ElderBranch Examines Trends in Geriatrics and Long-Term Care

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While there is much focus on the topic of long-term care, there are varying perceptions as to its goals and exact scope. As part of a series on trends in geriatrics and long-term care, ElderBranch interviewed three professors at various medical and nursing schools to obtain their perspectives on what these fields represent and how they are changing.

"We tend to conduct a lot of interventions that are not benefiting patients very much."

As part of an on-going series on trends in geriatrics and long-term care, ElderBranch spoke to three professors in the Geriatrics disciplines of various universities: Dr. Pamela Cacchione at the University of Pennsylvania, School of Nursing, Dr. Katalin Roth at George Washington University, and Dr. Thomas Caprio at the University of Rochester. The interviews covered various topics including the objectives and goals of geriatric medicine, trends in long-term care and the challenges associated with palliative care.

Objectives and Goals of Geriatric Medicine

People often mistake the objective of geriatric medicine as being focused solely on increasing life expectancy. While this may be a by-product of geriatric care, both Dr. Caprio and Dr. Roth emphasize that geriatrics is a discipline that focuses on extending the period of high-functioning time in an elderly person’s life, and on preserving overall quality of life. Oftentimes, the elderly are faced with multiple chronic conditions, and therefore maintenance of function, including physical, cognitive and social function, is of utmost importance to maintaining a good quality of life.

Trends in Geriatrics and Long-Term Care

Drawing on conversations with all three experts, certain themes emerge in regards to trends in geriatrics and long-term care.

First, the changing demographics and growing elderly population are creating an incredible need for a variety of long-term care services. Dr. Caprio further points out that as obesity and diabetes increasingly take hold of the population at all ages, even younger individuals are starting to require long-term care services because of complications related to these conditions.

Second, despite growing demand for geriatrics and long-term care, the supply of geriatrics-trained professionals is not keeping up. Dr. Roth attributes this to several reasons: a) there isn’t enough exposure to geriatrics in medical school and therefore it isn’t a field medical students typically consider, b) compared to other medical specialties, geriatrics is not a very high-paying field, and c) geriatrics is somewhat of a more time-intensive specialty.

Third, in an effort to meet the changing needs of the elderly population, more community-based care alternatives, such as Programs of All-Inclusive Care for the Elderly, are expected to emerge. In addition, Dr. Cacchione anticipates that technology will be increasingly leveraged to provide oversight and monitoring of older adults’ health status and medication adherence in these community-settings.

Challenges: End-of-Life and Palliative Care

End-of-life and palliative care are two topics receiving an increasing amount of discussion and exposure within the domain of long-term care. Broadly, there appear to be three key challenges in delivering effective palliative care today.

One of the largest challenges that Dr. Roth sees is a poor understanding amongst the general population as to what this kind of care entails and how it can be helpful at the end stages of life. Additionally, most people aren’t adequately aware of the limits of traditional medical intervention. People tend to have high expectations of being able to remedy almost all health issues, and have a difficult time accepting that life must naturally end at some point. "We tend to conduct a lot of interventions that are not benefiting patients very much,” explains Dr. Roth.

On top of this, it remains a challenge for patients who are undergoing disease-directed treatment to receive concurrent palliative care to address their symptom management needs. These patients often face a very significant symptom burden but find it difficult or are unable to access the appropriate symptom management care outside of in-patient settings.

Lastly, the funding of palliative care programs remains a barrier to widespread adoption. While there are some models that reimburse palliative care services in the in-patient setting, it remains a challenge to link individuals to on-going services once they are discharged back into the community.

About ElderBranch

ElderBranch is an online information portal that helps people find and evaluate long-term care providers. ElderBranch’s mission is to support users in making the best decision possible for themselves and their loved ones.

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Anila Sitaram Venkat
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