USA: Wanted - Experts On Old Age

Few doctors or nurses get special training CONCORD, NEW HAMSHIRE (Concord Monitor), October 25, 2005: Karen Tetreault explained how age affects human cells, warned against sneaky drug interactions and touched on the tight finances of many seniors. But before allowing her nursing students to interact with elderly patients, she stressed a nonscientific lesson: respect. "Remember to address your client as Mr. or Mrs.," she said as the class embarked on rounds at Concord Hospital last week. "And knock on the door before entering." For nearly a decade, Tetreault has taught courses on the special medical needs of older patients, or geriatrics, at the New Hampshire Technical Institute in Concord. Although Americans are living longer than ever before, classes like this remain a rarity at nursing and medical schools across the country - something experts say could contribute to a looming health care crisis. Millions of baby boomers are about to tangle with the maladies of old age, but few medical professionals are prepared to meet their needs. Just 10 of the nation's 125 medical schools and one-third of nursing schools require courses in geriatrics. When schools do offer specialized classes, professors find that the greatest challenge lies not in funding or textbooks, but in combating a cultural bias against the old. "The hope is that they will get a different viewpoint on aging,"Tetreault said. "A different way of looking at the older generation. . . . There's so much we can learn from them if we don't stereotype them into frail, demented, incontinent people." Tetreault spends much of each five-week rotation retooling her students' concept of "old." She introduces them to healthy, active octogenarians and stresses that caring for elderly patients can be the basis of a challenging, rewarding career. Age and death are not failures, she says, and even when patients are beyond healing, they still require expert care. At medical schools, selling the field is more difficult. Academic geriatricians are rare, and even the most elder-friendly student may eschew geriatrics because itdoesn't pay well. "The incentives are not there to some extent to go into geriatrics because it's largely driven by Medicare reimbursements," said Dr. Stephen Bartels, a geriatrician who teaches psychiatry and family health at Dartmouth Medical School. "Students finishing medical school, who often have huge loans to pay back, look at geriatrics and see they're going to be practicing in an environment where they'll have difficulty covering their costs." Older patients often don't require the high-tech medicine that appeals to young doctors, Bartels said. "Certainly ageism is highly prevalent in our culture," he said. "Confronting that and helping health care providers to look at the national treasure that is our older citizens is something we try to teach. . . . It's an ethical imperative that we should be providing excellent care to older individuals, but it's slow going." In recent years, medical schools have increased the number of geriatric fellowships, but one-third remain empty for lack of interested candidates. At Dartmouth, Bartels and other faculty members are overhauling the way the school and the hospital teach, research and treat older patients. Students receive only basic geriatric training now, but Bartels hopes that will soon change. Meanwhile, other health-related professions are also boosting their knowledge of older patients. New Hampshire has nine physical therapists with special certificates in geriatric care. The most recently accredited, Judy Thackaberry, knew she wanted to work with elderly clients when she became a physical therapist four years ago. She finds her patients both wise and challenging, but she worries that younger therapists have an unfavorable view of the field. "It's just the image," said Thackaberry, who lives in Sunapee and works at the Clough Center, a long-term care facility affiliated with New London Hospital. "They tend to be less glamorous than the outpatients or orthopedics. Or the image might be that it doesn't really require specialized knowledge, or that it's not challenging." Even Tetreault was wary when NHTI first asked her to teach geriatrics. She'd worked with children most of her career, and only a handful of nursing programs were focusing on older patients at the time. "Frankly, it was the last thing I wanted to do," she said. "Now I don't want to do anything else, ever." On the way to the ward, Tetreault stopped her class in front of a portrait of a man with a deeply-lined face and wispy, gray hair. She tapped the glass. "There's so much wisdom in that face," she said. By Meg Heckman mheckman@cmonitor.com Monitor staff Concord Monitor http://www.concordmonitor.com.