Are Physicians Referring Their Elderly Patients To Geriatricians? Asks Study That Finds Surprising Answer And Highlights The Need For A Shift In Care

Main Category: Seniors / Aging
Article Date: 01 May 2009 - 0:00 PDT

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While the U.S. counts only 7,500 or so geriatricians -- physicians with advanced training that prepares them to care for the frailest, sickest older patients -- it's now home to more than 38 million adults who are 65 and older. And that number is expected to nearly double, to 77 million, in the next two decades.

With so few geriatricians and so many older Americans, the Association of Directors of Geriatric Academic Programs (ADGAP) recently asked the directors of U.S. geriatric academic programs how best to make use of available geriatricians. Their answer: Given the shortage of geriatricians, these physicians should focus on the most vulnerable older adults and those with the most complex health problems. The American Geriatrics Society (AGS) is now conducting a follow-up survey of its own members, asking them which older adults are likely to benefit most from the care geriatricians provide.

There could, however, be obstacles to ensuring that adults who could benefit most from geriatrics care actually see geriatricians, suggests a study released here today at AGS' Annual Scientific Meeting.

The study surveyed 115 attending physicians and "non-attending" healthcare providers (including physician assistants, medical students, residents, and fellows) at three teaching hospitals with in-patient geriatric consultation services. Most of those surveyed -- nearly 65% -- were in internal medicine and more than 66% had been in practice between one and five years. Nearly 70% said that at least half of their patients were older than 65. And nearly a third reported having "limited or no training in geriatrics."

While three-quarters said they were comfortable treating older patients in general, fewer than half reported being comfortable treating patients who were frail. And just 43% said they were comfortable treating patients with dementia.

Even so, many of the attending physicians -- more than 80% of whom were familiar with the geriatrics consultation services at their hospitals -- expressed reservations about referring their older patients to the service. Of these physicians, more than 82% reported that referring these patients to geriatricians might result in their "losing a patient to another physician." In contrast, non-attending physicians, who reported being less comfortable treating older adults than attending physicians, were more likely to say they'd refer patients to geriatricians. This was particularly the case with frail older patients and those with complex health problems.

"Attending physicians appear to underutilize geriatric consults services, despite recognized lack of geriatric training," says Alina Gory, MD, of North Shore Long Island Jewish Heath System in New Hyde Park, NY, and co-authors. "Since our data revealed an optimistic and significant difference between non-attending and attendings in referral patterns, we suggest that educational programs be developed to encourage the utilization of geriatric consults for the benefits of elderly patients."

"In today's fast-paced medicine, physicians struggle daily with the challenges of managing the complexity of medical co-morbidities in their elderly patients," Dr. Gory added. "Geriatricians are uniquely positioned to provide support and expertise to both healthcare professionals and older adults."

Source
American Geriatrics Society

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