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As we age, number of specialists in aging lags

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Posted: Monday, January 3, 2011 10:30 am

By day, Hanaa al-Khansa is a fourth-year medical student at the University of Minnesota, hoping to practice family and pediatric medicine.

But on evenings, weekends and holidays, she's part of a small but significant experiment that could ease the widening gap between the needs of America's increasing population of elders and the supply of specialists who serve them.

She and her husband live amid people in their 80s, 90s and 100s at Augustana Apartments in Minneapolis. Recently, she walked the halls, delivering holiday treats. It was a way to check on frail neighbors -- and to master subtle lessons of aging that will help her be a better physician.

"You learn to listen with a different ear, to ask about problems in terms of daily life -- not 'How is your gait?' but 'Did you get to the grocery store today?'" said al-Khansa, 26, whose family emigrated to Duluth, Minn., from Malaysia a decade ago.

The leading edge of baby boomers is about to turn 65, eligible for Medicare, the federal health care program for the aged. Nationwide, for the next 18 years, about 10,000 more boomers will join them each day.

"But we're not ready for them," said Dr. Robert Kane, a physician and nationally known expert who heads the University of Minnesota's Center on Aging. "Doctors, nurses, social workers, psychiatrists, dentists, pharmacists -- you name a geriatric speciality, and we're short."

The looming consequences are serious. The nation has 7,200 certified geriatricians, one for every 2,500 older Americans. Some experts suggest that five times that many will be needed by 2030, when the country's aging population will have nearly doubled.

Scores of programs in Minnesota and beyond aim to develop specialists to care for the swelling ranks of the aged. Community colleges are training aides to work in nursing homes and home care. The U is training gerontological nurses and nurse practitioners -- a step between nurses and physicians.

Professionals with geriatric training can improve older clients' quality of life and lower medical costs by providing appropriate help, experts say.

"But a lot of people seem afraid to work with seniors," said geriatric social worker Christie Cuttell, 36, at Augustana Care Center, across the street from al-Khansa's apartment building.

Most older people remain active and independent, but advancing age brings many chronic health conditions.

"An 85-year-old with heart disease may also have diabetes, respiratory problems, arthritis and maybe the beginning of dementia, with five different doctors and 15 prescriptions," said Thomas Clark, who operates a commission in Virginia that has certified about 2,250 geriatric pharmacists nationwide.

"The goal in treating a middle-aged man with heart disease may be just to fix his heart, but for an old man it may be to allow him to get to church, join friends for lunch and hold his grandkids."

Some geriatric pharmacists have set up new businesses to help older patients reduce debilitating problems caused by prescriptions from doctors who are more focused on diseases than aging patients.

Not all experts on aging are pushing the panic button to get deeper training for health professionals.

"Let's quit worrying about getting docs and nurses and social workers with geriatric certification," said H. Rick Moody, a gerontologist and director of academic affairs for AARP. "...Lets give a bunch of generalists -- in just about every profession -- some training in gerontology, because that's who the customers will be. Older people are the fastest-growing segment of America, and guess what? They've got the money. So I want to see my barber, my waiter, my banker and insurance salesman understand how aging is changing my needs."

For 11 years, Dr. Ed Rattner took university medical students to Augustana Care Center while he made his rounds, a modest introduction into geriatrics.

It wasn't enough. Two years ago, the geriatrician proposed that Augustana provide discounted housing; he'd supply medical students to live there and, for course credit, interact with residents.

This year, eight graduate students, including social workers, seminarians and a physical therapist, live there. Each connects with residents, especially those most at risk of needing nursing home care.

"One student told me she needed a new resident because hers had gone into the nursing home after being hospitalized," Ratter said. "I said, 'Oh, no. Your job now is to get her home again,' so the student met with the nursing home staff and helped that resident get back home. That's geriatric education."

At Augustana last week, al-Khansa sat with neighbors Herb Hanson, 84, a retired Lutheran pastor from Iowa, and his wife, Joyce, 80.

"Herb and Joyce are a perfect example of what I'm learning," she said. "They are so active, and some of my other neighbors are younger but much more frail.

"Don't assume you know much about an older person and what they need until you talk -- really talk. I realize, as I practice medicine, I will always be the student, and my patients will be my teachers."

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