When I'm Sixty-five

A friend of mine has a golf-obsessed mother who moved South the split second her kids were grown. Though the kids sometimes worried about how she was getting on by herself, they were strangely reassured by the long list of medical specialists she was seeing regularly and seemed to regard as fondly as her grandkids.

There was the “darling man” who replaced her knee, the “smart little gal” who handled her physical therapy, the cardiologist (“from Harvard!”) who listened to her heart, not to mention the ophthalmologist who kept an eye on her glaucoma and the sports medicine expert who made sure her arthritis didn’t get in the way of her golf game. My friend’s seventy-something mother was in such good spirits, and spoke of her diverse medical team with such happy familiarity, that the call my friend received one day informing her that her mother had collapsed during an appointment took her entirely by surprise.

“I tried to call your father first, but he didn’t answer,” one of the doctors told her.

In fact, the woman’s husband had been dead for nearly a decade—an oversight that made her children worry about what else on her medical chart may have been overlooked or misread. Family members flew to her bedside, and for a while it looked as though she would have to leave her sunny second home and move in with one of her kids. Then another specialist introduced himself. He concluded that the woman’s dizziness had not been brought on by anything malignant, but by several competing medications that shouldn’t have been taken together. He also determined that her recent weight loss—and that of her cat—was probably the result of the arthritis pain she experienced trying to operate her manual can opener while preparing meals.

My friend knew her feisty mother was back to her former self when she balked at having to add the new specialist to her list of providers. “I’m not old enough to need a geriatrician,” her mom complained.

It’s a common notion—especially in an era when no one can agree on what qualifies any of us as “old.” Fifty is the new forty, sixty is the new sexy, and menopause, a topic barely mentioned a generation ago, is the subject of a “hot” off–Broadway musical. Some of this is the healthy result of new attitudes about aging as well as social and medical advances that have extended life expectancy well beyond what it was a century ago. (The average sixty-five-year-old American can now expect to live at least another 18.7 years.) On the other hand, some of our insistence that we’re getting better not older may be old-fashioned denial. As physician and New Yorker writer Atul Gawande put it recently, “People naturally prefer to avoid the subject of their decrepitude.”

“As a nation, we don’t like to think about getting older, and we certainly don’t like to plan for it,” says Joseph Gaugler, an assistant professor at the University of Minnesota School of Nursing Center on Aging. We’re often reluctant to acknowledge a loved one’s advancing years “until,” Gaugler says, “it becomes a full-scale family crisis” like the collapse that spurred my friend’s concern. Or a national one. 

In three years, the leading edge of the nation’s 78 million baby boomers will turn sixty-five, an age that makes them eligible for Medicare and will qualify them, in the parlance of the American Geriatrics Society, as “older persons.” What they will find when they reach that milestone, according to a report released this spring by the Institute of Medicine, a branch of the National Academy of Sciences, is a health care system “woefully unprepared” for meeting the needs of an aging population.

Among the problems outlined in the organization’s report is a system more effective at offering piecemeal acute care for the problems of middle age than providing the more complex care older patients need. Medicare doesn’t pay doctors enough to manage the care of elderly patients, and with steep pay cuts coming this summer, according to an American Medical Association report, some 60 percent of the nation’s physicians say they’ll be forced to limit the number of Medicare patients they can treat.

The existing shortage of geriatricians—there’s currently one physician certified in geriatric care for every 2,546 Americans over the age of sixty-five—is predicted to almost double in the next twenty years. Last year, according to the American Geriatrics Society, nearly half of the nation’s 468 first-year geriatric training fellowships went unfilled.

Alarm over the dire predictions has resulted in the usual congressional hearings and collective handwringing about what can be done to attract more health care workers to serve the elderly. Proposals call for financial incentives for geriatric work, loan-forgiveness programs for future providers, even a “rebranding” campaign that would change the term geriatrics to something that sounds less, well, old. Steven Miles, a board-certified geriatrician and professor at the University of Minnesota Medical School, says such approaches, though well-meaning and overdue, also “reflect an undue sense of pessimism about what can be done with older folks.” Geriatrics, he says, is “one of the more interesting human encounters in medicine, between a total human patient and an engaged practitioner.”