Issue link: https://tmcpulse.uberflip.com/i/1022543
T M C » P U L S E | S E P T E M B E R 2 0 1 8 13 part of the gross domestic product every year. I know there's a better way to do it. You're going to put a pediatrician in charge of a pediat- ric hospital. If you're a hospital, or somewhere where a large portion of your patients are elderly, you need geriatricians there. Q | Where, specifically, do you see the most acute need for better geriatric care? A | I could say everywhere, but I think I would start in the hospital. A lot of people disagree with me. They say, 'Carmel, don't you understand? We've got to keep people out of the hospital!' Yes, we do. However, we are not yet stopping heart attacks, sepsis or stroke. Well, we are making dents in those conditions, but people still have them and they still come into the hospital, and that's where the greatest harms are. Hospitalists are at a disadvan- tage. The patients have 80 years of history and the hospitalist is seeing them in a snapshot, and is chal- lenged to save their lives right then and there. The next area would be in the transition from the hospital out to the community. That's because it's hard for patients to understand all the instructions. Sometimes the medicines are changed. The third area is medication management—outpatient or inpa- tient. Older people react differently to medications. Older people with dementia react yet still differently than other older adults. I like to say if I could teach every doctor in the United States one thing, it would be how to manage medications in the very elderly, because there are no algorithms you can follow for that. I'm being very edgy and very controversial here. Q | You've testified in front of the U.S. Congress on behalf of vulnerable elderly people. Can you describe that experience? A | I have had the privilege to do work in elder abuse prevention and intervention and disaster preparedness for more than 20 years. We were able to present to the U.S. Senate Special Committee on Aging—to look them in the eye and tell them what we are seeing on the ground. It was a great privilege. Q | Did you see any tangible results from that special committee? A | Actually, out of that came the Elder Justice Act [signed into law by President Barack Obama on March 23, 2010, as part of the Patient Protection and Affordable Care Act]. The law, which protects seniors from elder abuse, helps stimulate a lot of activity at the federal level. (continued) U.S. GERIATRICIAN SUPPLY AND DEMAND Full-time Geriatricians SUPPLY Estimated supply, 2013 3,590 Projected supply, 2025 6,230 DEMAND Estimated demand, 2013 * 22,940 Projected demand, 2025 33,200 TOTAL SHORTAGE Projected supply (minus) demand, 2025 -26,970 * The 2013 demand estimates 30 percent of the 65-plus patient population needs care by a geriatrician. Source: U.S. Department of Health and Human Services, "National and Regional Projections of Supply and Demand for Geriatricians: 2013-2025"