Aging in the New Millennium
By Maria C. Dela Rosa, M.D.

Across the nation, we have been hearing more and more about the rising health care costs and how the Medicare health system is in jeopardy, not only because this is a presidential election year and health care is an important political issue, but because it is a reality that will affect us all.

The health care crisis is partly attributed to “the graying of America.” It is a fact that the elderly, as a whole, utilize health care more than most other population segments.

Our life expectancy has improved dramatically in the twentieth century because of decreased deaths related to acute illnesses, infections, accidents and better management of chronic diseases. The average life expectancy in the U.S. in 2007 is 82.4 years vs.76.9 in 1900. In 2000, there were 35 million persons 65 years and older and in 2030, the number is expected to be 71.5 million or one in five Americans will be seniors. The oldest old (85 years and older) are the fastest growing segment of the population.

This unprecedented growth rate is expected to cause a significant socioeconomic burden in our society.  There will be an increased demand for physicians and health care professionals who have special interest in caring for the elderly and also in the caregivers who will oversee their care at home.  The majority of the elderly reside in the community and only 5% of seniors currently live in nursing homes.  Of those 65 to 74 years of age, only 6.7% depend on others for care.  That percentage increases to 44% in the 85 and older age group.  Often the caregivers are their elderly spouses who are disabled themselves or the children who are often burdened by trying to make time between work, family time and caring for the aging parent.  As physicians, it will be our role not only to keep our complex, elderly patients healthy and safe, but also to provide resources in the community so that they can continue to live as independently and functionally as long as possible.

While most primary care clinics ran by general internists and family physicians could aptly provide in their care, a consultation with a Geriatric Clinic may be sought in the care of the frail elderly. 

The frail elderly patient is often someone over the age of 75 with a complex medical problem list and with significant physical, social and/or cognitive impairment.  They are often plagued with multiple chronic and often progressive, debilitating conditions. It is often very time consuming (and at times exhausting!) on the part of the health care provider to diagnose and provide treatment to these patients.

Since it opened in 1999, St. John’s Senior Health Center has been able to provide comprehensive care and a “team” approach in the management of these frail elderly.  Besides the usual disease management and preventive care, we routinely do functional assessments, nutrition screening, cognitive and psychological assessments, advance directives and coordination of care with other subspecialties.  Our visits are set in a time frame that allows us to spend more time with the patient to assess all their needs.

Our clinic is staffed by two physicians (myself, an internist with a special interest in geriatrics and Dr. Raj Purushothaman, a board-certified geriatrician). We have a full time medical social worker, Cynthia Zuch, who has been vital in providing community resources to patients and caregivers with special psychosocial and physical needs.  We also have special pharmacy review and nutrition consultation available in the clinic.

St. John’s Senior Health Center is located at the Fremont Medical Building, 1965 S. Fremont, Suite 300, Springfield, MO 65804. Tel No. (417) 820-3760.  Patients may be referred for primary care or for consultation only.

REFERENCES:  

1. The AGS Foundation For Health in Aging

   2.   Textbook of Primary Care Medicine, John Noble et al, pp. 71-72, 2001, Mosby, St. Louis, MO.