Najia Saleem, Class of 2024
We in the United States think of our health the way we think of a machine. When a machine breaks down, it is taken to the repair shop – just as when we are not feeling well, we go to a doctor. As the machine ages and new models appear, the older machines become obsolete. The patches and fixes geared towards the new models only wear it down. Rather than removing the machine and retiring it before it breaks down, we discard the machine only when it is beyond saving. You are that machine, and eventually, you meet the same fate. Under the current philosophy of the American healthcare system, you will be given patches and fixes rather than adequate end-of-life care. To dismantle this detrimental philosophy that is entrenched in our current system, we must understand why it exists, how we can implement an alternative philosophy of aging with dignity, and the immediate changes we can make to remedy this issue.
The root of the current American view of aging in healthcare is ignorance. In a national survey of medical school deans in 2008, it was revealed that only about 30% of medical schools had required coursework in hospice and palliative care, and 19% had required rotations in them (Van Aalst-Cohen et al., 2008). Although this figure has improved in the last few decades, it is still unacceptable that despite our aging population that all physicians do not receive some formal training with regard to end-of-life care since death and aging are very much a part of the continuum of care.
The logical progression is then to mandate formal geriatric and palliative care training at medical schools throughout the country. Alarmingly, there is already a shortage of hospice and palliative medicine (HPM) physicians in the United States now (Lupu 2010). The number of qualified teaching staff on this topic then is even less. Therefore, we are trapped in a vicious cycle born out of our ignorance. The years of not investing and training physicians for the elderly population are catching up to us, especially given that between 2020 and 2060, the number of adults over 65 is expected to increase from 56.0 million to 94.7 million, which is a dramatic 69% boom in less than half a century (Mather and Kilduff 2020).
For quite some time now, we have been suffering under this ignorance that begins at the medical school level. The increase in the elderly population, or the "graying of America," will only exacerbate these conditions. This suffering looks like geriatric patients being treated for their symptoms alone rather than the effect on their quality of life. This looks like nursing home care rather than improved home care. This looks like curative care rather than preventative care. Although we must bear the effects of this ignorance in the slow trickle of physicians, reforming the philosophy of aging and proposing immediate changes may steer us clear of the storm brewing on the horizon.
We must increase the compensation for young physicians who choose training and certification in geriatrics as they will be eager to get rid of their medical school debt. Next, we should train physician assistants and advanced nurse practitioners in this field to help combat the workforce shortage (Lester et al., 2019). We must also reinforce aging with dignity, not denial in continuing medical education courses issues (Head et al., 2016). Similarly, we can introduce geriatrics to students at the undergraduate and graduate levels. To help us break free of the vicious cycle in which ignorance perpetuates age-related health disparities, we must make these immediate changes.
Returning to the machine analogy, we do not need our healthcare system to provide patches and fixes to our machines, but we need the system to reform itself and provide adequate repair as our model becomes older so that we maintain dignity and autonomy till the very end. These direct changes, such as increased training and compensation, as well as education to uplift the perception of aging, must be accomplished so that the millions of graying Americans can age with dignity, not denial.
References:
Head, Barbara A et al. "Improving medical graduates' training in palliative care: advancing education and practice." Advances in medical education and practice vol. 7 99-113. 24 Feb. 2016, doi:10.2147/AMEP.S94550
Lester, Paula E., et al. "The Looming Geriatrician Shortage: Ramifications and Solutions." Journal of Aging and Health, vol. 32, no. 9, Oct. 2020, pp. 1052–1062, doi:10.1177/0898264319879325.
Lupu, Dale. "Estimate of Current Hospice and Palliative Medicine Physician Workforce Shortage." Journal of Pain and Symptom Management, vol. 40, no. 6, 2010, pp. 899–911., doi.org/10.1016/j.jpainsymman.2010.07.004.
Mather, Mark, and Lillian Kilduff. "The U.S. Population Is Growing Older, and the Gender Gap in Life Expectancy Is Narrowing." PRB, 19 Feb. 2020, https://www.prb.org/resources/u-s-population-is-growing-older/.
Van Aalst-Cohen, Emily S., et al. "Palliative Care in Medical School Curricula: A Survey of United States Medical Schools." Journal of Palliative Medicine, vol. 11, no. 9, 2008, pp. 1200–1202., doi.org/10.1089/jpm.2008.0118.
The root of the current American view of aging in healthcare is ignorance. In a national survey of medical school deans in 2008, it was revealed that only about 30% of medical schools had required coursework in hospice and palliative care, and 19% had required rotations in them (Van Aalst-Cohen et al., 2008). Although this figure has improved in the last few decades, it is still unacceptable that despite our aging population that all physicians do not receive some formal training with regard to end-of-life care since death and aging are very much a part of the continuum of care.
The logical progression is then to mandate formal geriatric and palliative care training at medical schools throughout the country. Alarmingly, there is already a shortage of hospice and palliative medicine (HPM) physicians in the United States now (Lupu 2010). The number of qualified teaching staff on this topic then is even less. Therefore, we are trapped in a vicious cycle born out of our ignorance. The years of not investing and training physicians for the elderly population are catching up to us, especially given that between 2020 and 2060, the number of adults over 65 is expected to increase from 56.0 million to 94.7 million, which is a dramatic 69% boom in less than half a century (Mather and Kilduff 2020).
For quite some time now, we have been suffering under this ignorance that begins at the medical school level. The increase in the elderly population, or the "graying of America," will only exacerbate these conditions. This suffering looks like geriatric patients being treated for their symptoms alone rather than the effect on their quality of life. This looks like nursing home care rather than improved home care. This looks like curative care rather than preventative care. Although we must bear the effects of this ignorance in the slow trickle of physicians, reforming the philosophy of aging and proposing immediate changes may steer us clear of the storm brewing on the horizon.
We must increase the compensation for young physicians who choose training and certification in geriatrics as they will be eager to get rid of their medical school debt. Next, we should train physician assistants and advanced nurse practitioners in this field to help combat the workforce shortage (Lester et al., 2019). We must also reinforce aging with dignity, not denial in continuing medical education courses issues (Head et al., 2016). Similarly, we can introduce geriatrics to students at the undergraduate and graduate levels. To help us break free of the vicious cycle in which ignorance perpetuates age-related health disparities, we must make these immediate changes.
Returning to the machine analogy, we do not need our healthcare system to provide patches and fixes to our machines, but we need the system to reform itself and provide adequate repair as our model becomes older so that we maintain dignity and autonomy till the very end. These direct changes, such as increased training and compensation, as well as education to uplift the perception of aging, must be accomplished so that the millions of graying Americans can age with dignity, not denial.
References:
Head, Barbara A et al. "Improving medical graduates' training in palliative care: advancing education and practice." Advances in medical education and practice vol. 7 99-113. 24 Feb. 2016, doi:10.2147/AMEP.S94550
Lester, Paula E., et al. "The Looming Geriatrician Shortage: Ramifications and Solutions." Journal of Aging and Health, vol. 32, no. 9, Oct. 2020, pp. 1052–1062, doi:10.1177/0898264319879325.
Lupu, Dale. "Estimate of Current Hospice and Palliative Medicine Physician Workforce Shortage." Journal of Pain and Symptom Management, vol. 40, no. 6, 2010, pp. 899–911., doi.org/10.1016/j.jpainsymman.2010.07.004.
Mather, Mark, and Lillian Kilduff. "The U.S. Population Is Growing Older, and the Gender Gap in Life Expectancy Is Narrowing." PRB, 19 Feb. 2020, https://www.prb.org/resources/u-s-population-is-growing-older/.
Van Aalst-Cohen, Emily S., et al. "Palliative Care in Medical School Curricula: A Survey of United States Medical Schools." Journal of Palliative Medicine, vol. 11, no. 9, 2008, pp. 1200–1202., doi.org/10.1089/jpm.2008.0118.
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