Recently, I had the opportunity to make a site visit to Baylor College of Medicine. The director of the Hartford Center of Excellence in Geriatric Medicine, George Taffet, MD, related a story that starkly underscores the need for policies that support greater awareness of geriatric issues in the training of all clinicians caring for older adults.
Dr. Taffet had been called in to consult on the case of a woman in her 80s who was under treatment for bradycardia, an abnormally slow heart rate. Her primary care doctor had picked up on the problem during a routine physical examination. At the time, the patient was also taking a drug called Aricept, commonly used to treat mild cognitive impairment. As the physician lacked expertise on geriatric considerations in prescribing, he didn't recognize that a slowed heartbeat is one of the drug's potential adverse effects, so he sent her to see a cardiologist.
Unfortunately, the cardiologist was no more familiar with geriatric pharmacology than the primary care physician had been. He too overlooked the medication as the culprit. As a result, after a battery of tests, a pacemaker was implanted in the woman's chest. She almost died of complications from the procedure.
Although it might be tempting to lay the responsibility for this situation at the feet of the doctors involved, this kind of mistake is bound to happen in a system that doesn't properly prepare physicians and other health care providers in geriatric issues or encourage them to utilize a team approach to care that includes consultation with people who do have the necessary expertise. As suggested in the recent IOM report Retooling for an Aging America, the need to make fundamental, systemic changes that take the very special needs of older adults into consideration becomes obvious.