Geriatrics is not necessarily seen as the most glamorous medical speciality, and so it’s no surprise that there is a rapidly growing demand for primary care physicians to treat the elderly. This is especially the case in Canada, where a rapidly aging population and very few practicing geriatricians are brewing up a storm for the Canadian healthcare system. It is estimated that the demographic of those aged 64 and above will rise to 6.4 million this year, and by 2051 one in four Canadians are expected to be over the age of 65. So, who will be responsible for this ballooning demographics’ health? It will most likely be geriatricians.
Despite making up only 15% of the Canadian population, seniors are one of the highest consumers of the health care system and are responsible for 50% of provincial healthcare spending. This can be attributed to the fact that older people typically have multiple health conditions, including multiple concurrent chronic illnesses, dementia, and other age-related conditions that require routine follow up. However, there are currently only 261 geriatricians in all of Canada, 40% of whom are aged 55 and over. In a few years time many of them will have retired, yet the demand for geriatricians will be higher than ever.
Though there is a greater demand for geriatricians, medical students are less likely to gravitate towards the field. In 2008, a survey of 16 Canadian medical schools found that undergraduate students received over 300 hours of paediatrics education but only 82 hours of geriatric teaching. Dr. Nathan Stall, a second-year University of Toronto resident of internal medicine, says that in medical school, geriatrics is a specialty that is often overlooked. This is disheartening, considering that in some specialties, there is such an abundance of trainees that many face unemployment. Geriatric medicine can’t seem to attract enough recruits to meet the needs of the aging population, and it doesn’t help that they earn less than almost any other specialty.
It must be noted that many seniors age successfully with the support of families, primary health care providers, and social networks. However, this isn’t the case for all elders, a number of whom are frail and suffer from a collection of overlapping chronic mental or physical conditions that render them one of the most vulnerable populations in society. These individuals require consistent care by specialists to help maintain their independence and avoid catastrophic health trajectories. This sentiment is echoed by Dr. Roger Wong, a Professor in the Division of Geriatric Medicine at the University of British Columbia, who notes that the shortage of geriatricians puts seniors at risk of functional decline. He says, “We are not just talking about looking after those seniors who are frail, but also those active seniors, who want to stay active.”
In contrast to Western cultures, cultures in the East hold older adults in higher esteem, a byproduct of a family-mediated society. A study surveyed individuals from 26 nations across the world and found that in general, participants from Asian cultures hold more positive societal views of aging than those of their Western counterparts. Canada spends 11.5% of its GDP on healthcare, whereas Japan only spends 7% of their GDP on healthcare. Daily stimulation, through talking, hearing, and spending time with family is thought to play a significant role in the overall better health of the elderly in Japan. It’s interesting that Japan spends less on healthcare than we do, but the overall health of the elderly in Japan is better than that of the elderly in Canada. Perhaps Canadians can take a page out of the Japanese’s’ book and focus on maintaining the health of the elderly as well.
One of the greatest accomplishments of the 20th century is said to be the doubling of human life expectancy. Thus, we should not only focus on longevity, but we should also focus on ensuring a high quality of life, no matter how long it is. How do we ensure this given that geriatric medicine is unlikely to meet the demand of a booming elderly population? Simple: prepare the current workforce to care for older patients. In the medical field, geriatricians should train medical residents who should also be simultaneously receiving a more intensive geriatric education in school. Even if this doesn’t produce more geriatricians, the doctors that come into the workforce will have some skill in caring for the elderly.
In addition to doctors, non-medical disciplines, such as nursing and physical therapy, also require additional training. As well, a greater focus must also be placed on geriatric research. With millions of baby boomers aging, research into current maladies and diseases may prevent a functional decline in other aging individuals. Regardless of whether or not any of this will happen, addressing our shortage of specialists for the elderly must be a priority. Otherwise, we’re going to be left wondering: who’s going to care for our parents, our grandparents, and eventually- our very selves?