts and researchers have fretted about the country having enough doctors, nurses, hospitals, nursing home beds and other caregivers to accommodate the surge.

The latest report in a long line comes from the Institute of Medicine, part of the National Academy of Sciences.

It notes that there are only about 7,100 geriatricians, doctors specially trained to juggle the treatment of several chronic conditions at once. There are already 35 million Americans 65 and older.

It's estimated that the nation will need at least 36,000 specialists in medicine for the aged by 2030, when the last of the boomers turn the corner.

That's not likely to happen, since only about 2 percent of med school grads go on to train in geriatrics each year. Physician organizations representing the aging specialty say much of this aversion is due to low reimbursement from Medicare and other insurance compared with other specialties.

Mentioned less often is that caring for the elderly is difficult and the wins are harder to measure than for most docs. Physicians like to see success just like the rest of us. The surgeon wants to remove the tumor or fix the damaged joint. The pediatrician sees the sore throat or rash go away.

Geriatricians know they can't defeat aging, only slow it down. They know a weakening heart or gradual loss of lung function or dementia will eventually claim every patient's life. So they measure by a different yardstick -- the months or years someone can keep working, keep traveling, continue gardening or simply remain able enough to live on their own.

The truth is, of course, that almost everyone in American health care is going to have to provide help for the boomers, just as most are now, as they continue to age.

So even though the IOM report rounds up the usual suspects of workforce shortages and misery pay, it also stresses that the health care system needs to be more innovative in caring for an aging population, that all providers need training and coordination in caring for seniors, as do family members and other informal caregivers.

"The sheer number of older patients in the coming years will require trying new models for delivering health care and the commitment of greater financial resources," said John Rowe, a professor of health policy at Columbia University who headed the panel that wrote the report.

The "financial resources" may be dicey unless new ways to pay for Medicare -- and hold spending down for the care of the elderly and disabled -- are found.

Clearly, there's room for some self-help. Many studies already show Americans in their 60s, 70s and 80s today are healthier and more independent than those in the same age bracket a decade or two ago. Many boomers are strongly committed to fitness and disease prevention. Of course, many others are also overweight and have lifestyles that bring the risk of more chronic disease and disability into their old age.

More than for any other group in the nation's history, it is important that society find ways to help the boomers age gracefully.

On the Net: http://www.iom.edu

(E-mail Lee Bowman at bowmanl(at)shns.com. Distributed by Scripps Howard News Service, http://www.scrippsnews.net)