The Decline in Geriatric Care Hurts Us All

Between 2010 and 2020, the number of Americans over the age of 65 grew faster than it had in more than 100 years. The American population is older than it’s ever been, with more than 55 million people over 65.

But those fortunate enough to live well into “late adulthood” also face an unfortunate reality: There are not enough doctors to give them the care they need. There is about one geriatrician for every 10,000 older Americans. And it’s getting worse. The number of board-certified geriatricians has fallen from about 10,000 in 2000 to barely 7,400 in 2022.

This is obviously bad news for the elderly. Just as the human body and brain are fundamentally different in childhood, so too do they differ in old age. Immunological functioning weakens, muscle mass declines, the kidneys become smaller and the body stores water differently. Medication functions differently in both the body and the brain.

But many doctors don’t learn enough about these differences in medical schools, the majority of which don’t report requiring a geriatric rotation. This also means a missed opportunity for future doctors, who might find greater fulfillment and lower burnout in a specialty that centers the kind of mission-based, patient-centered medicine many aspiring doctors value.

It’s also bad news for Americans of all ages, because the geriatric approach to patient care offers clear advantages over the way much corporatized health care is delivered in this country.

The central model for geriatric care is called the 4Ms, which stands for medication, mentation, mobility and “what matters most.” Geriatrics also takes into account multicomplexity, which means doctors must know how to prioritize among a mix of competing medical needs. Key to this model is allowing the patient to take the lead in complex treatment decisions where there isn’t one clear better pathway.