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Dr. Louise Aronson says that there are not enough geriatricians in the US – doctors dedicated to the health and care of the elderly. "Maybe there are six thousand or seven thousand geriatricians," she says. "Compare that to membership in the Pediatric Society, which is about 70,000."
Aronson is a geriatrician and professor of medicine at the University of California at San Francisco. She notes that older adults make up a much larger percentage of hospitalizations than their pediatric counterparts. The result, she says, is that many geriatricians focus on finding the "elders and the most infirm" rather than focusing on healthy aging.
Aronson sees geriatrics as a specialty that should adapt and change for each patient. "My youngest patient was 60 and my oldest was 111, so we're really talking about half a century here," she says. "I have to be a different kind of doctor for people of different ages and ages."
She writes in the new book Elderhood: Redefining aging, transforming medicine, redefining life.
How the health needs of people become more complicated with age
While age itself is not a disease, it increases susceptibility to disease. So it is the very rare person over 60 … and certainly over 80 who does not tend to already have several health problems. So when something new appears, it's not just the new symptoms of a possible new illness, but also the context of an older body of other diseases, the treatments for the other diseases.
If someone comes in with symptoms and they are an older person, we sometimes find this single unifying diagnosis, but that's actually the exception. If we're careful, we'll probably find something new and maybe a few other things. We add a larger list to a list [and] not a smaller one, if we really pay attention to everything that happens in the life and health of that person.
How the immune system changes with age
Our immune system has several different protective layers for us. And there are biological changes in all these layers, and sometimes it's the number of cells that can come to our defense if we have any infection. Sometimes it's literally about the immune response. For example, we know that vaccine responses tend to decrease with age, and sometimes human immunity is lower. It also tends to last less. And that's just the strength of the immune response, which changes in many ways. But our immune system is an integral part of every other organ system in our body, increasing our susceptibility as we age over the body's systems.
The Importance of Older Vaccines
Older people … are among the populations (even very small children) who are hospitalized or have to die as a result of the flu. The flu shot, especially in a good year, but even if the match is not perfect in a given year, [protects] older people get sick and die in the hospital. … Nevertheless, we have not optimized the vaccines for older adults as for other age groups. For example, if you look at the recommendations of the Centers for Disease Control on Vaccination, you will find that there are, I think, 17 categories for children, different subsections of childhood for which they have different recommendations, and five levels for adulthood. However, the over-65s are grouped together in a single category. … We are all different in our lives, and we must direct our interventions to all of us, not just to specific groups of the population, namely children and adults, and omit elders.
How medications can alter the impact on the patient over time.
Researchers have traditionally confirmed that we will not include older people in our studies because their bodies are different and / or because they have other ailments that could interfere with their response to this drug. But then they give the drug to the same elderly person … and so, with a new drug, we will very often see all kinds of drug reactions that are not listed in the warnings. The message number one is only because it is not listed, and does not mean that it is not the culprit. Another important point is that really every medicine can do this. And it can also be if the person has been around for a long time. … We regard drugs as a kind of solid entity, but in reality the interaction between medication and person is of crucial importance. Even if the medication stays the same, the person can change.
The importance of home visits in their work
What brought me into medicine and what keeps me there are the people. And when you make a home visit, you see the person around them so that they can be first a person and then a patient, which I love. I can also see their living conditions and more and more we observe how much these social factors affect people's health and the risk of good or bad outcomes.
Roberta Shorrock and Seth Kelley produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin have adapted it for shots.