- Canada faces shortage of geriatricians
- Hey Kids of baby boomers, forget about your inheritance – The Pulse – CIEP’S December 2011 newsletter
- Seniors in hospital beds costly for health system
Seniors population booming, but there are not enough specialists to deal with their issues, doctor says
By Jodie Sinnema, Postmedia News December 27, 2011
Dr. Adrian Wagg became a geriatrician due, in part, to inverse snobbery.
He was tired of the common perception that working with old folks is boring, not nearly as glamorous as the work of a heart surgeon, not as adrenalin-pumping as being an emergency physician, and involves wrinkles, incontinence and low pay.
That perception - a false one, say Wagg and supporters - has resulted in a dire shortage of geriatricians when the country is on the cusp of a seniors' population boom. Already, Canada has 4.2 million seniors. That's expected to more than double to 9.8 million in 25 years, Statistics Canada estimates.
And yet, as of January of this year, Canada had only 230 geriatricians to provide specialized care, according to data from the Canadian Medical Association. Of those, only seven are under the age of 35.
Experts say another 500 such doctors are needed.
Comparatively, Canada has 628 emergency physicians, of whom 46 are younger than 35. There are 2,372 pediatricians in Canada and 152 are younger than 35.
Wagg, 47 and director of geriatric medicine at the University of Alberta, followed in the footsteps of an influential teacher in the United Kingdom, where geriatrics is the second choice for residency, in part because other specialties have caps on positions.
Wagg was attracted to the career because of the opportunity to combine academics and practical components. Today's seniors are living longer and, once they reach 80 or 90, often have three or four chronic diseases that impact their social lives and cognitive ability.
Wagg needs to treat all their health concerns, sometimes compromising in one area so as to help in another, balancing the interplay of complex diseases and the effect of medication and doses on frail bodies. A senior who shows up in the emergency department with a broken hip might seem to be a simple case of a patient falling. But Wagg said he must determine if the fall was caused by urinary tract sepsis involving a blood infection or if heart or respiratory disease played a role.
"It's incredibly satisfying," he said. "All of those things you define as being unattractive [in the job] are actually intellectual challenges, so you might say geriatrics is where the real intellectual physicians should go and not the more simple protocol-driven specialties such as, say, cardiac surgery."
Wagg said his patients are people with amazing stories. He has met 90 year-olds who tell him about Edmonton in the 1920s. When he was based in the U.K., he met a man who was a test driver for Bugatti racing cars in the 1930s.
"Data shows that when times are pressured, quality goes down the pan - it becomes easy to depersonalize people to deal with their problems," Wagg said of the high pressure physicians are often under. "What geriatrics ensures and what these types of experiences [of listening to people's personal histories] ensures is that people are undoubtedly personalized. Retaining that personal link actually makes you step back and do your best for everybody."
That personal connection convinced Dr. Ramneek Rai, 33, to train in geriatrics. She is the first geriatric resident at the University of Alberta Hospital in two years, despite two open training spots each year. There has been a dearth of trainees worldwide, Wagg said.
"In my [Indian] culture, we have a lot of respect for our elders," said Rai, who grew up in Edmonton with her grandparents living in her home.
"I like this part of the field, the social aspect of it," said Rai, who received her medical degree in Providence, Rhode Island, in a facility surrounded by nursing homes and assisted-living facilities.
Susan Eng, vice-president of advocacy for the Canadian Association of Retired Persons, said all doctors need specialty and sensitivity training to better treat seniors.
"This is not something that is segregated only to specialists but rather [the aim should be] that every GP and every doctor knows how to deal with a person who ages because every single patient is going to be aging," Eng said.
© Copyright (c) The Victoria Times Colonist
Hey Kids of baby boomers, forget about your inheritance – The Pulse – CIEP’S December 2011 newsletter
The heirs of wealthy Baby Boomers shouldn’t be assuming that they’ll be inheriting a pot of gold when their parents pass away. Less than half of millionaires who are members of the famously selfish generation—boomers, not their kids—think it’s important to leave money to their children. What’s more important, apparently, is for boomers to enjoy their golden years.
The survey of Baby Boomers, conducted by the investment firm U.S. Trust (and summed up by the Los Angeles Times), reveals that increasingly, Gen Xers and other boomer offspring shouldn’t expect a handout when their parents die. A surprisingly low 49% of millionaire boomer parents said that leaving money to their kids was a priority.
Though boomers have a reputation for selfishness, many boomers see themselves quite differently. After decades of personal and professional sacrifices for the sake of their children, and after paying for their kids’ educations and perhaps helping them with down payments on first homes, boomers have reached the point that enough is enough. And after shaping their lives around the needs of their children, and, in essence, dishing out here and there what would have been one honey of an impressive inheritance if given in one lump sum upon one’s death, boomers believe their days of sacrifice are over. As one expert told the LA Times:
“I do not see my baby boomer clients giving up a vacation or wine or dinners out so that they can leave more money to their children, because they feel like they’ve already done it for their kids,” said Susan Colpitts, executive vice president of a wealth management firm in Norfolk, Va.
Boomer parents haven’t just stopped worrying about their kids. Instead, what aging boomers seem to be saying, through the survey and their actions, is that they don’t have much confidence in their children’s financial sense, and throwing more money at them isn’t going to help. So why not just use the money to enjoy yourself and take that round-the-world cruise?
In the U.S. Trust survey, one-fifth of boomers fear their children would squander any inheritance, and one-quarter worry an inheritance would make their heirs lazy (lazier?). Just 36% strongly agree that their children will be able to work together to make financial decisions once their boomer parents are gone. The majority of millionaire boomers (52%) even keep their kids in the dark as to exactly how much they’re worth.
That’s good, I suppose. If the children and grandchildren knew everything, they’d probably be resentful about how much potential inheritance money their boomer forefathers blew in their golden years, rather than remembering how generous and supportive their boomer parents were when they were alive.
…from an article found on CBC.ca and reproduced in The Pulse –December 2011
Canadian seniors account for 85 per cent of patients in hospital beds who could be receiving care elsewhere, a problem that will only grow as the first baby boomers turn 65 this year, according to a new report.
Thursday's report by the Canadian Institute for Health Information called Health Care in Canada, 2011: A Focus on Seniors and Aging examines how seniors use the health system and where there’s room for improvement.
For example, 47 per cent of seniors have completed their hospital treatment but remain in an acute-care hospital because they're waiting to be moved to a long-term care facility such as a nursing home or to rehab or home with support (so-called "alternate level of care" patients.)
Those patients have a ripple effect on the rest of a hospital, said Dr. Jeff Turnbull, chief of staff of the Ottawa Hospital.
"The delays of getting into the hospital delays, of getting timely surgery diagnostics, all are affected by our that fact that we have so many people sitting in our acute-care beds," said Turnbull.
Last year, those ripples meant the hospital had to cancel 600 elective surgeries, he said.
Currently, seniors represent 14 per cent of the population, but they use 40 per cent of hospital services and account for about 45 per cent of health spending of provincial and territorial government, the report's authors found.
For hospitals, an acute-care bed costs about $1,100 a day. In comparison, Turnbull estimated it costs a quarter of that to care for the same senior in the community.
The goal for governments should be to spend money on the right services so more seniors can stay at home and out of hospital longer, said Kathleen Morris, CIHI's director of health system analysis.
Those services include traditional health-care services such as nursing and physiotherapy as well as transportation or help with household chores to help the 93 per cent of seniors who live at home, Morris said.
Ensuring continuity of care for seniors across the health care system could potentially lead to better care and better quality of life, health policy researcher Marcus Hollander in Victoria said, commenting on the report.
The report's authors pointed to efficient use of new technologies such as:
- A medication monitoring system equipped with a sensor to allow family members to use online video clips to monitor which medications were taken for seniors receiving home-care services.
- Magnetic door sensors that send an email, text message or cell phone message to caregivers if a person with dementia goes outside unattended.
- Flexible bed mats with pressure sensors that let caregivers know when their family member has woken up and is moving.
- The report also included chapters on seniors' use of prescription drugs and caring for seniors in the community or in residential care.