Geriatricians, Angry and Otherwise

Last week, I had a fascinating conversation with French journalist Dominique Prédali, co-author of On Tue Les Vieux, or Killing Elders, which describes elder abuse in French nursing homes and hospitals. Written for the general public, the book's small initial printing sold out the first day it hit bookstores last year and is now in its third printing. She is currently researching a new book on elder abuse around the world, which will be called Douze Gériatres en Colère or Twelve Angry Geriatricians. The angry geriatricians will talk about the social and economic factors that contribute to elder abuse, including ageism in health care, inadequate pensions, and poverty. She will also be looking at the role of failed health policy, including the introduction of market oriented healthcare reforms, in compromising the poor's access to health services.

Her research on the role of economic forces in elder abuse has been far flung, and includes delving into the sociology and anthropology literature that focuses on the effect of poverty on violent crime in developing countries. Among the experts she's interviewed is Ted Miguel, a medical anthropologist at the University of California, San Francisco, who is looking at witch killings in Meatu villages in Tanzania. Witch killings, which have been reported in Kenya, Ghana, Zimbabwe, the Congo, South Africa, Uganda, and parts of South America and India are typically committed against elderly women, and, according to Miguel and others, are much more likely to occur when food is scarce as a result of drought, floods, and other "income shocks." For more on global issues in elder abuse, see my review of Missing Voices: Views of Older Persons on Elder Abuse, which was jointly produced by the World Health Organization and the International Network for the Prevention of Elder Abuse at Missing Voices.

What should make geriatricians happy is the loan forgiveness program for health care professionals proposed by Shirley Krohn, a member of the California Senior Legislator (CSL). Shirley has pulled together an impressive group of geriatricians and others to help draft legislation to cancel all or part of government student loans to those studying geriatrics. Modeled after the state assembly, CSL's 40 senior senators and 80 assembly members develop proposals, which are then ranked by the full group; the highest ranked are pitched to legislators for sponsorship. CSL boasts a 70% success rate of bills chaptered into law. Shirley is working on several other elder abuse bills that address such critical areas as criminal background checks for home care workers and adding undue influence to California's penal code section on elder abuse.

All the talk about geriatricians got me thinking me about a terrific article that appeared in The New Yorker last April, which I've been meaning to add to the reading list of a course I'm developing. In "The Way We Age Now," Atul Gawande, a surgeon, describes the field of geriatrics, beginning with an achingly graphic description of how the body declines as we age ("the gums tend to become inflamed and pull away from the teeth; when you reach inside an elderly patient during surgery, the aorta and other major vessels often feel crunchy under your fingers").

When he accompanies a geriatrician from his hospital on visits, Gawande is struck by the multiple complaints that his colleague's elderly patients describe (unlike his own patients who typically present with a single major problem) and how he triages them. For example, when they visit a patient with arthritis, back pain, incontinence, and what might be metastatic colon cancer, Gawande hypothesizes that his colleague will zero in on the potentially life-threatening cancer. Instead, he spends most of the visit inspecting her feet inch by inch, having concluded that the greatest threat to her engagement in the world is a fall. It is this emphasis on functional capacity and quality of life that Gawande finds remarkable. The article goes on to describe the dwindling number of geriatric programs across the U.S. It is available online at "The Way We Age Now."

And finally, according to the promotional materials, it's like “having a doctor in your pocket.” The UCI School of Medicine recently released its excellent “Pocket Doc” for social work, legal, and law enforcement professionals who want to talk the talk. Written by Laura Mosqueda, it's a portable, comprehensive guide to common geriatric disorders and medications. To get a copy, click on Pocket Doc.