Memo from the Editor

When I was growing up, "going gray" was almost an expletive among the women in my mother's circle of friends and, indeed, in female society at large. Today, there's much less resistance to allowing nature to take its course as the Baby Boomer generation gets closer and closer to 60.

The healthcare community has been anticipating a graying of America for decades. I distinctly remember being at a conference in the early '80s that focused on the imperative need for geriatricians. But that need has not been met. The American Geriatrics Society reports that fewer than 300 physicians entered geriatric medicine fellowships in 2003. By 2030, the Society says 36,000 geriatricians will be needed to care for the expected 70 million people age 65 and older; today there are 7,600.

Why hasn't geriatrics caught on as a specialty? I suspect one reason is that patients aren't asking for geriatricians. After all, who wants to admit that they're old? Who's going to say, "Well, I'm 65 now, I'll stop going to my internist and find myself a geriatrician." No one.

So what's a conscientious primary care doc to do to assure that all those gray heads in the waiting room stay as healthy as possible for as long as possible? At the very least, getting a set of the ACOVE quality indicators would be a good idea. (They're available online at http://www.annals.org in the study's Appendix Table. Here's the citation for the article: Ann Intern Med. 2005:143:274-281.)

Beyond that, CME courses in geriatric issues would be good. So would staffing to assure that each elderly patient gets the time she needs, even if all of it isn't with the physician. Ultimately, though, geriatrics will have to become a key part of the medical school curriculum.

But, whatever you do, don't think of your ever-increasing proportion of over-65 patients as a drain on your time. All those gray heads will keep your appointment book full long into the future.

PS

You can keep up to date on issues in geriatric medicine, plus earn CME credit through our sister publication Geriatrics. Visit them online at http://www.geri.com|~www.geri.com.