As the "silver tsunami" arrives at health care's doorstep, one California hospital is taking a different approach to treating this wave of complex elderly patients.
Using the regular primary care tactic to treat geriatric patients likely isn't going to cut it when they're battling multiple chronic conditions and other nonmedical barriers to care. With that in mind, Keck Medicine — the medical enterprise of the University of Southern California — is shifting how it trains students, aiming to build an interdisciplinary workforce to treat the elderly that incorporates everyone from pharmacists to dentists, occupational therapists and social workers.
USC has obtained a $2.5 million federal grant to help build out what it calls the USC–Los Angeles County Training a Workforce in Interprofessional Geriatrics program over the next three years. That will include developing a routine primary care assessment of elderly patients, building new training programs for students to work in teams to treat seniors, and opening a "geriatrics primary care assessment" clinic on its campus, according to an announcement last week.
The rapid aging of the population will result in an "enormous" number of people older than 65 who will be seeking care, and the system is short on having the necessary number of clinicians required to treat them, says Bonnie Olsen, a clinical professor of family medicine at USC, who is leading the team.
"There's this huge sort of bolus of older people emerging — we refer to this in the field of geriatrics as the 'silver tsunami' — and we're ill-equipped to care for them," she says. "This grant is, in large measure, an effort to build up a sufficient workforce, and we will just barely scratch the surface. But at least it's an effort to increase the number of skilled workers in a variety of professions who understand and can treat geriatric patients."
Olsen gives the example of an elderly patient who needs to drink lots of water to help control his condition and stay healthy, but isn't doing so because he's too feeble to stand up and use the bathroom. How is a primary care physician to overcome that hurdle to wellness, Olsen asks, especially when it doesn't surface during a brief doctor's appointment?
Along with aligning disciplines throughout the medical system, USC is also teaming with community partners to find better ways to serve seniors. The Alzheimer's Association, for one, will provide in-depth training to clinicians on behavioral management, and the California-based Center for Health Care Rights will help seniors navigate issues related to access and coverage. "We have all sorts of things that are somewhat new in the state of California, and it's really difficult for families to negotiate and understand what services are covered. It's not always immediately apparent."
Olsen says that while the clinical side of the effort may not be groundbreaking, the interprofessional approach to treating geriatric patients certainly is. It's sometimes challenging to teach students how to work in more of a team-based model, but that type of medicine is so critical in treating such patients. "You can't be a lone ranger," she says.
USC is now in the process of getting the first clinic set up and running at one of the ambulatory clinics in the Keck system the next month or so, with the next to follow on the campus of the Los Angeles County Medical Center. On the horizon, it will train students to work in those new clinical settings in July 2016.
They're also launching a new program that allows teams of medical students to meet with elderly USC alumni and understand more about the particulars of a healthy senior lifestyle. Olsen says it's also important that students meet and interact with seniors who are aging well and not ending up in the hospital.
"When you work in health care, sometimes you get this skewed picture of what any group or cohort looks like, because you're only seeing those who have a disease or disorder," she says. "I think it will help to balance out the perspective for our students of what healthy aging looks like. That's really an important thing."