Crash Course for Doctors in Treating the Elderly

Like children, older people have special medical needs. Adequately meeting them is a growing challenge as the elderly population increases. Longer lives and an aging baby-boom generation will boost the share of the U.S. population over 65 from less than 14% now to 20% by the year 2025, meaning that about 70 million Americans will be 65 or over. Yet too few physicians are specialists trained to deal with the illnesses and bodily changes that often go with aging. The American Geriatrics Society and the Blue Cross and Blue Shield Assn., the nation’s largest health insurer, hope to do something about that.

The geriatrics society is offering to provide a crash course in treating the elderly to about 10,000 Blue Cross Blue Shield doctors. The aim is not to produce more certified geriatricians--there are only about 8,000--but to better acquaint family doctors with the health problems they are more likely to encounter in the elderly than in the general patient population. Those include adverse drug reactions--older people are more likely to be taking a number of medications, raising the risk of harmful interactions--malnutrition, sleep disorders, osteoporosis, depression and dementia.

This initiative follows closely on the incentives Congress and President Clinton have approved to encourage Medicare recipients to enroll in managed care health plans. About 12% of seniors are now in such plans, a number expected to double in five years. Under managed care, Medicare patients are more likely to be treated by a general practitioner than a specialist. It’s increasingly important that managed care providers understand the particular problems of the elderly.

Besides trying to familiarize doctors with these special clinical problems, the new plan aims to alert physicians to other needs associated with growing older--for example, whether a patient’s physical or mental state indicates a need to get help with daily living activities. And, recognizing that older people tend to seek advice from their doctors more often than young people, the training will even suggest that doctors set aside time each day to return calls to elderly patients.

Medical science has learned much and is learning more each year about aging and its special health problems. The imperative is to spread that knowledge more widely among physicians. The Blue Cross Blue Shield experiment provides a possible model for other managed care providers.