Louse Aronson, associate professor of medicine at the University of California San Francisco, says it better than I can in her just published article in Health Affairs. The case she eloquently describes is a perfect example of what can happen when the complex issues faced by an older adult meet our fragmented health care system. Two key points that resonate with me:
Providers (whether it’s physicians, nurses, social workers, or others) are not universally required to have geriatrics training. The assumption is that “adult” medicine applies to older adults, too. Older adults, however, have different needs that require an individualized approach that coordinates care across different systems and focuses on health, not medicine.
The current reimbursement system doesn’t pay (or doesn’t pay adequately) for many of the interventions for older adults that we know work – for example, working to reduce falls, follow-up phone calls to address issues that may not require a visit to an office, or phone calls and meetings to coordinate with caregivers, social workers, and others. Without this level of coordination, the older patient spends unnecessary time and money shuttling between specialists and taking multiple medications that, at best, are unnecessary and can often do more harm than good.
Rather than focusing on diseases, the health care system (including training, reimbursement, infrastructure, etc.) should focus on a holistic, person-centered approach to care.