Tuesday, January 11, 2011

Boomers 2011

In 2011, the first wave of baby boomers will turn 65 years old. Sixty-five still has currency because that's the age at which non-disabled Americans are eligible to be covered under the Medicare program (now itself having reached middle age).

As our economy continues to recover (hopefully) from the Great Recession, the entrance of millions of Americans to the Medicare rolls over the next decade and a half will be a formidable planning challenge. Click on the chart to watch the baby boomers population surge.

So is the promise of Health Care Reform (the "PPACA"), which will enlarge Medicaid by an additional 16 million Americans--about half of the projected growth in coverage for those currently uninsured.

A couple of recent patient encounters got me thinking about these phenomena, and how we are very much in historically uncharted territory:

Never have we had so many living so well for so long. We have an entire generation of people reaching "seniority" who will continue to want the most out of life, without many guideposts on how to achieve it.

As an example, take a patient of mine I'll call Ted. He'll turn 65 in 2011. He's retired, healthy, and financially secure. Every year I see him once or at most twice for a physical and preventive care. He is motivated to exercise and undergo cancer screening, since he wants to enjoy his "dotage," and not succumb to some of the ravages of aging. I say some, since each year in anticipation of his physical, he sends me an update on his health status.

His numbered list this year was about a page and half, with copious detail on various ailment and insults. But it was number six, the last item, that really grabbed my attention. His prose has a poetry all its own: "Finally, I'd like to comment on the aging process again, if I may. I have alluded to 'death by small cuts' in the past as a way of describing what I was experiencing as I think about myself. This past year I've noted several specific things: my drop in motivation to exercise; my arthritis has become more pronounced; a notable decrease in my speed in walking ...; I am slower on steps than before, but still able to do as many as I need to; I find a distinct difference in how my sons and son-in-law always take the heavier boxes, packages, air conditioners, etc. ...; [I see] distinctly more courtesy from those so inclined, in public, as doors are opened, or I'm allowed to leave elevators first, for example; it takes longer to do chores in the yard, and I must pace myself very differently than in the past; I nap for 20-30 minutes in the afternoons, when I've done something physical earlier that day. There's nothing to prescribe, I'm afraid, short of a draught form the Fountain of Youth, but I thought you'd like to know some specifics on what I'm seeing as another year goes by. It does seem to change a bit every year. I'll tell Dr. P. [a geriatrician relative of his], of course, but I really don't think I'm bringing any breakthrough ideas to the field of Geriatrics, as I begin my eligibility for that class."

A man with too much time on his hands? Perhaps. But someone in touch with his body and its rhythms, trying to capture the emotions of aging. I tell him that he's "in the 99th percentile" of my patients, in terms of his health awareness and motivation for healthful longevity, because it's true.

I was ruminating about Ted, and what to advise him, when I had a similar sort of encounter with Sally [not her real name]. Sally is also 64, and stuck in the middle. She cares for an aging mother, and no longer has her children to care for since they've been married off.

Sally's main issue at her visit, other than preventive health (she's also retired and financially independent), was her anxiety about where to focus her energies.

Then, like a lightning bolt, she asked a simple question:

Had I ever heard of a doula?

Yes! What a GREAT idea! She could volunteer her time and serve as a doula.

Voila: an idea. Let's have Boomers fortunate enough to afford retirement give back to their communities. Volunteering. Teaching. Attending.

This recent New York Times column raises the whole question of adult education as a "new frontier."

What would you suggest for our Boomer friends?

This post by John H. Schumann, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist in Chicago's south side, and an educator at the University of Chicago, where he trains residents and medical students in both internal medicine and medical ethics. He is also faculty co-chair of the university's human rights program. His blog, GlassHospital, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people that inhabit them.

Labels: aging, geriatrics, GlassHospital, guest post, health care reform, John H. Schumann, medicare

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Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

CasesBlog
Ves Dimov, MD, ACP Member, is an allergist/immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago, where he evaluates and treats both pediatric and adult patients.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, ACP Member, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Musing of an Internist
Justin Penn, MD, ACP Associate Member, attended medical school at the University of Washington School of Medicine and trained in internal medicine at the University of Rochester, where he is serving as Chief Resident.

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

White Coat Underground
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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Tuesday, January 11, 2011

Boomers 2011

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