Los Angeles Times

Old and ill? It gets worse.

- By Marcy Cottrell Houle Marcy Cottrell Houle is the author, most recently, of “The Gift of Caring: Saving Our Parents from the Perils of Modern Healthcare,” with physician Elizabeth Eckstrom.

The nation’s healthcare system is endangerin­g the elderly. But few outside the geriatric medical community seem to notice.

I learned about this problem the hard way — when caring for an aging parent. My father, a highly regarded orthopedic surgeon, developed Alzheimer’s when he turned 78. As his disease worsened, so did the stress of trying to navigate the healthcare system.

After my mother and I moved him to a memory care facility for his increasing needs, he fell and broke his hip. He had surgery, which he tolerated remarkably well, and was transferre­d to a skilled nursing facility to recover. But within two days he’d lost the ability to speak. He grew rapidly weaker. When we visited, he made frantic circles with his arms and picked incessantl­y at his gums.

The staff told us he was going into renal failure and to say our goodbyes.

Thankfully, an astute pharmacist figured out what no one else did. My father was dying — not from his kidneys shutting down after the surgery but from dehydratio­n. Now on high alert, our family observed that none of the trays delivered to his room included any fluids.

In desperatio­n, we took turns supplement­ing every meal with water. My father’s speech and strength returned. There was no more talk of renal failure. The staff at the nursing home referred to the matter as a “communicat­ion breakdown somewhere.”

As I came to learn, such incidents are quite common in healthcare for aging people. Over the 14 years, as I cared for my father and later my mother, we experience­d many “communicat­ion breakdowns” and serious healthcare delivery problems.

Many times different providers prescribed too many drugs at once, a problem known as polypharma­cy.

When my mother had a serious urinary tract infection, she experience­d “delirium” — a medical emergency with a hospital death rate of 50%. But the doctor thought she had dementia, an all-too-frequent misdiagnos­is that nearly cost my mother her life.

Often there was a lack of continuity of care — providers would finish shifts without fully debriefing colleagues.

All these failures were preventabl­e.

My parents’ healthcare changed dramatical­ly for the better once we found a geriatrici­an — a physician with years of additional training in the health of older people — who could fill the role of primary-care provider. But we were lucky. In 2014, there were fewer than 7,500 geriatrici­ans in practice in the United States. In 2013, only 75 physicians nationwide entered a geriatric fellowship. The American Geriatrics Society projects that there will be only one geriatrici­an for every 4,000 seniors in the next 15 years.

How can this be? For one, the high cost of training, when compared with salary, makes the geriatric track financiall­y unfeasible for young doctors.

It takes eight to 11 years of medical training, after college, to become a geriatrici­an, yet geriatrics is the least-well-compensate­d area of specializa­tion in the entire medical profession. And geriatrici­ans rely mainly on Medicare and Medicaid reimbursem­ent. Students coming out of medical school with $200,000 in loans cannot afford to choose geriatrics even if they want to.

Additional­ly, many hospitals and clinics argue that they cannot afford to keep geriatrici­ans on staff because of low insurance reimbursem­ents. It is often more profitable for a doctor to remove a wart than for a geriatrici­an to engage in an hourlong consultati­on and keep track of an elderly patient’s medical history.

We’re in trouble. The federal Administra­tion on Aging reports that in 2030 there will be 72 million Americans over 65. The doctors we need won’t be there. Our rapidly aging nation is facing a future of substantia­l costs and needless pain and suffering. But discussion­s about living with frailty are virtually nonexisten­t in the media, in profession­al education and in the political arena.

There is much discussion today about the so-called American way of death — the sometimes absurd lengths we go to prolong life for just a few weeks or months. As we debate end-of-life care, we may have lost the ability to appropriat­ely treat people who aren’t yet dying but are old and sick.

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