July 29, 2024
As forecasters predict the number of people aged 65 and older in Texas will more than triple by 2050, doctors say the population will need more specialized physicians to meet the patients’ unique needs. Such attuned doctors can help reset assumptions about health as people age, but some hurdles must be overcome.
Understanding and caring for this unique segment of patients takes intent, says one geriatrician who specializes in caring for older patients.
“To best treat older adults, you really need additional skills and training to see the person holistically – including any potential health issues – to see how things are interacting and to work in an interdisciplinary team,” said Deborah Freeland, MD, a Dallas-based geriatrician and Texas Medical Association member.
Dr. Freeland says fully understanding older patients is ideal for any physicians caring for them.
“One of the issues with our medical system as it changes is there are specialists for every single organ system, but geriatric training is not required in most medical schools,” she said.
To fill this gap, some postgraduate medical programs like the UT Southwestern Medical Center in Dallas are launching new physician training curricula in geriatrics and internal medicine. Dr. Freeland is an assistant professor at UT Southwestern and the track director for the new combined Internal Medicine-Geriatrics residency and fellowship program, the only such curriculum in Texas.
Great care starts with understanding that being older doesn’t necessarily mean being in poor health, she says. Patients themselves even have incorrect assumptions about their conditions. Falls are a good example.
“Falling is embarrassing. Sometimes patients think that's normal with aging, so they don't bring it up” to the doctor, she said. Some of her patients over the age of 80 tell her, “Of course, I'm falling – because of my age.”
Physicians must probe and address the causes, however. Falls could be a sign of an orthopedic issue like osteoarthritis, or a side effect of medications, or an underlying neurologic condition. Many factors could lead to falls.
“A geriatrician is like a detective looking for all of these things, and trying to get the word out that this really isn't normal.” Dr. Freeland says another common misconception equates dementia with aging. The condition is abnormal even as someone gets older, she says; it is not necessarily inevitable for anyone who is aging.
Navigating health insurance can be confusing for senior patients too, so they often ask physicians to assist with that. Helping patients manage prescription medications, if they have any, also is important. “Managing the medicines, looking at the big picture, how do you coordinate care? You really have to understand the system to help patients navigate it,” Dr. Freeland said.
An Austin family physician has the same experience. Guadalupe Zamora, MD, says he and his staff often guide older patients through understanding Medicare, the government insurance for people over age 65 or with permanent disabilities.
“Most of them don't understand how to use their insurance correctly and therefore they're lost,” said Dr. Zamora.
Medicare also poses other challenges for these patients and their doctors. Annual cuts to physicians’ Medicare payments are negatively impacting physician practice viability, forcing some doctors to limit the number of Medicare patients they see in their practice, or out of medical practice altogether. A new nearly 3% cut for physicians Medicare pay is already forecast for 2025.
Similar pay cuts have hit doctors nearly every year for more than 20 years, threatening patients’ ability to receive care.
With an estimated 9.4 million Texans over age 65 by the middle of this century, doctors say it is imperative to ensure seniors can get the care they need from physicians, when they need care – not risk decreasing it. TMA and other physician groups are pressing Congress to stop cutting Medicare physician payments to ensure access to care.
“When our country makes a promise to its tax-paying elderly citizens, it is incumbent upon us to fulfill that promise – it’s the least we can do,” said TMA President G. Ray Callas, MD.
Also listen to the TMA Health Beat podcast for more on this topic.
TMA is the largest state medical society in the nation, representing more than 57,000 physician and medical student members. Located in Austin, TMA has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
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TMA Contacts: Brent Annear (512) 370-1381; cell: (512) 656-7320
Swathi Narayanan (512) 370-1382; cell: (408) 987-1318
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